IMPLEMENTATION OF PARENT MANAGEMENT TRAINING AT THE NATIONAL LEVEL: THE CASE OF NORWAY

This article describes early aspects of the nationwide implementation of an evidence‐based program (EBP) in Norway and the design for studying program fidelity over time. The EBP is the Parent Management Training, Oregon Model (PMTO). The project is a combination of a ‘top down’ initiative at the governmental and ministry level, and a ‘bottom up’ initiative from practitioners seeking effective interventions in the prevention and remediation of behavior problems in children and youth. The main components of the implementation strategy were to (a) establish a national implementation and research center; (b) provide for regional and local participation at county and municipal levels; (c) establish a comprehensive therapist recruitment, training, and maintenance program; (d) create a network for collaboration, supervision, and quality control; (e) conduct clinical outcome research; and (f) study the implementation process. Following the training of three successive generations of PMTO specialists, a study was designed to examine how individual, family, interventionist, organizational, and community characteristics influence program adoption and implementation, as well as how these factors impact upon how PMTO specialists provide the intervention to families with competent adherence to the model. Within the framework of the collaborative North American and Norwegian project, challenges and facilitators in the process of the continental crossing of the PMTO model are discussed.     

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 (6–9 months, 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.     

Exploring mental distress among immigrant mothers participating in parent training

This study of ethnic minority mothers assessed the intervention effects of Parent Management Training — Oregon Model (PMTO) on maternal mental distress. Ninety-six mothers from Somalia and Pakistan and their 3-year-old to 9-year-old children were randomized with respect to enrollment in PMTO or a wait-list condition. Immigrants living in European countries report having significantly more mental distress than natives. Surprisingly, the results in this current study showed that there were low levels of mental distress at enrollment in PMTO among the sample. An analysis of covariance showed that PMTO was not effective in alleviating maternal mental distress in this sample. Ethnicity, family size and the child's age served as moderators on the relationship between enrollment in PMTO or the wait-list condition and maternal mental distress outcomes. None of the subgroup analyses were in favor of the intervention. The results emphasize the importance of research on parent training with immigrant families.     

Fragile families in the American welfare state

The proportion of children born out of wedlock is now over 40%. At birth, about half of these parents are co-habiting. This paper examines data from the Fragile Families and Child Wellbeing study (N = 4271) to describe for the first time the role of welfare state benefits in the economic lives of married, cohabiting, and single parent families with young children. Surprisingly, total welfare state benefits received by the three family types are relatively similar. Nearly half of the full incomes of fragile families come from welfare state transfers. For single parent families the proportion is slightly more than two thirds. Though aggregate welfare state transfers are approximately equal across family type and thus change very little as marital status changes, these transfers and the taxes required to finance them cushion family status changes and substantially narrow the gap in full income between married and fragile families.     

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.     

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.     

Exploring the deployment and reintegration experiences of active duty military families with young children

Active duty military families are experiencing increased stress as service members deploy to and return from lengthy and repeated deployments to multiple war zones. These deployments have a cumulative impact on the behavioral health and well-being of not only the service member, but also the family, particularly in families with very young children (Lester et al., 2016). Emergent research concerning families with young suggests that greater attention to the military spouse is needed to ensure effective, supportive service provision for these families. The purpose of the present study is threefold: (1) to identify the challenges faced by families with young children during and after deployment, (2) to understand resource utilization by these families, and (3) to explore the strengths and strategies used during these experiences. Data were collected through semi-structured interviews with 19 active duty Marine Corps family members with young children (under 5 years old) and 10 key program providers on or near a large military base in the southeast region of the United States. Findings reveal significant social isolation, which is consistent with the literature, the need for formal and informal social supports as well as self-care for the at-home parent, challenges in co-parenting and utilizing known resources, and a range of strategies used to manage deployment and reintegration. Implications for practice are discussed.     

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.     

Same‐Sex Parent Families and Children's Academic Achievement

Children in traditional families (i.e., married, 2 biological parents) tend to do better than their peers in nontraditional families. An exception to this pattern appears to be children from same‐sex parent families. Children with lesbian mothers or gay fathers do not exhibit the poorer outcomes typically associated with nontraditional families. Studies of same‐sex parent families, however, have relied on a static conceptualization of the family and discounted the importance of the timing and number of family transitions for understanding children's outcomes. To examine whether same‐sex parent families represent an exception among nontraditional families, the author used data from the Early Childhood Longitudinal Study—Kindergarten cohort (N = 19,043) to create a dynamic indicator of children's family structure and tested its association with math assessment scores. The results indicated that children in same‐sex parent families scored lower than their peers in married, 2‐biological parent households, but the difference was nonsignificant net of family transitions.     

The Role of Behavioral Theory in Model Development Research with Single Parent Families

In this paper, the authors critically examine the plight of single parent families with young children. Next, they lay out in detail the contributions of the behavioral perspective to practice model development research with single-parent families of children under the age of 12. The authors discuss implications for future theory driven practice model development research with cultural specific single parent families. They believe that future model development research efforts with culturally diverse single parent families will aid in advancing the state of cultural competence research in social work while assisting single parents relieve suffering and enhance child and family well-being.     

Contributions of Family Leisure to Family Functioning Among Transracial Adoptive Families

ABSTRACT

The purpose of this study was to examine family leisure behavior among intact families with transracial adoptive children and make comparisons to a broad sample of families with only biological children. The sample consisted of 197 adoptive families. Data were analyzed from a parent, youth, and family perspective. The Family Leisure Activity Profile (FLAP) was used to determine family leisure involvement. FACES II was used to measure family functioning. Findings indicated that measures of family cohesion, family adaptability, and family functioning were higher among the adoptive family sample. Core, balance, and total family leisure involvement were also higher among the adoptive family sample. Multiple regression analyses indicated a positive relationship between family leisure and family functioning among this sample from the parent, youth, and family levels of measurement. Implications for practice and further research are discussed.     

Child Abuse on the Internet: Ending the Silence

The Melbourne Health (MH) Social Work Residential Care Team (RCT) was established in 2002 as a new and innovative approach to aged care. The service employs three full-time social workers and an Allied Health assistant with previous experience in aged care. The RCT works across the MH continuum of care with inpatients recommended for residential care. The service is predominantly patient- and family-focused, but is also consultative to meet the education needs of MH staff and the community. This paper discusses the MH Social Work Residential Care model, reviews data collected since RCT implementation and the benefits shown for patients, their families and interdisciplinary staff. This paper discusses pressures and factors that impinge on the ability to discharge patients to residential care and explores recommendations for ongoing clinical practice as well as recommendations that the RCT has submitted to management for further consideration.     

Reunification outcomes among Mexican immigrant families in the child welfare system

This study examined reunification outcomes among Mexican immigrant families involved in the child welfare system, and compared characteristics of Mexican-origin and non-immigrant children involved in the child welfare system. An exploratory retrospective longitudinal design using administrative data from two counties in Northern California was utilized. The quantitative sample (N = 2152) included children entering the foster care system for 8 or more days between January 1, 2001 and December 31, 2007 in the two participating counties. Child welfare administrative data (CWS/CMS) were merged with eligibility data (CalWIN) in order to obtain parent and child place of birth and citizenship status. Quantitative measures drawn from the merged CWS/CMS and CalWIN dataset included the following: demographic characteristics, immigrant characteristics, case characteristics and reunification outcomes. Results indicated that a significantly higher proportion of Mexican immigrant families (70.7%) were reunified than non-immigrant families (43.1%). Significant correlates of reunification among Mexican immigrant families included the following: mothers with authorized citizenship status (vs. unauthorized citizenship status), mothers whose primary language was Spanish (vs. English), and children with two or fewer placements (vs. three or more placements). Differences between Mexican-origin and non-immigrant children were that Mexican-origin children were older on average than non-immigrant children, and they were more likely to experience physical abuse, sexual abuse or emotional abuse; they were also more likely to be placed in foster care or a group home (vs. relative care). Implications for social work practice and policy are discussed.     

Examining risk,strengths, and functioning of foster families: Implications for strengths-based practice

ABSTRACT

Foster families provide safe and stable homes for children and youth who are removed from their homes due to maltreatment. Despite the stressors associated with bringing children in and out of a family’s home, many maintain healthy family functioning and continue fostering for many years serving an essential function in the child welfare system. This study sought to understand the factors that explained higher levels of family functioning within foster families. Collaborating with one statewide public child welfare agency, 681 licensed foster parents participated in an online survey that examined the association between family functioning with family strengths and risk factors. Findings from this study can inform strengths-based practice including training, assessment, and interventions for new and existing foster families to strengthen families and improve the well-being of children and youth in their care.     

THE EFFECTIVENESS OF FAMILY THERAPIES FOR SELECTED BEHAVIORAL DISORDERS OF CHILDHOOD

This article reviews the scientific evidence for the effectiveness of family-based aproaches in the treatment of selected childhood behavioral disorders. Although limitations certainly exist, family interventions have consitently improved child and, in some cases, parent functioning in families with children presenting with conduct disorder (CD) and autism. Parents and other family members also directly benefit from child-focused interventions, gaining in knowledge, child management skills, and attitudinal improvements. Longh-term follow-ups indicate that CD and autistic children achieved lasting gains. Similarly, the research on attention-deficit/hyperactivity disorder (ADHD) indicates that parent training improves child noncompliance and aggression yet does not consistently affect core symptoms of ADHD. There is no evidence that adding short-term family interventions improves ADHD child functioning beyond improvements from the use of psychostimulant medications. Some tentative support for family involvement in the treatment of childhood anxieties and fears is reviewed, but clear conclusions await future investigations. Finally, several methodological limitations and needed areas of research are discussed.     

The role of men in families: achieving gender equity and supporting children

Fathers and men in families are one of the most important resources for children's well-being. UNICEF, the Ford Foundation, Save the Children, other nongovernmental organizations, and resolutions from the 1994 International Conference on Population and Development have all recommended efforts to involve men in reproductive health programs. However, despite this interest and recommendations, social service and health programs, as well as development interventions, continue to target mothers and children, ignoring the major role of men in the lives of children and families. Most development interventions focusing upon family well-being have stressed the importance of the mother/child relationship, even in societies in which the father controls decisions about the household and family welfare. The author surveys program initiatives, conferences, research, and publications concerned with the role of men in the family.     

Integrating a family-centered approach into social work practice with families of children and adolescents with disabilities

This article identifies a family-centered practice construct for working with children and adolescents with disabilities and their families. The experiences of these families have shifted considerably over the past 30 years. A legislative and historical context provides the basis for an understanding of present policies and practices that influence current approaches to service delivery. Though family-centered practice is emphasized in various practice settings, there is still a need to integrate this philosophy into social work practice with children and adolescents with disabilities and their families. In order to enhance the ability of the social worker to integrate this construct into practice, a framework for exploring the experiences of children, adolescents and families is provided. This framework provides an overview of factors related to the individual child, the family and siblings for the social worker to consider when working with these families. The social worker's role as collaborator, advocate, team member and family resource is highlighted.     

Characteristics and factors impacting reunification outcomes among Vietnamese immigrant families in the child welfare system

Using a mixed methods approach, this study examined reunification processes and outcomes among Vietnamese immigrant families involved in the child welfare system. A quantitative design was used to describe characteristics and reunification outcomes of Vietnamese immigrant children and families who are involved in family reunification services. Qualitative methods were used to explore factors that may influence reunification outcomes among Vietnamese families.The quantitative portion of the study included an exploratory design using administrative data from one county in the Northern California. The quantitative sample (N = 32) included children entering the foster care system for 8 or more days between January 1, 2001 and December 31, 2007 from child welfare administrative data (CWS/CMS) which was merged with eligibility data (CalWIN) in order to obtain parent and child place of birth to determine country of origin. The qualitative study included an exploratory design using interview data from child welfare workers (N = 8) and Vietnamese immigrant parents who had successfully reunified (N = 7).Quantitative results indicated that the most common type of maltreatment leading to entry into care was caretaker absence or incapacity, an abuse category that is often used in cases of parental substance abuse. 53.8% of Vietnamese immigrant children in the quantitative sample reunified with their parents, which is close to the national rate of reunification. Qualitative findings pointed to the importance of the following factors within reunification: acculturation-related issues, parental substance abuse, child welfare worker cultural competency and issues related to service availability and effectiveness. Implications for social work practice and policy are discussed.     

Action-oriented evaluation of an in-home family therapy program for families at risk for foster care placement

The purpose of this study was to conduct an action-oriented evaluation of an in-home family therapy program serving families deemed at risk for the placement of children in foster care. In this study, feedback was solicited from both clients and therapists. Results indicate "duality" associated with several aspects of in-home family therapy, including the opportunity to observe families in their own homes versus the vulnerability some families feel when therapy is conducted in-home; therapists suggesting that sufficient training is required for in-home family therapy to be effective versus clients' opinions that therapists' lived experiences are more relevant; and the importance of the therapeutic alliance versus feelings of abandonment upon termination. Implications for researchers and practitioners are discussed.