Contains Video1
Delivering Parent Management Training in an Integrated Primary Care Setting: Description and Preliminary Outcome Data,☆☆,

https://doi.org/10.1016/j.cbpra.2014.04.003Get rights and content

Highlights

  • We describe how to use parent management training (PMT) in integrated care settings.

  • A modular approach to target the level of intervention is described.

  • Case vignettes and videos demonstrate this modular approach.

  • Preliminary outcome data support the efficacy of PMT in integrated care settings.

Abstract

This paper describes how behavioral health consultants (BHCs) in an integrated primary care setting use evidence-based principles that underlie parent management training (PMT) to assist caregivers of youth with externalizing behavior problems. Illustrated is the decision-making process that BHCs utilize from the moment they receive a patient referral from a primary care provider to how interventions are selected and delivered. When delivering PMT in integrated care, operant-based learning principles underlying PMT are often selected based on a combination of factors, including match with presenting problem, caregiver efficacy, caregiver beliefs about the causes and maintaining factors, and feasibility of implementation. We further present preliminary outcome data on the effectiveness of BHCs’ efforts to use PMT principles in a primary care setting. Participants were 21 caregivers and their children (Mage = 7.76 years, 38.1% female; 66.7% Hispanic) seen for an average of 2.38 visits. Pre-post data provided by caregivers (for youth 11 years or younger) and adolescents (self-report of patients 12–17 years of age) taken at the time of first and last sessions revealed significant reductions in global distress scores and high levels of satisfaction with services received. Findings support the viability of providing brief, focused PMT interventions for pediatric populations seen in primary care.

Section snippets

Externalizing Behavioral Problems in Primary Care

Children and their caregivers present to their primary care providers for a variety of problems, mostly medical in nature; however, research indicates that 12% to 16% of children present to their pediatrician with unaddressed emotional or externalizing behavioral concerns (Briggs-Gowan et al., 2003, Costello et al., 1988, Polaha et al., 2011). One study, conducted in pediatric primary care, surveyed families using the Pediatric Symptom Checklist and found that 16.2% of children met clinical

Participants

Participants were from an open trial evaluating the efficacy of integrated behavioral health care services at two primary care clinics. The study period (November 2010 to September 2012) included 56 caregiver/child dyads seen for at least two behavioral health visits. Analyses were based on 21 caregivers and their children who presented with a primary complaint of externalizing child behavior (Mage = 7.76 years, SDage = 4.31, range 1–17 years; 38.1% female; 66.7% Hispanic; 95.2% insured).

Results and Discussion

A paired-samples t-test showed significant improvement in child global distress following IBHC treatment (Mpre = 1.72, SDpre = 0.81; Mpost = 1.21, SDpost = 0.89), t(20) = 3.70, p < .001, within subjects Cohen’s d = .81 (rpre-post = .73). When using a difference score of .50, as recommended by the ACORN developers (Brown, 2011), 38.1% of patients experienced reliable change despite the brevity of the intervention. Similar reductions in global distress scores were obtained for both child (as reported by

Conclusion

Relatively little is known about the efficacy of delivering brief parenting interventions to children with disruptive behavior problems in integrated primary care settings. A variety of PMT protocols have been shown to produce significant reductions in problematic child behavior (Barkley and Benton, 1998, Eyberg, 1988, Kazdin, 2003, McMahon and Forehand, 2003, Webster-Stratton, 1984), but the formats used (10 to 12, hour-long sessions) are impractical for behavioral health consultants to

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    The authors wish to thank Kathy Grisham and Kim Shuler of Community Clinic at St. Francis House for partnering with us in the provision and evaluation of integrated care services. We also thank Pat Walker Health Center at the University of Arkansas for permission to film at their primary care site. We are grateful to Bianca Villalobos, Juventino Hernandez Rodriguez, and Elizabeth Anastasia for assistance with data collection, Blake Erickson for his narration, and the actors (both young and old) who assisted with the videos.

    ☆☆

    This project was supported by grant D40HP19640 (PI: Ana J. Bridges) from the U.S. Department of Health and Human Services/Health Resources and Services Administration (USDHHS/HRSA).

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    Video patients/clients are portrayed by actors.

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