Parenting Through Change

Parenting Through Change (PTC) is a theory-based intervention to prevent internalizing and externalizing conduct behaviors and
associated problems and promote healthy child adjustment. Based on the Parent Management Training--Oregon Model (PMTO), PTC
provides recently separated single mothers with 14 weekly group sessions to learn effective parenting practices including skill
encouragement, limit-setting, problem-solving, monitoring, and positive involvement. PTC also includes strategies to help parents decrease
coercive exchanges with their children and use contingent positive reinforcements (e.g., praise, incentives) to promote prosocial behavior.
Topics are presented in an integrated, step-by-step approach and are typically introduced in one or more sessions, then reviewed and
revisited throughout the remainder of the program.

Descriptive Information

Areas of Interest Mental health promotion

Outcomes Review Date: October 2006

1: Internalizing behaviors
2: Externalizing behaviors
3: Delinquency
4: Academic functioning
5: Noncompliance with mother's directives

Outcome Crime/delinquency
Categories Education
Family/relationships
Mental health
Social functioning
Violence

Ages 6-12 (Childhood)

18-25 (Young adult)
26-55 (Adult)

Genders Male
Female

Races/Ethnicities American Indian or Alaska Native

Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified

Settings Other community settings

Geographic Urban
Locations Suburban

Implementation As of October 2006, implementation of PTC was in its fourth year of a 5-year grant at Utah State University
History with Spanish-speaking immigrants in one- and two-parent families. The program has already been
implemented in three cohorts of families. Findings for this adaptation are expected to be available in 2007. In
2006 the University of Minnesota was also in its fourth year of a 5-year grant to adapt and test the program
with Spanglish- and English-speaking Latinas. The Parent Management Training--Oregon Model, the model that
provides the principles and methods for PTC, has been implemented in Norway, in Iceland, in three large
communities in the Netherlands, and statewide in Michigan. Competent adherence to implementation is being
evaluated using the Fidelity of Implementation Rating System, based on direct observation of therapy
 sessions.

NIH Funding/CER Partially/fully funded by National Institutes of Health: Yes

Studies Evaluated in comparative effectiveness research studies: No

Adaptations PTC has been applied among Latino families with children aged 4-12, with boys and girls in Spanish-speaking
one- and two-parent immigrant families, and with Spanglish- and English-speaking single Latina mothers. PTC
also has been employed in Norway, and training is underway for a large-scale dissemination in the Netherlands.
An adaptation of the program for use in battered women's shelters and in low-income housing is currently
underway in Minnesota.

Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.

IOM Prevention Indicated

Categories

Quality of Research
Review Date: October 2006

Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies
reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Beldavs, Z. G., Forgatch, M. S., Patterson, G. R., & DeGarmo, D. S. (2006). Reducing the detrimental effects of divorce: Enhancing the
parental competence of single mothers. In N. Heinrichs, K. Hahlweg, & M. Dopfner (Eds.), Strengthening families: Evidence-based
approaches to support child mental health (pp. 143-185). Munster, Germany: Psychotherapie-Verlag.

DeGarmo, D. S., & Forgatch, M. S. (2004). Putting problem-solving to the test: Replicating experimental interventions for preventing
youngsters' problem behaviors. In R. D. Conger, F. O. Lorenz, & K. A. S. Wickrama (Eds.), Continuity and change in family relations (pp.
267-290). Mahwah, NJ: Erlbaum.

DeGarmo, D. S., & Forgatch, M. S. (2005). Early development of delinquency within divorced families: Evaluating a randomized preventive
intervention trial. Developmental Science, 8(3), 229-239.

DeGarmo, D. S., Patterson, G. R., & Forgatch, M. S. (2004). How do outcomes in a specified parent training intervention maintain or
wane over time? Prevention Science, 5(2), 73-89.

Forgatch, M. S., & DeGarmo, D. S. (1999). Parenting through change: An effective prevention program for single mothers. Journal of
Consulting and Clinical Psychology, 67, 711-724.

Forgatch, M. S., & DeGarmo, D. S. (2002). Extending and testing the social interaction learning model with divorce samples. In J. B. Reid,
G. R. Patterson, & J. Snyder (Eds.), Antisocial behavior in children and adolescents: A developmental analysis and model for intervention
(pp. 235-256). Washington DC: American Psychological Association.

Forgatch, M. S., Patterson, G. R., DeGarmo, D. S., & Beldavs, Z. G. Nine years and counting: An efficacious delinquency prevention
program. Manuscript submitted for publication.

Martinez, C. R., Jr., & Forgatch, M. S. (2001). Preventing problems with boys' noncompliance: Effects of a parent training intervention for
divorcing mothers. Journal of Consulting and Clinical Psychology, 69, 416-428.

Patterson, G. R., DeGarmo, D., & Forgatch, M. S. (2004). Systematic changes in families following prevention trials. Journal of Abnormal
Child Psychology, 32(6), 621-633.

Supplementary Materials

Forgatch, M. S., DeGarmo, D. S., & Beldavs, Z. (2005). An efficacious theory-based intervention for stepfamilies. Behavior Therapy, 36
(4), 357-365.

Forgatch, M. S., Patterson, G. R., & DeGarmo, D. S. (2005). Evaluating fidelity: Predictive validity for a measure of competent adherence
to the Oregon Model of Parent Management Training. Behavior Therapy, 36, 3-13.

Knutson, N. M., Forgatch, M. S., & Raines, L. A. (2003). Fidelity of implementation rating (FIMP): The training manual for PMTO. Eugene,
OR: Oregon Social Learning Center.
Outcomes
Outcome 1: Internalizing behaviors
Description of Measures
Key Findings
Studies Measuring Outcome
Study Designs
Quality of Research Rating
Outcome 2: Externalizing behaviors
Description of Measures
Key Findings
Studies Measuring Outcome
Study Designs
Quality of Research Rating
Outcome 3: Delinquency
Description of Measures
Key Findings
Studies Measuring Outcome
Study Designs
Quality of Research Rating
Outcome 4: Academic functioning
Description of Measures
Key Findings
Indicators of internalizing behaviors included (1) scores on the Child Depression Inventory (CDI), a
27-item symptom-oriented index (sample items include "feel sad," "feel like crying," "things bother
you," "feel alone," "others love you"); (2) scores on the Loneliness in Child Scale--Child Report, a 16
-item scale of loneliness and dissatisfaction with peer relations (sample items include "lonely in
school" and "feel left out"); and (3) teacher reports on adaptive functioning (Teacher Report Form).
PTC participants showed significant decreases in internalizing behaviors at 30 months and 9 years
postintervention (p < .05 and p < .10, respectively).
Study 1
Experimental
3.6 (0.0-4.0 scale)
Youth externalizing behavior was a contruct score of three main indicators: (1) teacher ratings of
antisocial and delinquent behaviors (Teacher Report Form); (2) observational measures (Structured
Interaction Task--SIT) obtained in the laboratory during eight structured interaction tasks, which
included mother-son problem-solving discussions; and (3) observational measures of aggression
using a measure of physical aversive behaviors.
PTC participants showed significant decreases in externalizing behaviors over time (p < .05).
Study 1
Experimental
3.4 (0.0-4.0 scale)
Youth delinquency was assessed at 9-year follow-up using (1) court records obtained by contacting
applicable city and State agencies, including cumulative number of arrests at each follow-up wave;
and (2) delinquent scores on the Teacher Report Form (TRF), which measures child behaviors over
the previous 2 months include stealing, use of drugs or alcohol, and associating with
troublemakers.
Thirty-six months after the intervention, PTC participants had lower rates of delinquency than other
youth, as measured by teacher reports (p < .05).
Study 1
Experimental
3.6 (0.0-4.0 scale)
Youth academic functioning was assessed using (1) the Woodcock-Johnson Psychoeducational
Battery, conducted in the laboratory to measure reading achievement, and (2) the Teacher Report
Form (TRF), an adaptive functioning score where teachers were asked to compare the participant to
other pupils on four items (e.g., "How much is he learning?", "How hard is he working?").
PTC participants typically produced improved homework quality, which predicted improved adaptive
 functioning and reading achievement (p < .05). If participants were supported by effective
parenting, they also experienced increased school adjustment.

Studies Measuring Outcome Study 1

Study Designs Experimental

Quality of Research Rating 3.8 (0.0-4.0 scale)

Outcome 5: Noncompliance with mother's directives

Description of Measures
Youth noncompliance was assessed by (1) a microsocial score computed from the Interpersonal
Process Code (IPC), measuring the proportion of child noncompliance following the mother's
directive given the total number of directives issued by the mother during the observation period;
(2) global ratings of behavior, based on overall observations made directly following scoring on the
microsocial behaviors; and (3) Child Interviewer Impressions, a scaled score based on global ratings
of noncompliance and consisting of three items: was cooperative during interview, was
noncompliant with mother, was noncompliant with interviewer.

Key Findings PTC participants typically scored lower than other youth in noncompliance (p < .05).

Studies Measuring Outcome Study 1

Study Designs Experimental

Quality of Research Rating 3.4 (0.0-4.0 scale)

Study Populations
The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity

Study 1 6-12 (Childhood) 50% Female 86% White

18-25 (Young adult) 50% Male 9% Race/ethnicity unspecified
26-55 (Adult) 2% American Indian or Alaska Native
2% Hispanic or Latino
1% Black or African American

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

1. Reliability of measures
2. Validity of measures
3. Intervention fidelity
4. Missing data and attrition
5. Potential confounding variables
6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Reliability Validity
of of Missing Confounding Data Overall
Outcome Measures Measures Fidelity Data/Attrition Variables Analysis Rating

1: Internalizing behaviors 4.0 4.0 3.5 3.0 3.0 4.0 3.6

2: Externalizing behaviors 3.5 3.5 3.5 3.0 3.0 4.0 3.4

3: Delinquency 3.5 3.5 3.5 4.0 3.0 4.0 3.6

4: Academic functioning 4.0 4.0 3.5 3.0 4.0 4.0 3.8

 5: Noncompliance with mother's 3.0 2.0 3.5 4.0 4.0 4.0 3.4
directives

Study Strengths
The intervention was well described, and acceptable methods were used to establish intervention fidelity and study eligibility criteria. Both
the intervention and controls succeeded in engaging and retaining single mothers, and were sufficiently flexible to meet individual and
group needs. Secondary analyses provided evidence that the intervention was consistent with the proposed theory. Multiple methods
were used to evaluate outcomes, addressing some potentially confounding variables. Most of the assessment measures had high
reliability and reports of validity. Missing data were handled with sophisticated methods. Randomization methods were adequately
described. The program's other strengths include the longitudinal and cross-sectional multipronged approach to assessment and the
cooperation of teachers and other informants across nine measurement points.

Study Weaknesses
The lack of the examination of participation bias limits the generalizability of the study results.

Readiness for Dissemination

Review Date: October 2006

Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information
regarding implementation of the intervention and the availability of additional, updated, or new materials.

Forgatch, M., & Rains, L. (n.d.). Marriage and parenting in stepfamilies [Handout].

Forgatch, M., Rains, L., Elgesem, E., & Knutson, N. (2006). A course in the basic PMTO model: Workshops 1, 2, & 3. Eugene, OR:
Oregon Social Learning Center/Implementation Sciences International, Inc.

Knutson, N., Forgatch, M., & Rains, L. (2003). Fidelity of implementation rating system (FIMP): The manual for PMTO. Eugene, OR:
Oregon Social Learning Center.

Knutson, N., Rains, L., & Forgatch, M. (2006). PMTO modules: Workshop trainer guide. Eugene, OR: Oregon Social Learning
Center/Implementation Sciences International, Inc.

Oregon Social Learning Center/Implementation Sciences International, Inc. (2006). A course in the basic PMTO model: Workshops 2 & 3.
Parent materials. Eugene, OR: Author.

Parenting Through Change Session Manual [English version]

Parenting Through Change Session Manual [Norwegian version]

Parenting Through Change Session Manual [Spanish version]

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

1. Availability of implementation materials

2. Availability of training and support resources
3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Training and Support Quality Assurance Overall

Materials Resources Procedures Rating

2.8 2.5 3.0 2.8

Dissemination Strengths
Implementation materials are available in several languages, and separate materials for parents in stepfamilies are provided. This program
appears to have been implemented in a variety of settings with training provided as part of a research project. A quality intervention
fidelity instrument was developed specifically for PTC.

Dissemination Weaknesses
 The Spanish-language implementation and training materials do not appear to have culturally specific modifications, such as parenting
information specifically adapted to Latino families. No information is provided on available training, technical assistance, or supervision.
Fidelity measures for quality assurance rely on the videotaping of all client sessions, which might be difficult to implement outside a
research setting. No process was provided for gathering outcome data or gaining client feedback. Implementation and training materials
could benefit from some cultural modifications, such as adding culturally specific parenting information for Latino families within the
Spanish materials.

Costs
The cost information below was provided by the developer. Although this cost information may have been updated by the developer since
the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The
implementation point of contact can provide current information and discuss implementation requirements.

Required by
Item Description Cost Developer

Implementation materials, training, technical assistance/consultation, and quality Contact the Contact the developer
assurance materials developer

Additional Information
The estimated cost of implementing PTC is $1,000 per participant, based on 10-15 participants per group, with 2 group facilitators
conducting 14 sessions. This cost includes (1) recording equipment for supervision and fidelity check, training of group supervisor, and
training of group facilitators; (2) user guides, program materials, and training and evaluation materials; and (3) other program expenses
(personnel costs for facilitators/group supervisors, monetary incentives for participants, child care costs, meals for mothers and children,
transportation cost assistance, reproduction of materials for handouts, DVDs for recording sessions, etc.).

Replications
Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

Forgatch, M. S., DeGarmo, D. S., & Beldavs, Z. G. (2005). An efficacious theory-based intervention for stepfamilies. Behavior Therapy,
36(4), 357-365.

Martinez, Jr., C. R., & Eddy, J. M. (2005). Effects of culturally adapted parent management training on Latino youth behavioral health
outcomes. Journal of Consulting and Clinical Psychology, 73, 841-851.

Contact Information
To learn more about implementation or research, contact:
Marion S. Forgatch, Ph.D.
(541) 485-2711
marionf@oslc.org

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

This PDF was generated from http://nrepp.samhsa.gov/ViewIntervention.aspx?id=67 on 11/20/2014