School-Based Parent Education and Family Intervention

Module 4 Family Intervention

The Futures Task Force on Family-School Partnerships

Gloria Miller, Univ. of DenverCathy 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 ApproachFamily 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.

Tier 2: Targeted Group InterventionsSpecific 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).

The Multi-Tiered Approach to The Multi-Tiered Approach to Family-School PartnershipsFamily-School Partnerships

Tier 1 80-90%

Tier 31-7%

Tier 25-15%

Tier 1: Universal Interventions

Engaging all families as collaborative partners (e.g., 4 As,

Family-School Collaboration, Parent Involvement, Parent

Education).

Tier 3: Intensive, Individual InterventionsIndividualized supports for families and students unresponsive to the first two tiers (e.g., Parent

Consultation [conjoint behavioral consultation] and Family Intervention).

Two Evidenced-based Family Intervention

ProgramsParent 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 BackgroundResearch (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 BackgroundResearch (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)Orientation and pre-test session

1. Defining. Observing and Recording Behavior

2. Rational for Positive Reinforcement 3. Time Out from Reinforcement4. Attending and Planned Ignoring5. Shaping and School Program6. Review and Problem Solving7. Family Meeting8. Low-Rate Behaviors9. Reprimands10/11. Compromising & Negotiating12. Skill Review

See FI Handout 4, 5, 6 and FI Activity

Mod 1 - Introduction to ABC

Contingencies of ReinforcementANTECEDENTS are contextual factors or

conditions that set the stage for behaviors and what follows.

BEHAVIORS are behaviors that we wish to develop or eliminate.

CONSEQUENCES are events or actions delivered in specific ways contingent on the performance of a behavior we wish to develop or eliminate.

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 2nd to 6th 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 evaluation: 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 InterventionPrograms

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?