Can Health Care Efforts to Reduce Child Behavior Problems Also Reduce Social Risk? Unintended Collateral Benefits in Parent Training

Introduction: Lack of family resources, social risk, has been found to negatively impact development of child behavior problems. Thus, improving families’ access to resources, and thereby reducing social risk, would certainly benefit vulnerable children and their family. In Parent Management Training Oregon model (PMTO), social risk is not explicitly targeted. However, if PMTO has effects over and beyond child behavioral problems and reduces social risk, such collateral benefits implicate that the outcomes of PMTO to some extent are underestimated.

Methods: We used data from two randomized trials (N=353) evaluating two versions of PMTO, the preventive Brief Parent Training (BPT) and PMTO therapy. Both interventions are part of comprehensive primary care model to prevent and treat behavior problems. Using three time-points, we constructed a cumulative family resource index tapping parental health, poverty, and labor market affiliations. Autoregressive SEM-models were run in Mplus to examine collateral benefits in PMTO interventions. We examined direct effects and indirect effects via behavior problems change.

Results: We found that PMTO interventions had a direct effect increasing family access to resources 6 months after treatment termination (ß = 0.31, p < .01; ß is equivalent to Cohen’s d). The direct effect on collateral benefit was not significantly mediated through child behaviour change. Moreover, we analysed the two modes of PMTO separately. We found that collateral benefits were more strongly associated with the BPT sample (ß = 0.37, p < .00) compared to the PMTO sample (ß = 0.21, p = 0.18).

Conclusions: Overall, the findings indicate that PMTO interventions have collateral benefits in addition to the primary effects on child behavior change. This implicates that the focus on parenting practices comes to benefit parents and the family environment which is important for children’s future developments. Moreover, teaching positive parenting practices has probably a salutogenic effect by decreasing social risks that are broadly related to healthy child developments. Compared to the PMTO sample, the BPT sample included lower risk children and families. Thus, our results suggest that addressing problems before they get more serious gives immediate collateral benefits. In contrast, it seems that when both child and family problems are more severe, it takes more time and effort to have benefits beyond children’s behavior.

This abstract was submitted to the 2017 Society for Prevention Research Annual Meeting