Does Parent Training Format Affect Treatment Engagement? A Randomized Study of Families at Social Risk
We examined whether parent engagement in parent training (PT) differed based on PT format (parent group-based with video versus mastery-based individual coaching with child) in an economically disadvantaged sample of families seeking behavioral treatment for their preschool children in an urban mental health clinic. Parents (N = 159; 76.1% mothers, 69.8% African American, 73% low-income) were randomized to one of two interventions, Chicago Parent Program (parent group + video; CPP) or Parent–Child Interaction Therapy (individualized mastery-based coaching; PCIT). Parent engagement indicators compared were PT attendance and completion rates, participation quality, and parent satisfaction. Risk factors predictive of PT attrition (parent depression, psychosocial adversity, child behavior problem severity, length of wait time to start PT) were also compared to determine whether they were more likely to affect engagement in one PT format versus the other. No significant differences were found in PT attendance or completion rates by format. Clinicians rated parents’ engagement higher in PCIT than in CPP while satisfaction with PT was rated higher by parents in CPP compared to PCIT. Never attending PT was associated with more psychosocial adversity and externalizing behavior problems for CPP and with higher baseline depression for PCIT. Parents with more psychosocial adversities and higher baseline depression were less likely to complete PCIT. None of the risk factors differentiated CPP completers from non-completers. Delay to treatment start was longer for PCIT than CPP. Strengths and limitations of each PT format are discussed as they relate to the needs and realities of families living in urban poverty.
KeywordsParent training Treatment engagement Socioeconomic disadvantage Parent–child interaction therapy Chicago parent program Psychosocial adversity
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors give special thanks to Susan M. Breitenstein for her assistance with fidelity monitoring and to the clinicians and families who participated in this study.
D.G. designed and led the study and wrote the majority of the manuscript. H.B. collaborated on the study design, co-led the study, and helped write and edit the manuscript. C.B. led the data analyses and helped write and edit the manuscript M.O. collected the data and helped write and edit the manuscript. M.K.U. collaborated in the data analysis and helped write and edit the manuscript.
This study was funded by a grant from the National Institute for Nursing Research, #R01 NR012444. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health.
Compliance with Ethical Standards
Conflict of Interest
Under an agreement between Rush University Medical Center and Dr. Deborah Gross, Dr. Gross is entitled to revenue from the program described in this paper. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. This manuscript has been reviewed for bias by an independent committee prior to submission to this journal. The remaining authors declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Johns Hopkins Institutional Research Board. Informed consent was obtained from all individual participants included in the study.
- Achenbach, T., & Rescoria, L. (2000). Manual for the ASEBA preschool forms and profiles. Burlington: University of Vermont, Research Center for Children, Youth, and Families.Google Scholar
- American Academy of Child & Adolescent Psychiatry. (2013). Child and adolescent psychiatry workforce crisis: Solutions to improve early intervention and access to care. https://www.aacap.org/App_Themes/AACAP/docs/Advocacy/policy_resources/cap_workforce_crisis_201305.pdf.
- Chacko, A., Jensen, S. A., Lowry, L. S., Cornwell, M., Chimklis, A., Chan, E., et al. (2016). Engagement in behavioral parent training: Review of the literature and implications for practice. Clinical Child and Family Psychology Review, 19(3), 204–215. https://doi.org/10.1007/s10567-016-0205-2.CrossRefPubMedGoogle Scholar
- Chaffin, M., Valle, L. A., Funderburk, B., Gurwitch, R., Silovsky, J., Bard, D., & Kees, M. (2009). A motivational intervention can improve retention in PCIT for low-motivation child welfare clients. Child Maltreatment, 14(4), 356–368. https://doi.org/10.1177/1077559509332263.CrossRefPubMedGoogle Scholar
- Comer, J. S., Chow, C., Chan, P. T., Cooper-Vince, C., & Wilson, L. A. (2013). Psychosocial treatment efficacy for disruptive behavior problems in very young children: A meta-analytic examination. Journal of the American Academy of Child and Adolescent Psychiatry, 52(1), 26–36. https://doi.org/10.1016/j.jaac.2012.10.001.CrossRefPubMedGoogle Scholar
- Cunningham, C. E., Chen, Y., Deal, K., Rimas, H., McGrath, P., Reid, G., & Corkum, P. (2013). The interim service preferences of parents waiting for children’s mental health treatment: A discrete choice conjoint experiment. Journal of Abnormal Child Psychology, 41(6), 865–877. https://doi.org/10.1007/s10802-013-9728-x.CrossRefPubMedGoogle Scholar
- Eyberg, S. M. (2005). Tailoring and adapting parent–child interaction therapy to new populations. Education and Treatment of Children, 28(2), 197–201.Google Scholar
- Eyberg, S. M., Funderburk, B. W., Kigin-Hembree, T. L., McNeil, C. B., Querido, J. G., & Hood, K. K. (2001). Parent-child interaction therapy with behavior problem children: One and two year maintenance of treatment effects in the family. Child & Family Behavior Therapy, 23(4), 1–20.CrossRefGoogle Scholar
- Furlong, M., McGilloway, S., Bywater, T., Hutchings, J., Smith, S. M., & Donnelly, M. (2012). Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years. The Cochrane Database of Systematic Reviews, (2), Article:CD008225. https://doi.org/10.1002/14651858.CD008225.pub2.
- Gallo, K. P., Olin, S. S., Storfer-Isser, A., O’Connor, B. C., Whitmyre, E. D., Hoagwood, K. E., & Horwitz, S. M. (2017). Parent burden in accessing outpatient psychiatric services for adolescent depression in a large state system. Psychiatric Services, 68(4), 411–414. https://doi.org/10.1176/appi.ps.201600111.CrossRefPubMedGoogle Scholar
- Garland, A. F., Hawley, K. M., Brookman-Frazee, L., & Hurlburt, M. S. (2008). Identifying common elements of evidence-based psychosocial treatments for children’s disruptive behavior problems. Journal of the American Academy of Child and Adolescent Psychiatry, 47(5), 505–514. https://doi.org/10.1097/CHI.0b013e31816765c2.CrossRefPubMedGoogle Scholar
- Ghate, D. (2016). From programs to systems: Deploying implementation science and practice for sustained real world effectiveness in services for children and families. Journal of Clinical Child and Adolescent Psychology, 45(6), 812–826. https://doi.org/10.1080/15374416.2015.1077449.CrossRefPubMedGoogle Scholar
- Gross, D., Garvey, C., Julion, W., & Fogg, L. (2007). Preventive parent training with low-income ethnic minority parents of preschoolers. In J. M. Briesmeister & C. E. Schaefer (Eds.), Handbook of parent training: Helping parents prevent and solve problem behaviors. (3rd ed.). (pp. 5–24). New York: Wiley.Google Scholar
- Gross, D., Garvey, C., Julion, W., Fogg, L., Tucker, S., & Mokros, H. (2009). Efficacy of the Chicago Parent Program with low-income African American and Latino parents of young children. Prevention Science, 10(1), 54–65. https://doi.org/10.1007/s11121-008-0116-7.CrossRefPubMedPubMedCentralGoogle Scholar
- Hembree-Kigin, T. L, McNeil, C. (1995). Parent–Child Interaction Therapy. New York: Pienum Press.Google Scholar
- Lanier, P., Kohl, P. L., Benz, J., Swinger, D., Moussette, P., & Drake, B. (2011). Parent–child interaction therapy in a community setting: Examining outcomes, attrition, and treatment setting. Research on Social Work Practice, 1(6), 689–698. https://doi.org/10.1177/1049731511406551.CrossRefPubMedPubMedCentralGoogle Scholar
- Leijten, P., Raaijmakers, M. A., de Castro, B. O., & Matthys, W. (2013). Does socioeconomic status matter? A meta-analysis on parent training effectiveness for disruptive child behavior. Journal of Clinical Child and Adolescent Psychology, 42(3), 384–392. https://doi.org/10.1080/15374416.2013.769169.CrossRefPubMedGoogle Scholar
- Niec, L. N., Barnett, M. L., Prewett, M. S., & Shanley Chatham, J. R. (2016). Group parent–child interaction therapy: A randomized control trial for the treatment of conduct problems in young children. Journal of Consulting and Clinical Psychology, 84(8), 682–698. https://doi.org/10.1037/a0040218.CrossRefPubMedPubMedCentralGoogle Scholar
- Ofonedu, M. E., Belcher, H. M. E., Budhathoki, C., & Gross, D. A. (2017). Understanding barriers to initial treatment engagement among underserved families seeking mental health services. Journal of Child and Family Studies, 26(3), 863–876. https://doi.org/10.1007/s10826-016-0603-6.CrossRefPubMedGoogle Scholar
- Reyno, S. M., & McGrath, P. J. (2006). Predictors of parent training efficacy for child externalizing behavior problems—a meta-analytic review. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 47(1), 99–111. https://doi.org/10.1111/j.1469-7610.2005.01544.x.CrossRefPubMedGoogle Scholar
- Weisz, J. R., Krumholz, L. S., Santucci, L., Thomassin, K., & Ng, M. Y. (2015). Shrinking the gap between research and practice: Tailoring and testing youth psychotherapies in clinical care contexts. Annual Review of Clinical Psychology, 11, 139–163. https://doi.org/10.1146/annurev-clinpsy-032814-112820.CrossRefPubMedGoogle Scholar
- Wymbs, F. A., Cunningham, C. E., Chen, Y., Rimas, H. M., Deal, K., Waschbusch, D. A., & Pelham, Jr., W. E. (2016). Examining parents’ preferences for group and individual parent training for children with ADHD symptoms. Journal of Clinical Child and Adolescent Psychology, 45(5), 614–631. https://doi.org/10.1080/15374416.2015.1004678.CrossRefPubMedGoogle Scholar