The Role of Maternal Depression on Treatment Outcome for Children with Externalizing Behavior Problems

Studies have shown that, on average, Parent Management Training combined with cognitive-behavioral therapy decreases children’s externalizing behavior, but some children do not improve through treatment. The current study aimed to examine the role of maternal depression in understanding this variability in treatment outcome. Children with externalizing behavioral problems and their parents were recruited from combined Parent Management Training and Cognitive-Behavioral programs in “real-world” clinical settings. At pre- and post treatment, maternal depression and children’s externalizing behavior were assessed. Results showed that treatment was less effective for children of depressed mothers compared to non-depressed mothers and that improvements in maternal depression were associated with improvements in children’s externalizing behavior. These findings suggest that treatment programs for children with externalizing problems may be able to improve outcomes if maternal depression is a target of intervention

Problem Behavior in Children of Chronically Ill Parents: A Meta-Analysis

The aim of this meta-analysis is to examine whether children of chronically ill parents differ from norm groups in problem behavior. We report moderator effects and overall effect sizes for internalizing, externalizing and total problem behavior assessed by children and parents. In fixed effect models, we found a significant overall effect size for internalizing problem behavior (number of studies k = 19, total sample size N = 1,858, Cohen’s d = .23, p < .01) and externalizing problem behavior (k = 13, N = 1,525, d = .09, p < .01) but not for total problem behavior (k = 7; N = 896). Effects for internalizing and externalizing problem behavior were larger in non-cancer studies, in samples including younger children and younger ill parents, in samples defined by low average SES and in studies including parents with longer illness duration. In addition, effects for externalizing problem behavior were larger in studies characterized by a higher percentage of ill mothers and single parents. With exclusive self-report, effect sizes were significant for all problem behaviors. Based on these results, a family-centered approach in health care is recommended

Clinician and Parent Perspectives on Parent and Family Contextual Factors that Impact Community Mental Health Services for Children with Behavior Problems

The present study employed qualitative methods to examine multiple stakeholder perspectives regarding the role of parent and family contextual factors on community child mental health treatment for children with behavior problems. Findings suggest agreement between clinicians and parents on the number, types and importance of parent and family factors in children’s mental health services; however, stakeholders differed in reports of which factors were most salient. Specifically, clinicians endorsed most factors as being equally salient, while parents described a few salient factors, with parental stress and inadequate social support being the most frequently discussed. These qualitative data further elucidate the context of community services and have implications for evidence-based practice implementation and improving community care

Distilling Common History and Practice Elements to Inform Dissemination: Hanf-Model BPT Programs as an Example

There is a shift in evidence-based practice toward an understanding of the treatment elements that characterize empirically-supported interventions in general and the core components of specific approaches in particular. The evidence-base for Behavioral Parent Training (BPT), the standard of care for early-onset disruptive behavior disorders (Oppositional Defiant Disorder and Conduct Disorder), which frequently co-occur with Attention Deficit Hyperactivity Disorder, is well-established; yet, an ahistorical, program-specific lens tells little regarding how leaders, including Constance Hanf at the University of Oregon, shaped the common practice elements of contemporary evidence-based BPT. Accordingly, this review summarizes the formative work of Hanf, as well as the core elements, evolution, and extensions of her work, represented in Community Parent Education (COPE; Cunningham, Bremner, & Boyle, 1995; Cunningham, Bremner, Secord, & Harrison, 2009), Defiant Children (DC; Barkley 1987; Barkley, 2013), Helping the Noncompliant Child (HNC; Forehand & McMahon, 1981; McMahon & Forehand, 2003), Parent-Child Interaction Therapy (PCIT; Eyberg, & Robinson, 1982; Eyberg, 1988; Eyberg & Funderburk, 2011), and the Incredible Years (IY; Webster-Stratton, 1981; 1982; 2008). Our goal is not to provide an exhaustive review of the evidence-base for the Hanf-Model programs; rather, our intention is to provide a template of sorts from which agencies and clinicians can make informed choices about how and why they are using one program versus another, as well as how to make inform flexible use one program or combination of practice elements across programs, to best meet the needs of child clients and their families. Clinical implications and directions for future work are discussed