Training introduces a Model of Care. Implementation is what makes it a Model of Care.
The Triple-A Model of Therapeutic Care is designed to support organisations providing care to children and young people affected by adversity.
Triple-A training introduces staff to a shared framework for understanding children and responding therapeutically. Implementation goes further. It supports organisations to translate that understanding into everyday caregiving, reflection, supervision, decision-making and organisational practice.
For this reason, Secure Start approaches Triple-A as a Model of Therapeutic Care to be implemented, rather than simply as a training programme to be completed.
The contemporary Triple-A framework
At the centre of Triple-A are two complementary frameworks:
AAA – Understanding what may be happening for the child
Attachment
What might the child have learned about themselves, other people and their world?
Arousal
What might be happening in the child’s emotional and physiological state?
Accessibility to needs provision
What might the child have learned about whether important needs will be recognised and reliably met?
AAA supports caregivers and professionals to look beyond the immediate form of behaviour and develop a richer understanding of what may be happening for the child.
AURA – Considering how we can respond therapeutically
Accessible
Am I emotionally and physically available?
Understanding
Have I tried to understand what might be underneath the behaviour?
Responsive
Did my response meet the child’s need in that moment?
Attuned
Was I connected, warm and emotionally in sync?
AURA helps translate understanding into everyday therapeutic caregiving.
Together, AAA and AURA provide a shared language that can be used by caregivers, practitioners, supervisors and organisational leaders.
From training to implementation
Triple-A implementation is organised around four related processes:
1. Foundation Training
Foundation Training introduces participants to the theoretical and practice foundations of Triple-A and develops a working understanding of AAA and AURA.
Training considers how adversity can influence children’s relationships, arousal and regulation, behaviour, and expectations about how important needs are met.
Participants learn to apply AAA to everyday situations and use AURA to consider how they might respond therapeutically.
For organisations implementing Triple-A as a Model of Care, Foundation Training can ordinarily be delivered through three 2.5-hour live online sessions, totalling 7.5 hours. Delivery can also be adapted where the needs, size or circumstances of an organisation warrant a different format.
Foundation Training is the beginning of implementation rather than its completion.
2. Practice Integration
Practice Integration concerns what happens after staff have learned the Model.
The central question becomes:
Can we see Triple-A in everyday practice?
Staff are supported to use AAA and AURA when thinking about children, reflecting on behaviour, responding to distress, managing challenging situations, repairing relationships and making everyday caregiving decisions.
Triple-A can also provide a shared language for:
- clinical and reflective supervision;
- team reflection;
- discussion of challenging situations;
- case consultation;
- care planning; and
- reflection following significant incidents.
Practice Integration helps bridge the gap between knowing about Triple-A and providing care that is recognisably informed by Triple-A.
3. Organisational Embedding
Sustainable implementation requires more than individual staff changing their practice.
The organisation itself needs to support the Model.
Organisational Embedding considers how Triple-A can appropriately inform areas such as:
- staff induction;
- supervision;
- team meetings and reflective practice;
- care planning;
- workforce development;
- leadership;
- practice documentation;
- responses to significant incidents;
- organisational language and expectations; and
- ongoing professional development.
The aim is not to insert Triple-A terminology into every organisational document.
Rather, it is to create sufficient alignment between the Model of Care and the systems surrounding staff so that therapeutic practice is supported rather than dependent upon individual enthusiasm.
4. Fidelity and Continuous Development
Models of Care can change over time.
Staff leave. New staff arrive. Practices evolve. Organisational pressures emerge. Elements of a Model may become emphasised while others gradually disappear.
For this reason, Triple-A implementation includes attention to fidelity and continuous development.
A Triple-A Fidelity & Implementation Review considers areas such as:
- staff understanding of Triple-A;
- use of AAA and AURA;
- workforce learning;
- everyday therapeutic practice;
- supervision and reflection;
- organisational embedding;
- implementation strengths;
- areas requiring further development; and
- potential drift from the Model.
The purpose is developmental rather than punitive.
Fidelity review provides an opportunity to ask:
Is Triple-A still recognisable in the care being provided, and what would help strengthen implementation further?
A Triple-A Fidelity & Implementation Review is specific to implementation of the Model. It is not a statutory inspection, safeguarding audit, clinical audit or certification that a service or individual child is safe.
The role of clinical and reflective supervision
Supervision provides an important bridge between learning a Model and applying it in complex real-world situations.
Triple-A-informed supervision can support practitioners and teams to:
- use AAA when thinking about children and challenging situations;
- reflect on their own emotional responses;
- consider what may be communicated through behaviour;
- use AURA when considering therapeutic responses;
- think about relationships and relational repair;
- maintain curiosity when situations are difficult;
- identify patterns in team or organisational responses; and
- translate the Model into individualised care.
Supervision also creates a space in which Triple-A itself can be questioned and applied thoughtfully rather than mechanically.
The Model is intended to support professional judgement, not replace it.
Consultation concerning challenging situations
Implementation may include consultation regarding particularly challenging caregiving or clinical situations.
Consultation uses Triple-A as a framework for considering what may be happening for the child and what therapeutic responses might be available.
It does not replace appropriate clinical assessment, risk assessment, safeguarding procedures or specialist intervention.
Responsibility for individual case decisions, safeguarding and statutory obligations remains with the organisation and relevant professionals.
Supporting those who provide therapeutic care
Providing therapeutic care can be emotionally demanding.
Children affected by adversity can evoke powerful responses in the adults and systems around them. Maintaining accessibility, understanding, responsiveness and attunement is more difficult when caregivers themselves are overwhelmed, unsupported or persistently dysregulated.
Triple-A implementation therefore includes attention to the experience and support needs of caregivers and staff.
Self-care is not understood simply as something an individual does outside work. Reflective supervision, supportive leadership, psychologically informed teams, realistic expectations and organisational containment can all contribute to the capacity of adults to remain therapeutically available to children.
Implementation is collaborative
Triple-A is not intended to be imposed upon an organisation as an external set of instructions.
Every service has its own children and young people, workforce, culture, regulatory environment, existing practice frameworks and organisational history.
Implementation therefore involves collaboration between Secure Start and the organisation.
The objective is to preserve the core principles and integrity of Triple-A while considering how they can be meaningfully expressed within the organisation’s particular service context.
This allows appropriate contextual adaptation while reducing the risk of the Model becoming so modified that it is no longer recognisably Triple-A.
Building internal capability
Over time, organisations implementing Triple-A may wish to develop greater internal capacity to support the Model.
Secure Start is developing a Certified Triple-A Facilitator pathway through which appropriately experienced professionals may, subject to training, agreement and ongoing fidelity requirements, become authorised to support Triple-A learning within their organisation.
Facilitator authorisation is separate from ordinary Foundation Training and is not automatically conferred through an organisational licence.
This approach is intended to support sustainable implementation while protecting the integrity of the Model.
Evidence-informed implementation
Triple-A has a peer-reviewed conceptual foundation and more than a decade of implementation history across child and family services in Australia and Ireland.
Its development has included implementation within foster care, kinship care and statutory child welfare systems.
This history has reinforced an important lesson:
Providing training is relatively straightforward. Creating the conditions in which learning becomes sustained therapeutic practice is much more challenging.
The contemporary Triple-A implementation approach reflects this experience by deliberately addressing workforce learning, everyday practice, organisational systems, supervision and fidelity.
Triple-A remains an evidence-informed Model with an emerging direct evidence base. Secure Start is committed to transparent evaluation and to strengthening the independent evidence concerning implementation and outcomes.
Read the Triple-A Evidence & Practice Foundation
A history of implementation
The contemporary Triple-A implementation approach has developed through more than a decade of real-world experience.
This includes:
2014 – South Australia
Triple-A was implemented within Centacare’s Family Preservation Foster Care Service.
2015–2016 onward – Donegal, Ireland
Triple-A was formally implemented and evaluated with TUSLA foster carers and professional staff. Subsequent TUSLA documentation demonstrates that Triple-A moved beyond the initial implementation into ongoing foster-carer training arrangements.
2018–2020 – South Australian Kinship CARE Project
A contextualised framework explicitly incorporating Triple-A was implemented at scale with the support of the South Australian Department for Child Protection. The project involved carers, support workers, psychologists and program leadership and contributed significantly to the development of Triple-A’s approach to layered implementation and organisational embedding.
2021–2024 – Martinthi Aboriginal Kinship CARE Program
CARE and Triple-A-informed principles continued to be applied within an Aboriginal kinship care context through Martinthi.
CARE represents an important part of the developmental and implementation history of Triple-A. Secure Start now uses AAA and AURA as the complementary frameworks within the contemporary Triple-A Model of Therapeutic Care.
Read about the development and implementation history of the CARE Curriculum
Implementing Triple-A in your organisation
Triple-A implementation can be tailored to the scale and needs of an organisation while preserving the core integrity of the Model.
An implementation may include:
- initial organisational consultation;
- implementation planning;
- Foundation Training;
- implementation resources;
- practice integration;
- clinical and reflective supervision;
- consultation concerning challenging cases;
- leadership consultation;
- organisational embedding;
- fidelity and implementation review; and
- ongoing workforce development.
For organisations operating multiple sites, implementation can be staged so that learning from initial sites informs subsequent rollout.
The aim is not simply for staff to say:
“We have been trained in Triple-A.”
The longer-term aim is for children, staff and organisations to experience a Model of Care that is recognisable in everyday practice.
Find out more
Learn about the Triple-A Model of Therapeutic Care