Does Parent Training Format Affect Treatment Engagement? A Randomized Study of Families at Social Risk
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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.
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