When Cheap is Good : Cost-Effective Parent and Teacher Interventions for Children with Externalizing Behavior Problems

Sammanfattning: There is strong empirical support for behavioral parent training (BPT) as an intervention for children with externalizing behavior problems (EBP). However, there is a lack of studies that have investigated the effectiveness of BPT in routine care. Furthermore, most families in need of service do not gain access to it. Another issue of concern is that a sizable portion of children who take part in BPT does not show clinical significant improvement. With regard to behavioral teacher training (BTT) for students with EBP, there is a paucity of intervention trials using randomized design. The training procedures have rarely been standardized, which have resulted in interventions that are dependent upon heavy involvement of external consultants. To improve the accessibility to service for students with EBP, intervention models that are feasible for typical school personnel need to be developed.Study I investigated the effects of BPT in routine care. The participants were randomized to BPT with full practitioner support (BPT-P), self-administered BPT with minimal practitioner support (BPT-S), or a waitlist control group (WL). The study showed that BPT implemented by briefly trained social service employees (BPT-P) resulted in at least as large effects as previous efficacy studies. PMT-S also showed significant effects compared to the WL, but was less effective than PMT-P. Improvements in child behaviors were mediated by improved parenting behaviors. Study II investigated the effects of an enhanced version of the BPT-program from study I. The program targeted families with risk factors for non-response that were referred to service within the social services. The results showed strong intervention effects on child EBP and parent anxiety/depression for enhanced BPT compared to regular BPT. Study III used a randomized design to evaluate the effects of a standardized and feasible BTT program. At both posttest and follow-up, significant effects favoring the BTT-group over the active control group were found on student EBP, teacher behavior management, and peer problems. The study also showed that the effect on student EBP was mediated by change in teacher behavior management.