The Effectiveness of GenerationPMTO During Sustained Implementation in the Public Mental Health System: A Single-Arm Open Trial Evaluation.

To support families and reduce the burden of child mental, emotional, and behavioral problems, evidence-based parenting interventions must remain effective in real-world service delivery contexts. The purpose of the current study was to evaluate the effectiveness of the GenerationPMTO (GenPMTO) intervention during sustained implementation in the Michigan public mental health system using a single-arm open trial (pre-post) design. We also examined potential predictors of treatment response. A multilevel analysis framework was utilized to evaluate data from 365 caregivers who completed GenPMTO treatment. Results revealed significant positive improvements from pretest to posttest in all four outcome domains (i.e., parenting confidence, parenting practices, caregiver depressive symptoms, child behavior problems). When compared to group-based GenPMTO delivery, the individual delivery format was associated with significantly greater improvements in overall effective parenting practices, as well as in the subdomain of skill encouragement. Caregiver gender, caregiver educational level, and child age were all implicated as predictors of GenPMTO outcomes. These findings add to the literature by supporting the effectiveness of the GenPMTO intervention when fully integrated into mental health care practice and can inform continued efforts to provide families with evidence-based services in community settings.

Identifying Beneficial Training Elements: Clinician Perceptions of Learning the Evidence-Based GenerationPMTO Intervention.

Improving the process through which mental health professionals are trained in evidence-based practices (EBPs) represents an important opportunity for extending the implementation of EBPs in community settings. In this study, we used a qualitative approach to examine the specific training elements that were beneficial to clinicians' experiences learning an evidence-based intervention. Individual, semi-structured interviews were conducted with mental health professionals completing training in the GenerationPMTO parenting intervention. Data were analyzed using the tenets of thematic analysis. Overall, participants reported positive experiences in the training and growth in their attitudes, knowledge, and confidence in GenerationPMTO. The qualitative findings also suggested seven specific training elements that participants perceived as beneficial: support, role plays, engagement, structure, writing/visuals, working with training families, and experiencing the GenPMTO model. These results are discussed within the context of the existing literature on EBP training and more broadly as they relate to expanding the implementation of evidence-based interventions. We also suggest implications for practice meant to enhance future EBP training efforts.

The acceptability and preliminary effectiveness of a brief, online parenting program: Expanding access to Evidence-Based parenting intervention content.

Parenting interventions are a promising means for preventing and treating a variety of child behavior and conduct problems; yet, many families lack access to such services. Online parenting programs offer an opportunity to mitigate many barriers to intervention access by extending service delivery options. The purpose of the present study was to evaluate the acceptability and preliminary effectiveness of a brief, online parenting program. We developed a new online parenting program based on foundational content from the evidence-based GenerationPMTO intervention and used a mixed-methods, single-arm open trial (pre-post) design to perform a preliminary evaluation. The combined results from the quantitative and qualitative data provide initial support for the acceptability and preliminary effectiveness of the online program, based on participant self-report data from program completers. Participants indicated high levels of acceptability for the program topics and videos. They also reported statistically significant improvements from baseline to 4 weeks postintervention in parental efficacy, parenting practices, and child behavior problems. The qualitative data corroborated and expanded these findings. We go on to discuss important accessibility and sustainability considerations addressed by this online parenting program as well as to suggest implications for intervention research and mental health practice.

Investigating active ingredients of the GenerationPMTO intervention: Predictors of postintervention change trajectories in parenting practices.

Empirically determining the active ingredients of evidence-based parenting interventions is a promising means for strengthening interventions and enhancing their public health impact. This study aimed to determine which distinct ingredients of the GenerationPMTO (GenPMTO) intervention were associated with subsequent changes in parenting practices. Using a sample of 153 participants randomly assigned to the GenPMTO condition, we employed multilevel modeling to identify intervention ingredients empirically linked with change trajectories in parenting practices observed across the 2 years following intervention exposure. Coercive parenting and positive parenting outcomes were examined. Study results indicated that emotion regulation, effective communication, problem solving, and monitoring each demonstrated a significant pattern of findings for coercive parenting. Differential exposure to each of these ingredients significantly predicted the level of coercive parenting immediately postintervention and/or trajectories of change in coercive parenting across the subsequent 2-year period, controlling for coercive parenting at baseline. No significant predictors were found for positive parenting trajectories. Our findings suggest four components as active ingredients of the GenPMTO intervention for coercive parenting. Identification of these active ingredients may lead to strengthening future iterations of GenPMTO by expanding the set of core components specified in the model, which may further improve public health benefits. Implications for further understanding change stemming from evidence-based parenting interventions are also discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Reducing mental health disparities among racially and ethnically diverse populations: A review of couple and family intervention research methods (2010-2019).

Racially and ethnically diverse and globally underserved populations continue to experience mental health disparities. The goal of this review was to examine the extent to which diverse populations were included in couple and family intervention research over the past decade and whether these studies were conducted with attention to issues of diversity. We performed a review of 271 articles reviewed in the current special issue on the efficacy and effectiveness of couple and family interventions across 11 mental health topics. Overall, only 68 of the 271 (25%) articles included predominately racial/ethnic minority samples or globally underserved populations. Among articles (n = 60) describing US-based research with racial/ethnic minority samples, there was a pattern of inattention to methodological considerations relevant to diverse populations. Although some progress was noted, more research is necessary. Specifically, we call for research that advances social justice by using critically conscious methods to promote mental health equity.

Introduction to the special issue on the efficacy and effectiveness of couple and family interventions: Evidence base update 2010-2019.

This is the fourth Journal of Marital and Family Therapy (JMFT) special issue on the efficacy and effectiveness of couple and family therapy. Articles in this issue review studies published from 2010 to 2019 on couple and family interventions for prevalent mental and behavioral disorders and health conditions. The final article on mental health disparities tracks progress in the field and emphasizes the need for additional attention. In the current article, we provide a description of our methodological approach for the special issue and an overview of the state of the evidence for couple and family interventions across the conditions reviewed. We also offer recommendations to inspire researchers to further expand the empirical support for couple and family interventions to address pressing public health needs.

Development and Evaluation of a Component Level Implementation Fidelity Rating System for the GenerationPMTO Intervention.

Empirically determining the components of evidence-based interventions contributing to positive change is a crucial, yet understudied area of research. In support of this aim, we describe the development and evaluation of an observational rating system for measuring fidelity to specific components of the evidence-based GenerationPMTO parenting intervention. A five-step process was employed to systematically develop the rating system, which included consultation with the intervention developer and input from additional GenerationPMTO experts. The rating system was then tested using 247 h of video data from 184 parenting group intervention sessions. Study findings support the psychometric properties of the new measure with regard to item performance, reliability (i.e., inter-rater reliability of items, dimensionality of components, internal consistency of component scales), and validity (i.e., content validity, convergent validity, discriminant validity, and predictive validity of the component scales) for seven of the eight scales evaluated. The seven components include clear directions, skill encouragement, emotion regulation, limit setting, effective communication, problem solving, and monitoring. Data did not support the psychometric properties of the positive involvement scale. Overall, the ability to assess component-specific fidelity allows for a more nuanced examination of change processes, with meaningful implications for research and practice.

Examining the Emotional Experience of Mothers Completing an Evidence-Based Parenting Intervention: A Grounded Theory Analysis.

Parenting interventions are a well-established treatment for addressing child behavior problems that have also been shown to improve parent psychosocial health. Yet, little is known about how caregiver emotional experiences change over time during treatment. In response, the purpose of this study was to explore the emotional experiences of mothers following their participation in an evidence-based parenting intervention. Researchers conducted a secondary analysis of existing qualitative data. The study sample included semi-structured interview data from 17 mothers who previously completed the GenerationPMTO parenting intervention. Data analysis followed the grounded theory approach and included a sequential process of open, axial, and selective coding using the constant comparative method. Findings indicate mothers progressed through three distinct, yet interrelated stages of emotional experience: Before PMTO, their experiences were characterized by parenting through crisis (Stage 1); during PMTO, they transitioned to crisis stabilization (Stage 2); and following PMTO, they described experiences of emerging recovery and resilience (Stage 3). Maternal emotional experiences in each stage occurred across three contextual realms: (a) the individual (intrapersonal) level, (b) the parent-child relationship level, and the broader systemic level. Results highlight the dynamic and evolving nature of maternal emotional experience throughout various stages of the intervention process and suggest how these experiences may be associated with promoting effective parenting practices and positive child outcomes.

Las intervenciones en la crianza son un tratamiento firmemente consolidado para abordar los problemas de comportamiento de los niños y, a su vez, se ha comprobado que mejoran la salud psicosocial de los padres. Sin embargo, poco se sabe acerca de cómo las experiencias emocionales de los cuidadores cambian con el tiempo durante el tratamiento. En respuesta a esto, el propósito de este estudio fue analizar las experiencias emocionales de las madres después de su participación en una intervención factual en la crianza. Los investigadores llevaron a cabo un análisis secundario de los datos cualitativos actuales. La muestra del estudio incluyó datos de entrevistas semiestructuradas de 17 madres que anteriormente completaron la intervención en la crianza denominada GenerationPMTO. Los análisis de los datos siguieron el enfoque de teoría fundamentada e incluyeron un proceso secuencial de codificación abierta, axial y selectiva utilizando el método comparativo constante. Los resultados indican que las madres pasaron por tres estapas diferentes, pero interrelacionadas, de experiencia emocional: antes de la PMTO, sus experiencias estuvieron caracterizadas por la crianza durante la crisis (etapa 1), durante la PMTO, pasaron a la estabilización de la crisis (etapa 2) y después de la PMTO, describieron experiencias de surgimiento de recuperación y resiliencia (etapa 3). Las experiencias emocionales maternas de cada etapa se produjeron en tres ámbitos contextuales: a) el nivel individual (intrapersonal), b) el nivel de la relación entre padres e hijos y el nivel sistémico más amplio. Los resultados destacan la índole dinámica y cambiante de la experiencia emocional materna durante varias etapas del proceso de intervención y sugieren cómo estas experiencias pueden estar asociadas con el fomento de prácticas de crianza eficaces y resultados positivos en los niños.

Strengthening Clinical Research in Marriage and Family Therapy: Challenges and Multilevel Solutions.

There is a critical need for high-quality and accessible treatments to improve mental health. Yet, there are indications that the research being conducted by contemporary marriage and family therapy (MFT) scholars focuses less on advancing and disseminating clinical interventions than in previous decades. In this article, we describe challenges to increasing rigorous clinical research in MFT. We use systems mapping and the intervention-level framework to identify strategic goals designed to drive innovation in clinical research in the field. It is our hope this article encourages dialog and action among MFT stakeholder groups to support clinical science that will improve the health and functioning of families.

Adapting a parenting intervention for parents aging out of the child welfare system: A systematic approach to expand the reach of an evidence-based intervention.

Parents aging out of the child welfare system face a constellation of unique risk factors that threaten the well-being of themselves and their children. Although parenting interventions are an important resource for providing much-needed services to parents aging out, there is currently a lack of evidence-based parenting interventions that address the unique needs of this population. The purpose of this project was to systematically adapt an evidence-based parenting intervention for parents aging out. An established adaptation framework was used to guide this process, and acceptability and feasibility outcomes were evaluated as part of a pilot study of the adapted intervention. Preliminary intervention adaptations included modifications to program delivery and program content. Study findings indicated a high level of parent satisfaction with the adapted intervention but challenges to feasibility because of inconsistent attendance and the substantial effort required for intervention delivery. This study constitutes a critical first step toward increasing the reach of evidence-based parenting interventions among parents aging out of the child welfare system and underscores the need for continued efforts to develop sustainable and effective parenting services for this at-risk population. (PsycINFO Database Record

Adapting and Pilot Testing a Parenting Intervention for Homeless Families in Transitional Housing.

Intervention adaptation is a promising approach for extending the reach of evidence-based interventions to underserved families. One highly relevant population in need of services are homeless families. In particular, homeless families with children constitute more than one third of the total homeless population in the United States and face several unique challenges to parenting. The purpose of this study was to adapt and pilot test a parenting intervention for homeless families in transitional housing. An established adaptation model was used to guide this process. The systematic adaptation efforts included: (a) examining the theory of change in the original intervention, (b) identifying population differences relevant to homeless families in transitional housing, (c) adapting the content of the intervention, and (d) adapting the evaluation strategy. Next, a pilot test of the adapted intervention was conducted to examine implementation feasibility and acceptability. Feasibility data indicate an intervention spanning several weeks may be difficult to implement in the context of transitional housing. Yet, acceptability of the adapted intervention among participants was consistently high. The findings of this pilot work suggest several implications for informing continued parenting intervention research and practice with homeless families in transitional housing.

Exploring Factors That Contribute to Positive Change in a Diverse, Group-Based Male Batterer Intervention Program: Using Qualitative Data to Inform Implementation and Adaptation Efforts.

Although batterer intervention programs (BIPs) are often mandated for perpetrators of intimate partner violence, the precursors and mechanisms of change operating within these programs remain unclear. The purpose of this qualitative study was to examine the perceptions and experiences of participants in a diverse, group-based male BIP to better understand factors facilitating positive change. Data were gathered through individual interviews with 15 men and were analyzed using grounded theory. Findings suggest that change is taking place through a reciprocal process in which change occurring via the group context facilitates change within participants and vice versa. The specific benefits of the group context and value of group diversity were emphasized. Factors supporting this change process include the role of group facilitators and providing group members with access to ongoing support. These results are useful for informing the continued implementation and adaptation of BIPs with the goal of reducing and ultimately terminating abusive behaviors.

Dissemination and Implementation Research in Marriage and Family Therapy: An Introduction and Call to the Field.

Despite the considerable resources allocated to research to promote public health, interventions capable of benefiting individuals and families are not finding their way into regular practice. An important avenue for addressing this problem is through dissemination and implementation (D&I) science, a burgeoning research area focusing on translating empirical knowledge into everyday practice. This article begins by suggesting ways in which MFTs are uniquely equipped to contribute to and benefit from D&I research. We will then provide an overview of D&I research, outlines key D&I models, and highlight examples of family intervention research relevant to MFTs using the key models. Finally, we conclude by providing the field with important next steps to advance the presence of MFT research within D&I scholarship.

Identifying relevant components to include in a parenting intervention for homeless families in transitional housing: Using parent input to inform adaptation efforts.

Homeless families in transitional housing face a number of distinct challenges, yet there is little research seeking to guide prevention and intervention work with homeless parents. Informed by the tenets of community-based participatory research, the purpose of this study was to identify relevant components to include in a parenting intervention for this population. Data were gathered from 40 homeless parents through semistructured individual interviews and were analyzed using qualitative content analysis. The resulting 15 categories suggest several topics, approach considerations, and activities that can inform parenting intervention work with homeless families in transitional housing. Study findings are discussed within the context of intervention fidelity versus adaptation, and implications for practice, research, and policy are suggested. This study provides important insights for informing parenting intervention adaptation and implementation efforts with homeless families in transitional housing. (PsycINFO Database Record

Associations between positive parenting practices and child externalizing behavior in underserved Latino immigrant families.

This study examined whether five specific parenting practices (i.e., monitoring, discipline, skill encouragement, problem solving, and positive involvement) were associated with reduced child externalizing behaviors among a sample of Latino immigrant families. It utilized baseline data from 83 Latino couples with children participating in a larger randomized controlled trial of a culturally adapted parenting intervention. Results reveal that monitoring, discipline, skill encouragement, and problem solving each made independent contributions to the prediction of child externalizing behavior, although not all in the expected direction. Further analyses examining mothers and fathers separately suggest that mother-reported monitoring and father-reported discipline practices uniquely contributed to these findings. These results may have important implications for prevention and clinical intervention efforts with Latino immigrant families, including the cultural adaptation and implementation of parenting interventions with this underserved population.

"It's a struggle but I can do it. I'm doing it for me and my kids": the psychosocial characteristics and life experiences of at-risk homeless parents in transitional housing.

Families experiencing homelessness face a number of risks to their psychosocial health and well-being, yet few studies have examined the topic of parenting among homeless families. The purpose of this multimethod, descriptive study was to acquire a better understanding of the psychosocial status and life experiences of homeless parents residing in transitional housing. Quantitative data were collected from 69 parents and primary caregivers living in a transitional housing community, with a cohort of 24 participants also contributing qualitative data. The quantitative results suggest risk associated with depression, parenting stress, and negative parenting practices. The qualitative findings highlight five themes that convey both the challenges faced by homeless parents as well as the resilience they display in spite of such adversity. These results extend current scholarship on homeless families with children and can better inform how couple and family therapists work with this at-risk population.

The Role of Intrapersonal and Ecodevelopmental Factors in the Lives of Latino Alternative High School Youth.

Despite efforts aimed at achieving health equity, Latino youth continue to experience significant health and mental health disparities. The purpose of this investigation was to explore the role of intrapersonal and ecodevelopmental factors, including family, peer, school, and community, in the lives of Latino alternative high school youth residing in the Southwest, United States. Five focus groups were implemented with a total of 19 participants. Study findings are indicative of an ecology characterized by multiple challenges that have a significant impact on the lives of Latino alternative high school youth. Findings from this study reinforce that there remains a great need to fully understand the scope and influence of intrapersonal and ecodevelopmental factors among Latino alternative high school youth to inform the development of culturally-responsive social work preventive intervention programs.

Diversity, social justice, and intersectionality trends in C/MFT: a content analysis of three family therapy journals, 2004-2011.

In this study, we analyzed the amount of attention given to diversity, social justice, and an intersectional approach to social inequalities over an 8-year period (769 articles) in three family therapy journals. Overall, 28.1% of articles addressed at least one diversity issue, and a social justice framework was utilized in 48.1% of diversity articles. A systemic, intersectional approach to conceptualizing and analyzing multiple social inequalities was utilized in 17.6% of diversity articles. The most common goals addressed in diversity articles, articles using a social justice framework, and articles using an intersectional approach are also identified. Findings indicate that, despite important work being carried out, more work remains to further identify how addressing diversity issues can improve client outcomes.

Examining the process of change in an evidence-based parent training intervention: a qualitative study grounded in the experiences of participants.

While strong research evidence demonstrates that parent training interventions are capable of preventing child behavioral problems, much less is known about how the participants in these programs experience the change process. The purpose of this study was to provide a better understanding of how parents' experiences in an evidence-based parent training intervention led to change in their parenting practices, based on the first-person accounts of program participants. Qualitative data were collected through in-depth, individual interviews with parents who had completed the intervention known as Parent Management Training-the Oregon Model (PMTO™). Data were analyzed according to principles of the grounded theory approach, using the constant comparative method and a sequential process of open, axial, and selective coding. Study findings suggest that parents make active and intentional efforts to attempt, appraise, and apply the intervention material within their various life contexts, contributing to change in their parenting practices. Aspects of intervention content, method of delivery, and the role of the interventionist were also found to be important. This study can guide further prevention research into the mechanisms of change operating in parent training interventions and has the potential to inform continued efforts to adapt and implement evidence-based parent training interventions.

"En el grupo tomas conciencia (in group you become aware)": Latino immigrants' satisfaction with a culturally informed intervention for men who batter.

Qualitative interviews were conducted with 21 Latino immigrant men who participated in a culturally informed batterer intervention. The objectives of this investigation were twofold. First, to identify the treatment components that facilitated the participants' willingness to engage in a process of change aimed at terminating their abusive behaviors. Second, to describe the treatment components that led to their satisfaction with the intervention. Research findings confirm that the Spanish version of the Duluth curriculum can be beneficial for Latino immigrant batterers. Results also demonstrate the critical role of culture as it refers to content of the intervention and method of delivery.