• By Dartington SRU
  • Posted on Wednesday 26th October, 2011

Registering an interest

Only about a third of parents invited to do so enroll in prevention projects, and, of these, between 40 and 60 per cent drop out even when financial incentives, childcare, refreshments and transport are provided.These figures illustrate starkly the fact that, despite parent training programs being considered the gold standard for treating behavioral problems in children, they tend to suffer from both low levels of parent enrollment – defined as attending at least one session – and attendance.This is costly to individual young people (behavior problems have harmful long-term consequences) and to society as a whole (unaddressed serious behaviour problems can lead to problems later in life, such as crime). It also makes services less cost-effective because parents who drop out occupy slots that others could have filled.Poor enrollment and attendance rates also make it harder to do useful research on the programs concerned. High or differential drop-out rates can cause results to be biased and reduce the sample size and statistical power. It also makes it harder to generalize beyond the participants who signed up and stayed.While such concerns are widely expressed, enrollment and attendance are rarely studied – particularly for younger children and programs that do not target children with identified problems.In a recent study, a team from the University of Massachusetts sought to address this gap. They looked at how structural, demographic, child and parent characteristics were related to attendance and enrollment in the Incredible Years parent training program.Families were recruited from 20 pre-school classrooms in seven childcare centers in two urban New England areas. Half of the classrooms were randomly assigned to the Incredible Years program. The study focused on the parents of the 106 children in these classrooms, which comprised 56 boys and 51 girls.The parents received a shortened version of the Incredible Years program. This comprised eight weekly group sessions on weekday evenings, with meals and childcare provided. Sessions were led by two advanced clinical psychology doctorate students and covered topics such as play, praise, setting limits and strategies for dealing with misbehavior.Of the 106 families assigned to the intervention group, 51 (48 per cent) enrolled in the program. Attendance decreased steadily between session 1 (84 per cent) and session 7 (41 per cent). A higher rate in the eighth session might be attributable to the fact that this was when attendees could celebrate their time with the program, or it might be because the researchers phoned parents to remind them about it.There were six “perfect attendees” (they attended every session), 28 whose attendance was “mixed” (they might miss a session but then come to a subsequent one) and 17 “drop-outs” (those who once they missed a session never returned). According to the research team, this strongly suggests the need to engage with parents who miss even one session. It also points to the potential value of an intervention “explicitly aimed to increase parent motivation for treatment and address barriers to staying involved”.Enrollment rates were higher among better-off, two-parent and Caucasian families and among parents who reported having greater support from friends and family. However, having a child with behaviorial problems did not predict enrollment. Parent social support predicted enrollment even after people’s socio-economic status was controlled for.Parents from two-parent households had higher attendance rates, as did those whose children were engaged in more rule-breaking behavior. These relationships held irrespective of how well off parents were. Being a single parent arguably makes it harder to attend because of “logistical difficulties, shortages of time, and competing demands”. However, attendance was not related to socio-economic status, ethnic group or parents’ level of social support.The research team argue that these results demonstrate that “enrollment and attendance were related to different variables” and that these are, therefore, likely to be “qualitatively different”. Thus, the strategy to address poor enrollment might be different to efforts to boost attendance. For example, in the case of enrollment there is a need to enable poorer parents and those with less social support to participate. An outreach or home delivery model might be appropriate in such cases, as might less intrusive internet or self-administered approaches.Meanwhile, the fact that ethnicity predicted enrollment but not attendance suggests that “expectations of cultural mismatches may be just as important to consider as the cultural mismatches that occur during implementation, and point to the importance of considering cultural adaptations even before programs begin”.The attendance rates for the 51 families who enrolled were “discouragingly low” but comparable to average attendance rates for similar services. The research team conclude that “making prevention programs attractive and relevant to consumers is an important avenue of future research” because parents simply choose to spend their time and resources doing something else.ReferenceBaker, C. N., Arnold, D. H. and Meagher, S. (2011) ‘Enrollment and attendance in a parent training prevention program for conduct problems’, Prevention Science 12: 126-138.

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