The impact of therapy process on outcomes for families of children with disabilities and behaviour problems attending group parent training

Abstract

Despite the positive effects found for both parents and children following different parent training interventions, a significant proportion of families fail to experience successful outcomes (Assemany & McIntosh, 2002). High drop out rates, poor parental engagement and participation, and failure of families to maintain long term benefits after an intervention are common problems (Assemany & McIntosh, 2002; Littell, Alexander, & Reynolds, 2001; Miller & Prinz, 1990). Although a large body of literature exists supporting the efficacy and effectiveness of parent training programs for both typically developing children and children with disabilities, little is known about the mechanisms of change or the processes that create change in treatment (Kendall & Choudhury, 2003). This study investigated therapy process and its impact on outcomes for families of children with disabilities attending a group-based behavioural family intervention known as Stepping Stones Triple P program (SSTP). Study 1 examined the impact of both within session therapy process variables (working alliance, client satisfaction) and between session therapy process variables (homework completion, attendance) on child behaviour problems and parental adjustment. Participants included 15 groups (n = 79) of parents, each with a child with an intellectual disability and parent reported child behaviour problems. Parents completed the Homework Rating Scale, Working Alliance Inventory, and the Client Satisfaction Questionnaire.Child behaviour outcomes were measured by the Developmental Behaviour Checklist and changes in parental adjustment were measured by the Depression Anxiety Stress Scale. A series of logistic regressions found parents working alliance scores significantly predicted reliable change in child behaviour problems and parental anxiety at post-test. Homework completion at session 3 significantly predicted reliable change in parents depression scores at post-test. Using a sub-set of participants from Study 1 (n = 36), Study 2 investigated the impact of parent verbalisations on treatment outcomes. Parent-therapist interactions were coded according to the Therapy Process Code. Resistant and non-resistant parent verbalisations in combination were found to impact on parental anxiety scores at post-test. Parent resistant verbalisations were found to be significantly associated with reductions in parental depression at post-test. Study 3 (n = 71) examined the way families with a child with a disability behave during and respond to group-based parent training on a moment-to-moment basis using an Interpretative Phenomenological Approach (IPA). Results showed that parents of children with disabilities attending group-based parent training, experiences reflected six key themes including 1) advocating for child’s behaviour, 2) dealing with other’s reactions, 3) need for change, 4) its’ hard work, 5) learning to cope and 6) the experience of success. The factors contributing to these results, implications for clinicians and directions for future research are discussed.Understanding therapy processes provides opportunities to expand and refine parent training interventions to better fit the need of difficult to reach families. Meeting the needs of a greater number of families is likely to have a positive effect on the individual child, family system, and the wider community.