Parent Smart: Effects of a Technology-Assisted Intervention for Parents of Adolescents in Residential Substance Use Treatment on Parental Monitoring and Communication

Sara J. Becker, Sarah A. Helseth, Tim Janssen, Lourah M. Kelly, Katherine Escobar & Anthony Spirito (2021)
Evidence-Based Practice in Child and Adolescent Mental Health, 6(4), 459–472.

The Parenting Wisely program was used as a principal component of the Parent SMART intervention. Observations of parents and teens interacting showed significant improvements in parental monitoring and communication, two predictors of teen substance abuse. A related study showed reductions in teen substance use and school problems at a short-term facility when the parents received Parent SMART compared to a treatment-as-usual intervention.

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Parenting Wisely (PW) was implemented in projects, funded by the Center for Substance Abuse Prevention, in five community settings with different populations: a family-centered substance abuse service in Florida, a community health care clinic (inpatient and outpatient) in Massachusetts, a community substance abuse treatment service in California, and school-based programs in Kansas and Iowa. Part of the funding paid for independent evaluations by professionals who were not part of the implementing organization, nor connected with the publisher of Parenting Wisely(PW). In addition to these projects, PW was used with a consortium of youth offender treatment teams in England, a community health center in Ireland, and in a community mental health center in British Columbia, Canada. The various populations receiving the program include substance-abusing parents and their children, low-income ethnic minority families (Portuguese, Hispanic, Asian, African American, African Caribbean), and juvenile offenders. The pre-posttest differences summarized below are significant.
Stalker, K.C., Rose, R.A., Bacallao, M;, & Smokowski,P.R. (2018)
Parenting Wisely Six Months Later: How Implementation Delivery Impacts Program Effects at Follow-Up.
Journal of Primary Prevention.

Abstract: We evaluated the effectiveness of the Parenting Wisely (PW) program six months post intervention and assessed differences based on delivery format. Using a quasi-experimental design, parents (N = 311) participated in the PW program in one of five formats (i.e., parents- only intensive workshop, parents-only 5-week group, parents and adolescents 5-week group, parent and adolescent online, and parent-only online format). An additional 53 parents served as a comparison group. We used the McMaster Family Assessment Device, the Child Behavior Checklist, and the Violent Behavior Checklist to measure family functioning, parenting, and adolescent behavior. Relative to the comparison group, at 6 month follow-up parents who participated in PW reported increases in confidence in their parenting skills, decreases in conflicts with their adolescents, and decreases in adolescent externalizing and violent behavior. Mechanisms of change analyses supported the conceptual model that program effects were related to child behavior changes by influencing positive parenting and decreasing negative family dynamics. PW effectiveness did not vary substantially by delivery format, except for the brief workshop format, which was less effective than other formats. These findings extend research on PW to include evidence of sustained program effects on adolescent externalizing and violent behaviors in an ethnically diverse, socioeconomically disadvantaged sample. Study findings are relevant to agencies and clinicians who are seeking to implement an evidence-based, flexible parent-training program. ​
Katie L. Cotter, Martica Bacallao, Paul R. Smokowski, and Caroline I. B. Robertson (2013)
Parenting Interventions Implementation Science: How Delivery Format Impacts the Parenting Wisely Program 
Research on Social Work Practice, published online 31 May 2013, 1-12.

Objectives: This study examines the implementation and effectiveness of Parenting Wisely, an Internet-based parenting skills intervention. The study assesses whether parents benefit from Parenting Wisely participation and whether the delivery format influences program effectiveness. Method: This study uses a quasi-experimental design. Participating parents (N ¼ 144) come from a rural, impoverished, ethnically diverse county in a Southeastern state. The intervention is delivered via four formats: parents only intensive workshop, parents-only 5-week group, parent and adolescent 5-week group, and parent and adolescent online format.

Results: Findings show an association between Parenting Wisely participation and improvements in family problem solving, family roles, family involvement, parenting self-efficacy, parenting sense of competence, and decreased adolescent violent behavior. Effect sizes vary by delivery format. Conclusion: Positive program effects vary by delivery format and outcome. Practice implications are discussed.
Cefai, J., Smith, D., & Pushak, R.E. (2010)
Parenting Wisely: Parent Training via CD-ROM with an Australian sample.
Child and Family Behavior Therapy, 32, No. 1, 17-33.

This evaluation examined the effectiveness of the Parenting Wisely parenting program with an Australian sample in regards to improving parenting knowledge, parental sense of competence, and child behavior. One hundred and sixteen parents and their children participated in the evaluation. Participants were randomly assigned to one of three conditions: a 2 session group use of Parenting Wisely, self-administered Parenting Wisely, or to a wait list control group. Across both treatment modalities results revealed Parenting Wisely was effective in significantly increasing parental satisfaction, efficacy, and parenting knowledge and in reducing child problem behavior. These improvements were maintained at 3-months follow-up.

Contrary to expectations, self-administered Parenting Wisely achieved stronger reductions in child behavior problems and achieved higher ratings on parent satisfaction than group use of the program (93% compared to 85%). The self-administered parenting training led to greater increases in parent self-efficacy which may have contributed to the superior outcomes on child behaviour for this intervention format. The group program was delivered in only 2 sessions (a total of 4.5 hours) which left little time for group discussion. The lack of discussion time was identified by parents as weakness regarding the way the group program was delivered in this evaluation. Lack of feedback has been identified as a weakness in research on other self-administered parenting training programs but use of computer generated feedback on CD-ROM in the self-administered condition in this evaluation may have compensated for the absence of therapist feedback.

Outpatient Community Health Centers

In Fall River, MA, (Paull, N., Klimm, M.L., & Caldwell, D. 2001), the PW program was administered to over 300 parents who were outpatients of a community health center. The parents represented an ethnically diverse mix of low-income families receiving treatment for substance abuse. Data analyses on 153 parents who used the PW program were conducted. Pretest, and three and six month follow up data showed that:

  • Parent satisfaction was very high on usefulness, ease of use, relevance, realism
  • Program acceptability was highly rated by all ethnic groups, with no differences among them
  • Parents increased their availability for communication with other family members
  • Parents acted more loving and affectionate toward their children, and expressed appreciation more often
  • Parents lost their tempers and yelled less often
  • 38% of parents participated in a group-based parenting skills class after using PW alone
  • At three and six months follow up, 92 and 96% of parents reported that their parenting skills had improved
In Ireland (O'Neill H. & Woodward, Irish Journal of Psychology,(2002), 23, No.1-2, 62-72.), nine parents at a community health center who received PW showed gains in knowledge and their children showed reductions in problem behavior relative to a randomly assigned, delayed treatment control group.

Schools

In Kansas (Parish, 2001) over 400 parents participated in the PW program, as part of a Community In Schools effort, offered at middle and elementary schools. The parents showed an improvement in their knowledge of parenting skills, which was the sole measure used.
In Des Moines, Iowa, 38 families of middle schoolers received PW in groups for three sessions (Hein, Martin, & Else, 2002). Parents and youth used the program together. Hispanic families used the Spanish videotaped version of PW. For the 38 families who completed pre and post intervention measures, the following significant findings occurred:

  • Parents made the most significant progress in the areas of mentorship and help with homework/school projects and in acting as role models for their children, helping their children improve their school performance, talking with their children about how they are doing in school, and monitoring homework completion.
  • Parents, but not youth, reported increased monitoring of youth activities.
  • Parents' perceptions of family strengths increased on all of the twelve variables measured and that they made significant gains on five of those variables. The most significant progress was made in the area of family organization. Significant progress was also made in the areas of effective discipline style, physical health, positive family communication, and family unity.
  • Levels of interfamilial conflict were lower three variables, for both parent and youth reports: handling disagreements, getting along well with each other and family members getting so angry that they throw things.
  • Youth also reported improvements in frequency of serious arguments, and criticizing each other.
  • Regarding direct substance abuse measures, parents and youth made significant gains in knowledge of the effects of chemical dependency. The program did not impact substance use since at pretest youth did not report using substances to any significant degree.
  • Both parent and youth ratings of program satisfaction were high, with most rating it between extremely and moderately helpful.

Juvenile Probation

In Manchester, England, (Hoskins, C., McFarlane, H., & Tattersall, A., 2002)., Approximately 260 parents used the PW program through juvenile probation and formal data were collected on 150 parents. Main findings included:

  • Acceptance by parents of CD-ROM training delivered into their homes was very high, even by illiterate parents
  • Very flexible use of program by practitioners
  • Parents felt empowered by program, used skills in other areas of their lives, confidence raised, many parents felt affirmed in the skills they had
  • Program equally useful in voluntary and statutory (mandatory) use by parents
  • Program used effectively with individuals and groups
  • Program delivered successfully in secure care unit (residential treatment center for delinquents)
  • Teens' behavior problems were reduced significantly, as measured by the Eyberg Child Behavior Inventory and the Strengths and Difficulties Questionnaire

Mental Health Clinics

In Redondo Beach, California, family therapists enrolled clients in a study comparing family therapy without Parenting Wisely (PW)(control group) to brief family therapy with PW (Carr & Friedman, 2002). Measures were taken at pretest, posttest (at the end of treatment) and 6 months follow-up. Thirty families were in the PW group, and 10 in the control group. The following were the significant findings for the PW (plus therapy) group compared to pretest scores, at post test and follow-up:

  • Parents and youth agreed that parents were more likely to know if the child were going to come home late.
  • Parents and youth indicated that parents were clearer about family rules.
  • Family relationships also were strengthened, as parents and youth alike believed it was much easier to think of things to do with other family members.
  • PW parents significantly reduced their use of prescription drugs while in the program, and reduced their use of alcohol and other drugs.
  • Additionally, participating in the program appeared to open up lines of communication between parents. Parents reported that they talked about parenting issues more frequently with their partner than they did prior to participating in the program. After participating in the Parenting Wisely program, parents reported significantly less depression, whereas the control group did not change.
  • Parents who hit their kids were less likely to report doing so after they participated in the program.
  • Parents also reported yelling less at post implementation. Furthermore, after participating in the PW program with their children, parents were less worried about their child trying to "get back at them" if they disciplined them.
  • Parents who used PW reported fewer behavior problems after use, whereas the control parents reported greater difficulties.
  • Youth reported fewer difficulties in their own behavior in both groups.
  • Youth in the PW group reported improved grade point averages in school (2.7 at pretest, 3.2 at posttest).
  • In general, most means improved from pretest to 6 month followup. That is, improvements for the PW group accelerated from post test to 6 months followup.
In British Columbia, Pushak (2002) compared Parenting Wisely individually to group use. Data was collected on a total of 47 children between the ages of 6 to 12 who met diagnostic criteria for a Disruptive Disorder. The Eyberg Behaviour Inventory (ECBI) was used as the pre and post test measure. Some parents used the CD-ROM program individually along with 1 to 4 sessions with a therapist who gave homework assignments based on the Parenting Wisely workbook and who helped parents troubleshoot the use of skills taught in the program. Some of these parents went on to complete a parent group program where 2 therapists used alternate versions of Parenting Wisely to stimulate group discussion. Some parents in the group program had not used Parenting Wisely individually before participating in group. The average ECBI Total Problem scores decreased by 29% for the individual use of Parenting Wisely and by 43% for the group program. The acuity of the children's behaviour problems in the evaluation was quite high and the mean change in scores for the group program is stronger than the results found in other evaluations of Parenting Wisely used on its own. The Effect Size for individual use of the program was .64 and 1.1 for the group program. In the group program 6 children (17%) showed over 3 Standard Deviations of change on the ECBI. None of these 6 children were placed on medication or had a medication change during the treatment period. 71% of parents poled on the group program indicated they would strongly recommend the program to others. An additional 22% indicated they would recommend the program. Penticton Mental Health started using the Parenting Wisely program in March of 2001, 1-½ years ago. The positive results reported by parents who have completed the program has generated enough interest that 12 agencies have formed partnerships with Mental Health in using different versions of Parenting Wisely and 7 nearby communities have also started using the program.
ECBI Total Problem

A score of 19 indicates the cutoff for clinically significant behaviour problems. A score of 8 represents the reported behaviour problems of the average child.
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Privacy Statement
Parenting Wisely has been included in the National Registry of Evidence-based Programs and Practices since 2002 for prevention and early intervention of juvenile substance abuse and behavior problems.

The Office of Juvenile Justice and Delinquency Prevention rates Parenting Wisely as a promising program for preventing juvenile delinquency.