From an integrated clinical framework to more than a decade of implementation across child and family services in Australia and Ireland.
The Triple-A Model of Therapeutic Care has developed through the interaction of psychological theory, clinical practice, caregiver experience and implementation in real-world child and family services.
The foundational Triple-A approach was published in 2010. Since then, Triple-A and closely related frameworks developed from it have been implemented across foster care, kinship care and child welfare settings in Australia and Ireland.
This history has shaped not only the content of contemporary Triple-A, but also its approach to implementation.
Experience across different services has reinforced an important principle:
Training people in a Model of Care is not the same as implementing a Model of Care.
The contemporary Triple-A approach therefore attends to Foundation Training, Practice Integration, Organisational Embedding, and Fidelity and Continuous Development.
2010 — The published foundation
The foundational Triple-A approach was published by Colby Pearce in Educational and Child Psychology in 2010.
The paper brought together attachment theory, developmental and neurobiological knowledge, learning theory and reflective clinical practice in an integrated approach to understanding and caring for children affected by significant adversity.
It described three interrelated areas:
Attachment
Arousal
Accessibility to needs provision
These became the AAA framework within contemporary Triple-A.
The paper also emphasised caregiver accessibility, understanding, responsiveness and affective attunement — qualities that are reflected in the contemporary AURA framework.
The 2010 publication established the conceptual foundation from which the Triple-A Model of Therapeutic Care continued to develop.
2014–2015 — Centacare Family Preservation Foster Care Service, South Australia
An early organisational implementation of Triple-A occurred within Centacare’s Family Preservation Foster Care Service in South Australia in 2014–2015.
Triple-A was implemented as the service’s preferred Model of Care, providing an opportunity to translate the conceptual framework into an organisational foster-care setting.
Outcome data were collected during this implementation. These data are not publicly reported because permission for their disclosure has not been obtained, and no outcome claims from the Centacare implementation are relied upon in Secure Start’s public evidence position.
The significance of the Centacare implementation is therefore historical and developmental: it represents an early application of Triple-A as an organisational Model of Care.
2015–2016 — Triple-A comes to Donegal, Ireland
In 2015, discussions commenced with the TUSLA Child and Family Agency Fostering Service in County Donegal, Ireland, concerning implementation of Triple-A with foster carers and professional staff.
A formal implementation followed between December 2015 and March 2016 with the support and funding of TUSLA.
The implementation included preparation of professional staff and five weekly half-day workshops for participating foster carers.
Content addressed the theoretical foundations of Triple-A, therapeutic caregiving, the caregiving environment, caregiver self-care, and monitoring and evaluation.
Approximately 29 foster caregivers participated.
Importantly, the Donegal implementation was evaluated.
2016 — Preliminary evaluation of Triple-A
The Donegal implementation produced the first published direct evaluation of the Triple-A Model of Therapeutic Care.
Participant feedback demonstrated consistently high acceptability. Across both implementation locations and all five weeks, 100% of respondents reported that the programme had been communicated effectively and 100% said they would recommend it to others.
The evaluation also included preliminary child-level monitoring data that produced promising practice-based findings.
However, the evaluation was small and uncontrolled and relied substantially upon caregiver-reported outcomes.
The findings therefore provided preliminary evidence concerning feasibility, acceptability and potential practice effects rather than establishing the effectiveness of Triple-A.
This distinction remains part of Secure Start’s contemporary evidence position.
2016 onward — From implementation to embedding in Donegal
Triple-A did not disappear following the initial Donegal implementation and evaluation.
A subsequent TUSLA Donegal Fostering Service Training Needs Analysis, developed in the context of actions arising from a HIQA inspection concerning foster-carer training systems, documented Triple-A/AAA as commissioned mandatory training within the service’s rolling foster-carer training provision.
This provides evidence that Triple-A had moved beyond the initial implementation and become incorporated into ongoing service training arrangements.
In September 2018, twelve local Triple-A trainers were trained in Donegal — six TUSLA staff members and six foster carers.
Developing local capability represented another important step in implementation. Rather than remaining dependent upon the Model’s developer travelling from Australia to deliver all training, knowledge and capability could increasingly be maintained within the local service.
The Donegal experience became an important influence on later thinking about organisational embedding, local capability and implementation sustainability.
2018–2020 — The South Australian Kinship CARE Project
A further major phase of development occurred through the Kinship CARE Project, a two-year initiative delivered by Secure Start with the support of the South Australian Department for Child Protection.
The project commenced in March 2018 and concluded in March 2020.
Kinship CARE was a contextualised therapeutic-care framework for kinship carers that drew explicitly upon Triple-A.
At that stage in the development of Secure Start’s work, therapeutic responding was organised through the CARE framework:
Consistency
Accessibility
Responsiveness
Emotional Connectedness
By completion, Kinship CARE had been delivered to:
250 kinship carers
across
24 South Australian locations — 17 metropolitan and 7 regional.
Twelve per cent of participating carers identified as Aboriginal or Torres Strait Islander.
What was learned through Kinship CARE?
Evaluation produced encouraging practice-based findings.
Among carers completing training and a three-month follow-up survey:
84% reported improved relationships with children in their care.
89% reported greater confidence in their role as a kinship carer.
98% reported learning helpful strategies.
100% reported receiving helpful information.
Pre- and post-training evaluation also suggested a meaningful change in the way carers understood children’s behaviour. Following training, carers were more than twice as likely to understand behaviour as an expression of children’s needs rather than simply in terms such as “naughtiness”.
These findings concern the Kinship CARE implementation and should not be interpreted as direct evidence of the effectiveness of contemporary Triple-A.
Learning how to implement across a system
One of the most important contributions of the Kinship CARE Project concerned how therapeutic-care principles were implemented.
The project did not focus solely upon training kinship carers.
Kinship care support workers and psychology staff also received complementary preparation.
This created a layered implementation structure:
Kinship carers
experienced the framework through their support workers.
Support workers
were supported by psychologists familiar with the framework.
Psychologists and program leadership
helped maintain consistency and support implementation across the wider service.
The purpose of this layered approach was explicitly to support fidelity and embeddedness.
This experience contributed to the development of Triple-A’s contemporary distinction between:
Foundation Training
Practice Integration
Organisational Embedding
and
Fidelity and Continuous Development.
2021–2024 — Martinthi Aboriginal Kinship CARE Program
Following completion of the Department for Child Protection Kinship CARE Project, the approach continued through the Martinthi Aboriginal Kinship CARE Program in South Australia.
Martinthi involved collaboration between Aboriginal/community organisations and Secure Start and provided another context in which Kinship CARE and Triple-A-informed therapeutic-care principles were applied.
The Martinthi period contributes to the implementation and developmental history of Triple-A and related Secure Start work.
It is not presented as outcome evidence because Secure Start does not currently hold evaluation material from this implementation suitable for public reporting.
The role of CARE in Triple-A’s development
CARE represents an important stage in the development of Triple-A.
During the Kinship CARE and Martinthi periods, CARE provided a practical framework for considering the caregiving experiences provided to children:
Consistency
Accessibility
Responsiveness
Emotional Connectedness
The experience gained through CARE informed the continuing development of Triple-A’s therapeutic-responding framework.
Contemporary Triple-A now brings together two complementary frameworks:
AAA — Understanding
Attachment
Arousal
Accessibility to needs provision
AURA — Therapeutic Responding
Accessible
Understanding
Responsive
Attuned
CARE is therefore retained within Secure Start’s materials as part of the developmental and implementation history of Triple-A rather than as a separate contemporary framework within the Model.
Contemporary Triple-A
The contemporary Triple-A Model of Therapeutic Care brings together learning accumulated across more than a decade of implementation.
AAA supports caregivers and professionals to ask:
What might be happening for this child?
AURA supports them to ask:
What can I do to respond therapeutically?
The implementation framework then asks:
How do we help this become everyday practice?
And fidelity and continuous development ask:
Is Triple-A still recognisable in the care being provided, and how can implementation be strengthened?
This creates a contemporary architecture of:
Understand ? Respond ? Implement ? Review
AAA ? AURA ? Implementation ? Fidelity
What the implementation history tells us
The history of Triple-A does not establish that the Model causes particular child or service outcomes.
Implementation history and effectiveness evidence are different things.
What the history does demonstrate is that Triple-A and frameworks closely associated with its development have been applied over an extended period in real-world child and family services, across different organisations, caregiving populations and jurisdictions.
This experience has contributed to continuing refinement of:
- the conceptual Model;
- caregiver and workforce training;
- translation of psychological knowledge into everyday practice;
- reflective supervision;
- layered implementation;
- organisational embedding;
- local implementation capability;
- fidelity; and
- evaluation.
The contemporary Triple-A Model is therefore not simply the product of theory.
It reflects an ongoing interaction between research, clinical practice, caregiver experience, organisational implementation and evaluation.
Building the next phase
Triple-A is now entering another stage of development.
Secure Start is formalising an implementation and licensing framework designed to support organisations wishing to adopt Triple-A as a Model of Therapeutic Care.
This includes:
Foundation Training
Practice Integration
Organisational Embedding
Fidelity and Continuous Development
Clinical and reflective supervision
Implementation consultation
and, in the future,
Certified Triple-A Facilitators.
As Triple-A is implemented across new services and jurisdictions, there is also an opportunity to build a stronger cumulative evidence base through consistent implementation, fidelity processes and prospective evaluation.
The objective is to continue the approach that has characterised Triple-A’s development from the beginning:
bringing theory, evidence and reflective practice together in the everyday care of children.
Explore the history
The CARE Curriculum: Development and Implementation History
Kinship CARE: Development and Implementation History
Kinship CARE: A South Australian Implementation Project
Historical Donegal resources are also retained on the Secure Start website as part of the implementation record.
Learn about contemporary Triple-A
Triple-A Model of Therapeutic Care