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MEASURING THE IMPACT OF PARENTAL PARTICIPATION IN TREATMENT ON THE BEHAVIOR OF CHILDREN

Purpose

A prior outcome study determined that the Friday Seminar Series presented to parents whose children are enrolled at Devereux Glenholme resulted in changes in the parents behaviors. The Friday Seminar Series is a training series which utilizes the New Directions curriculum and other behavioral training.  Last year’s results indicated that parents who attended the Friday Seminar Series were more likely to utilize the behavioral techniques that are trained.

The current study seeks to expand on these results by determining whether these changes in parental behaviors are associated with a corresponding change in the behavior of the children.  Specifically, the current study will attempt to replicate the results of last year’s study while also measuring the rate of progress in the children.  Analyses will be conducted to determine whether the rate of improvement in children whose parents attend seminars is different from those whose parents do not attend. 

Methods

Participants
Participants were parents and their children who are residential students at Devereux Glenholme.  All parents are invited to participate in the “Friday Seminar Series” and “Parent Day” events where seminars are offered.  Parents were divided into two groups, those who attend the Friday Seminar Series, and those who do not participate.  A minimum threshold of 30% attendance was determined for including parents in the group of parents who attend.

Variables
1. Evaluation Tool: Clinicians rated parents on their use of the behavioral techniques taught in seminars.  The tool measured:

  1. Appropriate use of Parent Point Program
  2. Appropriate use of Ignoring
  3. Appropriate use of Positive Reinforcement
  4. Appropriate use of Predirection
  5. Appropriate use of the Time-out Technique
  6. Appropriate use of Reinforcement for No Time-outs
  7. Following recommendations of Glenholme Clinical Team

Ratings were made on a six point likert scale ranging from 0, indicating never to 5, indicating always.

2. Behavior Frequency Ratings: Staff rated the children’s disruptive behaviors on a 5 point likert scale.  The data is taken from ratings conducted at the start of the study and again one year later.

3. Parent Attendance: Parent attendance was tracked for participation in:

  1. Friday Seminars
  2. Parent Days
  3. Family therapy sessions
  4. On-campus events

Results

Data were analyzed using independent sample t-tests comparing the ratings of parents who attended the Friday Seminar Series to those who had not on each of the seven target behaviors in order to replicate the findings of last year’s study.  Replication did occur, as significant findings were found on almost all analyses.  Parents who attended the Friday Seminar Series were once again rated significantly higher on nearly all behaviors than those who did not.  Specifically, attendees were found to use the Parent Point Program (t(54)=3.25, p<.01), Positive Reinforcement (t(56)=3.84, p<.01), Predirection (t(56)=2.755, p<.01), and Time-out (t(48)=2.64, p<.05) techniques more frequently than non attendees according to clinician’s ratings. No difference was found for Reinforcement for no Time-out, while a trend was found for Ignoring (t(56)=1.74, p=.08).  Attendees were also more likely to follow the recommendations of the clinical team (t(56)=2.91, p<.01) than non-attendees indicating that attendees might be generally more receptive to treatment or change, or that participating in the seminars enhances the therapeutic relationship.

Correlations between the clinician’s ratings of parents’ use of each of the behavioral techniques and child’s behavior frequency ratings were conducted to determine whether parental behavior was associated with improvement in children’s behavior.  Significant results were obtained for all correlations.  Specifically parents utilization of the Parent Point Program (r=.42, p<.01), Ignoring (r=.27, p<.05), Positive Reinforcement (r=.45, p<.01), Predirection (r=.40, p<.01), Time-out Technique (r=.39, p<.01), Reinforcement for no Time-out, (r=.36, p<.05) and Following Clinical Team Recommendations (r=.36, p<.01) were all positively correlated with children’s improvement in disruptive behaviors.  T-tests revealed that children’s rates of improvement was better for those whose parents were rated by the clinicians as utilizing the behavioral techniques on a moderate to high frequency basis versus those who utilize them on a low frequency basis (t(51)=2.74, p<.01). Moreover, children whose parents attended Friday Seminars were more likely to have greater rates of improvement than those who did not (t(53)=3.262, p<.01).  See graph below for visual representation of this difference.

 

All parent variables were then entered in a stepwise regression to determine which predicted most strongly for children’s behavioral improvement.  According to the regression model, two variables were found to account for 58% of the variance in children’s behavioral improvement.  The first variable entered into the equation was parental use of Predirection which accounted for 40% of the variance.  The second variable, which accounted for a unique 18% of the variance after the first variable was entered, was frequency of attendance in learning opportunities, as measured by participation in Parent Day, Friday Seminars, and Family Therapy.  It is important to note, that no variables were included from the milieu therapy program, thus it is difficult to determine the relative weight of the parent behaviors in accounting for the improvement in children’s behavior.

Discussion

Devereux Glenholme has continued to place a heavy emphasis on parent education.  The Friday Seminar Series is a training series which utilizes a behavioral curriculum that is offered to parents on Friday afternoons before they pick up their child for a weekend visit.  The goal of the seminars is to provide the same training to parents that is provided to staff in order to increase the consistency between the treatment program and home so that treatment gains can be transferred to other settings outside the treatment program.  The current study sought to replicate last year’s study, as well as to investigate the effects that this training has had on the participants and their children.

The results of last year’s study were replicated, indicating that parental participation in learning opportunities, such as Devereux Glenholme’s Friday Seminar Series, and Parent Day events are having the intended effects.  Namely that parents who attend the educational seminars are more likely to apply the techniques that are trained, as measured by the ratings of the clinicians.

The current study also indicated that children of parents who attend the seminars and apply the behavioral techniques are more likely to have higher rates of improvement on their referral behaviors when compared to children whose parents have not been involved in the educational offerings. The results must be interpreted with some caution however, as there are obvious threats to the validity of the study which are difficult to avoid.  While the raters of the children’s behavior are blind to the parents’ participation (or lack thereof) in training opportunities, the raters of the parents’ behavior were not blind to this.

The findings are exciting, as they indicate that the seminars are having the intended effects, and that most importantly, they may be associated with the children’s improvement, which is the ultimate goal.  The implications for programming are that energy should continue to be invested to ensure parental involvement in treatment and parental utilization of the behavioral treatment techniques.  Steps have already been taken to improve the availability of the trainings through videotaping all seminars and providing these tapes to parents.  Continued and enhanced effort will be made to thank, support, and encourage parents for their involvement in treatment.