School-Based Parent Education and Family Intervention

Module 4 Family Intervention

The Futures Task Force on Family-School Partnerships Gloria Miller, Univ. of Denver Cathy Lines, Cherry Creek (CO) School District Virginia Smith Harvey, Univ. Mass Boston

Definition of Family Intervention

A systematic therapeutic process with parents (and other family members) that focuses on interpersonal relationships and effective child management strategies for the purpose of modifying identified sources of child and parent distress.

See FI Handout 1

General FI Characteristics

 Specific concerns and conditions are covered that interfere with a child’s schooling or development.  Sessions are both therapeutic as well as educational and feel more like “therapy”.

 Sessions guided by a treatment manual and focus on relationship processes and social learning principles.  Sessions are geared towards specific groups of parents who are invited or required to participate.

FI Trainer Characteristics

 Strong understanding of child development, counseling, and family systems.  History of supervised therapeutic applied experiences working with families.  Comfort with role as a counselor/therapist.

 Clinical training and supervision, graduate level educational background.

Where PE fits within a Multi-tiered Family-School Partnership Approach

Family Intervention Occurs either as a Tier II-Targeted Group or a Tier III-Intensive, Individual intervention.

Offered to families with children already displaying serious emotional or behavioral concerns.

The Multi-Tiered Approach to Family-School Partnerships

Tier 3: Intensive, Individual Interventions Individualized supports for families and students unresponsive to the first two tiers (e.g., Parent Consultation [conjoint behavioral consultation] and Family Intervention).

Tier 2: Targeted Group Interventions Specific preventions and remedial interventions for targeted groups of families and students identified as “at risk” and unresponsive to the first tier (e.g., Parent Education or Family Intervention, Parent Consultation ).

Tier 3

1-7%

Tier 2

5-15% Tier 1: Universal Interventions Engaging all families as collaborative partners (e.g., 4 As, Family-School Collaboration, Parent Involvement, Parent Education ).

Tier 1

80-90%

Two Evidenced-based Family Intervention Programs

Parent Management Training PMT

Kazdin (2005) &

Social Learning Family Therapy SLFT

Sayger, Horne, Walker, & Passmore (1988)

Distinguishing Features of Both PMT & SLFT

    Conceptual underpinning is social learning theory - child behaviors are strongly influenced by sources “outside of the child”. Treatment emphasizes operant behavioral principles and techniques.

Active and directive skill building is employed.

Assessment and evaluation are integrated into the intervention.

Background Research Supporting Both PMT & SLFT

 Development began in 1960’s and was grounded in social learning behavioral theory.

 Influenced by the work of Gerald Patterson (1976) who identified coercive parenting practices that impact the development of conduct problems in children.

PMT & SLFT Background Research (continued)

 Longitudinal studies reveal that aggressive children become more aggressive over time with higher likelihood of incarceration as adults (don’t “outgrow” on own).

 Parent education alone did not lead to clear reductions in serious childhood aggression.

PMT & SLFT Background Research (continued)

 Large prior research base on these therapeutic programs relative to other treatments.  Effectiveness has been demonstrated for a range of behaviors that vary from serious conduct problems to normal life challenges.

One Evidenced-based Family Intervention Program

Parent Management Training (PMT)

Parent Management Training Author

Kazdin (2005)

Parent Management Training: Treatment for Oppositional, Aggressive and Antisocial Behavior in Children and Adolescents Also see: Kazdin, Siegel, & Bass (1992). Problem-Solving Skills Training plus Parent Management Training See FI Handout 2, 3

Parent Management Training Program Description

 A 12-18 session individually administered, structured family treatment program.

 Program is most typically employed with parents of young children ranging in age from 4 to 9 years.

 Children typically have been referred due to serious concerns about aggression or oppositional behavior.

Parent Management Training Program Goals

Goal 1 - To reduce problem behaviors and increase adaptive child functioning Goal 2 - To restructure parent-child interactions by teaching parents to respond contingently to their child and improving a child’s responsiveness to the parent.

     

Parent Management Training Program Features

Appropriate for families with children between the 4 to 8 years old. How these two goals are achieved vary over the course of treatment.

Initially the focus is on Goal # 2 and not on reducing problem behavior.

Parents are taught how to respond positively and contingently to their child’s behavior.

A gradual and cumulative mastery approach is used to change and build upon parents’ contingent responses . Parents initially apply new skills to child behaviors that do not evoke intense reactions.

Parent Management Training Program Structure

 Core content is structured and sequenced into 12 module lessons.

 Lessons typically are delivered during 12-16 weekly 45 60” sessions.  New skills are practiced during sessions and also between sessions via homework.

 Ongoing evaluation is collected weekly through parent reports, homework review, and reenactments.  A minimal level of proficiency is expected before proceeding to next core content lesson.

Parent Management Training Program Structure (continued)

 Intervention is typically delivered in small groups or to individual parents.

 Intensity is increased through changes in delivery (i.e., individual format or adding more sessions) not by changing core content.  Optional sessions can be added to further practice a core issue/skill or to practice how a procedure can best fit into a family’s routine.

Parent Management Training Program Content (12 module units)

1. 2.

3.

4.

5.

Orientation and pre-test session Defining. Observing and Recording Behavior Rational for Positive Reinforcement Time Out from Reinforcement Attending and Planned Ignoring Shaping and School Program 6.

7.

Review and Problem Solving Family Meeting 8.

Low-Rate Behaviors 9.

10/11. Compromising & Negotiating 12.

Reprimands Skill Review See FI Handout 4, 5, 6 and FI Activity

Mod 1 - Introduction to ABC Contingencies of Reinforcement A NTECEDENTS

are contextual factors or conditions that set the stage for behaviors and what follows.

B EHAVIORS

are behaviors that we wish to develop or eliminate.

C ONSEQUENCES

develop or eliminate.

are events or actions delivered in specific ways contingent on the performance of a behavior we wish to See FI Handout 7

Contingent

Positive Reinforcement is Core Focus of the PMT Program Why?

1.

Because our attention is typically focused on how to suppress, eliminate, or reduce a problem behavior.

2.

Because the use of contingent positive reinforcement is much more complex than it sounds.

3.

Because this skill is easily generalized and mapped onto token reinforcement programs.

Parent Management Training Individual Session Characteristics

 Review previous week, homework assignment and discuss how program is working at home.

 Present a new principle or theme and review how it translates to home and other settings.

 Practice and role play, first without then with the child in the session.

 Assign a homework activity for how to implement new skills during the week.

See FI Handout 8

Another Evidenced-based Family Intervention Program

Time-Limited Social Learning Family Therapy (SLFT)

Social Learning Family Therapy Authors

Sayger, Horne, Walker, & Passmore (1988)

Time-Limited Social Learning Family Therapy See FI Handout 9

Social Learning Family Therapy Program Description

 A 10 session individually administered, structured family treatment program.

 Program is most typically employed with parents of children ranging in age from 2 nd to 6 th grade.

 Children typically have been referred by teachers due to serious concerns about aggression or oppositional behavior.

Social Learning Family Therapy Program Goals

Goal 1 -Long-term reduction of aggressive behavior Goal 2 - Positive changes in the family environment Goal 3 - Improved family problem-solving strategies See FI Handout 10

Social Learning Family Therapy Program Features

 Extensive pre- and post-intervention e valuation:  CBCL  Parent Daily Report  Beavers-Timberlawn Family Evaluation Scale  Family Problem-solving Behavior Coding  Family Environment Scale  Daily Behavior Checklist

Social Learning Family Therapy Program Structure

 Core content is structured and sequenced into 10 unit lessons.

 Lessons typically are delivered during weekly 45-60” sessions.  Sessions are taped and analyzed for fidelity.  Discussion and role-play is used to teach new skills during sessions and skills are practiced between sessions via homework.

 Conscious generalization of skills is stressed via weekly assignments and parental reports of activities outside the session.

Social Learning Family Therapy Core Program Content

       Discipline (time out, loss of privileges) Reinforcement (allowance, point systems) How to encourage your child How to develop self-control in your child Setting-up for success Family communication Working effectively with your child’s school/teachers See FI Handout 4, 5, 6 and FI Activity

Social Learning Family Therapy Individual Session Characteristics

 Review previous week, homework assignment and discuss how program is working at home.

 Present a new principle or theme and review how it translates to home and other settings.

 Practice and role play, first without then with the child in the session.

 Assign a homework activity for how to implement new skills during the week.

Empirical Support for Parent Management Training & Social Learning Family Intervention Programs

Prior Research Designs

 Random assignment to treatment versus a waitlist control group that was offered treatment later.  Multiple outcome measures and approaches have been employed to capture changes in child behavior, parent knowledge, attitudes, and skills, and parent-child interactions.

 Immediate and follow-up assessments have been conducted up to two years post treatment

Parent Management Training Significant Outcomes

 Improvements in parent and teacher ratings of child behavior & reduced levels of deviant child behavior.  Magnitude of change is significant – initial clinical ratings reduced to non-clinical levels after PMT.

 Other benefits: reduced maternal depression and stress, improved family interactions and relations.  Changes maintained for up to two years in several well controlled studies.

Social Learning Family Therapy Significant Outcomes

      Improved behavior of children Increased family cohesion, empathy, and positive family relationships Improved problem-solving efficiency Decreased family conflict Reduced negative and aggressive child behavior in school Changes maintained 9-12 months after end of treatment

Prior Research Limitations

 Did not compare against other treatments, mostly evaluated against no-treatment control  Cultural homogeneity, primarily conducted with Caucasian families  Few father participants were included in prior studies  Most families entered the program due to a male child or adolescent referral  Limited information is provided on attrition or drop-out

Ideas to Further Enhance Outcomes

 Call during the week to check-in and suggest modifications when needed.  Spend time on how to implement during critical life routines at home and outside of the home.  Add other sessions to address significant parental needs and issues.  Address parent’s cognitions and find ways to build parental confidence and efficacy (Miller & Prinz, 2002).

Module 4 – PMT and SLFI Discussion Questions

How might these programs be adopted in school based settings? What types of cases or situations are most suited for these programs?

What implementation obstacles would need to be considered before adopting these programs?