Abstract
Most parenting interventions report high dropout rates for parents who exhibit clinically high levels of stress and/or are parents of adolescents with severe emotional and/or behavioral difficulties. The objective of this preliminary study was to evaluate the feasibility and real-world effectiveness of the Open Door Approach to Parenting Teenagers (APT), a six-session individually delivered face-to-face intervention for typically hard to engage parents of 11 to 21-year-olds. A one-group, pre-post evaluation design was adopted due to the naturalistic clinic-based setting of the study. Participants were 279 parents reporting clinical levels of stress relating to parenting an adolescent. Parents receiving the APT intervention demonstrated lower dropout rates than other parenting programs and reported high scores across several items relating to service satisfaction. The APT intervention was associated with significant reductions in parental stress and improvements in parent-adolescent relationships immediately post-intervention. Findings suggest that parents found the APT intervention acceptable and beneficial, and further suggest that the intervention is feasible and effective in retaining hard to engage parents. Moreover, preliminary findings suggest that the APT intervention is a promising intervention that may support parents who fail to engage in group programs. However, further research is required to establish the efficacy of the intervention.
Highlights
-
This study evaluated a universal, manualized, intervention for parents of adolescents, Open Door Approach to Parenting Teenagers (APT).
-
Findings suggested feasibility and acceptability of the intervention.
-
APT was generally effective, even for parents who struggle to engage with group-based interventions.
-
The intervention reduced parent stress and improved parent-adolescent relationships.
-
APT is a promising intervention to fill a current gap in healthcare pathways.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Achenbach, T. M., Howell, C. T., Quay, H. C., Conners, C. K., & Bates, J. E. (1991). National survey of problems and competencies among four-to sixteen-year-olds: Parents’ reports for normative and clinical samples. Monographs of the Society for Research in Child Development, i-130. https://doi.org/10.2307/1166156.
Arnett, J. J. (1999). Adolescent storm and stress, reconsidered. American Psychologist, 54(5), 317.
Austin, C., Davis, H., & Jezzard, B. (1995). Evaluation of the Lewisham and Guy’s Child Mental Health Service: Final report. London: Lewisham and Guys Mental Health Trust.
Axford, N., Lehtonen, M., Kaoukji, D., Tobin, K., & Berry, V. (2012). Engaging parents in parenting programs: lessons from research and practice. Children and Youth Services Review, 34(10), 2061–2071.
Barber, B. K. (1996). Parental psychological control: revisiting a neglected construct. Child Development, 67, 3296–3319. https://doi.org/10.1111/j.1467-8624.1996.tb01915.x.
Barber, B. K., & Erickson, L. D. (2001). Adolescent social initiative antecedents in the ecology of social connections. Journal of Adolescent Research, 16, 326–354. https://doi.org/10.1177/0743558401164003.
Barlow, J. (2010). Group-based parent-training programs for improving emotional and behavioral adjustment in children from birth to three years old. The Cochrane Database of Systematic Reviews, 3, 1–91, CD003680.
Barton, A. W., Beach, S. R., Kogan, S. M., Stanley, S. M., Fincham, F. D., Hurt, T. R., & Brody, G. H. (2015). Prevention effects on trajectories of African American adolescents’ exposure to interparental conflict and depressive symptoms. Journal of Family Psychology, 29, 171. https://doi.org/10.1037/fam0000073.
Baruch, G., Vrouva, I., & Wells, C. (2011). Outcome findings from a parent training programme for young people with conduct problems. Child and Adolescent Mental Health, 16, 47–54. https://doi.org/10.1111/j.1475-3588.2010.00574.x.
Boggs, S. R., Eyberg, S. M., Edwards, D. L., Rayfield, A., Jacobs, J., Bagner, D., & Hood, K. K. (2005). Outcomes of parent-child interaction therapy: a comparison of treatment completers and study dropouts one to three years later. Child & Family Behavior Therapy, 26, 1–22. https://doi.org/10.1300/J019v26n04_01.
Britto, P. R., Ponguta, L. A., Reyes, C., & Karnati, R. (2015). A systematic review of parenting programmes for young children in low-and middle-income countries. New York, NY: United Nations Children’s Fund.
Burke, K., Brennan, L., & Cann, W. (2012). Promoting protective factors for young adolescents: ABCD Parenting Young Adolescents Program randomized controlled trial. Journal of Adolescence, 35, 1315–1328. https://doi.org/10.1016/j.adolescence.2012.05.002.
Burke, K., Brennan, L., & Roney, S. (2010). A randomised controlled trial of the efficacy of the ABCD Parenting Young Adolescents Program: rationale and methodology. Child and Adolescent Psychiatry and Mental Health, 4, 1–14. https://doi.org/10.1186/1753-2000-4-22.
CAMHS EBPU (2012). Current view. Child and adolescent mental health services evidence based practice unit retrieved 1st September 2016. http://pbrcamhs.org/wp-content/uploads/2012/10/Current-View-Form.pdf.
Chu, J. T. W., Bullen, P., Farruggia, S. P., Dittman, C. K., & Sanders, M. R. (2015). Parent and adolescent effects of a universal group program for the parenting of adolescents. Prevention Science, 16(4), 609–620.
Chu, J. T. W., Farruggia, S. P., Sanders, M. R., & Ralph, A. (2012). Towards a public health approach to parenting programmes for parents of adolescents. Journal of Public Health, 34, i41–i47. https://doi.org/10.1093/pubmed/fdr123.
Conger, R. D., Patterson, G. R., & Ge, X. (1995). It takes two to replicate: a mediational model for the impact of parents’ stress on adolescent adjustment. Child Development., 66(1), 80–97.
Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837–844. https://doi.org/10.1001/archpsyc.60.8.837.
Deković, M., Janssens, J. M., & As, N. (2003). Family predictors of antisocial behavior in adolescence. Family Process, 42, 223–235. https://doi.org/10.1111/j.1545-5300.2003.42203.x.
DeVore, E. R., & Ginsburg, K. R. (2005). The protective effects of good parenting on adolescents. Current Opinion in Pediatrics, 17, 460–465. https://doi.org/10.1097/01.mop.0000170514.27649.c9.
Dumka, L. E., Garza, C. A., Roosa, M. W., & Stoerzinger, H. D. (1997). Recruitment and retention of high-risk families into a preventive parent training intervention. Journal of Primary Prevention, 18(1), 25–39.
Eichelsheim, V. I., Buist, K. L., Deković, M., Wissink, I. B., Frijns, T., Van Lier, P. A., & Meeus, W. H. (2010). Associations among the parent–adolescent relationship, aggression and delinquency in different ethnic groups: a replication across two Dutch samples. Social Psychiatry and Psychiatric Epidemiology, 45, 293–300. https://doi.org/10.1007/s00127-009-0071-z.
Eshel, N., Daelmans, B., Mello, M. C. D., & Martines, J. (2006). Responsive parenting: interventions and outcomes. Bulletin of the World Health Organization, 84, 991–998.
Farrington, D. P., Gottfredson, D. C., Sherman, L. W., & Welsh, B. C. (2002). The Maryland scientific methods scale. Evidence-based crime prevention, 13–21. https://doi.org/10.4324/9780203166697_chapter_2.
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191.
Fonagy, P. (1998). Prevention, the appropriate target of infant psychotherapy. Infant Mental Health Journal, 19(2), 124–150.
Forgatch, M. S., & Patterson, G. R. (2010). Parent Management Training—Oregon Model: An intervention for antisocial behavior in children and adolescents. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (p. 159–177). The Guilford Press.
Forgatch, M. S., Patterson, G. R., DeGarmo, D. S., & Beldavs, Z. G. (2009). Testing the Oregon Delinquency Model with 9-year follow-up of the Oregon Divorce Study. Development and Psychopathology, 21, 637–660.
Foster, E. M., Prinz, R. J., Sanders, M. R., & Shapiro, C. J. (2008). The costs of a public health infrastructure for delivering parenting and family support. Children and Youth Services Review, 30, 493–501. https://doi.org/10.1016/j.childyouth.2007.11.002.
Friars, P., & Mellor, D. (2009). Drop-out from parenting training programmes: a retrospective study. Journal of Child and Adolescent Mental Health, 21, 29–38. https://doi.org/10.2989/jcamh.2009.21.1.5.807.
Ghate, D. (2001). Community‐based evaluations in the UK: scientific concerns and practical constraints. Children & Society, 15, 23–32. https://doi.org/10.1002/1099-0860(200101)15:1%3C23::aid-chi643%3E3.0.co;2-9.
Gordon, Jr, R. S. (1983). An operational classification of disease prevention. Public Health Reports, 98(2), 107.
Grolnick, W. S., & Pomerantz, E. M. (2009). Issues and challenges in studying parental control: Toward a new conceptualization. Child Development Perspectives, 3, 165–170. https://doi.org/10.1111/j.1750-8606.2009.00099.x.
Gross, D., & Grady, J. (2002). Group-based parent training for preventing mental health disorders in children. Issues in Mental Health Nursing, 23, 367–383. https://doi.org/10.1080/01612840290052578.
Henricson, C., & Roker, D. (2000). Support for the parents of adolescents: a review. Journal of Adolescence, 23, 763–783. https://doi.org/10.1006/jado.2000.0358.
Hoddinott, P., Allan, K., Avenell, A., & Britten, J. (2010). Group interventions to improve health outcomes: a framework for their design and delivery. BMC Public Health, 10(1), 800 https://doi.org/10.1186/1471-2458-10-800.
Hooven, C., Walsh, E., Pike, K. C., & Herting, J. R. (2012). Promoting CARE: including parents in youth suicide prevention. Family & Community Health, 35, 225–235. https://doi.org/10.1097/fch.0b013e318250bcf9.
Huth-Bocks, A. C., & Hughes, H. M. (2008). Parenting stress, parenting behavior, and children’s adjustment in families experiencing intimate partner violence. Journal of Family Violence, 23, 243–251. https://doi.org/10.1007/s10896-007-9148-1.
Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12. https://doi.org/10.1037//0022-006x.59.1.12.
Jarvis, C. (2005). Parenting problems: research and clinical perspectives on parenting adolescents: Problemi di genitorialità: prospettive cliniche e di ricerca sull’essere genitori di adolescenti. Journal of Child Psychotherapy, 31, 209–220. https://doi.org/10.1080/00754170500221592.
Jarvis, C., Trevatt, D., & Desatnik, A. (2011). Open Door. Approach to parenting teenagers: APT. Unpublished training manual, Open Door. London.
Jarvis, C., Trevatt, D., & Drinkwater, D. (2004). Parenting teenagers: setting up and evaluating a therapeutic parent consultation service: Work in progress. Clinical Child Psychology and Psychiatry, 9, 205–225. https://doi.org/10.1177/1359104504041919.
Jaworska, N., & MacQueen, G. (2015). Adolescence as a unique developmental period. Journal of Psychiatry & Neuroscience, 40(5), 291. https://doi.org/10.1503/jpn.150268.
Johnson, S. B., Blum, R. W., & Giedd, J. N. (2009). Adolescent maturity and the brain: the promise and pitfalls of neuroscience research in adolescent health policy. Journal of Adolescent Health, 45, 216–221. https://doi.org/10.1016/j.jadohealth.2009.05.016.
Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training program effectiveness. Journal of Abnormal Child Psychology, 36, 567–589. https://doi.org/10.1007/s10802-007-9201-9.
Kane, G. A., Wood, V. A., & Barlow, J. (2007). Parenting programmes: a systematic review and synthesis of qualitative research. Child: Care, Health and Development, 33(6), 784–793.
Kazdin, A. E. (1990). Premature termination from treatment among children referred for antisocial behavior. Journal of Child Psychology and Psychiatry, 31, 415–425. https://doi.org/10.1111/j.1469-7610.1990.tb01578.x.
Kieling, C., Baker-Henningham, H., Belfer, M., Conti, G., Ertem, I., Omigbodun, O., & Rahman, A. (2011). Child and adolescent mental health worldwide: evidence for action. The Lancet, 378(9801), 1515–1525. https://doi.org/10.1016/S0140-6736(11)60827-1.
Knapp, M., McDaid, D., & Parsonage, M. (2011). Mental health promotion and mental illness prevention: the economic case. London: Department of Health.
Kolko, D. J., & Kazdin, A. E. (1993). Emotional/behavioral problems in clinic and nonclinic children: Correspondence among child, parent and teacher reports. Journal of Child Psychology and Psychiatry, 34, 991–1006. https://doi.org/10.1111/j.1469-7610.1993.tb01103.x.
Koutakis, N., Stattin, H., & Kerr, M. (2008). Reducing youth alcohol drinking through a parent‐targeted intervention: the Örebro Prevention Program. Addiction, 103, 1629–1637. https://doi.org/10.1111/j.1360-0443.2008.02326.x.
Liddle, H. A., Rowe, C., Dakof, G., & Lyke, J. (1998). Translating parenting research into clinical interventions for families of adolescents. Clinical Child Psychology and Psychiatry, 3, 419–443. https://doi.org/10.1177/1359104598033007.
Liem, J. H., Cavell, E. C., & Lustig, K. (2010). The influence of authoritative parenting during adolescence on depressive symptoms in young adulthood: Examining the mediating roles of self-development and peer support. The Journal of Genetic Psychology, 171, 73–92. https://doi.org/10.1080/00221320903300379.
Lundahl, B., Risser, H. J., & Lovejoy, M. C. (2006). A meta-analysis of parent training: moderators and follow-up effects. Clinical Psychology Review, 26, 86–104. https://doi.org/10.1016/j.cpr.2005.07.004.
Maynard, M., & Harding, S. (2010). Perceived parenting and psychological well‐being in UK ethnic minority adolescents. Child: Care, Health and Development, 36, 630–638. https://doi.org/10.1111/j.1365-2214.2010.01115.x.
Medlow, S., Klineberg, E., Jarrett, C., & Steinbeck, K. (2016). A systematic review of community-based parenting interventions for adolescents with challenging behaviours. Journal of Adolescence, 52, 60–71. https://doi.org/10.1016/j.adolescence.2016.07.003.
Metzler, C. W., Sanders, M. R., Rusby, J. C., & Crowley, R. N. (2012). Using consumer preference information to increase the reach and impact of media-based parenting interventions in a public health approach to parenting support. Behavior Therapy, 43(2), 257–270. https://doi.org/10.1016/j.beth.2011.05.004.
Montemayor, R. (1986). Family variation in parent-adolescent storm and stress. Journal of Adolescent Research, 1(1), 15–31. https://doi.org/10.1177/074355488611003.
Moran, P., Ghate, D., & Van Der Merwe, A. (2004). What works in parenting support?: a review of the international evidence (No. 1844783081): London: Department for Education and Skills.
Morris, A. S., Silk, J. S., Steinberg, L., Myers, S. S., & Robinson, L. R. (2007). The role of the family context in the development of emotion regulation. Social Development, 16, 361–388. https://doi.org/10.1111/j.1467-9507.2007.00389.x.
Nitsch, E., Hannon, G., Rickard, E., Houghton, S., & Sharry, J. (2015). Positive parenting: a randomised controlled trial evaluation of the Parents Plus Adolescent Programme in schools. Child and Adolescent Psychiatry and Mental Health, 9, 1–12. https://doi.org/10.1186/s13034-015-0077-0.
Nowak, C., & Heinrichs, N. (2008). A comprehensive meta-analysis of Triple P-Positive Parenting Program using hierarchical linear modeling: effectiveness and moderating variables. Clinical Child and Family Psychology Review, 11, 114–144. https://doi.org/10.1007/s10567-008-0033-0.
Pantin, H., Prado, G., Lopez, B., Huang, S., Tapia, M. I., Schwartz, S. J., & Branchini, J. (2009). A randomized controlled trial of Familias Unidas for Hispanic adolescents with behavior problems. Psychosomatic Medicine, 71, 987. https://doi.org/10.1097/psy.0b013e3181bb2913.
Petrie, J., Bunn, F., & Byrne, G. (2007). Parenting programmes for preventing tobacco, alcohol or drugs misuse in children <18: a systematic review. Health Education Research, 22(2), 177–191. https://doi.org/10.1093/her/cyl061.
Piehler, T. F., & Winters, K. C. (2015). Parental involvement in brief interventions for adolescent marijuana use. Psychology of Addictive Behaviors, 29, 512–521. https://doi.org/10.1037/adb0000106.
Pineda, J., & Dadds, M. R. (2013). Family intervention for adolescents with suicidal behavior: a randomized controlled trial and mediation analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 52, 851–862. https://doi.org/10.1016/j.jaac.2013.05.015.
Ralph, A., & Sanders, M. R. (2003). Preliminary evaluation of the Group Teen Triple P program for parents of teenagers making the transition to high school. Australian e-Journal for the Advancement of Mental Health, 2, 169–178. https://doi.org/10.5172/jamh.2.3.169.
Rohrbach, L. A., Hodgson, C. S., Broder, B. I., Montgomery, S. B., Flay, B. R., Hansen, W. B., & Pentz, M. A. (1994). Parental participation in drug abuse prevention: results from the Midwestern Prevention Project. Journal of Research on Adolescence, 4(2), 295–317.
Rosenthal, R. (1994). Parametric measures of effect size. In H. Cooper & L. V. Hedges (Eds.), The handbook of research synthesis (1st edn., pp. 231–244). New York: Ryssell Sage Foundation.
Salari, R., Ralph, A., & Sanders, M. R. (2014). An efficacy trial: positive parenting program for parents of teenagers. Behaviour Change, 31, 34–52. https://doi.org/10.1017/bec.2014.23.
Sandler, I., Ingram, A., Wolchik, S., Tein, J. Y., & Winslow, E. (2015). Long‐term effects of parenting‐focused preventive interventions to promote resilience of children and adolescents. Child Development Perspectives, 9, 164–171. https://doi.org/10.1111/cdep.12126.
Shah, R., Kennedy, S., Clark, M. D., Bauer, S. C., & Schwartz, A. (2016). Primary care–based interventions to promote positive parenting behaviors: a meta-analysis. Pediatrics, 137(5), e20153393. https://doi.org/10.1542/peds.2015-3393.
Sheras, P. L., Abidin, R. R., & Konold, T. (1998). Stress index for parents of adolescents. Odessa, FL: Psychological Assessment Resources.
Smokowski, P. R., Bacallao, M. L., Cotter, K. L., & Evans, C. B. (2015). The effects of positive and negative parenting practices on adolescent mental health outcomes in a multicultural sample of rural youth. Child Psychiatry & Human Development, 46(3), 333–345. https://doi.org/10.1007/s10578-014-0474-2.
Snyder, J., Schrepferman, L., Bullard, L., McEachern, A., & Patterson, G. R. (2012). Covert antisocial behavior, peer deviancy training, parenting processes, and sex differences in the development of antisocial behavior during childhood. Development and Psychopathology, 24, 1117–1138.
Spoth, R., Randall, G. K., & Shin, C. (2008). Increasing school success through partnership-based family competency training: experimental study of long-term outcomes. School Psychology Quarterly, 23, 70. https://doi.org/10.1037/1045-3830.23.1.70.
Steinberg, L. (2001). We know some things: parent–adolescent relationships in retrospect and prospect. Journal of Research on Adolescence, 11, 1–19. https://doi.org/10.1111/1532-7795.00001.
Steinhausen, H.-C., Eschmann, S., & Metzke, C. W. (2009). Continuity, psychosocial correlates, and outcome of problematic substance use from adolescence to young adulthood in a community sample: correction. Child and Adolescent Psychiatry and Mental Health, 3, 37. https://doi.org/10.1186/1753-2000-3-37.
Trevatt, D. (2005). Adolescents in mind. Journal of Child Psychotherapy, 31, 221–238. https://doi.org/10.1080/00754170500221527.
Westen, D., Novotny, C. M., & Thompson-Brenner, H. (2004). The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials. Psychological Bulletin, 130, 631. https://doi.org/10.1037/0033-2909.130.4.631.
Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24, 190. https://doi.org/10.1037/0735-7028.24.2.190.
Woolfenden, S., Williams, K. J., & Peat, J. (2001). Family and parenting interventions in children and adolescents with conduct disorder and delinquency aged 10–17. Cochrane Database of Systematic Reviews (2). https://doi.org/10.1002/14651858.CD003015.
Wolpert, M., Vostanis, P., Young, S., Clark, B., Davies, R., Fleming, I., & Whale, A. (2015). Child and adolescent mental health services payment system project: final report. London: CAMHS Press.
Yalom, I. D., & Leszcz, M. (2005). Theory and practice of group psychotherapy. 5th ed. New York: Basic books.
Author Contributions
All authors contributed to the study conception and design. All authors read and approved the final manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
The Open Door ethics board reviewed the design, data collection and analysis processes and granted authorization to carry out the study, given that participants were experiencing the same intervention and evaluation procedures implemented in the standard clinical practice of the institution. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Open Door ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Desatnik, A., Jarvis, C., Hickin, N. et al. Preliminary Real-World Evaluation of an Intervention for Parents of Adolescents: The Open Door Approach to Parenting Teenagers (APT). J Child Fam Stud 30, 38–50 (2021). https://doi.org/10.1007/s10826-020-01855-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-020-01855-6