A Model of Care needs to make sense in theory, work in everyday practice, and remain meaningful when caring becomes difficult.
Organisations caring for children and young people affected by adversity face an important decision when choosing a Model of Care.
The Model needs to be grounded in credible psychological and developmental knowledge. But that is not enough.
It also needs to be understandable to the people providing care, applicable to the complexity of children’s everyday lives, capable of informing organisational practice, and sufficiently clear that implementation can be supported and reviewed over time.
The Triple-A Model of Therapeutic Care has been developed with these challenges in mind.
At its centre are two complementary frameworks:
AAA — Understanding
Attachment
Arousal
Accessibility to needs provision
and
AURA — Therapeutic Responding
Accessible
Understanding
Responsive
Attuned
Together, they provide a practical way of moving from:
What might be happening for this child?
to:
What can we do to respond therapeutically?
1. Simple enough to remember. Rich enough to think with.
Models of Care can become complicated.
When staff are presented with too many concepts, acronyms and procedures, there is a risk that the Model becomes something discussed during training but difficult to recall when a child is distressed and the environment is under pressure.
Triple-A deliberately provides a simple organising structure.
AAA helps us understand.
AURA helps us respond.
Behind that simplicity, however, sit substantial bodies of psychological and developmental knowledge concerning attachment, relationships, emotional and physiological regulation, learning, behaviour, caregiver responsiveness and child development.
The objective is not to simplify the child.
It is to make complex knowledge sufficiently accessible that caregivers can actually use it.
2. It connects understanding with action
Many approaches provide useful explanations of trauma, attachment or children’s behaviour.
The challenge for caregivers is often:
“What does this mean for what I do next?”
Triple-A explicitly connects understanding with therapeutic responding.
AAA encourages caregivers to consider:
Attachment — what might this child have learned about themselves, other people and relationships?
Arousal — what might be happening in the child’s emotional and physiological state?
Accessibility to needs provision — what might this child have learned about how important needs get met?
AURA then asks:
Accessible — am I emotionally and physically available when needed?
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?
This creates a direct bridge between formulation and everyday care.
3. It focuses on everyday therapeutic experience
Triple-A does not assume that therapeutic care occurs only during therapy sessions.
Children experience care through hundreds of ordinary interactions.
Getting up.
Eating together.
Travelling to school.
Receiving help.
Being told no.
Managing disappointment.
Having fun.
Becoming distressed.
Going to bed.
Getting something wrong.
Repairing a relationship afterwards.
Triple-A encourages organisations to recognise the therapeutic potential of these repeated experiences.
The question becomes not simply:
“What intervention does this child receive?”
but also:
“What does this child repeatedly experience from the adults who care for them?”
For children whose previous experiences of care have involved adversity, the quality and consistency of these ordinary interactions matter.
4. It does not reduce children to their behaviour
Challenging behaviour can easily become the organising focus of care.
Triple-A encourages a different starting point.
Behaviour matters, particularly where safety is involved. But behaviour also occurs within a developmental, relational, emotional and learning context.
AAA encourages caregivers to look beneath the immediate behaviour and remain curious about what may be happening for the child.
This does not mean excusing unsafe behaviour.
It means recognising that:
understanding the child and maintaining appropriate boundaries are not opposites.
A caregiver can stop unsafe behaviour while remaining interested in the child who is expressing it.
5. It is a Model of Care, not simply a training course
Training staff in therapeutic concepts is relatively straightforward.
Sustaining those concepts in everyday practice is harder.
For this reason, Triple-A distinguishes between four elements of implementation:
Foundation Training
Staff learn the Model and develop a shared understanding of AAA and AURA.
Practice Integration
Triple-A becomes visible in everyday caregiving, reflection, supervision and decision-making.
Organisational Embedding
The organisation supports the Model through leadership, induction, supervision, team reflection, care planning, workforce development and relevant systems.
Fidelity and Continuous Development
Implementation is reviewed over time to identify strengths, support development and reduce drift from the Model.
The aim is not simply for an organisation to say:
“Our staff have completed Triple-A training.”
The aim is for Triple-A to become recognisable in the experience of care.
6. It can create a shared language across an organisation
Children do not experience departments.
They experience people.
Care staff, managers, clinicians, social workers and organisational leaders may have different professional roles, but greater coherence becomes possible when they share a way of thinking about the primary task.
AAA and AURA provide a common language without requiring everyone to perform the same role.
A residential care worker might use AAA when reflecting upon an incident.
A supervisor might use it to help a staff member think about a challenging relationship.
A clinician might use the same framework as one part of a richer formulation.
A manager might use AURA when considering the quality of everyday care within a home.
The language remains recognisable across different levels of the organisation.
7. It recognises that caregivers need support too
Therapeutic care is demanding.
Remaining Accessible, Understanding, Responsive and Attuned is considerably harder when caregivers themselves are overwhelmed, frightened, unsupported or persistently under pressure.
Triple-A therefore does not locate responsibility for therapeutic care solely within individual workers.
Supervision matters.
Team functioning matters.
Leadership matters.
Reflective space matters.
Organisational culture matters.
A Model of Therapeutic Care needs to consider not only:
“What do children need from their caregivers?”
but also:
“What do caregivers need from their organisation in order to provide it?”
This is one reason Practice Integration and Organisational Embedding are central to Triple-A implementation.
8. It supports professional judgement rather than replacing it
Children are different.
The same behaviour can mean different things for different children, and the same child may need different responses at different times.
Triple-A therefore does not provide scripts for every situation.
AAA supports curiosity and formulation.
AURA supports reflection about the quality and appropriateness of our response.
Neither replaces professional judgement.
Triple-A is intended to help people think more effectively, not to remove the need to think.
It also does not replace safeguarding procedures, risk assessment, statutory obligations, specialist assessment or clinical treatment where these are required.
9. It has a substantial real-world implementation history
Triple-A is not a newly created commercial training package.
Its foundational approach was published in Educational and Child Psychology in 2010, and its development has subsequently been informed by implementation across child and family services in Australia and Ireland.
This history includes:
2014–2015 — South Australia
Implementation within Centacare’s Family Preservation Foster Care Service.
2015–2016 onward — Donegal, Ireland
Formal implementation and preliminary evaluation with TUSLA foster carers and professional staff, followed by incorporation into ongoing foster-carer training arrangements and development of local training capability.
2018–2020 — South Australia
The large-scale Kinship CARE Project, delivered with the support of the South Australian Department for Child Protection, applied a contextualised framework explicitly incorporating Triple-A principles with 250 kinship carers across 24 locations.
2021–2024 — South Australia
Further application of Kinship CARE and Triple-A-informed principles through the Martinthi Aboriginal Kinship CARE Program.
Learning from these implementations has contributed to the continuing development of Triple-A and its contemporary approach to training, implementation, organisational embedding and fidelity.
10. Its evidence position is transparent
Triple-A is evidence-informed.
Its theoretical foundations draw upon established bodies of research concerning attachment, caregiver sensitivity and responsiveness, emotional regulation and co-regulation, learning, foster care, relational intervention and therapeutic care.
Triple-A also has direct preliminary evaluation and related practice-based implementation evidence.
At the same time, Secure Start does not claim that the current evidence establishes Triple-A as an independently proven intervention or that it causes particular child outcomes.
AAA and AURA are not presented as validated psychological assessment instruments.
These distinctions are set out openly in the Triple-A Evidence & Practice Foundation.
For organisations considering a Model of Care, we believe transparency about what the evidence does — and does not — establish is important.
11. It can be adapted to context without losing its core
No two organisations are identical.
Different services operate within different regulatory environments, organisational cultures, workforce structures and communities.
The children and young people themselves are different.
Triple-A implementation therefore allows for appropriate contextual adaptation.
What should remain recognisable are the Model’s core principles and frameworks.
This creates a distinction between:
adaptation
and
drift.
Adaptation asks:
“How can Triple-A be meaningfully expressed in this service?”
Drift occurs when the Model changes to the point that its core principles are no longer recognisable.
Implementation support and fidelity review are intended to help organisations navigate that distinction.
12. It provides a framework for continued development
Triple-A is not intended to be installed and then forgotten.
Organisations change.
Staff change.
Children’s needs change.
Knowledge develops.
Implementation therefore includes opportunities for reflection, supervision, consultation, fidelity review and continued workforce development.
Over time, organisations may also develop internal capability to support Triple-A implementation through appropriately trained and authorised Certified Triple-A Facilitators.
This allows the Model to become increasingly sustainable within an organisation while maintaining appropriate connection with its core framework and fidelity requirements.
What might Triple-A offer your organisation?
Triple-A may be particularly useful for organisations seeking:
- a coherent Model of Therapeutic Care;
- an accessible shared language across care, clinical and leadership teams;
- a framework that connects psychological understanding with everyday caregiving;
- a strong relational and developmental orientation;
- an approach that does not reduce therapeutic care to behaviour management;
- structured implementation beyond initial staff training;
- integration with clinical and reflective supervision;
- attention to workforce support and organisational context;
- a framework for implementation fidelity and continuous development; and
- an evidence position that is explicit about both strengths and limitations.
Triple-A is not intended to be the right Model for every organisation.
Choosing a Model of Care should involve consideration of the children and young people being served, the organisation’s purpose and values, existing practice, workforce capability, regulatory context and capacity to support implementation over time.
Where there is a good fit, Triple-A provides a framework for bringing these elements together around a central task:
understanding children affected by adversity and creating everyday experiences of care that support their development, relationships and wellbeing.
Explore Triple-A
Learn about the Triple-A Model of Therapeutic Care
Read the Evidence & Practice Foundation
Explore Triple-A Training and Implementation
Explore Triple-A’s Implementation History
Interested in Triple-A for your organisation?
Organisations considering Triple-A can contact Secure Start to discuss their service, the children and young people they support, their existing Model of Care and what Triple-A implementation might involve.
An initial conversation can help determine whether Triple-A is an appropriate fit before decisions are made about training or implementation.