Maternal Depression and Parent Management Training Outcomes

This study examines the impact of maternal depression on reductions in children’s behavior problems severity following implementation of the Brief Behavioral Intervention—a brief, manualized parent management training treatment. The parents of 87 children aged 2–6 years of age received parent management training at a metropolitan hospital. Parents of participants completed measures of externalizing behavior and maternal depression. The association between pre-post treatment change in externalizing behavior and maternal depression was examined using an autoregressive cross-lagged model. Results showed that self-reported maternal depressive symptoms at pre-treatment negatively influenced the overall magnitude of reduction of reported externalizing behaviors in children following treatment. Results indicate that aspects of family functioning not specifically targeted by parent management training, such as maternal depression, significantly affect treatment outcomes. Clinicians providing parent management training may benefit from assessing for maternal depression and modifying treatment as indicated.     

Parent Care in the Context of Women's Multiple Roles

This article addresses the multiple roles held by women involved in parent care and the ways in which these roles affect the women's well-being. Research on women's roles (including that of caregiver) has been guided by two opposing perspectives, the scarcity hypothesis and the expansion hypothesis. Findings from our studies of role quality, role combinations, and role spillover have provided abundant evidence that the lives of these women cannot be easilycaptured by either the scarcity or the expansion hypothesis alone.     

The Effectiveness of Brief Parent Training for the Management of Children's Homework Problems

The present study evaluated the effectiveness of a combined parent manual group training program for the management of children's homework problems. Parents of 13 children who were experiencing significantly more homework problems than their grade-school peers were assigned to either a treatment or wait-list control group. Training consisted of 3 weekly, 1-½ hour group meetings wherein behavioral techniques outlined in the parent manuaI were discussed and practiced via modeling, behavior rehearsal, and completion of home assignments. In comparison to the 7 waitlist parents, the 6 treatment parents repotted significantly fewer homework difficulties at post-treatment as measured by scores on the Homework Problem Checklist and the Learning Disability scale of the LouisviIle Behavior Check List. The control group parents increased the frequency of criticisms to their children during the waiting period. When the control group was subsequently treated, no significant gains were reported, however, training was conducted during the last four weeks of school. Scores on Homework Problem Checklists re-administered at a 6-month follow-up indicated maintenance of positive behavior change over time for the treatment group.     

Behavioral Parent Training:

Parents of 42 conduct disordered children were randomly allocated to either contingency management training, communication skills training or a waiting list control condition. The two treatments were conducted with the problem child either present or absent during sessions. Assessment devices included the Behavior Problem Checklist, Becker Adjective Checklist, Parent Attitude Survey, Piers-Harris Self-Concept Scale, and Daily observations made by parents. In comparison to waiting list controls, significant treatment effects were found on the Behavior Problem Checklist and on one attitude subscale (Understanding). More subjects in the contingency management condition met a criterion of clinical success than in the other conditions. No differential effect was associated with the conduct of treatment under conditions where the child was either present of absent form the sessions.     

Intimate Partner Violence and Poverty in the Context of Botswana

The study aimed at exploring pathways of intimate partner violence and poverty. The sample consisted of 30 women (aged 18 to 54 years) who had experienced intimate partner violence. Data were collected through semi-structured in-depth interviews and analysed thematically. The results revealed that intimate partner violence was related to a lack of financial resources and stable income, financial dependency on the perpetrator, lack of child support, and intergenerational exposure to violence and poverty. The findings suggest that experiences of poverty and intimate partner violence are largely intertwined.     

Implementing the Boulder Model of Training in a Psychology Training Clinic

The scientist–practitioner (S–P) model of training has guided professional psychology in the United States for nearly six decades. However, since its inception, the model has been hotly debated and implementation of the model has been chronically problematic. One counseling psychologist who is working as both a faculty member and psychology training clinic director describes how scientific principles can be retained in a practice setting. He overviews the Boulder model of training, provides a brief review of the psychology training clinic (PTC), describes his current work setting and unique faculty appointment, and outlines five strategies for integrating science and practice in applied clinical settings. He also highlights how embracing the Boulder model has promoted a strong professional identity and presents the PTC as a model professional home for S–Ps.     

Parenting Cognition and Affective Outcomes Following Parent Management Training: A Systematic Review

Parent management training (PMT) is considered the gold standard in the treatment of child behavior problems. The secondary effects of these interventions, particularly on parent well-being, are infrequently studied, despite evidence that parents of children with behavior problems often experience personal difficulties. This narrative review examined the affective and parenting cognition outcomes of PMT for mothers and fathers of children ages 2–13 years, across 48 controlled treatment studies. Substantial support was found for reductions in parenting stress, and increases in perceived parenting competence following PMT. Evidence indicated fewer improvements in domains more distal from parenting, including parent depressive symptoms and marital relationship dysfunction. A number of studies suggested parent gender as a moderator of parent outcomes of PMT; however, the underrepresentation of fathers in existing research limits conclusions in this regard. Avenues for future research are highlighted to address current gaps in the literature, and to further our understanding of the ways in which both children and parents may benefit from PMT.     

Parent Training with Non-Traditional Families:

Although behavioral parent training has been shown to be effective with a variety of child behavior problems, this review notes that the adaptation and generalization of this treatment across family populations has not met with consistent success. The therapeutic need of families with diverse backgrounds and those facing interpersonal and intra-familial conflicts only recently has been raised by therapists. To promote effective and generalized treatment success across this population, some therapists recommend adjunctive or alternative treatment strategies that encompass the specific needs and characteristic make-up of a family. Several of the recommended adaptations that have been made are described in this review. Despite the therapeutic merit of many of these recommendations, it is concluded that little empirical information currently exists on the implementation of the various treatment adaptations. Recommendations are made to evaluate further clinical issues related to the needs of non-traditional and other non-middle class families.     

Predicting Treatment Success in Child and Parent Therapy Among Families in Poverty

Behavior problems are prevalent in young children and those living in poverty are at increased risk for stable, high-intensity behavioral problems. Research has demonstrated that participation in child and parent therapy (CPT) programs significantly reduces problematic child behaviors while increasing positive behaviors. However, CPT programs, particularly those implemented with low-income populations, frequently report high rates of attrition (over 50%). Parental attributional style has shown some promise as a contributing factor to treatment attendance and termination in previous research. The authors examined if parental attributional style could predict treatment success in a CPT program, specifically targeting low-income urban children with behavior problems. A hierarchical logistic regression was used with a sample of 425 families to assess if parent- and child-referent attributions variables predicted treatment success over and above demographic variables and symptom severity. Parent-referent attributions, child-referent attributions, and child symptom severity were found to be significant predictors of treatment success. Results indicated that caregivers who viewed themselves as a contributing factor for their child's behavior problems were significantly more likely to demonstrate treatment success. Alternatively, caregivers who viewed their child as more responsible for their own behavior problems were less likely to demonstrate treatment success. Additionally, more severe behavior problems were also predictive of treatment success. Clinical and research implications of these results are discussed.     

Children With Conduct Problems and Co-occurring ADHD: Behavioral Improvements Following Parent Management Training

To scale up evidence-based treatment of conduct problems, parent management training, Oregon model (PMTO) has been disseminated throughout Norway. This study examined whether Attention Deficit Hyperactivity Disorder (ADHD) predicted the outcomes of PMTO. Of 253 children and families, 97 were reported to have an ADHD diagnosis. Although different at intake, the groups with and without ADHD had close to an equal change in behavioral status following treatment. Maternal depression and family income predicted the combined group's behavior following PMTO. The study indicates that reductions in conduct problems following PMTO are of the same magnitude in children with or without ADHD. However, some characteristics may differentially predict outcomes for children with combined problems.     

Delivering Parent Management Training in an Integrated Primary Care Setting: Description and Preliminary Outcome Data

This paper describes how behavioral health consultants (BHCs) in an integrated primary care setting use evidence-based principles that underlie parent management training (PMT) to assist caregivers of youth with externalizing behavior problems. Illustrated is the decision-making process that BHCs utilize from the moment they receive a patient referral from a primary care provider to how interventions are selected and delivered. When delivering PMT in integrated care, operant-based learning principles underlying PMT are often selected based on a combination of factors, including match with presenting problem, caregiver efficacy, caregiver beliefs about the causes and maintaining factors, and feasibility of implementation. We further present preliminary outcome data on the effectiveness of BHCs’ efforts to use PMT principles in a primary care setting. Participants were 21 caregivers and their children (M_age = 7.76 years, 38.1% female; 66.7% Hispanic) seen for an average of 2.38 visits. Pre-post data provided by caregivers (for youth 11 years or younger) and adolescents (self-report of patients 12–17 years of age) taken at the time of first and last sessions revealed significant reductions in global distress scores and high levels of satisfaction with services received. Findings support the viability of providing brief, focused PMT interventions for pediatric populations seen in primary care.     

Bringing Culture Into Parent Training With Latinos

Traditional frameworks of parenting have failed to capture the distinctive nature of parenting in Latino families. Cultural values likely influence parenting practices. The study of cultural values may allow us to identify aspects of parenting that are unique to Latinos and which complement traditional frameworks of parenting. This paper presents qualitative work on two Latino cultural values, familismo and respeto, and examines ways in which these values may inform the provision of standard parent training programs with Latinos. The first study is an ethnography that explored the value of familismo. The second study consisted of focus groups in which Latina mothers discussed the value of respeto. Findings from these two studies are used to examine the cultural congruence of the characteristics of parent training programs and the Latino values of familismo and respeto. In light of the issues identified, clinical guidelines for working with Latino parents in parent training programs are offered.     

Father Involvement in Parent Training for Oppositional Child Behavior

Outcome literature (1981 to 1988) on behavioral parent training interventions for nonhandicapped children with oppositional behavior is reviewed to assess the extent and effects of father involvement in parent training. Thirteen studies were found that included some father involvement. Weaknesses of these studies include a failure to observe and measure changed in father-child interactions, a lack of emphasis on the impact of the marital relationship, a lack of attention to similarities in parental child management strategies, and a lack of assessment of paternal characteristics. Further research to assess the effects of including fathers on parent training outcomes can improve the efficiency and effectiveness of these interventions.     

Community-Delivered Collaborative and Proactive Solutions and Parent Management Training for Oppositional Youth: A Randomized Trial

The aim of this study was to examine the relative effectiveness of Collaborative and Proactive Solutions (CPS) and Parent Management Training (PMT) for youth with oppositional defiant disorder (ODD) in a community setting. Based on a semistructured diagnostic interview, 160 youth with ODD (ages 7–14; 72% male; ethnicity representative of the wider Australian population) were randomized to CPS (n = 81) or PMT (n = 79) for up to 16 weekly sessions. The primary hypothesis was that participants in the CPS group, treated in a community setting, would exhibit significant improvement in ODD, equivalent to that of an evidence-based treatment, PMT. Assessment was conducted at baseline, post-intervention, and at 6-month follow-up, using independently rated semistructured diagnostic interviews, parent ratings of ODD symptoms, and global ratings of severity and improvement. Analyses were conducted with hierarchical growth linear modeling, ANCOVA, and equivalence testing using an intent-to-treat sample. Both treatments demonstrated similar outcomes, with 45–50% of youth in the nonclinical range after treatment, and 67% considered much improved. No differences were found between groups, and group equivalency was shown on the independent clinician and parent-rated measures. Gains were maintained at the 6-month follow-up. In conclusion, CPS works as effectively as the well-established treatment, PMT, for youths with ODD, when implemented in a community-based setting. As such, CPS provides a viable choice for families who seek alternate treatments.     

Reducing Child Whining Through Self-Instructional Parent Training Materials

Parents used self-instructional booklets to decrease their children's (age4-8) whining. In each of 9 families, a multiple-baseline design across three problems, whining and two other was used. Parent data indicate mean improvement of 26% of the maximum possible from baseline means, with 8 of 9 children showing improvement. All parent final consumer ratings were positive. All interobserver reliabilities exceeded 80% agreement weighted for occurrence and nonoccurrence. Correlations for two sets of data between frequencies of whining estimated by parents twice an hour and percent of intervals recorded for whining from observer interval data for the hour produced median correlations of .62 and .51. Percent agreement between observer and parent data, both using interval recording at the same time, produced a median coefficient of agreement weighted for occurrence and non-occurrence of 59%. Results suggest that parents using self-instructional materials alone could reduce children's whining from levels originally considered excessive to levels parents considered acceptable.     

Addressing Cultural Variables in Parent Training Programs With Latino Families

There has recently been increased attention given to understanding how cultural variables may have an impact on the efficacy of treatments with Latino families seeking psychological services. Within parent training programs, understanding the extent to which culture can affect parenting practices is vital to providing quality care. The focus of this article is to discuss how different cultural variables such as respeto, personalismo, machismo, marianismo, and acculturation can impact the efficacy of parent training programs for Latino families. Recommendations for addressing these cultural variables in parent training programs are provided.     

Differences in Mothers' and Fathers' Readiness for Change in Parent Training

We investigated readiness for change (RFC), a construct that may contribute to the discrepancies between fathers' and mothers’ rates of participation in behavioral parent training. One hundred and twenty fathers and mothers of 2- to 7-year-old children with conduct problems completed standardized measures of RFC, child behavior problems, and parent stress as part of an intake to a parent-child interaction therapy clinic. Fathers reported less readiness for change, less confidence in their ability to make changes, were more defensive about the need to change, and saw treatment as less important than mothers. Results suggest that if clinicians match parent training interventions to mothers’ readiness, fathers may be left behind.     

Implementing and Expanding on Carkhuff's Training Technology

This article describes the implementation and expansion of Robert Carkhuff's Training Technology to maximize trainees' skill transfer to applied settings and to maximize their ability to integrate various theoretical orientations into their counseling repertoire. The article summarizes training outcomes and invites counselor educators to demonstrate the effectiveness of their training program by measuring their students' skill levels with actual clients in the field.