Abstract
Background
Behavioral parent training has been demonstrated to be an effective treatment for child behavior problems; however, lack of parent engagement can limit the effectiveness of treatment. Understanding more about predictors and correlates of a specific measure of parent engagement—homework completion—in parent training can help to improve treatment effectiveness and treatment outcomes.
Objective
We examined predictors of homework completion, as well as the relationship between homework completion, treatment correlates, and treatment outcomes in an open trial of parent–child interaction therapy (PCIT), a behavioral parent training program.
Methods
Participants included 53 families (mean child age = 4.40 years, SD = 1.43) who received PCIT in a community mental health center serving demographically (i.e., SES, ethnicity) diverse families.
Results
Homework completion varied significantly between mothers and fathers but did not vary with other demographic family characteristics. Parents who completed treatment showed a somewhat greater likelihood of completing homework throughout treatment and a significantly greater likelihood of completing homework during the first phase of treatment. Additionally, parents who completed more homework were more likely to report higher levels of treatment satisfaction and showed a trend toward completing treatment in fewer sessions.
Conclusions
Our findings suggest that homework has some benefits for treatment outcomes. Despite the benefits of homework, rates of adherence to homework were variable and below optimal levels. Study findings have implications for further understanding the role of homework in behavioral parent training programs.
Similar content being viewed by others
References
Baker-Ericzén, M. J., Hurlburt, M. S., Brookman-Frazee, L., Jenkins, M. M., & Hough, R. L. (2010). Comparing child, parent, and family characteristics in usual care and empirically supported treatment research samples for children with disruptive behavior disorders. Journal of Emotional and Behavioral Disorders, 18, 82–99.
Baydar, N., Reid, M. J., & Webster-Stratton, C. (2003). The role of mental health factors and program engagement in the effectiveness of a preventive parenting program for Head Start mothers. Child Development, 74, 1433–1453.
Berkovits, M. D., O’Brien, K. A., Carter, C. G., & Eyberg, S. M. (2010). Early identification and intervention for behavior problems in primary care: A comparison of two abbreviated versions of parent-child interaction therapy. Behavior Therapy, 41, 375–387.
Brestan, E., Jacobs, J., Rayfield, A., & Eyberg, S. M. (1999). A consumer satisfaction measure for parent-child treatments and its relation to measures of child behavior change. Behavior Therapy, 30, 17–30.
Bryant, M. J., Simons, A. D., & Thase, M. E. (1999). Therapist skill and patient variables in homework compliance: Controlling an uncontrolled variable in cognitive therapy outcome research. Cognitive Therapy and Research, 23, 381–399.
Cammin-Nowak, S., Helbig-Lang, S., Lang, T., Gloster, A. T., Fehm, L., Gerlach, A. L., & Wittchen, H. U. (2013). Specificity of homework compliance effects on treatment outcome in CBT: Evidence from a controlled trial on panic disorder and agoraphobia. Journal of Clinical Psychology, 69, 616–629.
Carroll, K. M., Nich, C., & Ball, S. A. (2005). Practice makes progress? Homework assignments and outcome in treatment of cocaine dependence. Journal of Consulting and Clinical Psychology, 73, 749–755.
Chacko, A., Anderson, L., Wymbs, B. T., & Wymbs, F. A. (2013). Parent-endorsed reasons for not completing homework in group-based behavioural parent training for high-risk families of youth with ADHD. Behaviour Change, 30, 262–272.
Chacko, A., Wymbs, B. T., Chimiklis, A., Wymbs, F. A., & Pelham, W. E. (2012). Evaluating a comprehensive strategy to improve engagement to group-based behavioral parent training for high-risk families of children with ADHD. Journal of Abnormal Child Psychology, 40, 1351–1362.
Chacko, A., Wymbs, B. T., Wymbs, F. A., Pelham, W. E., Swanger-Gagne, M. S., Girio, E., & O’Connor, B. (2009). Enhancing traditional behavioral parent training for single mothers of children with ADHD. Journal of Clinical Child and Adolescent Psychology, 38, 206–218.
Chaffin, M., Valle, L. A., Funderburk, B., Gurwitch, R., Silovsky, J., Bard, D., & Kees, M. (2009). A motivational intervention can improve retention in PCIT for low-motivation child welfare clients. Child Maltreatment, 14, 356–368.
Christian, A. S., Niec, L. N., Acevedo-Polakovich, I. D., & Kassab, V. A. (2014). Dissemination of an evidence-based parenting program: Clinician perspectives on training and implementation. Children and Youth Services Review, 43, 8–17.
Cunningham, C. E., Davis, J. R., Bremner, R., Dunn, K. W., & Rzasa, T. (1993). Coping modeling problem solving versus mastery modeling: Effects on adherence, in-session process, and skill acquisition in a residential parent-training program. Journal of Consulting and Clinical Psychology, 61, 871–877.
Dozois, D. A. (2010). Understanding and enhancing the effects of homework in cognitive- behavioral therapy. Clinical Psychology: Science and Practice, 17, 157–161.
Eyberg, S. M., & Child Study Lab. (1999). Parent-Child Interaction Therapy Integrity Checklists and Session Materials. Gainesville, FL: University of Florida.
Eyberg, S. M., & Funderburk, B. W. (2011). Parent–child interaction therapy protocol. Gainesville, FL: PCIT International.
Eyberg, S. M., & Matarazzo, R. G. (1980). Training parents as therapists: A comparison between individual parent–child interaction training and parent group didactic training. Journal of Clinical Psychology, 36, 492–499.
Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology, 37, 215–237.
Eyberg, S. M., & Pincus, D. (1999). Eyberg child behavior inventory and Sutter–Eyberg student behavior inventory-revised: Professional manual. Odessa, FL: Psychological Assessment Resources.
Fabiano, G. A., Chacko, A., Pelham, W. E, Jr, Robb, J., Walker, K. S., Wymbs, F., & Pirvics, L. (2009). A comparison of behavioral parent training programs for fathers of children with attention-deficit/hyperactivity disorder. Behavior Therapy, 40, 190–204.
Forehand, R. T., & McMahon, R. J. (1981). Helping the noncompliant child. New York: The Guilford Press.
Haine-Schlagel, R., & Walsh, N. E. (2015). A review of parent participation engagement in child and family mental health treatment. Clinical Child and Family Psychology Review, 18, 133–150.
Harpaz-Rotem, I., Leslie, D., & Rosenheck, R. A. (2004). Treatment retention among children entering a new episode of mental health care. Psychiatric Services, 55, 1022–1028.
Helbig, S., & Fehm, L. (2004). Problems with homework in CBT: Rare exception or rather frequent? Behavioural and Cognitive Psychotherapy, 32, 291–301.
Högström, J., Enebrink, P., Melin, B., & Ghaderi, A. (2015). Eighteen-month follow-up of internet-based parent management training for children with conduct problems and the relation of homework compliance to outcome. Child Psychiatry and Human Development, 46, 577–588.
Ingoldsby, E. M. (2010). Review of interventions to improve family engagement and retention in parent and child mental health programs. Journal of Child and Family Studies, 19, 629–645.
Jones, D. J., Forehand, R., Cuellar, J., Parent, J., Honeycutt, A., Khavjou, O., & Newey, G. A. (2014). Technology-enhanced program for child disruptive behavior disorders: Development and pilot randomized control trial. Journal of Clinical Child and Adolescent Psychology, 43, 88–101.
Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training program effectiveness. Journal of Abnormal Child Psychology, 36, 567–589.
Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000). Homework assignments in cognitive and behavioral therapy: A meta-analysis. Clinical Psychology: Science and Practice, 7, 189–202.
Kazantzis, N., Deane, F. P., Ronan, K. R., & L’Abate, L. (Eds.). (2005). Using homework assignments in cognitive behavioral therapy. New York: Routledge.
Kazantzis, N., Whittington, C., & Dattilio, F. (2010). Meta-analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice, 17, 144–156.
Kling, A., Forster, M., Sundell, K., & Melin, L. (2010). A randomized controlled effectiveness trial of parent management training with varying degrees of therapist support. Behavior Therapy, 41, 530–542.
Krieger, N. (1992). Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology. American Journal of Public Health, 82, 703–710.
Krieger, N., Williams, D. R., & Moss, N. E. (1997). Measuring social class in US public health research: Concepts, methodologies, and guidelines. Annual Review of Public Health, 18, 341–378.
Lindsey, M. A., Brandt, N. E., Becker, K. D., Lee, B. R., Barth, R. P., Daleiden, E. L., & Chorpita, B. F. (2014). Identifying the common elements of treatment engagement interventions in children’s mental health services. Clinical Child and Family Psychology Review, 17, 283–298.
Lundahl, B., Risser, H. J., & Lovejoy, M. C. (2006). A meta-analysis of parent training: Moderators and follow-up effects. Clinical Psychology Review, 26, 86–104.
Lyon, A. R., & Budd, K. S. (2010). A community mental health implementation of parent-child interaction therapy. Journal of Child and Family Studies, 19, 654–668.
Mausbach, B. T., Moore, R., Roesch, S., Cardenas, V., & Patterson, T. L. (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis. Cognitive Therapy and Research, 34, 429–438.
McNeil, C. B., & Hembree-Kigin, T. L. (Eds.). (2010). Coaching child-directed interaction. In Parent–child interaction therapy (pp. 77–102). New York: Springer.
Morrissey-Kane, E., & Prinz, R. J. (1999). Engagement in child and adolescent treatment: The role of parental cognitions and attributions. Clinical Child and Family Psychology Review, 2, 183–198.
Nix, R. L., Bierman, K. L., & McMahon, R. J. (2009). How attendance and quality of participation affect treatment response to parent management training. Journal of Consulting and Clinical Psychology, 77, 429–438.
Nock, M. K., & Ferriter, C. (2005). Parent management of attendance and adherence in child and adolescent therapy: A conceptual and empirical review. Clinical Child and Family Psychology Review, 8, 149–166.
Nock, M. K., & Kazdin, A. E. (2001). Parent expectancies for child therapy: Assessment and relation to participation in treatment. Journal of Child and Family Studies, 10, 155–180.
Patterson, G. R., & Forgatch, M. S. (1985). Therapist behavior as a determinant for client noncompliance: A paradox for the behavior modifier. Journal of Consulting and Clinical Psychology, 53, 846–851.
Prinz, R. J., & Miller, G. E. (1994). Family-based treatment for childhood antisocial behavior: Experimental influences on dropout and engagement. Journal of Consulting and Clinical Psychology, 62, 645–650.
Reid, M. J., & Webster-Stratton, C. (2001). The incredible years parent, teacher, and child intervention: Targeting multiple areas of risk for a young child with pervasive conduct problems using a flexible, manualized, treatment program. Cognitive and Behavior Practice, 8, 377–386.
Reid, M. J., Webster-Stratton, C., & Baydar, N. (2004). Halting the development of conduct problems in Head Start children: The effects of parent training. Journal of Clinical Child and Adolescent Psychology, 33, 279–291.
Reyno, S., & McGrath, P. (2006). Predictors of parent training efficacy for child externalizing behavior problems – a meta-analytic review. Journal of Child Psychology and Psychiatry, 47, 99–111.
Schoenfield, L. J. (2004). The predictive ability of adherence to homework and skill acquisition for treatment outcome in parent–child interaction therapy. Master’s thesis, University of Florida.
Staudt, M. (2007). Treatment engagement with caregivers of at-risk children: Gaps in research and conceptualization. Journal of Child and Family Studies, 16, 183–196.
Tiano, J. D., Grate, R. M., & McNeil, C. B. (2013). Comparison of mothers’ and fathers’ opinions of parent–child interaction therapy. Child and Family Behavior Therapy, 35, 110–131.
Travis, J. K., & Brestan-Knight, E. (2013). A pilot study examining trainee treatment session fidelity when parent–child interaction therapy (PCIT) is implemented in community settings. The Journal of Behavioral Health Services & Research, 40, 342–354.
Tynan, W., Chew, C., & Algermissen, M. (2004). Concurrent parent and child therapy groups for externalizing disorders: The rural replication. Cognitive and Behavioral Practice, 11, 99–101.
Tynan, W., Schuman, W., & Lampert, N. (1999). Concurrent parent and child therapy groups for externalizing disorders: From the laboratory to the world of managed care. Cognitive and Behavioral Practice, 6, 3–9.
Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24, 190–195.
Zisser, A., & Eyberg, S. M. (2010). Treating oppositional behavior in children using parent-child interaction therapy. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 179–193). New York: Guilford.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Danko, C.M., Brown, T., Van Schoick, L. et al. Predictors and Correlates of Homework Completion and Treatment Outcomes in Parent–Child Interaction Therapy. Child Youth Care Forum 45, 467–485 (2016). https://doi.org/10.1007/s10566-015-9339-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10566-015-9339-5