John Kjøbli

A randomized trial of group parent training: reducing child conduct problems in real-world settings.

OBJECTIVE Group-based Parent Management Training, the Oregon model (PMTO, 12 sessions) was delivered by the regular staff of municipal child and family services. PMTO is based on social interaction learning theory and promotes positive parenting skills in parents of children with conduct problems. This study examined the effectiveness of the group-based training intervention in real world settings both immediately following and six months after termination of the intervention. METHODS One hundred thirty-seven children (3-12 years) and their parents participated in this study. The families were randomly assigned to group-based training or a comparison group. Data were collected from parents and teachers. RESULTS The caregiver assessments of parenting practices and child conduct problems and caregiver and teacher reported social competence revealed immediate and significant intervention effects. Short- and long-term beneficial effects were reported from parents, although no follow-up effects were evident on teacher reports. CONCLUSIONS These effectiveness findings and the potential for increasing the number of families served to support the further dissemination and implementation of group-based parent training.

Measurement of implementation components ten years after a nationwide introduction of empirically supported programs – a pilot study

BackgroundTen years after the nationwide dissemination of two evidence-based treatment programs, the status of the implementation components was evaluated in a cross-sectional study. The aim of the study was to pilot a standardized measure of implementation components by examining the factor structure, the reliabilities of the scores, and their association with implementation outcome variables. The aim was also to compare implementation profiles of the two evidence-based programs based on multi informant assessments.MethodsThe 218 participants in the study were therapists, supervisors, and agency leaders working with Parent Management Training, the Oregon model (PMTO), and Multisystemic Therapy (MST) in Norway. Interviewers filled in an electronic version of the Implementation Components Questionnaire during a telephone interview.ResultsThe factor analysis of the eight one-dimensional subscales resulted in an individual clinical-level factor and an organizational system-level factor. Age, experience, and number of colleagues in the workplace were negatively correlated with positive ratings of the implementation process, but the number of colleagues working with the same program predicted positive ratings. MST and PMTO had different implementation profiles and therapists, supervisors, and managers evaluated some of the implementation drivers significantly differently.ConclusionsThe psychometric quality of the questionnaire was supported by measures of internal consistency, factor analyses of the implementation components, and the comparisons of implementation profiles between programs and respondent groups. A moderate, but consistent association in the expected direction was found with the implementation outcome variables.

A Randomized Effectiveness Trial of Brief Parent Training Six-Month Follow-Up

Objective: To examine the follow-up effectiveness of brief parent training (BPT) for children with emerging or existing conduct problems. Method: With the use of a randomized controlled trial and parent and teacher reports, this study examined the effectiveness of BPT compared to regular services 6 months after the end of the intervention. Participants included 216 children (3–12 years) and parents randomly assigned to BPT or a comparison group. Results: BPT had beneficial effects on caregiver assessments of parenting practices (i.e., positive parenting and harsh discipline) and child conduct problems in the families 6 months after the intervention. The effects of BPT in schools and day care centers were limited. Compared to posttest the effects sizes were smaller and number of significant effects lower. Conclusion: Although effects decreased over time, this study demonstrate that a short-term manual-based intervention (3–5 sessions) could be effective in reducing conduct problems 6 month after the intervention.

Early Initiatives for Children at Risk—Development of a Program for the Prevention and Treatment of Behavior Problems in Primary Services

During the past decade, Norwegian authorities have initiated and funded a project to scale up the use of evidence-based programs for the prevention and treatment of conduct problems in children. The first step in this process was to increase treatment competence by implementing the Parent Management Training-Oregon Model (PMTO) in specialist services for children. The second step was to develop the program Early Initiatives for Children at Risk (Norwegian acronym, TIBIR), designed to identify children with possible conduct problems as early as possible and to offer tailored interventions as part of the ordinary primary services for children in individual municipalities. The theoretical rationale and practical considerations leading to the design of TIBIR are presented, together with the program modules and current research activities. Some of the challenges concerning the program’s ability to reach various risk groups are discussed, as are the challenges encountered regarding quality assurance and fidelity maintenance. Finally, some future research questions are presented and discussed.

Adherence to brief parent training as a predictor of parent and child outcomes in real‐world settings

Purpose – This study aims to examine the predictive validity of an adherence measure to Brief Parent Training (BPT) delivered in real‐world settings. BPT promotes effective parenting practices in families with children who either are at an early stage of problem behaviour development or have developed conduct problems.Design/methodology/approach – In a sample of 108 families who received BPT, whether adherence predicted parenting practices and child conduct problems after intervention completion was examined.Findings – The results showed that high ratings of adherence predicted low levels of inconsistent discipline and high levels of appropriate discipline and positive parenting. The combined effect of inconsistent discipline and positive parenting mediated the relationship between adherence and child conduct problems. When the indirect effects were separated, inconsistent discipline functioned as a mediator, whereas positive parenting did not.Originality/value – Findings indicate that it is possible to d...

Construct Validity of the Eyberg Child Behavior Inventory (ECBI)

Despite the wide use of the Eyberg Child Behavior Inventory (ECBI), its construct validity is still an issue of debate. Whereas previous studies primarily have relied on confirmatory factor analyses (CFAs), the present study aimed to evaluate the Norwegian 22-item version of the ECBI intensity scale using exploratory structural equation modeling (ESEM), which offers more flexibility compared to traditional CFA. The study used data from three samples of parents with children with emerging or existing problem behaviors. Results showed that the ESEM model showed good fit and identified the three factors Oppositional defiant behavior, Conduct problem behavior, and Inattentive behavior. In addition, the ESEM approach revealed several small and significant (&lgr; ⩽ .21) cross-loadings. The results illustrated the strengths of ESEM over CFA and suggest that ESEM provide a useful statistical framework to evaluate the structure of ECBI items.

Children With Conduct Problems and Co-occurring ADHD: Behavioral Improvements Following Parent Management Training

To scale up evidence-based treatment of conduct problems, parent management training, Oregon model (PMTO) has been disseminated throughout Norway. This study examined whether Attention Deficit Hyperactivity Disorder (ADHD) predicted the outcomes of PMTO. Of 253 children and families, 97 were reported to have an ADHD diagnosis. Although different at intake, the groups with and without ADHD had close to an equal change in behavioral status following treatment. Maternal depression and family income predicted the combined groups behavior following PMTO. The study indicates that reductions in conduct problems following PMTO are of the same magnitude in children with or without ADHD. However, some characteristics may differentially predict outcomes for children with combined problems.

Observed callousness as a predictor of treatment outcomes in parent management training.

Background: The goal of this study was to examine how observed Callous–Unemotional (CU) behavior influenced change in externalized and internalized problems, hyperactivity, social competence, and treatment satisfaction following parent management training. Methods: Three hundred twenty-three children and their families received Parent Management Training—the Oregon model (PMTO). They were compared at intake and after treatment in order to examine differences in 14 treatment outcomes using hierarchical regression analyses. Results: Children with low levels of observed CU showed the greatest gains after PMTO treatment. This was evident in parent, therapist, self, and teacher reports. Conclusions: The results indicate that it is possible to observe CU behavior among children with conduct problems, and that children with elevated levels of observed CU behavior may be in need of additional treatment or components of treatment or more intense versions of parent management treatment.

Three Randomized Effectiveness Trials — One Question: Can Callous-Unemotional Traits in Children Be Altered?

Children with conduct problems and callous-unemotional (CU) traits are at risk for multiple problems. Outcome research and mediation analyses testing for mechanisms of change in CU traits have been limited. We examined whether parent training—in a short-term (Brief Parent Training; BPT) or a comprehensive format (Parent Management Training, Oregon Model; PMTO)—or child-directed social skills training (Individual Social Skills Training [ISST]) produced positive effects on CU traits. In mediation models we tested parenting practices as mechanisms of change for CU traits. We pooled data from three randomized effectiveness trials, and 551 families were included in this study. Families had children between 3 and 12 years of age and displayed emerging or present conduct problems at home, day care, or school (BPT M age = 7.28, 31.9% girls; PMTO M age = 8.56, 36.5% girls; ISST M age = 7.64, 19.7% girls). Assessments were completed preintervention, postintervention, and at follow-up (6 months following intervention). Both BPT (d = .32) and PMTO (d = .39) had positive effects on CU traits at posttest, whereas ISST did not (d = –.06). At follow-up, only PMTO produced a significant effect (d = .48) on CU traits. A significant indirect effect on CU traits emerged by positive parenting. Both parent training conditions outperformed ISST. Only PMTO maintained its effects at follow-up. The findings suggest that PMTO can reduce CU traits and that improved positive parenting is associated with positive outcomes for children’s CU traits.