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Journal ArticleDOI

Parent Functioning and Child Psychotherapy Outcomes: Predicting Outcomes in Usual Care

01 Jan 2021-Journal of Clinical Psychology (John Wiley & Sons, Ltd)-Vol. 77, Iss: 1, pp 49-59
TL;DR: Results suggested that parent domains significantly predicted their child's symptoms at intake as well as change in psychotherapy, which highlighted the important relationship between youth and parent functioning in the context of treatment of youth mental health issues.
Abstract: Objective The purpose of this study was (1) to examine whether three domains of a parent's functioning-parent distress, interpersonal relationships, and social role performance-changed over the course of their child's treatment, (2) to examine how these factors as measured at intake predicted youth progress in psychotherapy, and (3) to examine whether changes in these parent factors over the course of youth psychotherapy were associated with changes in youth symptoms. Method Participants were 339 youth, ages 4-17 and their parents from a community outpatient treatment setting undergoing usual care. Parent and child outcomes were examined across five time points over the course of child treatment. Hierarchical linear modeling was used to examine the relationship between parent domains and youth progress in therapy. Results Results suggested that parent domains significantly predicted their child's symptoms at intake as well as change in psychotherapy. In addition, parent domains improved over the course of youth treatment and the progression of these changes was related to the progression of changes in youth scores across the course of treatment. Conclusions The results of this study highlight the important relationship between youth and parent functioning in the context of treatment of youth mental health issues.

Summary (2 min read)

BYU ScholarsArchive Citation

  • Packard, Anna Elise, "Parent Functioning and Child Psychotherapy Outcomes: Predicting Outcomes in Usual Care" (2009).
  • In examining mechanisms of change in youth psychotherapy, variables related to parent functioning may be among the most important factors to consider in predicting and promoting good child outcomes.
  • I would like to express my appreciation for all the support, productive feedback, and guidance provided by my dissertation chair, Jared Warren, Ph.D. Research on child and adolescent psychotherapy has made great advances in recent decades (Kazdin, 2003), with over 1,500 treatment outcome studies conducted (Kazdin, 2003; Kazdin & Kendall, 1998; Kazdin & Wassel, 2000).
  • Thus, extending treatment research to typical clinical settings is critical to establish true effectiveness of therapy, build robust and practical treatments, and lend evidence to theory.

Parent Functioning and Children’s Mental Health

  • There are numerous potential mediators and moderators of treatment outcome for children and adolescents.
  • Parental psychopathology also influences the environment in which the child resides and grows and changes the ways in which parents interact with their children.
  • In a review of the literature on marital conflict as influential of child adjustment, Grych and Fincham (1990) found that frequent exposure to interparental conflict increases distress and maladaptive behavior in children, with more severe conflict associated with higher child distress.
  • Addressing child symptoms may in turn influence parent and family factors (Kazdin, 2004; Kazdin & Wassel, 2000).
  • Finally, the literature provides compelling evidence for the connection between parent functioning and the development and maintenance of child psychopathology as well as influencing child psychotherapy outcomes.

Participants

  • Children aged 4 to 17 years and their primary caregivers were recruited for participation through the Valley Mental Health Child Outpatient Clinic in Salt Lake City, Utah.
  • Using the reliable change indices for both the OQ-45 and the Y-OQ, as described earlier in the measures section, I was able to determine if significant and reliable change occurred for participants and examined the effect sizes of these changes.
  • Intake scores for the Y-OQ and Y-OQ-SR were tested as predictors of parent Symptom Distress, Interpersonal Relations, Social Role performance, and OQ total scores at intake and rate of change in these variables over Parent Functioning 52 the course of treatment.
  • Thus, it is not surprising that the significant relationship found in this study serves to further support the empirical observation that parent functioning is associated with youth outcomes in therapy opposed to youth symptoms predicting changes in parent functioning.
  • That is, therapists varied in psychotherapy orientation and may or may not have followed specific evidence based treatment Parent Functioning 63 protocols depending on presenting problems.

Study Applications and Future Directions

  • This study underscores the importance of attending to parent functioning both in the assessment and treatment phase for youth presenting for mental health services in traditional community settings.
  • Thus, these findings not only indicate significant therapeutic gains that extend to the parents of youth being treated, but also suggest more Parent Functioning 65 optimistic outcomes in regards to the maintenance of therapeutic gains due to improved family functioning.
  • Parent psychological distress, parent–child relationship qualities and child adjustment: Direct, mediating and reciprocal pathways.

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Brigham Young University Brigham Young University
BYU ScholarsArchive BYU ScholarsArchive
Theses and Dissertations
2009-11-14
Parent Functioning and Child Psychotherapy Outcomes: Parent Functioning and Child Psychotherapy Outcomes:
Predicting Outcomes in Usual Care Predicting Outcomes in Usual Care
Anna Elise Packard
Brigham Young University - Provo
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Packard, Anna Elise, "Parent Functioning and Child Psychotherapy Outcomes: Predicting Outcomes in
Usual Care" (2009).
Theses and Dissertations
. 2311.
https://scholarsarchive.byu.edu/etd/2311
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Parent Functioning and Child Psychotherapy Outcomes:
Predicting Outcomes in Usual Care
Anna E. Packard
A dissertation submitted to the faculty of
Brigham Young University
in partial fulfillment of the requirements for the degree of
Doctor of Philosophy
Jared S. Warren, Chair
Gary M. Burlingame
Michael J. Lambert
Sally H. Barlow
Joseph A. Olsen
Department of Psychology
Brigham Young University
August 2010
Copyright © 2009 Anna E. Packard
All Rights Reserved

ABSTRACT
Parent Functioning and Child Psychotherapy Outcomes:
Predicting Outcomes in Usual Care
Anna E. Packard
Department of Psychology
Doctor of Philosophy
A prominent need in the youth psychotherapy literature includes the examination of
mechanisms of change within the context of “real world” clinical settings, where the practice of
psychotherapy differs significantly from that in controlled clinical trials. In examining
mechanisms of change in youth psychotherapy, variables related to parent functioning may be
among the most important factors to consider in predicting and promoting good child outcomes.
The purpose of the present study was to evaluate three important aspects of parent functioning—
psychological symptom distress, interpersonal relations, and social role performance—as
potential predictors of successful treatment outcomes in a traditional community outpatient
treatment setting for children and adolescents. Further, this study examined whether parents
indirectly benefited from their children receiving services, expanding our view on the scope and
benefits inherent in youth psychotherapy. Parent Symptom Distress, Interpersonal Relations, and
Social Role performance were measured using the domains of the Outcome Questionnaire 45
(OQ-45; Lambert et al., 2004), and youth treatment outcomes were measured using the parent
and self-report versions of the Youth-Outcome Questionnaire (Y-OQ; Burlingame, Wells,
Lambert, & Cox, 2004; Y-OQ-SR; Wells, Burlingame & Rose, 2003). Using Hierarchical Linear
Modeling with this sample of 339 youth, aged 4-17 and their parents, this study examined the
relationship between these parent domains and youth progress in therapy. Results revealed that
parent Symptom Distress and Social Role performance improved significantly over the course of
yo uth treatment. Further, Social Role performance at intake significantly predicted the rate of
change in parent-reported youth outcome; and Interpersonal Relations at intake significantly
predicted rate of change in youth-reported outcome. Finally, changes in parent Social Role
performance were associated with changes in youth symptoms over the course of treatment.
Examining the associations between these variables is an important step toward identifying
potential mechanisms of change in youth mental health treatment. The results of this study
provide valuable information on the importance of attending to parent functioning in the
assessment and treatment of youth mental health issues.
Keywords: youth psychotherapy, treatment outcome, parent distress, mental health services
research, usual care, Youth Outcome Questionnaire

ACKNOWLEDGEMENTS
I would like to express my appreciation for all the support, productive feedback, and
guidance provided by my dissertation chair, Jared Warren, Ph.D. Id also like to extend a special
thanks to my committee members, Gary Burlingame, Ph.D., Michael Lambert, Ph.D., Sally
Barlow, Ph.D. and Joseph Olsen, Ph.D., for their thoughtful insights and careful reviews. Finally,
I want to express a special thank-you to my husband, Chad, and my family for all their patience
and moral support through this long and rigorous process.

v
TABLE OF CONTENTS
Introduction………………………………………………………………………………………..1
Child Psychotherapy Research……………………………………………………………3
Child/Adolescent Outcome Research in Usual Care……………………………………...4
Mechanisms of Change in Child Psychotherapy………………………………………….7
Parent Functioning and Children’s Mental Health………………………………………..9
Parent Functioning and Child Psychotherapy Outcomes………………………...............15
Potential Impact of Child Treatment on Parent Symptoms……………………...............20
Limitations of Previous Research………………………………………………………..22
Study Aims………………………………………………………………………………23
Hypotheses……………………………………………………………………………….24
Method…………………………………………………………………………………...............24
Participants……………………………………………………………………………….25
Measures…………………………………………………………………………………26
Procedures………………………………………………………………………………..29
Analysis…………………………………………………………………………………..31
Results……………………………………………………………………………………………35
Hypothesis 1: Examining Whether Change Occurred in Parent Domains………………35
Hypothesis 2: Intake OQ Scores Predicting Changes in Y-OQ Scores and Intake
Y-OQ Scores Predicting Changes in OQ Scores……….………………………………..45
Hypothesis 3: Relationship Between Changes in OQ Scores and Changes in
Youth Symptoms………………………………………………………………...............54
Discussion………………………………………………………………………………………..55

Citations
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TL;DR: This application applied longitudinal data analysis modeling change and event occurrence will help people to enjoy a good book with a cup of coffee in the afternoon instead of facing with some infectious virus inside their computer.
Abstract: Thank you very much for downloading applied longitudinal data analysis modeling change and event occurrence. As you may know, people have look hundreds times for their favorite novels like this applied longitudinal data analysis modeling change and event occurrence, but end up in malicious downloads. Rather than enjoying a good book with a cup of coffee in the afternoon, instead they are facing with some infectious virus inside their computer.

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Journal ArticleDOI
TL;DR: In this article, interpretative phenomenological analysis was used to analyze semi-structured interviews of eight parents who had completed parent-child psychotherapy about their understanding of change, and five master themes emerged that encapsulated participants' understanding and acceptance of change.
Abstract: Understanding how change occurs in psychotherapy is imperative in informing clinical practice. Increasing attention has been given to the role that qualitative research could play in enhancing our understanding of therapeutic change. Although quantitative research suggests that parent-child psychotherapy is effective in facilitating change, no research to date has focused on how parents make sense of their change experience. In this study, interpretative phenomenological analysis was used to analyze semi-structured interviews of eight parents who had completed parent-child psychotherapy about their understanding of change. Five master themes emerged that encapsulated participants’ understanding of change. These included constructing a survivor narrative, the experience of being understood enabling further understanding, adjusting expectations and practicing acceptance, and feeling empowered to relinquish control. The final theme summarized how despite psychotherapy being conceptualized as a “preci...

6 citations


Cites background from "Parent Functioning and Child Psycho..."

  • ...…highlighted the importance of child-therapist and parent-therapist alliance in predicting therapeutic change (Kazdin & Whitley, 2006), and some research suggests that variables relating to parent-functioning are the most important to consider when predicting improved child outcomes (Packard, 2009)....

    [...]

  • ...Quantitative research and questionnaires can measure improvement but cannot pick up the more subtle aspects of the parent’s experience or how they make sense of changes that occur (Packard, 2009)....

    [...]

  • ..., 1998), and others suggesting that parent functioning variables are the most important to consider (Packard, 2009)....

    [...]

  • ...Research reflects this tension, with some studies reporting quantifiable behavior changes in children (Hawley et al., 2003; Schuhmann et al., 1998), and others suggesting that parent functioning variables are the most important to consider (Packard, 2009)....

    [...]

  • ...Findings have highlighted the importance of child-therapist and parent-therapist alliance in predicting therapeutic change (Kazdin & Whitley, 2006), and some research suggests that variables relating to parent-functioning are the most important to consider when predicting improved child outcomes (Packard, 2009)....

    [...]

Journal ArticleDOI
TL;DR: The results from the National Survey of Children's Exposure to Violence (NatSCEV) demonstrate that nearly 26% of children were exposed to domestic violence at some point in their lives.
Abstract: Domestic violence is a serious societal problem that sadly threatens many children. Results from the National Survey of Children’s Exposure to Violence (NatSCEV) demonstrate that nearly 26% of chil...

2 citations


Cites result from "Parent Functioning and Child Psycho..."

  • ...This may indicate that parental mental health and children’s mental health are interconnected, which is an idea that previous research has also supported (e.g., Packard, 2010; Smith, 2004; Vostanis et al., 2006)....

    [...]

References
More filters
Journal ArticleDOI
TL;DR: This article seeks to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating the many ways in which moderators and mediators differ, and delineates the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena.
Abstract: In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.

80,095 citations

Book
01 Jun 1991

12,618 citations


"Parent Functioning and Child Psycho..." refers methods in this paper

  • ...Concurrent validity estimates have been computed between both Y-OQ total and subscale scores and the Achenbach’s Child Behavior Checklist (CBCL) total and subscale scores (Achenbach, 1991) and the Conner’s Parent Rating Scale total and subscale scores (CPRS-93, Conners, 1994)....

    [...]

Book
01 Jan 2003
TL;DR: In this paper, a framework for investigating change over time is presented, where the multilevel model for change is introduced and a framework is presented for investigating event occurrence over time.
Abstract: PART I 1. A framework for investigating change over time 2. Exploring Longitudinal Data on Change 3. Introducing the multilevel model for change 4. Doing data analysis with the multilevel mode for change 5. Treating TIME more flexibly 6. Modelling discontinuous and nonlinear change 7. Examining the multilevel model's error covariance structure 8. Modelling change using covariance structure analysis PART II 9. A Framework for Investigating Event Occurrence 10. Describing discrete-time event occurrence data 11. Fitting basic Discrete-Time Hazard Models 12. Extending the Discrete-Time Hazard Model 13. Describing Continuous-Time Event Occurrence Data 14. Fitting Cox Regression Models 15. Extending the Cox Regression Model

8,435 citations


"Parent Functioning and Child Psycho..." refers background or methods in this paper

  • ...Unlike “typical” pre-post analyses, these sophisticated mixed model analyses allowed me to examine the shape and rate of change as well as covariates of change (Laurenceau et al, 2007; Singer & Willett, 2003)....

    [...]

  • ...Hierarchical linear modeling can be conceptualized as a two-stage model (Bryk & Raudenbush, 1987; Laurenceau, et al., 2007: Singer & Willett, 2003)....

    [...]

  • ...That is, interindividual differences in change and slope are examined as they relate to specific predictors of change (Singer & Willett, 2003)....

    [...]

  • ...HLM is a type of mixed model, which is often used with longitudinal data to examine inter-individual variability in change along with predictors or other covariates of interest that may affect the rate and shape of change (Laurenceau, Hayes & Feldman, 2007; Singer & Willett, 2003)....

    [...]

Journal ArticleDOI
TL;DR: In this paper, the authors defined clinically significant change as the extent to which therapy moves someone outside the range of the dysfunctional population or within the ranges of the functional population, and proposed a reliable change index (RC) to determine whether the magnitude of change for a given client is statistically reliable.
Abstract: In 1984, Jacobson, Follette, and Revenstorf defined clinically significant change as the extent to which therapy moves someone outside the range of the dysfunctional population or within the range of the functional population. In the present article, ways of operationalizing this definition are described, and examples are used to show how clients can be categorized on the basis of this definition. A reliable change index (RC) is also proposed to determine whether the magnitude of change for a given client is statistically reliable. The inclusion of the RC leads to a twofold criterion for clinically significant change.

7,653 citations


"Parent Functioning and Child Psycho..." refers background or methods in this paper

  • ...developed by Jacobson and Truax (1991). The RCI can be used to indicate whether a score on an...

    [...]

  • ...With this in mind, Lambert (1998) developed algorithms based on a statistical index known as the reliable change index, or RCI, developed by Jacobson and Truax (1991)....

    [...]

  • ...Jacobson and Truax (1991) point to “clinical significance” as an important gauge of treatment effect when monitoring outcome....

    [...]

Frequently Asked Questions (2)
Q1. What are the contributions mentioned in the paper "Parent functioning and child psychotherapy outcomes: predicting outcomes in usual care" ?

The purpose of the present study was to evaluate three important aspects of parent functioning— psychological symptom distress, interpersonal relations, and social role performance—as potential predictors of successful treatment outcomes in a traditional community outpatient treatment setting for children and adolescents. Further, this study examined whether parents indirectly benefited from their children receiving services, expanding their view on the scope and benefits inherent in youth psychotherapy. Parent Symptom Distress, Interpersonal Relations, and Social Role performance were measured using the domains of the Outcome Questionnaire 45 ( OQ-45 ; Lambert et al., 2004 ), and youth treatment outcomes were measured using the parent and self-report versions of the Youth-Outcome Questionnaire ( Y-OQ ; Burlingame, Wells, Lambert, & Cox, 2004 ; Y-OQ-SR ; Wells, Burlingame & Rose, 2003 ). Using Hierarchical Linear Modeling with this sample of 339 youth, aged 4-17 and their parents, this study examined the relationship between these parent domains and youth progress in therapy. Further, Social Role performance at intake significantly predicted the rate of change in parent-reported youth outcome ; and Interpersonal Relations at intake significantly predicted rate of change in youth-reported outcome. The results of this study provide valuable information on the importance of attending to parent functioning in the assessment and treatment of youth mental health issues. Examining the associations between these variables is an important step toward identifying potential mechanisms of change in youth mental health treatment. 

Further research is needed to highlight this potentially important association ; subsequent research will be needed to further examine the specific aspects of parent social role performance that are most strongly associated with youth symptoms and outcomes. Finally, it may be advantageous if future research examined whether providing clinicians and parents with specific feedback on parent functioning in the context of youth treatment would facilitate treatment gains and decrease the frequency of negative outcomes. Maternal expressed emotion and clinician ratings of emotional maltreatment potential.