lim by wuyunyi


									                         A One-Session Intervention for Parents
                                of Young Adolescents:
                                      Videotape Modeling and Motivational
                                               Group Discussion

                              MAY LIM, ELIZABETH A. STORMSHAK, AND THOMAS J. DISHION

        arent training groups frequently show low attendance rates and are        time and peer clustering (Dishion, Nelson, & Bullock, in press;
        often costly to administer. Accordingly, there is an urgent need to de-   Oetting & Beauvais, 1987).
        velop and evaluate brief, effective interventions that can be delivered         The intervention of choice for addressing adolescent prob-
in a timely and cost-effective manner. Using two therapeutic components that      lem behavior is one that motivates and supports family man-
have demonstrated efficacy,the following study attempted to demonstrate the       agement skills. A plethora of research programs have shown
effectiveness of a brief, 2-hour parenting program. Eighty-one families were      positive effects of family-centered interventions during early
randomly assigned to the control or videotape modeling and group discus-          and late adolescence in the reduction of problem behavior
sion (VMG) condition. Self-reports and observer ratings reflected a trend         and the enhancement of parenting skills (Adams, 2001; Capaldi
toward greater parental involvement among parents in the VMG condition            & Patterson, 1991; Dishion & Kavanagh, 2003; Henggeler,
compared to parents in the control group.Findings from this study are promis-     Schoenwald, Borduin, Rowland, & Cunningham, 1998; Kacir
ing and show that even a brief, 2-hour intervention can be effective at moti-     & Gordon, 1999; Patterson, Dishion, & Chamberlain, 1993;
vating parents to change behavior.                                                Schmidt, Liddle, & Dakof, 1996; Sloane, Endo, Hawkes, & Jen-
                                                                                  son, 1990; Spoth, Redmond, & Shin, 2001; Szapocznik et al.,
                                                                                  1991; Webster-Stratton, 1991).
Parenting during the teenage years can be a challenging enter-                          Despite this strong evidence in support of family-centered
prise. Parents and their adolescents may experience conflicts re-                 intervention programs, there are several barriers to including
lated to schoolwork, drugs, alcohol, time spent with friends,                     these strategies within the general armamentarium of a com-
and household responsibilities (Foster & Robin, 1998). Non-                       prehensive prevention model (see Spoth, Kavanagh, & Dishion,
compliance with parental discipline and conflict in the parent–                   2002). First, parent groups frequently show low attendance
adolescent relationship are among the most commonly seen                          rates. For example, in one 8-week parenting group, only 35%
problems in family guidance clinics (Kazdin, 1987). Family                        of the parents attended more than one parenting group session
management difficulties, such as low levels of monitoring, in-                    (Goodman, 2002). Community-based parenting interventions
consistent parenting, and poor problem-solving skills, have                       also reflect low participant retention rates (Katz et al., 2001;
been associated with a variety of negative adolescent outcomes                    Powell, 1984). The reasons for low rates of attendance may in-
(Baumrind, 1985; Patterson & Stouthamer-Loeber, 1984; Pet-                        clude busy work schedules, extracurricular activity schedules
tit, Bates, & Dodge, 1993; Webster-Stratton, 1990). Of most                       for youth, and the changing constitution of the American fam-
relevance to prevention theory is that parents of youth with prob-                ily (e.g., more stepparents).
lem behavior tend to give up during the transition to adoles-                           Relatedly, traditional parent training intervention pro-
cence, potentiating risk by means of increasing unsupervised                      grams are often costly and time-consuming to implement, par-

194     JOURNAL       OF   EMOTIONAL         AND    B E H AV I O R A L   DISORDERS,   WINTER   2005,   VOL.   13,   NO.   4,   PAG E S   194–199
ticularly given the low attendance rates. Low attendance rates,          this family were excluded and only data from the remaining 80
in turn, are related to the issue of motivation (Patterson & Cham-       families were included in the final analyses. A majority of the
berlain, 1994). Even when parents attend sessions, subtle vari-          families (68%) were from European American two-parent
ations in message or in client–therapist dynamics can reduce             households. A smaller percentage of the sample (17%) were
motivation to change and thus reduce future attendance or                from nonwhite two-parent households. European American,
lengthen the number of sessions and intensiveness of the inter-          single-parent households made up the smallest percentage
ventions required to realize clinically significant change (Miller       (15%) of the sample. The ethnic distribution of the sample re-
& Rollnick, 2002). To increase parent motivation it is often help-       flects the demographics of the community, primarily European
ful to offer a menu of intervention services, providing variety          American with a small percentage of families of color. Each
in initial time commitment, delivery, and interactive format             family had at least one child entering the seventh grade; that
(Dishion & Kavanagh, 2003).                                              child was the focus of this intervention. Children ranged from
      Currently, there is a lack of brief interventions. Given this      12 to 13 years of age.
lack, as well as the demands challenging 21st-century families,
there is an urgent need to develop and evaluate effective, brief
interventions for families of adolescents that can be delivered
in a timely and cost-effective manner (e.g., Sanders, 1999;              The target population was parents who would like help in par-
Sanders & Turner, 2002). Such interventions may be particu-              enting their adolescents via a brief intervention. The participants
larly appropriate for contemporary families, who are balancing           were drawn from a larger pool of parents who participated in
multiple responsibilities, such as stepparenting, single parent-         The Next Generation Project, funded by the National Institute
ing, and career demands. A brief intervention that does not put          of Drug Abuse (DA 13,773). Participants in this project were
undue demands on parents’ busy schedules may be especially               sixth-grade students and their families from four public middle
appealing to those who would otherwise not consider family               schools in suburban Oregon. The Next Generation Project was
therapy. The concept of brief, time-limited therapy has also be-         a universal intervention program aimed at reducing problem be-
come increasingly popular in the general public. Consider the            havior and preventing drug use within a public school envi-
self-help books at the local bookstore that market quick, do-it-         ronment. This program used a family resource center and an
yourself strategies for feeling good, losing weight, overcoming          on-staff parent consultant to facilitate home–school communi-
depression, and also raising children during the turbulent ado-          cation, disseminate information encouraging positive family
lescent years. The current study tests the effectiveness of a brief      management, and provide parents information about resources
(2-hour) parenting intervention delivered to a community sam-            within the school.
ple. Given the brevity of the intervention, our intent was not to              As part of the Next Generation Project, all families were
completely reduce child behavior problems. Instead, we fo-               contacted by project staff. Postcards were mailed to families
cused on motivating families for future change and beginning             asking the following question: “Which of the following options
a process of enhancing the parent–child relationship. The aims           from our project would you consider being involved with? Op-
of this study include teaching parents effective skills that may         tion A: Attending an 8-week parenting group. Option B: Com-
be helpful in improving their relationships with their adoles-           ing in for a brief, 1-day parenting group and watching a short
cents and helping parents to recognize what family issues may            video focusing on parenting techniques. Or Option C: Reading
need further professional guidance.                                      some pamphlets on parenting issues.
      The study attempted to evaluate the short-term effects                   Parents who checked the second option were contacted
of a brief videotape modeling and group discussion (VMG)                 and invited to participate in this brief intervention project. There
parenting program. The intervention includes two components              was a 20% (86/438) response rate for this study. Families agree-
that have demonstrated efficacy: (a) videotape modeling and              ing to participate were randomly assigned to the VMG condition
(b) therapist-led discussion groups. The goal of this research           or the control condition. To ensure equity among participants in
was to determine whether a brief parenting intervention for par-         the control condition, they were also provided the option of re-
ents who self-identify as experiencing behavioral problems with          ceiving the VMG intervention 4 weeks later, when poststudy
their adolescents can (a) improve parent–adolescent interac-             data had been collected. All families were compensated $100
tions and (b) help parents learn new skills for the management           for their full participation in the assessments for this study.
of normative adolescent behavior problems.                                     Families in the control condition completed preinterven-
                                                                         tion questionnaires during their initial visit, returned 4 weeks
                                                                         later to engage in the problem-solving task, and completed
                           METHOD                                        postintervention questionnaires during this second visit.
Eighty-one families initially participated in this study, with 40
                                                                         Independent Variables
in the control group and 41 in the VMG condition. One family             The independent variable for this study was the group factor:
from the VMG condition withdrew from the study. Data from                the control condition or the VMG condition. In the VMG con-

                           JOURNAL     OF   EMOTIONAL     AND   B E H AV I O R A L   DISORDERS,   WINTER   2005,   VOL.   13,   NO.   4   195
dition, parents watched a brief video entitled Parenting in the         observable behavior in 15 sections of time throughout a video-
Teenage Years (Dishion, Kavanagh, & Christianson, 1995). This           taped parent–adolescent interaction. Using video and computer
30-minute video models parents engaging in counterproductive            coding equipment, a coder independently watched the first
and constructive parental reactions to typical adolescent situa-        15-second section of an interaction. During these 15 seconds,
tions such as using drugs, spending too much time with friends,         observers coded the frequency of positive family interactions
completing schoolwork, and having unsupervised time. With               (e.g., parent or adolescent said, “I love you,” “You’re doing a
the aid of a trained therapist, parents discussed among them-           great job”; or gave each other hugs, high fives, or pats on the
selves their impressions of the video, exchanged different par-         back) and negative family interactions (e.g., parent or adoles-
enting techniques that had worked for them in the past, learned         cent said, “I hate you,” “You’re stupid”; or engaged in light
parenting skills that might help them manage adolescent-related         pinching or hitting). In an effort to reduce observer exposure
behavior problems, and received a take-home manual summa-               and bias to data, coders were allowed to view each family in a
rizing the information discussed that day. The intervention took        project only once during their service as an observer. Coding
about 2 hours to implement                                              reliability was assessed by sampling 20% of the family video
                                                                        observations and correlating five independent observer ratings.
                                                                        From this sample, correlations among the five independent
Dependent Variables
                                                                        coders ranged from r = .78 to r = .85, indicating satisfactory
This study examined the intervention effects on observed                agreement among observers. Cronbach alphas were also com-
parent–adolescent interactions and self-reported parent man-            puted based on the items associated with each construct. Cron-
agement skills. This study focused on four variables: parental          bach alphas were .81 and .88 for the positive family interaction
involvement (self-report), parent motivation to change (self-           and negative family interaction variables, respectively.
report), positive family interactions (observed), and negative
family interactions (observed).
      Self-Report Measures. Parents answered questions on
the Parent Self-Check Questionnaire (PARQ), a 64-item mea-              Pretest Comparisons
sure with demonstrated reliability (Dishion & Stormshak,                Separate two-way contingency table analyses were conducted
2001). PARQ items ask respondents about their current parent-           to check for possible group differences on the following demo-
ing strategies and level of parental involvement.                       graphic variables: household type and ethnicity. For the first
      Five items from the PARQ were used to construct the               analysis, the two variables were group membership, with two
parental involvement variable. Coefficient alphas were com-             levels (experimental and control), and household type, with
puted to obtain internal consistency estimates of reliability for       three levels (single-parent home, two-parent home, and shared
this construct. With an internal consistency of .71 (Cronbach’s         custody). For the second analysis, the two variables were group
alpha), this scale consisted of five items assessing how fre-           membership, with two levels (experimental and control), and
quently parents used various parenting management strategies            ethnicity, with six levels (European American, African Ameri-
in the past 3 weeks. On a 5-point Likert scale (0 = never, 1 =          can, Native American, Asian American, Hispanic American,
sometimes, 2 = about half the time, 3 = often, 4 = always), par-        and Other). No significant differences for the above demo-
ents rated the frequency with which they try to build a positive        graphic variables were found (p > .05). In general, results sug-
relationship with their adolescent, actively negotiate conflict,        gest that groups were equivalent at the beginning of the study.
set limits on drugs and alcohol, and engage in other specific
family management strategies.
      Parents also reported whether they had recently made              Statistical Significance of Treatment Effects
changes in their parenting strategies (0 = I haven’t thought            To test the effects of this intervention, a mixed model repeated
about it, 1 = I’m considering making changes, 2 = I recently            measures analysis of covariance (ANCOVA) was conducted for
made positive changes, 3 = I’m actively involved in improving           the self-report variable parental involvement. Because pretest
my parenting, 4 = I have made major changes in my parenting             scores for the family interaction variables were not collected,
that seem to make a difference in my family). This item was used        separate one-way ANCOVAs were conducted for the remain-
to create a measured variable labeled “parent motivation to             ing observed variables, positive family interactions and nega-
change.”                                                                tive family interactions. The covariate used for these analyses
                                                                        was the variable parent motivation to change. We hypothesized
      Observational Data. Observational data of parent–                 that parent reports of their motivation to change their parenting
adolescent interactions as they engaged in a problem-solving            at pretest would also covary with parental involvement and ob-
task were used to construct the remaining two dependent vari-           served family interactions.
ables, positive family interactions and negative family interac-
tions. We used the Relationship Process Code (Dishion, Rivera,               Parental Involvement. A mixed model repeated mea-
Jones, Verberkmoes, & Jabson, 2002) to code the frequency of            sures ANCOVA was conducted to evaluate the effect of group

196    JOURNAL    OF   EMOTIONAL     AND   B E H AV I O R A L   DISORDERS,   WINTER   2005,   VOL.   13,   NO.   4
and time on the dependent variable parental involvement. The                                  16.2
between-subjects factor was condition, with two levels (control                               16.0

                                                                         Mean Parental Involvement
and VMG), and the within-subject factor was time, with two                                    15.8
levels (pretest and posttest). The group main effect was mar-
ginally significant, F(1, 39) = 3.31, p = .07, partial 2 = .041.
The univariate tests associated with the time main effect and
condition × time main effect were nonsignificant.                                             15.2
      Paired-samples t tests were conducted to assess for differ-                             15.0
ences between condition at each time period, controlling for                                  14.8
familywise error rate using Holm’s sequential Bonferroni ap-                                                                                              Pretest
proach. At Time 1, the two groups were not significantly dif-
                                                                                              14.4                                                        Posttest
ferent from each other. As indicated in Table 1, at posttest the
groups were marginally significantly different from each other,
t(39) = −1.88, p = .067. Figure 1 also shows the mean parental
involvement scores by group at pretest and posttest. These re-           FIGURE 1. Mean parental involvement by group at
sults suggest that parents in the VMG condition may have in-             pretest and posttest. VMG = videotape modeling and
creased their level of parental involvement after participating in       group discussion.
the treatment condition.

     Positive Family Interactions. A one-way ANCOVA was                  positive physical behaviors toward their adolescents, and ex-
conducted to determine the effect of group membership on the             press more directive requests with rewarding consequences at
posttest means for the positive family interactions variable. As         the 4-week follow-up meeting than parents in the control group.
indicated in Table 1, significant results were found for positive        Overall, outcomes associated with self-report and observational
family interactions, with parents in the VMG condition ex-               data reflect a trend toward the application of parenting skills
pressing more positive family interactions than parents in the           after attending this program.
control condition, F(1, 73) = 4.56, p = .036, partial 2 = .059.                Though it appears that parents did learn new, useful par-
                                                                         enting techniques and family interactions were moderately
      Negative Family Interactions. A one-way ANCOVA was                 improved, the results of this study were modest, with one sig-
conducted to determine the effect of group membership on                 nificant finding and one marginally significant finding. There
means for the negative family interactions variable. Significant         are several explanations for these results. First, a 2-hour parent
results were not found for negative family interactions.                 training intervention alone may not be enough to provide some
                                                                         families with the skills they need to resolve more serious prob-
                                                                         lems. More chaotic families may need additional training, sup-
                         DISCUSSION                                      port, and therapy. Second, parents in the VMG condition
Traditional parent training groups can be costly and time-               appeared to be relatively satisfied with their current parenting
consuming to implement. The purpose of this study was to de-             practices and did not report many serious adolescent behavioral
termine the efficacy of a brief parent training program using a          problems. For example, when instructed to list five specific
videotape modeling and group discussion paradigm. The pri-               problem behaviors, “fighting with siblings” was the most fre-
mary clinical goals of this study included improving parent–             quently cited problem behavior (53%), followed by “cleaning
adolescent interactions and teaching parents useful family               room” (40%) and “helping at home” (37%). Only a small per-
management skills to assist in parenting their adolescent.               centage of parents listed more serious behavior problems, such
      Parents in the treatment condition showed greater im-              as “disrespect” (22%) and “bad behavior or attitude” (11%).
provements on both self-report of parent involvement and ob-             None of the parents endorsed “talking back to parents” as a cur-
server ratings of positive family interactions than the control          rent problem behavior. It is likely that parents were seeking help
group. There was a trend toward greater parental involvement             for normative behavior problems and were generally satisfied
among parents who watched the parent training video and par-             with their current parenting strategies.
ticipated in the group discussion compared to parents in the con-              Interestingly, the effects of this intervention were primar-
trol group. Parents in the VMG condition were more likely to             ily related to changes in positive behavior rather than reduction
try to build positive relationships with their adolescents, discuss      in negative interactions. Perhaps negative interactions are asso-
problems openly with their adolescents, and use praise or                ciated with more severe behavioral problems and are less
otherwise reinforce good behavior they observed among their              amenable to change in the context of a brief intervention. The
adolescents. Additionally, observational video data reflected            results of this research suggest that brief interventions focused
significant group differences for positive family interactions.          on enhancing positive skills may be the most effective.
Parents in the VMG condition were observed to express more                     Results from this study have additional clinical appli-
positive verbal statements to their adolescents, display more            cations. Perhaps having parents watch a brief parenting video

                           JOURNAL     OF   EMOTIONAL     AND   B E H AV I O R A L                   DISORDERS,   WINTER   2005,   VOL.   13,   NO.   4     197
                                                    TABLE 1
    Means and Standard Deviations for Pretest and Posttest Scores on Self-Report and Observational Measures

                                                                                                Positive family                  Negative family
                                     Parental involvement                                        interactions                     interactions

                                 Pre                                   Post                             Post                             Post

Condition                 M              SD                     M              SD                M                SD              M               SD

VMG                     15.55            2.79               15.93**           2.44             2.480*             5.74           1.37             2.26
(n = 40)
Control                 14.83            3.38               14.55**           3.46             0.886*             0.928          1.85             1.63
(n = 40)

Note. VMG = videotape modeling and group discussion.
*p < .05. * *p < .10.

consisting of different scenarios modeling appropriate and in-                2001; Goodman, 2002; Kacir & Gordon, 1999; Kazdin, 1987;
appropriate parenting strategies prior to initiating family ther-             Webster-Stratton, 1991). In particular, this study demonstrated
apy could be useful as a screening procedure to help motivate                 that brief parenting interventions show promise in terms of
families in the process of therapy. A videotaped intake inter-                working with families. Given the changing constitution of the
vention such as this might assist parents in identifying goals for            modern American family, brief interventions may be a valuable
treatment. For some parents, watching such a video may help                   strategy within the context of an overall approach that addresses
them realize that they do need help addressing their adolescent’s             multiple levels of risk and the unique needs of families across
behavioral problems. As part of the intake procedure, watching                a variety of community contexts.
such a video could help parents with the decision-making
process of whether to seek professional consultation.                         About the Authors
       Limitations to this research include several potential threats         MAY LIM, MS, is a doctoral student at the University of Oregon. Her
to external and internal validity. For instance, participants were            clinical and research interests include the relationship between ac-
largely from European American, two-parent families living in                 culturation and mental health among immigrant adolescents and their
a midsized northwestern city. It may be that these families were              families. ELIZABETH A. STORMSHAK, PhD, is an associate pro-
not representative of most families who need help with parent                 fessor of counseling psychology at the University of Oregon. Her
management practices. These families may have had fewer life                  interests include family-centered interventions and prevention of sub-
stressors (e.g., divorce or financial problems) than the average              stance abuse. THOMAS J. DISHION, PhD, is a professor of clini-
non-European American family or one-parent household. In                      cal psychology at the University of Oregon. His interests include
general, it is also unclear whether other factors, such as family             prevention and intervention with adolescents and their families at risk
variables (i.e., family income, family dynamics) or involvement               of substance abuse. Address: Mary Lim, Child and Family Center, 195
                                                                              West 12th Ave., Eugene, OR 97401.
in the larger NIDA-funded study may have influenced the fam-
ilies to engage in parenting changes and increase their level of
involvement. These factors are unaccounted for and study find-                Authors’ Notes
ings, though promising, may be spurious. Additionally, the                    1. This project was supported by a grant from the National Institute
covariate used in the analyses was a single-item construct. Con-                 of Drug Abuse (DA 13773) to Thomas J. Dishion and Elizabeth A.
sequently, the reliability of this variable may be tenuous. Lastly,              Stormshak.
only short-term effects were captured. It is unclear if the effects           2. We thank staff at the Child and Family Center for their help in the
of this brief intervention are stable over time. Replicating this                research for this study, in particular Barbara Berry, Jennifer Jabson,
study with more diverse families (e.g., nonwhite families or sin-                Trina McCartney, and Peggy Veltman for their helpful suggestions
                                                                                 and contributions.
gle-parent households) and obtaining extended follow-up data
may improve the study’s generalizability and external validity.
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