Children exhibiting conduct problems comprise the largest source of referrals to children's mental health services in this county. Significant research has been conducted in an attempt to identify specific risk factors that result in increased vulnerability of a child developing conduct problems. Knowledge of these factors increases our ability to identify young children who are at greater risk for developing conduct problems. The treatment for conduct problems that possesses the greatest amount of empirical support is behavioral parent training. Yet behavioral parent training fails to address behaviors and risk factors that are present during a child's early development. Preventative behavioral parent training is a very brief primary prevention strategy designed to prevent the development of chronic and age-inappropriate display of conduct problems. This project was an initial longitudinal assessment examining the merits of preventative behavioral parent training as a primary prevention strategy for young children at-risk of developing conduct problems. Results demonstrated that prevention participants were engaging in normative rates of noncompliance and tantruming at 6-month follow-up, whereas comparison children showed a general worsening in their disruptive behaviors over time.

Despite a well-documented need for parent training in the treatment and prevention of child behavior problems, as well as the well-documented benefit of including fathers in preventative and treatment interventions, surprisingly little clinical intervention research examines the role of fathers in such trainings. This research examined the role of father involvement in behavioral parent training by examining parent-related characteristics in relation to treatment outcomes for both mothers and fathers, examining differences between mothers and fathers, and examining the additive benefit of including fathers in treatment across two studies. Both studies utilized archival data obtained from a university- and community-based parent training program for families and service providers of children displaying challenging or disruptive behavior offered through a large south eastern university medical center. The first study examined associations and relationships among parenting knowledge, parenting stress, and treatment engagement in 39 fathers and 107 mothers. The second study examined the associations and relationships among child behavior problems, treatment engagement, and therapy attitudes in 43 fathers and 98 mothers. Surprising patterns of effects were found; overall, the pattern of results of both studies across multiple levels indicated that the treatment was effective and that the pre-post changes observed were robust to a number of covariates. These findings indicate that the observed treatment efficacy was not diminished when examining specific groups of participants. It is possible that specific strengths of the program discussed in detail such as the social support and problem-solving opportunities augmented treatment benefit for subgroups of participants and mitigated the impact of group differences. While differences between mothers and fathers are often portrayed as having dramatic impacts on treatment engagement and efficacy, these group differences may not be as straightforward as is commonly depicted in the literature. Treatments that identify the nature of differential patterns of benefit and address them through treatment design may be able to deliver efficacious treatment generalizable to multiple subgroups of parents. These findings may have important implications for improving treatment engagement and treatment efficacy in the future. Based on the synthesized findings of these two studies, recommendations for treatment development, clinical practice, and future research are discussed.

This study investigated outcomes of a parent training curriculum: Helping Our Toddlers Developing Our Children's Skills (HOT DOCS), using secondary analyses of existing data collected between May 2007 and March 2009. The evaluation studied the impact of specific components of the parent training program on both participants' knowledge and attitudes and their perceptions of target children's behavior. Caregivers (n = 334) of children between the ages of 18 months and 5.11 years of age who were participants in the parent training program were included in the study. Measures included a pre/post knowledge test, pre/post rating scales of child problem behavior, and a program evaluation survey. Results indicated significant increases in caregiver knowledge following participation in the program, but non-significant differences between groups of participants based on various demographic variables. Prior to participation in the program, caregivers' perceptions of the severity of child problem behaviors were significantly different from that of the normative population. Following participation in the program, results showed a significant decrease in caregiver perceptions of the severity of child problem behaviors, regardless of caregiver/target child demographic variables. Caregiver feedback indicated high levels of satisfaction with the program.

In this study, a concurrent randomized multiple baseline across three parent-child dyads single-case design was employed to evaluate the effects of a brief three-week parent training program, titled Practiced Routines. The Practiced Routines parent training program included positive behavior supports (PBS) and mindfulness strategies within the context of natural family routines. Three mothers and their children with autism spectrum disorder (ASD) participated. Visual analysis combined with a standardized mean difference analysis revealed mixed results with a medium effect found for increases in parent behavioral strategy use and small effects found for reductions in parent stress and child challenging behavior. All three mothers rated the social validity of the Practiced Routine program favorably. Implications for science and practice in educational and behavior health early intervention for families of children with ASD are discussed.

Child maltreatment affects 900 thousand children in the U.S. every year and impacts all areas of daily functioning. Behavioral parent training (BPT) programs have effectively taught parenting and demonstrated externally valid outcomes (i.e., lower recidivism rates). Skill maintenance assessments for BPTs have mixed results. The Behavior Management and Parenting Services (BMAPS) program has shown effective skill training for court-mandated families. This study assessed skill maintenance and performance factors that may have impaired parents using an ABAB single-case research design in Phase 1 & external validity with a survey in Phase 2. Results for Phase 1 found that most BMAPS parents acquired all parenting tools to criteria, dropped below criteria at the 3 month probe, then fully demonstrated their regained skills after a brief review. Psychological and classroom factors do not appear to have systematically influenced performance at any time, although homework completion was associated with better scores at the end of class. Phase 2 results found a 91% reunification rate and a 0% recidivism rate over 1-3 years. All limitations aside, it appears that the BMAPS program is able to effectively train skills to criteria and these skills can be sustained with a booster session. The vast majority of parents we contacted were reunified with their children and none were involved with additional charges of child maltreatment.

A two-part study explored the maintenance effect of Behavioral Parent Training (BPT) featuring multi-component treatments by examining one year follow-up data from a larger study. Participants were ten parents of children (ages 3-5) with developmental disabilities and severe problem behaviors. Parents were also identified as having high levels of pessimism. BPT featuring multi-component treatments was provided in two conditions: Positive Behavior Support (PBS) and Positive Family Intervention (PFI). PBS included a standardized protocol to teach parents how to conduct a functional assessment, develop and implement a multi-component treatment, which includes the following strategies: prevention, teaching replacement skills, and managing consequences. PFI embedded optimism training in the same protocol used in PBS. Optimism training included presenting parents with their negative self-talk and having them practice using more positive self-talk throughout all sessions. In the first study, improvements in child behavior were observed after treatment, which maintained one year later for both conditions. The second study further revealed that participants in the PBS condition frequently used passive strategies vs. participants in the PFI condition who frequently used proactive strategies during post and one year follow-up. The current study did not reveal a specific treatment component to be responsible for behavior change and maintenance, but provided some insight as to the type of prevention strategies pessimistic parents are likely to use depending on whether or not they received optimism training. Suggestions for future research in assessing the remaining treatment components are discussed.

Externalizing behavior problems such as noncompliance, tantrums, and aggression constitutes the most frequently cited reason for referral of young children to mental health clinics. The treatment for conduct problems (CP) that possesses the greatest amount of empirical support is referred to as behavioral parent training (BPT). Yet available data suggest that after accounting for treatment failures and dropouts, only about one third of children receiving BPT benefit significantly. More recently, there has been a shift towards the development of early intervention and prevention models for treating children at-risk for developing CP. While many of these programs have been shown to be effective, they fail to address shortcomings of BPT such as the length of treatment and the context of service delivery. Furthermore, the majority of these programs continue to be classified as selective or indicated prevention programs, thereby targeting children once they have already begun showing elevated levels of disruptive behaviors. More recently, a preventative and abbreviated version of BPT, called preventative behavioral parent training (PBPT), has been developed to address the limitations inherent in BPT. A recent evaluation of PBPT has demonstrated its utility in reducing rates of noncompliance and tantruming in children at-risk for developing CP. This study sought to add to previous findings regarding PBPT by evaluating its effectiveness when disseminated as a universal prevention program within a primary care setting. More specifically, this study aimed to evaluate whether PBPT could be utilized to support parents in learning effective strategies for managing their young child's typical misbehaviors, thereby preventing the development of clinical levels of CP and strengthening the practices of all parents. Results demonstrated that PBPT yielded positive outcomes in regards to both child and parent outcome variables. Furthermore, program evaluation data revealed that the PBPT program was socially acceptable and the strategies discussed were both feasible and effective. Taken together, the current study provides preliminary evidence of the positive proximal impact of the PBPT program. Potential clinical implications of these findings and future directions for research are discussed.

Parent’s ability to implement a skill like time out is considered to have generality when it lasts over time, it appears in environments in which it was not initially trained, and it is seen in use for child behaviors it was not initially trained for. A recent study suggested that parents have difficulty implementing time out in the home when they are supposed to (Jensen et al., 2016). The present study aimed to determine if there were difficulties in stimulus or setting generalization. Six parent participants completed pre and post training in-home naturalistic video observations, as well as a generalization probe role-play test following training. Results showed that parent’s accuracy and parent’s ability to implement when they should were two different skills. Parents scored high for accuracy of steps correct in both the post training in-home observations and the generalization probe role-plays. However, parent’s correct attempts out of the possible opportunities were only moderate in the post training generalization probes and poor in both the pre and post training in-home observations. How to implement time out was the only skill directly taught to parents and not when to implement time out. The authors suggest that knowing when to implement time out may be a generalization deficit and a recognition of opportunities in the home deficit. This version of time out training may benefit from additional training to foster generalization. Future research may benefit from systematically analyzing whether parents can recognize opportunities for time out in the home through other parent in-home videos and if they can, more emphasis on generalization of a skill to the parent’s home would be necessary in training.

Dissemination and Implementation (D&I) Science is an evolving field of models and methods aimed at closing the research-practice gap. This chapter provides an overview of D&I Science with particular emphasis on its relevance for academic and clinical medical family therapists (MedFTs) and/or graduate students in training. It begins with a discussion of the poor reach of evidence-based treatments, building a case for the evolution of D&I Science. Basic definitions of dissemination research and implementation research are provided, followed by a description of the characteristics of D&I Science. Two exemplary D&I models are described with examples that relate to MedFT. The chapter closes with a discussion about how the reader can learn more about this dynamic and growing field.

Parent training programs are widely used to remediate ineffective strategies being used by parents of children with maladaptive behaviors. While there are a multitude of parenting workshops available, it has been estimated that over half have no established effectiveness. The purpose of this study was to advance our knowledge regarding the effects of modeling and role-playing (in an experimentally controlled design), used to supplement the parent workshop called “Winning at Parenting” and enhance development of adaptive parenting skills of participants. This study trained parents in the behavioral techniques of clear communication, differential attention, and time-out procedures via modeling by the instructor, roleplaying with the parents, and instructor feedback to parents. A multiple-baseline design across four participants was used in an experimentally controlled manner to demonstrate the positive effect of modeling and role-playing on the development of these adaptive skills in a parent training program. Two research questions were analyzed. The first considered whether participants would increase their use of adaptive parenting strategies via modeling, role-playing and instructor feedback, within the multiple baseline design. The results clearly showed a mean increase in correct demonstration of each target behavior for each parent only after the treatment condition was introduced, indicating a significant treatment effect. Furthermore, because there was no overlap of data points from baseline to treatment, changes in level were evident, providing a strong case that behavior was changed due to treatment effects. Although trend of the behaviors in baseline varied, data points in the treatment phase for each target behavior for each parent made such a dramatic and immediate jump that they each were indicative of a treatment effect. These findings are consistent with previous research demonstrating that the use of modeling and roleplaying are superior to readings and lecture-style for parent training programs. The second question considered whether or not parent’s ratings of competence, depression, and life stress, as measured on the Parenting Stress Index (PSI), would change as a result of the intervention. Results showed no clear trends in data for the effects of treatment on the PSI scores.