Parent Management Training-Oregon Research Articles

Strengthening parenting among refugees in Europe (SPARE): initial feasibility in Iceland and Norway

Several European countries have offered refuge to families forced to flee their homes because of violence, war, and other disasters. Stressful factors associated with displacement and relocation place families at risk for disrupted effective child-rearing practices and associated growth in problems for parents and their children. The need to promote healthy adjustment and prevent and ameliorate problems for refugee families is vital. The present study describes SPARE (Strengthening Parenting Among Refugees in Europe), a trauma-informed adaptation of the evidence-based parenting program Generation Parent Management Training Oregon Model (GenerationPMTO). SPARE integrates core parenting components in GenerationPMTO with skills designed to address families’ trauma experiences. A collaborative team of GenerationPMTO experts in Iceland, Norway, Denmark, and the Netherlands have adapted this parent group intervention for Arabic-speaking (Middle Eastern) refugee families who have relocated in Europe. This report describes results from an acceptability and feasibility study based on the first two SPARE groups completed in Iceland and Norway. Overall, attendance was good, parents reported satisfaction with their experiences in the groups and said that the material addressed important family needs. Parents also indicated the need for more time to deepen their understanding, provide greater focus on age-specific needs, and in Norway in particular, more information about the child welfare system.

The Effectiveness of KEEP for Families of Children with Developmental Delays: Integrating FIND Video Coaching into Parent Management Training-Oregon Model: a Randomized Trial.

Children with developmental delays or disabilities (DD) are at risk for self-regulation difficulties and behaviour problems compared to typically developing children. Intervening early is crucial to prevent long-term adjustment challenges across home and school contexts. Parenting has been identified as a malleable target of intervention for improving children's adaptive functioning across behavioural, emotional and cognitive domains. Although parent management training (PMT) is an identified best-practice, key questions remain about the critical components of interventions and how novel approaches like video feedback may offer additional benefits. Using a pre-test-post-test one group and superiority design, we evaluated the efficacy of two models of the Keeping Parents Trained and Supported (KEEP) preschool program with parent-only components among 175 families with children diagnosed or at-risk for DD. KEEP-P included core PMT (Oregon Model) methods and KEEP-V integrated KEEP with Filming Interactions to Nurture Development video coaching methods for enhancing developmentally supportive interactions. Intervention outcomes on children's behaviour problems and executive functioning, parenting stress and parent-child relationship quality were compared between groups. Both groups demonstrated significant reductions over time in child behavioural problems, developmental problems and parenting stress. Significant improvements were observed in children's executive functioning, parents' sense of competence and mindfulness in parenting. Group differences were observed in parent's sense of competence, with individuals receiving KEEP-P displaying greater increases over time. Higher intervention dosage predicted a greater reduction in stressful child behaviours and greater improvements in children's inhibitory control.

Heterogeneity of Treatment Effects of PMTO in Foster Care: A Latent Profile Transition Analysis

Parent Management Training-Oregon (PMTO) model has demonstrated significantly improvements in parental functioning and child’s social skills and socio-emotional well-being among families whose children were placed in foster care. Yet, there is a dearth of studies examining for whom PMTO works the best. The aim of this study was to examine the potential familial typologies in relation to parental and children’s functioning and how these typologies change after participating in PMTO. The sample consisted of 918 children in foster care and their biological parents recruited in September 2012-2014 in a Midwestern state and randomized to in-home PMTO (n = 461) or services as usual (SAU) (n = 457). Latent profile transition analysis examines how participation in PMTO influences changes in children’s behavior and their biological parent’s functioning over time while placed in out-of-home care. PMTO families reporting high parental functioning and children’s social-emotional outcomes were more likely to move to a higher functioning class (OR = 0.22, p = 0.01) than SAU families all characteristics equal. Yet, when families experienced poor parental functioning of all four types, PMTO was not helpful in improving parent’s functioning and children’s problem behaviors (OR = 4.41, p = 0.01). This study provides empirical support for child welfare agencies to sustain the PMTO program to improve children’s emotional and behavioral health.

Parent Management Training Oregon Model and Family-Based Services as Usual for Behavioral Problems in Youth: A National Randomized Controlled Trial in Denmark.

This randomized control trial used intent-to-treat analyses to compare parent management training-Oregon model (PMTO) (N = 64) to family-based services as usual (SAU) (N = 62) in 3.5-13-year-old children and their families in Denmark. Outcomes were parent report of child internalizing and externalizing problems, parenting efficacy, parenting stress, parent sense of coherence, parent-report of life satisfaction, and parental depressive symptoms. Outcomes were measured at pretreatment, post-treatment, and 18-20months post-treatment. Results demonstrated that both PMTO and family-based SAU resulted in significant improvements in child externalizing and internalizing problems, parenting efficacy, as well as parent-reported stress and depressive symptoms, life satisfaction, and aspects of sense of cohesion. Effect sizes at post-treatment and follow-up were in the small to moderate range, consistent with prior PMTO evaluations. However, there were no significant differences between PMTO and family-based SAU. Further research on the process and content of family-based SAU is needed to determine how this approach overlaps with and is distinct from PMTO.

Randomized trial of PMTO in foster care: 12-month child well-being, parenting, and caregiver functioning outcomes

Evidence-supported parenting interventions (ESPIs) increasingly are used in child welfare to improve child well-being and parenting. However, little evidence exists on the effectiveness of ESPIs with biological families of children in foster care with serious behavioral health problems. To address this gap in the literature, we examined the outcomes of in-home Parent Management Training Oregon model (PMTO). PMTO was evaluated in a randomized trial in which 918 children were assigned to PMTO or services as usual with assessment at baseline, 6 months, and 12 months. Outcome domains included child social-emotional well-being, parenting, and caregiver functioning. Our results show PMTO demonstrated linear improvements in children's social-emotional functioning, problem behaviors, and social skills. Although results for parenting were inconclusive, two of four caregiver functioning outcomes (parent mental health and readiness for reunification) were significantly improved. Overall, these findings suggest PMTO and similar ESPIs may hold promise for promoting better outcomes for biological families of children in foster care with behavioral health problems.

Parenting intervention effects on reunification: A randomized trial of PMTO in foster care.

Evidence-supported parenting interventions (ESPIs) have expanded into child welfare because a growing research base has demonstrated positive results among children with serious emotional and behavioral problems. Despite a clear federal policy emphasis on reunification, few randomized trials have tested ESPIs with biological families of children in foster care; even fewer studies have investigated the distal outcomes of ESPIs. The aim of the current study was to examine the effects of Parent Management Training, Oregon (PMTO) model on reunification. Children in foster care with emotional and behavioral problems were randomized to in-home PMTO (n = 461) or services as usual (SAU) (n = 457). Cox regression models tested whether children in the PMTO group achieved higher rates of reunification. We applied life tables data for integrals calculations to estimate days saved in foster care. Analyses were conducted as intent-to-treat (ITT), and per protocol analysis (PPA). ITT results showed reunification rates were 6.9% higher for the PMTO group (62.7%) than the SAU group (55.8%) with 151 days saved per typical child. PPA indicated that intervention completion strengthened effects as PMTO completers' reunification rates (69.5%) were 13.7% higher than the SAU group (55.8%), and were 15.3% higher than non-completers (54.2%). Days saved were also greater for completers as compared to the SAU group (299 days) and non-completers (358 days). Overall, findings suggest that an in-home parenting intervention positively affected reunification as delivered to biological parents of children and youth in foster care with serious emotional and behavioral problems. Implications and future considerations for research are discussed.

Do Parent Preferences for Child Conduct Problem Interventions Impact Parenting Outcomes? A Pilot Study in Community Children's Mental Health Settings.

A pilot, doubly randomized preference trial was conducted to investigate the impact of providing parents preferences on parenting outcomes. Families with children having conduct problems were randomly assigned to a choice group in which they received their preferred treatment among the four intervention options or a no-choice group in which they were randomized assigned to one of the four options. Results of mixed-effects models showed that parents in the choice group who selected Parent Management Training-Oregon Model (PMTO) had better parenting outcomes over time compared to parents in the choice group who selected child therapy. It highlights the importance of incorporating parent preferences in the delivery of evidence-based treatments.

Does Giving Parents Their Choice of Interventions for Child Behavior Problems Improve Child Outcomes?

Empowering consumers to be active decision-makers in their own care is a core tenet of personalized, or precision medicine. Nonetheless, there is a dearth of research on intervention preferences in families seeking interventions for a child with behavior problems. Specifically, the evidence is inconclusive as to whether providing parents with choice of intervention improves child/youth outcomes (i.e., reduces externalizing problems). In this study, 129 families presenting to community mental health clinics for child conduct problems were enrolled in a doubly randomized preference study and initially randomized to choice or no-choice conditions. Families assigned to the choice condition were offered their choice of intervention from among three different formats of the Parent Management Training-Oregon Model/PMTO (group, individual clinic, home based) and services-as-usual (child-focused therapy). Those assigned to the no-choice condition were again randomized, to one of the four intervention conditions. Intent-to-treat analyses revealed partial support for the effect of parental choice on child intervention outcomes. Assignment to the choice condition predicted teacher-reported improved child hyperactivity/inattention outcomes at 6months post-treatment completion. No main effect of choice on parent reported child outcomes was found. Moderation analyses indicated that among parents who selected PMTO, teacher report of hyperactivity/inattention was significantly improved compared with parents selecting SAU, and compared with those assigned to PMTO within the no-choice condition. Contrary to hypotheses, teacher report of hyperactivity/inattention was also significantly improved for families assigned to SAU within the no-choice condition, indicating that within the no-choice condition, SAU outperformed the parenting interventions. Implications for prevention research are discussed.

PROTOCOL: Strategies for scaling up the implementation of interventions in social welfare: protocol for a systematic review.

PROTOCOL: Strategies for scaling up the implementation of interventions in social welfare: protocol for a systematic review.

Predictors of Consent in a Randomized Field Study in Child Welfare

ABSTRACTPurpose: Randomized controlled trials (RCTs) are often viewed as the “gold standard” for proving the efficacy and effectiveness of new interventions. However, some are skeptical of the generalizability of the findings that RCTs produce. The characteristics of those willing to participate in research studies have the potential to affect the generalizability of its findings. This study examined factors that could influence consent among families recruited to participate in a randomized field trial in a real-world child welfare setting. Methods: This study tested the Parent Management Training Oregon Model for children in foster care with serious emotional disturbance. It employed a post-randomization consent design, whereby the entire sample of eligible participants, not just those who are willing to consent to randomization, are included in the sample. Initial eligibility assessment data and data from the federally mandated reporting system for public child welfare agencies provided the pool of potential predictors of consent. Bivariate and multivariate analyses were conducted to identify statistically significant predictors of consent. Results: Being a dual reunification family was the most significant factor in predicting consent. Unmarried individuals, younger, female parents, cases where parental incarceration was the reason for removal and cases where the removal reason was not due to their children’s behavioral problem(s) were also more likely to participate. Discussion: As one of the first research studies to examine predictors of consent to a randomized field study in child welfare settings, results presented here can act as a preliminary guide for conducting RCTs in child welfare settings.

Randomized Study of PMTO in Foster Care

Objective: This study examined the effects of Parent Management Training, Oregon (PMTO) model on parenting effectiveness and caregiver functioning. Method: Children in foster care with emotional and behavioral problems were randomized to PMTO ( n = 461) or services as usual ( n = 457) in a nonblinded study design. Using an intent-to-treat approach, analysis of covariance models tested the intervention’s overall effect and time interactions for parenting and caregiver functioning. Additional analyses were conducted to identify significant predictors of outcomes. Results: PMTO did not significantly affect parenting practices; however, positive effects were observed on caregiver functioning in mental health (odds ratio [ OR] = 2.01), substance use ( OR = 1.67), social supports ( OR = 2.37), and readiness for reunification ( OR = 1.64). While no time interactions were detected, several child, parent, and case characteristics were associated with improvements in 6-month outcomes. Conclusion: This study extends evidence on PMTO to biological families of children in foster care, including those with older youth.

Changes in parenting practices during Parent Management Training Oregon model with parents of children in foster care

This study examined changes in parenting practices among parents receiving Parent Management Training Oregon model (PMTO). These parents had children in foster care with serious emotional disturbance and were randomized to receive in-home PMTO for up to six months. Using data from the Parent Child Checklist, an observation-based measure administered by therapists after each parent-child session, latent growth curve modeling was conducted with a sample of 318 parents of children, aged 3–16years old, in foster care. Results showed that overall parenting effectiveness improved and that the change trajectory was best fit by a cubic model (two changes in trajectory). Parenting effectiveness initially increased but was found to turn downward temporarily, then rebounded toward additional improvements. Similarly, three of the six subscales – skill encouragement, positive involvement, and communication/monitoring – demonstrated significant change and a cubic trajectory. In contrast, problem solving and effective discipline subscales showed significant improvement but the trajectory was best fit by a quadratic model, indicating that these parenting practices improved and then leveled off near the end of treatment. The ineffective discipline subscale did not demonstrate significant change. Additionally, parents with high initial scores experienced lower rates of improvement and higher rates of deceleration. However, parents who started with relatively high rates of change were better able to maintain improvements over time. Overall, the results suggested PMTO was associated with increased effective parenting but the trajectory for positive change included both gains and setbacks. Future research is needed to determine whether gains in parenting practices are sustained beyond the treatment period.

Neurobiological stress responses predict aggression in boys with oppositional defiant disorder/conduct disorder: a 1-year follow-up intervention study

To improve outcome for children with antisocial and aggressive behavior, it is important to know which individual characteristics contribute to reductions in problem behavior. The predictive value of a parent training (Parent Management Training Oregon; PMTO), parenting practices (monitoring, discipline, and punishment), and child neurobiological function (heart rate, cortisol) on the course of aggression was investigated. 64 boys with oppositional defiant disorder or conduct disorder (8–12 years) participated; parents of 22 boys took part in PMTO. All data were collected before the start of the PMTO, and aggression ratings were collected three times, before PMTO, and at 6 and 12 month follow-up. Parent training predicted a decline in aggression at 6 and 12 months. Child neurobiological variables, i.e., higher cortisol stress reactivity and better cortisol recovery, also predicted a decline in aggression at 6 and 12 months. Heart rate and parenting practices were not related to the course of aggression. These results indicate that child neurobiological factors can predict persistence or reduction of aggression in boys with ODD/CD, and have unique prognostic value on top of the parent training effects.

Effects of PMTO in Foster Families with Children with Behavior Problems: A Randomized Controlled Trial

The present randomized controlled trial examined the effectiveness of Parent Management Training Oregon for foster parents with foster children (aged 4–12) with severe externalizing behavior problems in long-term foster care arrangements. Foster children’s behavior problems are challenging for foster parents and increase the risk of placement breakdown. There is little evidence for the effectiveness of established interventions to improve child and parent functioning in foster families. The goal of Parent Management Training Oregon, a relatively long and intensive (6–9 months, with weekly sessions) parent management training, is to reduce children’s problem behavior through improvement of parenting practices. We specifically investigated whether Parent Management Training Oregon is effective to reduce foster parenting stress. A significant effect of Parent Management Training Oregon, compared to Care as Usual was expected on reduced parenting stress improved parenting practices, and on reduced child behavior problems. Multi-informant (foster mothers, foster fathers, and teachers) data were used from 86 foster families (46 Parent Management Training Oregon, 40 Care as Usual) using a pre-posttest design. Multilevel analyses based on the intention to treat principle (retention rate 73 %) showed that Parent Management Training Oregon, compared to Care as Usual, reduced general levels of parenting stress as well as child related stress and parent-related stress (small to medium effect sizes). The clinical significance of this effect was, however, limited. Compared to a decrease in the Care as Usual group, Parent Management Training Oregon helped foster mothers to maintain parental warmth (small effect size). There were no other effects of Parent Management Training Oregon on self-reported parenting behaviors. Child behavior problems were reduced in both conditions, indicating no additive effects of Parent Management Training Oregon to Care as Usual on child functioning. The potential implication of reduced foster parenting stress for placement stability is discussed.

Clinicians' Observations of Family Interactions in the Reunification Process: The Parent Child Checklist

The present article employed a sample of 365 families of children in foster care to conduct a validation test of a newly developed instrument, the Parent Child Checklist (PCC). The PCC is a 54-item direct observation measure assessing parent–child interactions in the context of a family session. The PCC was developed to support the effective implementation of an evidence-based intervention, Parent Management Training-Oregon model, in the Kansas child welfare system. The PCC was designed to capture two scales of child behavior (prosocial and problem behavior) and five parenting domains (encouragement, positive involvement, problem solving, communication skill, and effective discipline). A combination of exploratory and confirmatory factor analysis was used in this first stage validation of the checklist. Results indicated the PCC scales obtained adequate internal consistency and interrater reliability. The confirmatory factor analysis supported 6 of the 7 expected scale domains; however, a two-factor solution was better - supported among the discipline items, labeled as effective and ineffective discipline. Test–retest reliability ranged from 0.45 to 0.80 across child behavior and parenting domains with alpha levels ranging from 0.65 to 0.88. A behavioral observation rating scale for clinicians that is reliable and feasible to implement can represent a significant improvement to practice-as-usual.

Randomized Trial of PMTO in Foster Care: Six-Month Child Well-Being Outcomes

Objective: This study tested the effectiveness of Parent Management Training, Oregon (PMTO) model on child social–emotional well-being. Methods: Using a randomized controlled design and three measures of social–emotional well-being, the study investigated effectiveness of PMTO with families of children in foster care with serious emotional disturbance (SED). Participants included children (3–16 years) and parents who were randomly assigned to PMTO ( n = 461) or services as usual ( n = 457). Study condition was known to participants and assessors. Six months after baseline, analysis of covariance models examined the intervention’s overall effect and time interactions using intent-to-treat analysis. Follow-up analyses identified salient predictors of well-being. Results: PMTO demonstrated small but significant positive effects on three primary outcomes: social–emotional functioning (Cohen’s d = .31), problem behaviors (Cohen’s d = .09), and prosocial skills (Cohen’s d = .09). Conclusion: Results suggest that PMTO was effective at improving short-term social–emotional well-being in a high-risk population of children with SED.

Social gradients and participant characteristics in child behavior problem interventions

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.

Parent training in foster families with children with behavior problems: Follow-up results from a randomized controlled trial

The present randomized controlled trial examined the four months follow-up effectiveness of Parent Management Training Oregon (PMTO) for parents with foster children (aged 4–12) with severe externalizing behavior problems in long-term foster care arrangements. The aim of PMTO, a relative long and intensive (6–9months, with weekly sessions) parent management training is to reduce children's problem behavior through improvement of parenting practices. We specifically investigated whether PMTO is effective to reduce foster parenting stress. It was expected that PMTO would reduce parenting stress in foster parents, improve the quality of parenting practices, and reduce children's problem behavior. Multi-informant (foster mothers, foster fathers, and teachers) data were used from 86 families. Multilevel analyses based on the intention to treat principle (retention rate 73%) showed that PMTO, compared to care as usual, had no significant direct, nor indirect or sleeper effects at follow-up on parenting stress, parenting behavior and child behavior problems. Earlier reported immediate effects of PMTO on reduced parenting stress at posttest disappeared at follow-up. Additional analyses on the role of non-specific intervention factors in PMTO effects showed that higher therapist fidelity scores resulted in stronger effects of PMTO on parenting responsiveness, parental explaining and autonomy granting. Unexpectedly, higher fidelity scores also predicted less decrease of parenting stress at follow-up.

Practitioner views on the core functions of coaching in the implementation of an evidence-based intervention in child welfare

Despite coaching being identified as an important implementation strategy, scant information is available on the core functions of coaching, and few empirical studies are specific to coaching in the child welfare setting. This study explored practitioners' perceptions of the core functions of coaching by using semi-structured focus groups with coaches (n=13) and interviews with coachees (n=11) who were delivering Parent Management Training, Oregon (PMTO) model to families of children in foster care. Four themes were identified as the core functions of coaching: (1) supporting practitioners via strengths-oriented feedback; (2) promoting skill-building via collaboration and active learning strategies; (3) problem-solving for appropriate use and adaptation of the EBI with real-world cases, and (4) providing an accountability mechanism for high fidelity implementation. Collectively, this study's findings build knowledge on the core functions of coaching, which may be a critical strategy for integrating evidence-based interventions (EBI) into usual practice in child welfare settings. The findings suggest that this implementation strategy is more than a simple extension of training. Coaching was viewed as vital for supporting practitioners full adoption of the intervention in their day-to-day practice, fitting an EBI to the complex needs of child welfare families, and ensuring high-quality implementation. Also identified were some unique aspects of PMTO coaching, such as a strict strengths-orientation and observation-based feedback via mandatory video recordings of client sessions. Further research is needed to explore different coaching techniques, protocols, and formats to examine whether certain features promote a more effective path to implementation and, ultimately, client outcomes.

Resurrecting the chimera: Progressions in parenting and peer processes

This report uses 6-year outcomes of the Oregon Divorce Study to examine the processes by which parenting practices affect deviant peer association during two developmental stages: early to middle childhood and late childhood to early adolescence. The participants were 238 newly divorced mothers and their 5- to 8-year-old sons who were randomly assigned to Parent Management Training-Oregon Model (PMTO®) or to a no-treatment control group. Parenting practices, child delinquent behavior, and deviant peer association were repeatedly assessed from baseline to 6 years after baseline using multiple methods and informants. PMTO had a beneficial effect on parenting practices relative to the control group. Two stage models linking changes in parenting generated by PMTO to children's growth in deviant peer association were supported. During the early to middle childhood stage, the relationship of improved parenting practices on deviant peer association was moderated by family socioeconomic status (SES); effective parenting was particularly important in mitigating deviant peer association for lower SES families whose children experience higher densities of deviant peers in schools and neighborhoods. During late childhood and early adolescence, the relationship of improved parenting to youths' growth in deviant peer association was mediated by reductions in the growth of delinquency during childhood; higher levels of early delinquency are likely to promote deviant peer association through processes of selective affiliation and reciprocal deviancy training. The results are discussed in terms of multilevel developmental progressions of diminished parenting, child involvement in deviancy producing processes in peer groups, and increased variety and severity of antisocial behavior, all exacerbated by ecological risks associated with low family SES.