Evidence-based Parenting Interventions Research Articles

Implementing an Evidence-Based Intervention for Children in Europe: Evaluating the Full-Transfer Approach

This study evaluated the implementation outcomes of GenerationPMTO, an evidence-based parenting intervention for child and adolescent behavior problems, in three European countries. The implementation approach was full transfer, in which purveyors train a first generation (G1) of practitioners; adopting sites assume oversight, training, certification, and fidelity assessment for subsequent generations (Forgatch & DeGarmo, 2011; Forgatch & Gewirtz, 2017). Three hundred therapists participated in trainings in GenerationPMTO in Iceland, Denmark, and the Netherlands. Data are from the implementation’s initiation in each country through 2016, resulting in 6 generations in Iceland, 8 in Denmark, and 4 in the Netherlands. Therapist fidelity was measured at certification with an observation-based tool, the Fidelity of Implementation Rating System (Knutson, Forgatch, Rains, & Sigmarsdóttir, 2009). Candidates in all generations achieved fidelity scores at or above the required standard. Certification fidelity scores were evaluated for G1 candidates, who were trained by the purveyor, and subsequent generations trained by the adopting implementation site. In each country, certification fidelity scores declined for G2 candidates compared with G1 and recovered to G1 levels for subsequent generations, partially replicating findings from a previous Norwegian study (Forgatch & DeGarmo, 2011). Recovery to G1 levels of fidelity scores was obtained in Iceland and the Netherlands by G3; in Denmark, the recovery was obtained by G5. The mean percentage of certification in each country was more than 80%; approximately 70% of certified therapists remained active in 2017. Findings support full transfer as an effective implementation approach with long-term sustainability and fidelity.

Technology in Parenting Programs: A Systematic Review of Existing Interventions

Behavioral parent training is an evidence-based intervention that reduces child problem behavior. Unfortunately, there are notable disparities in access to and use of evidence-based parenting interventions, including BPT. One way to address the service gap is through technology-based parenting interventions. The purpose of this systematic review is to identify the populations targeted in technology-based parenting interventions, the effectiveness of these interventions, and areas and populations where future research is warranted. A search of three databases yielded 31 articles that met inclusion criteria. We included articles if they (a) were treatment outcome studies using web-based interventions or (b) discussed methodologies or models pertaining to web-based interventions, (c) specified demographic information such as race, ethnicity, and SES, and (d) were published in English or Spanish. We coded 25 treatment outcome studies and six feasibility studies. Technology-based parenting interventions have successfully improved parenting variables such as parent knowledge, behavior, and self-efficacy. Yet the vast majority of these interventions are validated with White American families and lack adaptations that may make them more accessible to underserved populations. As the burgeoning area of technology-based interventions continues to grow, researchers should consider underserved populations and appropriate cultural adaptations that could reduce mental health disparities and increase the scope of evidence-based interventions.

Parent perspectives of engagement in the strengthening families program: An evidence‐based intervention for families in child welfare and affected by parental substance use

AbstractDespite growing use of evidence‐based parenting interventions (EBPIs) in child welfare settings, few qualitative studies have obtained parents' direct views and feedback on these programs. Further, engagement in EBPIs continues to present challenges in a child welfare context, particularly for parents affected by substances. We sought to understand parents' experiences of the supports and barriers to engagement in an EBPI. Semistructured interviews were conducted with a purposive sample of 10 parents who were involved in child welfare and a family drug treatment court, affected by parental substance use, and had recently completed the Strengthening Families Program. Our results indicated that barriers and supports comprised individual, provider, and programmatic factors. A prevalent theme was providers' abilities to build supportive helping relationships and facilitate a dynamic group effectively. Also significant were pragmatic program features that directly assisted families' access and ongoing participation, such as transportation and scheduling.

Development of an Internet-Administered Cognitive Behavior Therapy Program (ENGAGE) for Parents of Children Previously Treated for Cancer: Participatory Action Research Approach.

BackgroundParenting a child through cancer is a distressing experience, and a subgroup of parents report negative long-term psychological consequences years after treatment completion. However, there is a lack of evidence-based psychological interventions for parents who experience distress in relation to a child’s cancer disease after end of treatment.ObjectiveOne aim of this study was to develop an internet-administered, cognitive behavior therapy–based, psychological, guided, self-help intervention (ENGAGE) for parents of children previously treated for cancer. Another aim was to identify acceptable procedures for future feasibility and efficacy studies testing and evaluating the intervention.MethodsParticipatory action research methodology was used. The study included face-to-face workshops and related Web-based exercises. A total of 6 parents (4 mothers, 2 fathers) of children previously treated for cancer were involved as parent research partners. Moreover, 2 clinical psychologists were involved as expert research partners. Research partners and research group members worked collaboratively throughout the study. Data were analyzed iteratively using written summaries of the workshops and Web-based exercises parallel to data collection.ResultsA 10-week, internet-administered, cognitive behavior therapy–based, psychological, guided, self-help intervention (ENGAGE) was developed in collaboration with parent research partners and expert research partners. The content of the intervention, mode and frequency of e-therapist support, and the individualized approach for feedback were modified based on the research partner input. Shared solutions were reached regarding the type and timing of support from an e-therapist (eg, initial video or telephone call, multiple methods of e-therapist contact), duration and timing of intervention (eg, 10 weeks, 30-min assessments), and the removal of unnecessary support functions (eg, removal of chat and forum functions). Preferences for study procedures in future studies testing and evaluating the intervention were discussed; consensus was not reached for all aspects.ConclusionsTo the best of our knowledge, this study is the first use of a participatory action research approach to develop a psychological intervention for parents of children previously treated for cancer and to identify acceptable study procedures. Involvement of parents with lived experience was vital in the development of a potentially relevant and acceptable intervention for this population.

Strengthening Families Program: An Evidence-Based Family Intervention for Parents of High-Risk Children and Adolescents

ABSTRACTThis article reviews the contents and research on the Strengthening Families Program (SFP), a family evidence-based seven- to 14-session intervention for drug prevention in high-risk children ages 0 to 17. Twelve Randomized Control Trials (RCTs) found significant improvements in youths' behavioral health, including 50% reductions in substance misuse, depression/anxiety, and child maltreatment. Culturally adapted SFP versions have improved family relations and the children's behavioral health in 36 countries. To reduce costs of SFP's family groups, a SFP Years DVD was developed and found effective in schools, health clinics, child welfare, and juvenile justice. Future directions include putting SFP on the Web and on smartphones.

Feasibility of Biological Sample Collection among a High-Risk Maternal Population for Child Maltreatment-Qualitative Pilot Findings

ABSTRACTLittle is known on the feasibility of biological sample collection among at-risk parents for child maltreatment participating in evidence-based parenting intervention studies evaluating behavioral outcomes. This study explored acceptability and feasibility of collecting biospecimen samples among 12 high-risk mothers. Data were taken from semi-structured baseline interviews among participants who provided salivary, hair and buccal swab samples for a pilot study examining biobehavioral stress responses to an evidence-based parenting program. Content analysis results suggest that while uncomfortable, biospecimen collection will not impede research participation. Providers should highlight connections between biology and behaviors to motivate parents and increase engagement in parenting programs.

Cognitive Development of Toddlers: Does Parental Stimulation Matter?

To examine the impact of quality of early stimulation on cognitive functioning of toddlers living in a developing country. The developmental functioning of 150 toddlers in the age range of 12-30 mo (53% boys; Mean = 1.76 y, SD = 0.48) was assessed by the mental developmental index of the Developmental Assessment Scale for Indian Infants (DASII). The StimQ questionnaire- toddler version was used to measure cognitive stimulation at home. The questionnaire consists of four subscales including availability of learning materials (ALM), reading activities (READ), parent involvement in developmental activities (PIDA), and parent verbal responsivity (PVR). Multivariate regression analysis was used to predict cognitive scores using demographic (age of child), socio-economic status (SES) (income, parental education), and home environment (subscale scores of StimQ) as independent variables. Mean Mental Development Index (MDI) score was 91.5 (SD = 13.41), nearly one-fifth (17.3%) of the toddlers had MDI scores less than 80 (cognitive delay). Children with cognitive delay, relative to typically developing (TD, MDI score ≥ 80) cohort of toddlers, had significantly lower scores on all the subscales of StimQ and the total StimQ score. Despite the overall paucity of learning materials available to toddlers, typical developing toddlers were significantly more likely to have access to symbolic toys (P = 0.004), art materials (P = 0.032), adaptive/fine motor toys (P = 0.018), and life size toys (P = 0.036). Multivariate regression analysis results indicated that controlling for confounding socio-economic status variables, higher parental involvement in developmental activities (PIDA score) and higher parental verbal responsivity (PVR score) emerged as significant predictors of higher MDI scores and explained 34% of variance in MDI scores (F = 23.66, P = 0.001). Disparities in child development emerge fairly early and these differences are not all linked to economic disparities. There is a need to develop evidence-based parenting interventions for primary prevention of developmental problems, especially in resource poor countries.

A Tailored Web-Based Intervention to Improve Parenting Risk and Protective Factors for Adolescent Depression and Anxiety Problems: Postintervention Findings From a Randomized Controlled Trial.

BackgroundDepression and anxiety disorders in young people are a global health concern. Parents have an important role in reducing the risk of these disorders, but cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking.ObjectiveThis study aimed to examine the postintervention effects of the Partners in Parenting (PiP) program on parenting risk and protective factors for adolescent depression and anxiety, and on adolescent depression and anxiety symptoms.MethodsA two-arm randomized controlled trial was conducted with 359 parent-adolescent dyads, recruited primarily through schools across Australia. Parents and adolescents were assessed at baseline and 3 months later (postintervention). Parents in the intervention condition received PiP, a tailored Web-based parenting intervention designed following Persuasive Systems Design (PSD) principles to target parenting factors associated with adolescents’ risk for depression and anxiety problems. PiP comprises a tailored feedback report highlighting each parent’s strengths and areas for improvement, followed by a set of interactive modules (up to nine) that is specifically recommended for the parent based on individually identified areas for improvement. Parents in the active-control condition received a standardized package of five Web-based factsheets about adolescent development and well-being. Parents in both conditions received a 5-min weekly call to encourage progress through their allocated program to completion. Both programs were delivered weekly via the trial website. The primary outcome measure at postintervention was parent-reported changes in parenting risk and protective factors, which were measured using the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS). Secondary outcome measures were the adolescent-report PRADAS, the parent- and child-report Short Mood and Feelings Questionnaire (depressive symptoms), and parent- and child-report Spence Children’s Anxiety Scale (anxiety symptoms).ResultsParents in the intervention condition completed a mean of 73.7% of their intended personalized PiP program. A total of 318 parents (88.6%, 318/359) and 308 adolescents (92.8%, 308/332) completed the postintervention assessment. Attrition was handled using mixed model of repeated measures analysis of variance. As hypothesized, we found a significant condition-by-time interaction on the PRADAS, with a medium effect size, Cohen d=0.57, 95% CI 0.34-0.79. No significant differences between conditions were found at postintervention on any of the secondary outcome measures, with adolescent depressive (parent-report only) and anxiety (both parent- and adolescent-report) symptoms decreasing significantly from baseline to postintervention in both conditions.ConclusionsThe fully automated PiP intervention showed promising short-term effects on parenting behaviors that are associated with adolescents’ risk for depression and anxiety. Long-term follow-up is required to ascertain whether these effects translate into reduced adolescent depression and anxiety problems. The intervention may be useful as a low-cost universal public health program to increase parenting practices believed to benefit adolescents’ mental health.Trial RegistrationAustralia New Zealand Clinical Trials Registry: ACTRN12615000328572; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx? id=368274 (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj)

Adapting a parenting intervention for parents aging out of the child welfare system: A systematic approach to expand the reach of an evidence-based intervention.

Parents aging out of the child welfare system face a constellation of unique risk factors that threaten the well-being of themselves and their children. Although parenting interventions are an important resource for providing much-needed services to parents aging out, there is currently a lack of evidence-based parenting interventions that address the unique needs of this population. The purpose of this project was to systematically adapt an evidence-based parenting intervention for parents aging out. An established adaptation framework was used to guide this process, and acceptability and feasibility outcomes were evaluated as part of a pilot study of the adapted intervention. Preliminary intervention adaptations included modifications to program delivery and program content. Study findings indicated a high level of parent satisfaction with the adapted intervention but challenges to feasibility because of inconsistent attendance and the substantial effort required for intervention delivery. This study constitutes a critical first step toward increasing the reach of evidence-based parenting interventions among parents aging out of the child welfare system and underscores the need for continued efforts to develop sustainable and effective parenting services for this at-risk population. (PsycINFO Database Record

A Randomized Micro-trial of a Loving-Kindness Meditation to Help Parents Respond to Difficult Child Behavior Vignettes

Loving-kindness meditations (LKM) have not been examined within a parenting context, which is surprising given that LKM helps to build social relationships and connectedness through promoting caring pro-social behavior. This study examined the effects of LKM in a parenting context, using a fifteen-minute audio-guided LKM. In a group-based design micro trial, a total of 61 parents (50 female, mean age = 38.41 years, SD = 6.11) were randomly assigned to receive a LKM or a matched control focused imagery (FI) exercise. Participants completed a series of measures that examined compassion, parenting and child behavior, and parent’s emotional, cognitive and behavioral responses to a set of six hypothetical vignettes describing difficult child behavior. We also assessed for parents’ acceptability towards LKM as a strategy. As predicted, parents who received LKM displayed higher levels of self-compassion and motivation to show themselves compassion compared to the control group; however not compassion towards others. Parents in the LKM compared to the FI group also had more positive (e.g., calm and sympathetic) and less negative emotional (e.g., frustration and anger) responses to the situations of childhood distress; however, parent’s cognitive and behavioral responses did not significantly change. Parent’s also found LKM to be highly acceptable, with 60% indicating they would complete it weekly. The present findings suggest that LKM might be a valuable component to include in evidence-based parenting interventions.

Partners in Parenting: A Multi-Level Web-Based Approach to Support Parents in Prevention and Early Intervention for Adolescent Depression and Anxiety.

Depression and anxiety disorders in young people are a global health concern. Various risk and protective factors for these disorders are potentially modifiable by parents, underscoring the important role parents play in reducing the risk and impact of these disorders in their adolescent children. However, cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. In this paper, we propose a multi-level public health approach involving a Web-based parenting intervention, Partners in Parenting (PIP). We describe the components of the Web-based intervention and how each component was developed. Development of the intervention was guided by principles of the persuasive systems design model to maximize parental engagement and adherence. A consumer-engagement approach was used, including consultation with parents and adolescents about the content and presentation of the intervention. The PIP intervention can be used at varying levels of intensity to tailor to the different needs of parents across the population. Challenges and opportunities for the use of the intervention are discussed. The PIP Web-based intervention was developed to address the dearth of evidence-based resources to support parents in their important role in their adolescents’ mental health. The proposed public health approach utilizes this intervention at varying levels of intensity based on parents’ needs. Evaluation of each separate level of the model is ongoing. Further evaluation of the whole approach is required to assess the utility of the intervention as a public health approach, as well as its broader effects on adolescent functioning and socioeconomic outcomes.

Predicting post-training implementation of a parenting intervention

Purpose While evidence-based parenting interventions (EBPIs) are proven effective at addressing numerous emotional and behavioral health challenges for children and youth, and reduce rates of child maltreatment, they are often not well implemented in the real-world settings. Even with the state-of-the art training, many practitioners do not deliver the intervention, or do so at a reduced capacity. The purpose of this paper is to examine system-contextual implementation factors that predict timely initiation of use of an EBPI (i.e. within the first six months following training). A secondary purpose is to document additional impacts of training. Design/methodology/approach Repeated measures were used to collect predictors and the dependent variable. The relationship between participant characteristics and use of the Triple P program was estimated using exact logistic regression. Findings The results from 37 practitioners across three communities indicated approximately 54 percent delivered the intervention with at least one family within the first six months following training. Practitioner self-efficacy immediately following training and general attitudes toward evidence-based practices were the most significant predictors of timely use of the model. The vast majority of practitioners, regardless of implementation status, generalized learning from the training to other aspects of their work. Originality/value Prospective examination of the predictive value of implementation factors helps to refine targeted approaches to support implementation.

Feasibility of Implementation of a Parenting Intervention with Karen Refugees Resettled from Burma.

Parents and children exposed to war and relocation have high rates of negative relational and mental health outcomes. This study tested the feasibility of implementing an adapted evidence-based parenting intervention for contexts of trauma and relocation stress. Eleven Karen refugee caregivers from Burma participated in the intervention. Participants and a focal child completed ethnographic interviews as well as structured assessments at baseline and follow-up. Caregivers reported changes in their teaching, directions, emotional regulation, discipline, and child compliance. Children reported changes in these areas and in positive parent involvement. Caregivers reported higher mental health distress immediately after the intervention, potentially due to increased awareness. Researchers made personalized referrals for counseling services as needed. Children reported a decrease in mental health symptoms.

Preventing enduring behavioural problems in young children through early psychological intervention (Healthy Start, Happy Start): study protocol for a randomized controlled trial

BackgroundBehavioural problems are common in early childhood, and can result in enduring costs to the individual and society, including an increased risk of mental and physical illness, criminality, educational failure and drug and alcohol misuse. Most previous research has examined the impact of interventions targeting older children when difficulties are more established and harder to change, and have rarely included fathers. We are conducting a trial of a psychological intervention delivered to families with very young children, engaging both parents where possible.MethodsThis study is a two-arm, parallel group, researcher-blind, randomized controlled trial, to test the clinical effectiveness and cost-effectiveness of a parenting intervention, Video Feedback Intervention to Promote Positive Parenting and Sensitive Discipline (VIPP-SD) for parents of young children (12–36 months) at risk of behavioural difficulties. VIPP-SD is an evidence-based parenting intervention developed at Leiden University in the Netherlands which uses a video-feedback approach to support parents, particularly by enhancing parental sensitivity and sensitive discipline in caring for children.The trial will involve 300 families, who will be randomly allocated into either an intervention group, who will receive the video-feedback intervention (n = 150), or a control group, who will receive treatment as usual (n = 150). The trial will evaluate whether VIPP-SD, compared to treatment as usual, leads to lower levels of behavioural problems in young children who are at high risk of developing these difficulties. Assessments will be conducted at baseline, and 5 and 24 months post-randomization. The primary outcome measure is a modified version of the Preschool Parental Account of Child Symptoms (Pre-PACS), a structured clinical interview of behavioural symptoms. Secondary outcomes include caregiver-reported behavioural difficulties, parenting behaviours, parental sensitivity, parental mood and anxiety and parental relationship adjustment. An economic evaluation will also be carried out to assess the cost-effectiveness of the intervention compared to treatment as usual.DiscussionIf shown to be effective, the intervention could be delivered widely to parents and caregivers of young children at risk of behavioural problems as part of community based services.Trial registrationISRCTN Registry: ISRCTN58327365. Registered 19 March 2015.

A Toddler Parenting Intervention in Primary Care for Caregivers With Depression Symptoms.

Caregiver depression impacts parenting behaviors and has deleterious effects on child behavior. Evidence-based interventions to address parenting have not been adapted for use with depressed caregivers in pediatric primary care settings. Our study examined the feasibility and explored outcomes of an evidence-based parenting program implemented in primary care and adapted for caregivers with depressive symptoms caring for toddlers. We conducted a randomized controlled trial with a wait-list control. Participants were caregivers who screened positive for depressive symptoms in pediatric settings with a toddler. Our study was implemented from July 2011 to June 2012. We adapted the Incredible Years Parents, Babies and Toddlers program with the addition of depression psychoeducation (12 weekly sessions), and assessed caregivers at baseline and immediately post-intervention. We assessed participation rates, depressive symptoms, parenting discipline practices, social support, and parenting stress. Our results revealed that 32 caregivers participating in the intervention group had significantly greater improvement in self-reported parenting discipline practices compared to the 29 wait-list control group caregivers. We found no differences between groups in depressive symptoms, social support, or parenting stress. Our study demonstrated that the average attendance was poor (mean attendance=3.7 sessions). We adapted an evidence-based parenting intervention for caregivers with depressive symptoms and toddlers in primary care; however, participation was challenging. Alternative intervention strategies are needed to reach and retain low-income caregivers with depression symptoms as they face multiple barriers to participation in groups within center-based services. Trial Registration Clinical Trials.gov identifier NCT01464619.

IMPLEMENTING AN ATTACHMENT-BASED PARENTING INTERVENTION WITHIN HOME-BASED EARLY HEAD START: HOME-VISITORS' PERCEPTIONS AND EXPERIENCES.

Implementation of evidence-based interventions in "real-world" settings is enhanced when front-line staff view the intervention as acceptable, appropriate, and feasible. This qualitative study addresses Early Head Start (EHS) home visitors' perceptions and experiences of an evidence-based parenting intervention, the Attachment and Biobehavioral Catch-up program (M. Dozier, O. Lindhiem, & J. Ackerman, 2005), when added to EHS services as usual within the context of a research-practice partnership. Thematic analysis of in-depth, qualitative interviews indicates that home visitors experienced the intervention as positive and helpful for EHS families. Some challenges included scheduling and uncertainty regarding the goals of the intervention. Concerns over participation in the research centered on information exchange, confidentiality, and time limitations.

Video-Based Approach to Engaging Parents into a Preventive Parenting Intervention for Divorcing Families: Results of a Randomized Controlled Trial.

The public health impact of evidence-based, preventive parenting interventions has been severely constrained by low rates of participation when interventions are delivered under natural conditions. It is critical that prevention scientists develop effective and feasible parent engagement methods. This study tested video-based methods for engaging parents into an evidence-based program for divorcing parents. Three alternative versions of a video were created to test the incremental effectiveness of different theory-based engagement strategies based on social influence and health behavior models. A randomized controlled trial was conducted to compare the three experimental videos versus two control conditions, an information-only brochure and an information-only video. Participants were attendees at brief, court-mandated parent information programs (PIPs) for divorcing or never married, litigating parents. Of the 1123 eligible parents, 61% were female and 13% were never married to the child's other parent. Randomization to one of five conditions was conducted at the PIP class level, blocking on facilitator. All participants completed a 15-item, empirically validated risk index and an invitation form. Results of regression analyses indicated that the most streamlined version, the core principles video, significantly increased parents' interest in participating in the parenting intervention, enrollment during a follow-up call, and initiation (i.e., attending at least one session) compared to one or the other control conditions. Findings suggest that videos based on social influence and health behavior theories could provide an effective and feasible method for increasing parent engagement, which would help maximize the public health benefits of evidence-based parenting interventions.

Engaging Parents in Preventive Interventions for Young Children: Working with Cultural Diversity Within Low-Income, Urban Neighborhoods.

A robust literature documents the impact of poverty on child development and lifelong health, well-being and productivity. Racial and ethnic minority children continue to bear the burden of poverty disproportionately. Evidence-based parenting interventions in early childhood have the potential to attenuate risk attributable to poverty and stress. To reduce racial, ethnic, and socioeconomic disparities in the USA, parenting interventions must be accessible, engaging, and effective for low-income families of color living in large urban centers. This paper describes the initial development of ParentCorps and ongoing improvements to realize that vision. Initial development focused on creating a parenting intervention that places culture at the center and effectively embedding it in schools. ParentCorps includes core components found in nearly all effective parenting interventions with a culturally informed approach to engaging families and supporting behavior change. As the intervention is implemented at scale in increasingly diverse communities, improvement efforts include augmenting professional development to increase racial consciousness among all staff (evaluators, coaches, and school-based facilitators) and applying an implementation science framework to study and more fully support schools' use of a package of engagement strategies.

Relationships in the early years

EIF gives advice on how to commission evidence-based parenting interventions in early years services

Examining the impact of differential cultural adaptation with Latina/o immigrants exposed to adapted parent training interventions.

There is a dearth of empirical studies aimed at examining the impact of differential cultural adaptation of evidence-based clinical and prevention interventions. This prevention study consisted of a randomized controlled trial aimed at comparing the impact of 2 differentially culturally adapted versions of the evidence-based parenting intervention known as Parent Management Training, the Oregon Model (PMTOR). The sample consisted of 103 Latina/o immigrant families (190 individual parents). Each family was allocated to 1 of 3 conditions: (a) a culturally adapted PMTO (CA), (b) culturally adapted and enhanced PMTO (CE), and (c) a wait-list control. Measurements were implemented at baseline (T1), treatment completion (T2) and 6-month follow up (T3). Multilevel growth modeling analyses indicated statistically significant improvements on parenting skills for fathers and mothers (main effect) at 6-month follow-up in both adapted interventions, when compared with the control condition. With regard to parent-reported child behaviors, child internalizing behaviors were significantly lower for both parents in the CE intervention (main effect), compared with control at 6-month follow-up. No main effect was found for child externalizing behaviors. However, a Parent × Condition effect was found indicating a significant reduction of child externalizing behaviors for CE fathers compared with CA and control fathers at posttest and 6-month follow-up. Present findings indicate the value of differential cultural adaptation research designs and the importance of examining effects for both mothers and fathers, particularly when culturally focused and gender variables are considered for intervention design and implementation. (PsycINFO Database Record