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Does Giving Parents Their Choice of Interventions for Child Behavior Problems Improve Child Outcomes?

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Abstract

Empowering consumers to be active decision-makers in their own care is a core tenet of personalized, or precision medicine. Nonetheless, there is a dearth of research on intervention preferences in families seeking interventions for a child with behavior problems. Specifically, the evidence is inconclusive as to whether providing parents with choice of intervention improves child/youth outcomes (i.e., reduces externalizing problems). In this study, 129 families presenting to community mental health clinics for child conduct problems were enrolled in a doubly randomized preference study and initially randomized to choice or no-choice conditions. Families assigned to the choice condition were offered their choice of intervention from among three different formats of the Parent Management Training-Oregon Model/PMTO (group, individual clinic, home based) and services-as-usual (child-focused therapy). Those assigned to the no-choice condition were again randomized, to one of the four intervention conditions. Intent-to-treat analyses revealed partial support for the effect of parental choice on child intervention outcomes. Assignment to the choice condition predicted teacher-reported improved child hyperactivity/inattention outcomes at 6 months post-treatment completion. No main effect of choice on parent reported child outcomes was found. Moderation analyses indicated that among parents who selected PMTO, teacher report of hyperactivity/inattention was significantly improved compared with parents selecting SAU, and compared with those assigned to PMTO within the no-choice condition. Contrary to hypotheses, teacher report of hyperactivity/inattention was also significantly improved for families assigned to SAU within the no-choice condition, indicating that within the no-choice condition, SAU outperformed the parenting interventions. Implications for prevention research are discussed.

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Funding

The research reported here was funded by grant no. P20 MH 079906 from the National Institute of Mental Health to Gerald August (Center PI) and Abigail Gewirtz (PI of this study)

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Authors and Affiliations

  1. Department of Family Social Science & Institute of Child Development, University of Minnesota, 290 McNeal Hall, 1985 Buford Ave, St. Paul, MN, 55108, USA

    Abigail H. Gewirtz

  2. Department of Psychiatry, University of Minnesota, 2312 S 6th St. Minneapolis, St. Paul, MN, 55454, USA

    Susanne S. Lee

  3. Department of Family Social Science, University of Minnesota, 290 McNeal Hall, 1985 Buford Ave, St. Paul, MN, 55108, USA

    Gerald J. August

  4. The Family Institute, Northwestern University, 618 Library Place, Evanston, IL, 60201, USA

    Yaliu He

Authors
  1. Abigail H. Gewirtz
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  2. Susanne S. Lee
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  3. Gerald J. August
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  4. Yaliu He
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Correspondence to Abigail H. Gewirtz.

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Ethical Approval

This study was approved by the University of Minnesota IRB and the Human Subjects Research Protection Board of the State of Michigan’s Department of Community Health. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all participants included in the study.

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Gewirtz, A.H., Lee, S.S., August, G.J. et al. Does Giving Parents Their Choice of Interventions for Child Behavior Problems Improve Child Outcomes?. Prev Sci 20, 78–88 (2019). https://doi.org/10.1007/s11121-018-0865-x

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