Abstract
A social gradient has been found in both children's behavior problems and among the users of services that treat such problems. If low-resource families are simultaneously at higher risk of having a child with behavior problems and less inclined to use services to address such problems, healthcare inequality and social inequity could be exacerbated. I focus on social gradients in participant characteristics in two evidence-based parent training interventions that target children who display behavior problems: Parent Management Training—Oregon Model (PMTO) and Brief Parent Training. This study extends the literature on social gradients in participant characteristics by focusing on family social and economic resources independently and in an additive cumulative risk index. I investigated potential social gradients overall in a pooled sample and in separate analyses relating social gradients to more intensive treatment. The results revealed inverse social gradients among the intervention participants compared with the Norwegian general population of families with children; intervention participants had fewer social and economic resources. The inverse social gradient was partially replicated through analyses that focused on treatment intensity. Families with fewer resources were more likely to receive high-intensity treatment; however, these associations disappeared for families with >3 cumulative risks. These results indicate that these PMTO interventions do not exacerbate social inequality by serving a high-resource population.
Highlights
Mental health problems, and behavior problems such as inattentive behavior, conduct problems, oppositional problems, and antisocial behavior, affect both children’s emotional states and social relationships at present and their life chances; (Cuellar, 2015; Patterson, Forgatch, & DeGarmo, 2010)
Results revealed that the Brief Parent Training (BPT) had direct effects on improving parent wellbeing compared to the families receiving regular care, whereas families receiving Parent Management Training – Oregon model (PMTO) did not experience significant changes on parent wellbeing compared to the regular care families
The results showed that the children in the PMTO group from families with one additional cumulative risk generally experienced more benefit from treatment; in T2, behavior problems were reduced by an average of 16% of a standard deviation for each accumulated risk (ß = −0.16, p < 0.01; results were standardized on Y only)
Summary
Behavior problems such as inattentive behavior, conduct problems, oppositional problems, and antisocial behavior, affect both children’s emotional states and social relationships at present and their life chances; (Cuellar, 2015; Patterson, Forgatch, & DeGarmo, 2010). In caring for behavior problems, social gradient approaches have commonly focused on family resources in the form of socioeconomic status (SES), typically assessed in terms of parental income and education level (Leijten et al 2013). SES has been proposed as a “fundamental cause” of health inequality, structuring (un-) favorable mechanisms across contexts and diseases (Link and Phelan 1995; Muntaner et al 2013) This implies that high SES families enjoy a vast number of flexible assets that they can use to their advantage to implement protective strategies and produce favorable treatment outcomes
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