Why Parent Management Training is Relevant in a Primary Care SettingParent management training is a term used to describe a set of interventions that focus on teaching the parents specific skills to help them address the disruptive behaviors that their children demonstrate (Kazdin, 1997). Drawing largely from behaviorism, parent management training rests on the assumptions that unwanted behaviors are learned over time, and these behaviors are unknowingly reinforced by parents and teachers, while also being modeled by those who end up using too harsh of discipline practices (Patterson, 1982). Although the techniques may differ, they tend to focus on some major themes. First, most parent management training techniques involve giving positive praise for desired behaviors. Second, they involve selectively using attention so that minor infractions can be ignored and eventually extinguished. Third, the use of a proper time out (from reinforcement of any kind) is characteristic of parent management training. Finally, the use of a token economy system, where rewards are available for desired behaviors is also a common component.

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Parent management training has been found to be effective for a wide variety of conditions and in a vast number of settings. The goal of parent management training is to provide a more structured way of interacting with children so that desired behaviors are more likely to occur and so that unwanted behaviors wane over time. While this can provide relief for all parties involved, it may also serve to improve the quality of the relationship between children and parents.

Within a primary care setting, children and their families may present with a number of issues, ranging from ADHD to conduct disorder and other externalizing and behavioral problems. As such, the primary care setting may be a great location in which to begin teaching parent management skills to families. This technique can help with compliance to medication regimens (if medications are included within the token economy system), and it can help with cooperation between the parent and child between appointments.

Main Points and Critical Analysis
Seeing the niche for parent management training within the primary care setting, Gomez and colleagues (2014) developed a short parent management training program designed to be implemented within a primary care setting and they presented some preliminary findings in a recent publication. Given the limited number of contacts in primary care versus in a therapy based setting, parent management training was adapted.

Participants were 21 caregivers and their children, and the mean age of the child was 7.76 years with a standard deviation of 4.31. The patients were seen for an average of 2.38 visits with a standard deviation of 0.74. Most often, the caregivers were the mothers. The most prevalent presenting concern was inattentive/hyperactive symptoms, followed by anxiety-related behaviors and oppositional defiant behaviors. The most common parent management interventions that were used were psychoeducation, praise, and selective ignoring, along with a token economy system.

The researchers found support for the implementation of brief parent management training within a primary care setting. In fact, they found that this flexible approach, which focused more on teaching the operant learning principles, led to the gains seen in the study.

Although this is preliminary data, the results are promising. Nonetheless, this study is not without limitations. First, while it demonstrates that adapted parent management training within a primary care setting can be useful, the short number of sessions in which the children and parents were seen is troubling from a behavior-change and behavior-modification perspective. For instance, one can easily imagine a parent who learns a few skills and then has trouble implementing these skills; it would be more helpful to have check-in sessions to make sure techniques are being implemented properly. Second, while the focus of this primary care intervention was on teaching the principles that underlie the concept of parent management training, there may be more benefit in teaching this as a weekly group course so that the parents may get the most benefit of having more sessions within a routine weekly meeting. Finally, because of the small sample size, it is unclear how well these results may generalize to other settings or populations, especially given the limited nature of the presenting concerns.

How the Findings can be Applied?
While these results are preliminary and more research needs to be done, possibly by randomly assigning to a parent management group versus a supportive counseling intervention, the success of this implementation is certainly face valid. In terms of application, I would like to see parent management skills training used within a primary care setting where children are struggling with medical conditions such as Attention Deficit Hyperactivity Disorder as well as conditions like diabetes where behavioral management of the disease is necessary, but may not be easily managed between parents and their children. By providing parents with simple skills such as positive praise, active ignoring, time out, and a token economy system, the provider may not only help with an identified problem behavior, but that provider may be able to help the family to manage independence and autonomy better as the child grows in age. I hope to apply these techniques within a primary care setting as it appears that most children could benefit from such skills.

Conclusion
In sum, parent management training is a well-validated treatment approach to manage problem behaviors. When implemented in a brief manner within a primary care setting, gains were seen among the children. This suggests that larger scale research is needed to confirm these preliminary findings.

    References
  • Gomez, D., Bridges, A. J., Andrews, I. R., Cavell, T. A., Pastrana, F. A., Gregus, S. J., & Ojeda, C. A. (2014). Contains Video11Video patients/clients are portrayed by actors.: Delivering Parent Management Training in an Integrated Primary Care Setting: Description and Preliminary Outcome Data. Cognitive and Behavioral Practice, 21296-309. doi:10.1016/j.cbpra.2014.04.003
  • Kazdin, A. E. (1997). Parent management training: Evidence, outcomes, and issues. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 1349–1356. http://dx.doi.org/10.1097/ 00004583-199710000-00016)
  • Patterson, G. R. (1982). Coercive family process. A Social Learning Approach Series, Vol. 3. Eugene, Oregon: Castalia.