Participation, Engagement, Alliance, and Social Validity of a Motivational Parenting Intervention

Background and Purpose: Approximately 15%-20% of children exhibit conduct problems (Briggs-Gowan & Carter, 2008), which can be predictive of myriad negative outcomes (Briggs-Gowan & Carter, 2008).  Dysfunctional caregiving practices are associated with the development of challenging child behavior (Stormshak et al., 2000), and Parent Management Training (PMT) interventions seek to enhance parental practices to improve child behavior (Patterson, Reid, & Dishion, 1992). The homeBase program, developed to address parent engagement of elementary level students, uniquely incorporates motivational interviewing (MI) into a brief, in-home, PMT.  This study describes the extent to which parents (a) participate in homeBase; (b) are engaged in implementing intervention procedures; (c) form effective relationships with interventionists; and (d) report homeBase as socially valid.   

Methods: One child was recruited from each participating classroom in graded k-3. Children were screened using the Systematic Screening for Behavior Disorders, and subsequently randomly assigned to receive homeBase from 2015-2017. This analysis was sub analysis from a larger randomized controlled trial. Parental participation was measured by the number of intervention steps completed. Engagement was assessed using an interventionist-reported, 5-point likert scale (α = .92).  Alliance was measured with the Therapeutic Alliance Scale (Walker et al., 2009), an interventionist-reported, 5-point scale (α = .95), as well as a parent-reported scale reporting their relationship with the interventionist (α = .95).  Social validity was assessed using a 5-point, interventionist-reported measure of effectiveness (α = .89), as well as a parent-reported satisfaction measure (α = .93). Additionally, parents were invited to participate in an hour-long focus group to provide feedback.    

Results: Parents were 35.1 (SD = 9.4) years old on average, predominantly female (85%), and mostly African-American (48%) or Caucasian (47%). Additionally, 75% reported being employed, with 41% reporting annual incomes below the poverty line.

Of the 71 homeBase families, forty-one families (58%) completed the intervention, fifteen (21%) families were partial-completers, and fifteen families (21%) did not start the intervention.  There were no statistically significant differences between families based on number of steps completed (χ² = 2.11, p = .550).  Interventionist-reported data demonstrated an average engagement score of 3.5 (SD = 0.7).  The mean interventionist-reported alliance score was 3.8 (SD = 0.9) and parent-reported alliance scores were higher at 4.3 (SD = 0.6).  Interventionist-reported effectiveness scores had a mean of 3.78 (SD = 0.6) and the average parent satisfaction score was 4.1 (SD = 0.6).  Focus group participants (n=2) reported positive experiences with the intervention, improvements in youth behavior, and strong therapeutic rapports with interventionists. 

Conclusions and Implications: Although participation was challenging, participants were highly engaged, developed effective relationships with interventionists, and perceived homeBase to be socially valid. Overall, homeBase shows promise as a support for youth who exhibit challenging behaviors.  Also, given that MI skills are generalizable to all conversations focused on change, school districts and professional preparation programs should consider incorporating MI into their professional development and training programs for school personnel.  Still, future research is needed.