Parenting Wisely: Parent Training via CD-ROM with an Australian Sample

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Parenting Wisely: Parent Training via CD-ROM with an Australian SampleJosie Cefai PhD a , David Smith PhD a & Robert E. Pushak BA, MST b ca Division of Psychology , School of Health Sciences, RMITUniversity , Bundoora, Victoria, Australiab Tri-Cities Mental Health , Penticton, British Columbia, Canadac Family Works Inc. , Athens, Ohio, USAPublished online: 09 Mar 2010.

To cite this article: Josie Cefai PhD , David Smith PhD & Robert E. Pushak BA, MST (2010) ParentingWisely: Parent Training via CD-ROM with an Australian Sample, Child & Family Behavior Therapy, 32:1,17-33, DOI: 10.1080/07317100903539709

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Parenting Wisely: Parent Training via CD-ROMwith an Australian Sample

JOSIE CEFAI, PhD and DAVID SMITH, PhDDivision of Psychology, School of Health Sciences, RMIT University,

Bundoora, Victoria, Australia

ROBERT E. PUSHAK, BA, MSTTri-Cities Mental Health, Penticton, British Columbia, Canada and Family Works Inc.,

Athens, Ohio, USA

The effectiveness of a parenting program was examined with anAustralian sample regarding improved parent knowledge, parentalsense of competence, and child behavior. One hundred andsixteen parents and their children were randomly assigned to threeconditions: a two-session group based intervention, a two-sessionself-administered individual intervention, or to a waitlist controlgroup. Across both treatment modalities results reveal a significantincrease in parental satisfaction, efficacy, and a reduction in childproblem behavior. Improvements were maintained at 3-monthsfollow-up. Results indicate the individual self-administered formatenhanced treatment gains relative to the group format.

KEYWORDS behavior problems, children, parent training

There is a need for effective interventions for children showing aggressiveand anti-social behaviors. Such interventions need to be effective across cul-tures and distances and be relatively simple and easy to use so that expensiveand intensive practitioner training is not a barrier for dissemination.Behavioral parent training has been shown to prevent and reduce behavioral

Received 3 September 2008; revised 11 March 2009; accepted 15 March 2009.Josie Cefai, PhD, is deceased.This research was conducted by Josie Cefai as part of a Doctor of Psychology (clinical)

program at RMIT University.Address correspondence to David Smith, PhD, Division of Psychology, School of Health

Sciences, RMIT University, Bundoora, Victoria, Australia 3083. E-mail: [email protected]

Child & Family Behavior Therapy, 32:17–33, 2010Copyright # Taylor & Francis Group, LLCISSN: 0731-7107 print=1545-228X onlineDOI: 10.1080/07317100903539709

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disorders in children (Connolly, Sharry, & Fitzpatrick, 2001; Taylor & Biglan,1998; Webster-Stratton & Hammond, 1997) to within the normative range offunctioning relative to peers (Kazdin, 1998). A meta-analysis of 36 rando-mized studies on behavioral parent training found an average effect size of.86 in decreasing child anti-social behavior (Serketich & Dumas, 1996). Theeffectiveness of behavioral parent training is well-established and has thelargest empirical support of any psycho-social intervention (Kazdin, 2006,p. 32). The current study will compare the effectiveness of individualself-administered and group parent training—both of which are deliveredin an easy to use, highly cost effective manner that does not require extensivepractitioner training.

Research demonstrates that brief, self-directed parent education can beas effective as therapist-led intervention. Nicholson and Sanders (1999) com-pared self-directed parent training, standard parent training with a therapist,and a control group. No difference was found on measures of child disrup-tive behaviors for the 2 treatment groups. Webster-Stratton demonstrated thata self-administered videotaped parenting program was effective in improvingparent-child interactions, improving parental attitudes, and reducing childconduct behavior (Webster-Stratton, 1985, 1990, 1994; Webster-Stratton,Hollinsworth, & Kolpacoff, 1989). In one study (Webster-Stratton, Kolpacoff,& Hollinsworth, 1988), self-administered videotape achieved significantimprovement in child conduct problems, with a low drop-out rate of 8.2%and treatment effects were sustained at 1-year follow-up (Webster-Strattonet al., 1989). Consumer satisfaction, however, was significantly lower forself-administered parent training compared to videotape combined withgroup discussion. Participants indicated that the lack of personal contactand feedback were undesirable (Webster-Stratton et al., 1988).

Sanders (1982) compared parent instruction with and without feedbackand found feedback increased parent attending to appropriate child behaviorand decreased attending to deviant behavior. Therefore, combining video-tape modeling with feedback via CD-Rom may increase both the effective-ness and satisfaction of parent self-administered training.

A possible advantage of self-directed intervention is that parental senseof competence may be improved more compared to therapist-directed inter-ventions. Parenting sense of competence is conceptualized as the degree towhich a parent feels competent and confident in the parental role (Coleman& Karraker, 1997; Johnston & Mash, 1989). Parents with low self-efficacy per-ceive their child’s behavior as more problematic, than parents with highself-efficacy (Johnston & Mash; Lovejoy, Verda, & Hays, 1997; Teti & Gelfand,1991). Parents who feel less competent may elicit testing and problematicchild behavior which reinforces feelings of parental incompetence. Whenchildren misbehave, parents with high self-efficacy are more likely to persist,whereas parents with low self-efficacy are more likely to withdraw or con-cede defeat (Coleman & Karraker; Donovan, Lewis, & Walsh, 1990).

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Self-administered parent education may result in greater increases in parentself-efficacy because parents may attribute decreased child behaviorproblems to their own efforts and not to therapist-directed changes.

Interactive CD-ROM shows promise in reducing barriers to parent edu-cation. Therapists’ attempts to correct parental errors by teaching or confron-tation increases resistance and contributes to drop out (Patterson & Forgatch,1987). Training via CD-ROM can correct common parental errors withoutparents feeling personally criticized or judged. CD-ROM may be ideal for par-ents who have difficulties discussing family problems or who are afraid to askfor help (MacKenzie & Hilgedick, 1999). Practitioner competence is highlyvariable (Barnosky, 2002) and is greatly reduced with self-administeredinstruction. Another advantage of CD-ROM is that the client will not be dis-tracted by therapist shortcomings or weaknesses.

PARENTING WISELY (PW)

PW is a CD-ROM parent training program developed by Gordon (2000).Through self-administration, parents view video clips of nine common familyproblems. After selecting a problem, parents view a video clip depicting afamily struggling with that problem. Parents select a solution to the problemout of the alternatives, view a video enactment of their selected solution, andparticipate in a critique of that choice. Strategies such as contracting, contin-gency management, I statements, active listening, assertive discipline, andpraise are presented. After viewing the most effective solution, a series ofmultiple-choice questions reviews the concepts and skills depicted in thatsection. Parents complete the program in a little over 2 hours.

Evaluations on PW

In a randomized study, Kacir and Gordon (1999) evaluated PW in a disadvan-taged community of Appalachia. Compared to the waitlist control, mothersreported significantly decreased child problem behaviors at 1-monthfollow-up. Gains were maintained at 4-month follow-up and effect sizeson the Child Behavior Inventory (ECBI; Eyberg & Ross, 1978) were .66 onthe Problem Intensity scale and .51 on the Problem Number scale.

Gordon, Kacir, and Pushak (2008) evaluated mandatory use of PW withcourt-referred low-income parents of juvenile delinquents compared to amatched control group of youth who received probation services. Adoles-cents in the treatment group showed a 50% reduction in problem behavior(as measured on the ECBI). Gains were maintained at 1-, 3-, and 6-monthsfollow-up. Effect sizes on the ECBI ranged from .46 to .76.

In a randomized study with parents at outpatient clinics and a residentialtreatment center for delinquents, Segal, Chen, Gordon, Kacir, and Gylys

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(2003) found significant decreases in the number and intensity of childproblem behaviors on the ECBI. Effect sizes ranged from .78 (ECBI) to1.27 (Parent Daily Report).

HYPOTHESES

It is hypothesized that completing PW, either individually or by groupformat, will increase parental sense of competence, reduce child behaviorproblems, and result in a lower drop out rate than the average drop out rateof 28% for behavioral parent education reported by Forehand, Middlebrook,Rogers, and Steffe (1983). It is expected group intervention will achievegreater participant satisfaction compared to the self-administered format.

METHOD

Participants

In response to advertising, 116 families completed pretest data collection.One parent and one child from each family participated in the project. Parentsranged in age from 24 to 55 (M¼ 40.7, SD¼ 5.3), with 92 female (M¼ 40.5years, SD¼ 4.8) and 24 male (M¼ 41.2 years, SD¼ 7.2) participants. Childrenranged in age from 9 to 15 (M¼ 11.9, SD¼ 1.8), with 57 being female (M¼ 12.1years, SD¼ 1.8) and 59 male (M¼ 11.7 years, SD¼ 1.8). Families were allo-cated randomly to either a waitlist control or to one of two treatment groups(individual or group administration). Participants in the treatment condition(n¼ 92 families) completed PW. This sample included 22 participants pre-viously allocated to the waitlist control and after 3 months were randomlyassigned to group or individual administration. Data from these families areincluded in both the control and treatment group analyses.

Family ethnicity is predominately Australian (n¼ 76, 66%), then Italian(n¼ 14, 12%) and Maltese (n¼ 9, 9%). Parent educational levels were: collegeor higher, 20%; technical school certificate, 15%; high school diploma, 21%;completed years 10 or 11, 39%, and year 9 or below, 6%. The most frequentparent occupation was parent or home duties (n¼ 24, 21%), followed byadministration (n¼ 16, 14%), manager (n¼ 7, 6%), self-employed (n¼ 7,6%), and police (n¼ 7, 6%). Holinshed Index of Social Position scores were31% upper-middle, 27% middle, 36% lower middle, and 5% lower.

Materials and Outcome Measures

Materials consisted of the PW program, a computer, workbook, and thefollowing outcome measures: Parenting Sense of Competence (PSOC) andEyberg Child Behavior Inventory (ECBI).

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PARENTING SENSE OF COMPETENCE (PSOC)

The PSOC (Gibaud-Wallston & Wandersman, 1978) consists of 16 items thatmeasures parental competence on two dimensions: (a) Efficacy—defined asperceived competence in the parenting role and problem solving ability(reliability coefficients of .82) and (b) Satisfaction—defined as satisfactionwith the parenting role (reliability coefficient of .70; Gibaud-Wallston &Wandersman). Johnston and Mash (1989) found the overall internal consist-ency of the PSOC to be .79, with a Cronbach alpha of .75 for the Satisfactionfactor and .76 for the Efficacy factor. Other studies have demonstrated goodinternal consistency, ranging from .77 to .82 for the Efficacy and Satisfactionscales. Hence, it is a valid and reliable measure of parental efficacy and sat-isfaction. Ngai, Wai-Chi Chan, and Holroyd (2007) translated the PSOC intoChinese. Factor analysis supported the two-factor structure of efficacy andsatisfaction for the measure. The scale discriminated between Primiparasand multiparas (t¼ 2.2, p< .05). Significant correlations with Rosenberg’sSelf-Esteem Scale (r¼ .60, p< .01) and the Edinburgh Postnatal DepressionScale (r¼�.48, p< .01) demonstrated good construct validity.

EYBERG CHILD BEHAVIOR INVENTORY (ECBI)

The ECBI is a 36-item measure, designed for children aged 2–16 years, thatassesses the number (problem scale) and frequency (intensity scale) of childproblem behaviors. A score of 131 or over on the Intensity scale is consideredto be in the clinically significant range. A score of 15 or more on the problemnumber scale is considered to be in the clinical range. The ECBI discriminatesbetween problem and non-problem children (Eyberg & Ross, 1978). TheECBI has a test-retest reliability of .86 and an internal consistency of .98(Eyberg & Ross). Robinson, Eyberg, and Ross (1980) and Boggs, Eyberg,and Reynolds (1990) report that the Eyberg Child Behavior Inventorydemonstrates high concurrent validity with the Child Behavior Checklist(Achenbach & Edelbrock, 1983).

Procedure

INDIVIDUAL ADMINISTRATION CONDITION

Participants allocated to individual administration scheduled an appointmentto attend a center of their choice: a University Psychology Clinic and twocommunity treatment centers in outer metropolitan Melbourne. Participantscompleted the pretest outcome measures, were given basic instructionson how to navigate through the program, were advised they could completeas much of the program as they desired, and they could return for additionalsessions (40%, 54%, and 6% took one, two, and three sessions, respectively).An average of 3.2 hours was spent completing the program. Parents were


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given the PW workbook to keep. At the conclusion of the program, parti-cipants completed a satisfaction questionnaire, and 3 months later completedall of the outcome measures.

GROUP ADMINISTRATION CONDITION

These participants completed PW in a group setting. The researcherfacilitated each group. After each vignette was viewed, the group was askedto select the solution they would most likely experience in their own families.The question and answer section was used to generate group discussion.After viewing at least one of the ineffective solutions, the correct solutionwas shown. The facilitator allowed discussion to develop among the group,while allowing almost 2–3 hours for each of the two sessions. An average of4.5 hours was spent completing the program.

CONTROL GROUP

The waitlist control did not receive intervention. At the conclusion of a3-month wait, these participants were asked to complete and return a secondquestionnaire booklet. Upon receipt of this material, the researcher contactedthe participant to offer them a place in the treatment program. Those (n¼ 22)that wished to proceed were randomly allocated to either the group or indi-vidual administration of the program. Their final scores after the 3-monthwait were used as pretest scores for treatment, with follow-up measuresgiven 3 months after treatment.

RESULTS

Random Allocation Analysis

A multivariate analysis of variance showed participants in the waitlist control,individual format, and the group format did not significantly differ in terms ofparent or child mean age, Wilks’ K¼ .95, F(4, 224)¼ 1.51, p> .05. Chi-squareanalysis indicated no significant difference between groups according toparents’ sex, v2(2, N¼ 116)¼ 1.29, p> .05, Cramer’s V¼ .11, child’s sex,v2(2, N¼ 116)¼ 4.54, p> .05, Cramer’s V¼ .20, and parents’ education level,v2(8, N¼ 116)¼ 3.15, p> .05, Cramer’s V¼ .12.

Hypothesis Testing


A 2-way repeated measures Manova was utilized with parent satisfaction andefficacy. Multivariate analyses revealed a significant interaction effect, Wilks’

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K¼ .80, F(4, 242)¼ 7.04, p¼ .00, g2¼ .10. There was a significant multivariateeffect for time, Wilks’ K¼ .85, F(2, 121)¼ 10.85, p¼ .00, g2¼ .15. There was,however, no significant effect for treatment format, Wilks’ K¼ .98, F(4,242)¼ .66, p> .05, g2¼ .01. Means and standard deviations for satisfactionand efficacy scores are presented in Table 1.

To examine the interaction between treatment format and time,follow-up tests of simple main effects were performed separated intobetween-group and within-group comparisons.

WITHIN-GROUP COMPARISONS

Means in both treatment groups improved across time on satisfaction andefficacy, while the waitlist control group experienced a slight decline.Within-group simple effects revealed the measures changed significantly forthe individual format, Wilks’ K¼ .74, F(2, 121)¼ 20.77, p¼ .00, g2¼ .26, andfor the group format, Wilks’ K¼ .95, F(2, 121)¼ 3.01, p¼ .05, g2¼ .05, butnot for the waitlist control, Wilks’ K¼ .99, F(2, 121)¼ .59, p> .05, g2¼ .01.

BETWEEN-GROUP COMPARISONS

With regard to the pretest period, a simple effects multivariate test revealedno significant difference among the three groups, Wilks’ K¼ .94, F(4,242)¼ 1.77, p> .05, g2¼ .03. There were also no significant differencesamong the groups at posttest, Wilks’ K¼ .98, F(4, 242)¼ .68, p> .05, g2¼ .01.

ANALYSIS OF CHANGE

The biggest change from baseline to posttest occurred for participants in theindividual format on both parenting satisfaction and efficacy, with animprovement of 16.55% and 13.47%, respectively. Participants in the groupformat experienced a 5.50% increase in parental satisfaction and 4.97%improvement in efficacy. In contrast, waitlist participants experienced a slightdecrease in both parenting satisfaction (�2.39%) and efficacy (�1.78%).

TABLE 1 Descriptive Statistics for PSOC (n¼ 125)

Pretest Posttest

Treatment group n M SD M SD

EfficacyWaitlist 46 28.13 6.22 27.63 6.49Individual 40 25.98 7.61 29.48 4.41Group 39 27.77 7.98 29.15 7.48

SatisfactionWaitlist 46 35.48 8.06 34.63 7.98Individual 40 30.50 10.52 35.55 7.86Group 39 34.54 8.18 36.44 8.13


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Parent Reports of Child Behavior


Univariate analyses for the individual format showed significant improve-ment across time on both ECBI Intensity scores, F(1, 122)¼ 42.77, p¼ .00,g2¼ .26, and ECBI Problem scores, F(1, 122)¼ 49.02, p¼ .00, g2¼ .29. Thegroup format also showed significant improvement on both ECBI Intensityscores, F(1, 122)¼ 42.77, p¼ .00, g2¼ .26, and Problem scores, F(1,122)¼ 49.02, p¼ .00, g2¼ .29. Means, standard deviations, and effect sizesare reported in Table 2. As suggested by Becker (1998), a single group effectsize for the control condition was subtracted from the single group effectsizes for the treatment groups.


A simple effects multivariate test revealed a significant difference betweenthe three groups at baseline, Wilks’ K¼ .87, F(6, 240)¼ 2.84, p¼ .01,g2¼ .07, but not at posttest, Wilks’ K¼ .97, F(6, 240)¼ .70, p> .05, g2¼ .02.Univariate simple effects revealed a significant difference between groupsat baseline on both ECBI Intensity scores, F(2, 122)¼ 4.00, p¼ .02, g2¼ .06,and ECBI problem scores, F(2, 122)¼ 5.51, p¼ .01, g2¼ .08. Univariate analy-sis for the ECBI Intensity Scores show the waitlist control group significantlydiffered from the individual format (p¼ .01) and the group format (p¼ .049).The Problem Number scores for the waitlist control were also significantlydifferent from both individual (p¼ .01) and group formats (p¼ .01).

ANALYSIS OF CHANGE SCORES

Inspection of Table 3 shows parents in the waitlist condition reported anincrease in child problem behavior over time on each dependent measure.In contrast, parents in the treatment conditions reported consistent

TABLE 2 Pre- and Posttest Means of ECBI Intensity and Problem Scores (n¼ 125)

Pretest Posttest

Treatment group n M SD M SD Effect size

ECBI intensityWaitlist 46 99.90 37.11 102.76 35.30 �.08Individual 40 119.96 35.52 97.88 26.53 .70Group 39 115.51 35.53 102.26 34.51 .45

ECBI problemWaitlist 46 8.80 8.87 9.65 8.33 �.10Individual 40 14.43 7.73 8.33 5.59 .89Group 39 13.72 9.16 8.26 7.44 .69

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improvements in child behavior at posttest. The greatest change on bothmeasures was reported by participants in the individual condition.

RELATIONSHIP BETWEEN CHANGE SCORES

Correlations between change scores indicate satisfaction, efficacy, andknowledge were inversely related to ECBI scores (range: �.28 to �.58).

PROGRAM SATISFACTION

Participants rated how enjoyable and how satisfied they were with the pro-gram on a 5-point Likert scale. Ninety-two percent of participants (n¼ 82)said they found the program enjoyable and 89% indicated they were satis-fied. Chi-square analysis indicates parents in the individual format foundthe program to be significantly more enjoyable and were more satisfied thanparents in the group format, v2(3, N¼ 83)¼ 9.95, p¼ .02, Cramer’s V¼ .35;11.10, p¼ .01, Cramer’s V¼ .37, respectively. Over 80% of participants saidthey would recommend the program to others. Chi-square analysis indicatesno significant difference between formats on this measure; v2(2, N¼ 82)¼4.98, p> .05, Cramer’s V¼ .25.

ATTRITION

Four participants (4.3%), two each from the individual and group formats,failed to complete the entire program by failing to attend subsequent ses-sions. Twelve participants (13%) failed to return 1-month follow-up ques-tionnaires and a further 21 (38.9%) failed to return the 3-month follow-upquestionnaires.

Three-Month Follow-Up


A 2-way repeated measures Manova was utilized on parental satisfaction andefficacy scores at posttest and 3-month follow-up. Multivariate analysesrevealed a significant interaction effect, Wilks’ K¼ .80, F(8, 164)¼ 2.38,p¼ .02, g2¼ .10, and a significant effect for time, Wilks’ K¼ .88, F(4, 82)¼ 2.92,

TABLE 3 Percentage Change from Baseline in Parent ReportedChild Behavior Scores

Treatment group Intensity score Problem scores

Waitlist �2.9% �9.7%Individual 19.1% 42.3%Group 11.5% 39.8%


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p¼ .03, g2¼ .13. The multivariate effect for treatment format was not signifi-cant, Wilks’ K¼ .96, F(4, 168)¼ .77, p> .05, g2¼ .02. Means and standarddeviations are presented in Table 4.


Mean scores for both treatment groups improved across time on parentsatisfaction and efficacy, and remained relatively stable at follow-up(see Table 5). However, within-group simple effects reveal significant changeover time only for the individual format, Wilks’ K¼ .79, F(4, 82)¼ 5.55,p¼ .00, g2¼ .21, but not for the group format, Wilks’ K¼ .93, F(4,82)¼ 1.50, p> .05, g2¼ .07, or the waitlist control, Wilks’ K¼ .99, F(4,82)¼ .25, p> .05, g2¼ .01.

Univariate analyses reveal significant improvement over time for bothsatisfaction, F(1, 170)¼ 2.28, p¼ .00, g2¼ .06, and efficacy scales, F(1,170)¼ 2.28, p¼ .01, g2¼ .03 for the individual format. The differencebetween pre- and posttest means and between pretest and follow-up

TABLE 4 Mean Scores at Pretest, Posttest, and Follow-Up for Parental Efficacy andSatisfaction Scores

Pretest Posttest Follow-up

Subscales n M SD M SD M SD

EfficacyWaitlist 31 27.48 6.72 27.13 7.31 27.00 7.18Individual 25 25.40 8.02 29.16 5.03 29.16 4.55Group 32 27.94 8.07 28.88 7.64 27.63 7.57

SatisfactionWaitlist 31 33.42 8.65 32.55 8.68 32.35 8.66Individual 25 31.88 10.91 34.52 7.90 34.88 8.03Group 32 35.13 7.34 36.56 7.53 36.09 6.50

TABLE 5 Mean Scores at Pretest, Posttest, and Follow-Up for Intensity and Problem Scores(n¼ 88)

Pretest Posttest Follow-up

Subscales n M SD M SD Effect size M SD Effect size

Intensity ScoresWaitlist 31 105.90 40.24 107.94 39.52 �.05 109.32 37.73 �.09Individual 25 119.64 35.91 100.28 30.24 .59 99.00 29.33 .66Group 32 115.22 33.92 103.06 32.96 .41 96.94 28.24 .62

Problem ScoresWaitlist 31 10.94 9.16 11.65 8.70 �.08 12.06 8.29 �.12Individual 25 14.52 7.19 9.00 5.67 .85 7.28 6.33 1.04Group 32 14.66 9.09 8.44 7.34 .76 7.41 5.84 .92

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means were significant on both measures (p¼ .02). The significant improve-ment for the individual format was maintained from posttest to follow-up.

PARENT REPORT OF CHILD BEHAVIOR

Univariate analyses reveal that within the individual format there was signifi-cant improvement across time on the Intensity scores, F(2, 170)¼ 21.59,p¼ .00, g2¼ .20, and Problem scores, F(2, 170)¼ 36.57, p¼ .00, g2¼ .30.The difference between pre- and posttest means and between pretestand follow-up means are significant on both measures (p¼ .00), indicatingthis improvement was maintained at follow-up.

Univariate analyses reveal the group format experienced significantimprovement across time on the ECBI Intensity, F(2, 170)¼ 21.59, p¼ .00,g2¼ .20, and Problem scales, F(2, 170)¼ 36.57, p¼ .00, g2¼ .30. Significantdifferences were found between baseline and posttest, and baseline andfollow-up (p¼ .00) for the Intensity and Problem scores, indicating signifi-cant improvements were maintained. Effect sizes ranged from .41 to 1.04.


A simple effects multivariate test reveals no significant difference betweenthe three groups at baseline, Wilks’ K¼ .91, F(6, 166)¼ 1.28, p> .05,g2¼ .04; posttest, Wilks’ K¼ .92, F(6, 166)¼ 1.20, p> .05, g2¼ .04; orfollow-up, Wilks’ K¼ .88, F(6, 166)¼ 1.83, p> .05, g2¼ .06.

QUALITATIVE ANALYSIS

A total of 75 participants completed qualitative responses (39 group formatand 36 individual format). All respondents commented positively about theprogram and several stated they had no criticism of the program.

Participants were asked: (a) What did you like most about the program?;and (b) What was your main criticism of the program? The majority (53%,n¼ 40) stated what they liked most were the skills and strategies taught bythe program. Many of these parents indicated they felt better equipped todeal with their children after learning the skills taught in the program.Twenty participants (27%) indicated the video scenarios were the aspect ofthe program they liked most. Some of these parents indicated the interactivevideo’s helped to maintain their attention and some indicated the videoshelped them to more clearly understand the situation or the skills beingtaught. A small number of parents (n¼ 5) indicated what they liked mostwas the simplicity of the program, that it was clear and easy to understand.

The main criticism is that the program is not Australian (i.e., Americanactors and American colloquialisms; n¼ 13, 17%). Five participants (7%) cri-ticized the program as being ‘‘too structured.’’ Alternatively, others found the


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program structure to be ‘‘unclear,’’ ‘‘confusing,’’ and ‘‘somewhat stilted.’’ Fourparents (5%) indicated the choice of solutions offered were poorly describedin written form and did not accurately represent the video solution. Thirteenparticipants (17%) expressed concerns about how realistic the program was.Some parents indicated the solution scenarios were ‘‘too perfect’’ and ‘‘toosimplistic.’’ One parent said ‘‘it seemed slightly unreal when the situationswere solved so quickly.’’ Four parents (5%) indicated they would have likeda broader range of problem scenarios such as children with poor behaviorrelated to eating. Three participants indicated they had difficulty integratingthe skills they learned stating; for example, ‘‘(I) tried some of the things athome but they did not work for me.’’

Individual and Group Format Differences

INDIVIDUAL FORMAT

A total of nineteen participants (25%) stated they had no criticism of theprogram. Seventeen (23%) of these participants completed the program byindividual format. ‘‘No criticism’’ was by far the most common responsegiven by individual-format participants to the question regarding their great-est criticism of the program.

GROUP FORMAT

In response to what they liked most about the program, the most commonresponse of group format participants (31%, n¼ 13) was the discussion andinteraction with other parents. This issue was not raised by participants whocompleted the program via individual format. Many group participants foundcompleting the program with others very enjoyable. One participant statedwhat she liked most was ‘‘talking to other parents (and) hearing how they han-dle situations.’’ However, discussion was also a criticism for the group format.Eight participants (21%) indicated there was not enough discussion time.

In summary, participants had more positive comments than criticisms,with a large proportion of individual-format participants indicating they hadno criticism of the program at all. Interestingly, several issues raised as posi-tives for some parents were also raised by others as criticisms. For example,the vignettes were liked by several participants yet disliked by others, aswas the simplicity of the program. Similarly, some parents found the programadequately instructed how to put the skills and strategies into action, whileothers argued that the inability to do this was a main criticism of the program.

DISCUSSION

The hypothesis that PW would improve parental competence was supported.Completion of self-administered and group use of the program resulted in

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significant improvements in both parental satisfaction and efficacy. Thesefindings are consistent with previous research reporting enhanced parentalcompetence after completion of behavioral parent training (Anastopoulos,Shelton, DuPaul, & Guevremont, 1993; Bor, Sanders, & Markie-Dadds,2002; Pisterman et al., 1992; Sofronoff & Farbotko, 2002; Tiedemann, &Johnston, 1992), and more recently, specifically using the PW program(Hein, Martin, & Else, 2002). However, the aforementioned studies did notconduct follow-up analyses on this outcome. This outcome is pertinent sinceresearch (Coleman & Karraker, 1997) demonstrates parental sense ofcompetence can substantially impact parent’s ability to implement parentingstrategies.

The current study found gains in parenting sense of competence weremaintained after 3 months for parents who completed the individual formatof the program, but not for group-format participants. This suggests aself-administered program may have a stronger impact on self-competencethan practitioner-directed interventions. Completion of PW was effective inenhancing parenting knowledge, increasing use of effective parenting skills,and improving child behavior irrespective of existing levels of self efficacy.Perhaps the apparent simplicity of the program described in the above quali-tative analysis helped parents with low self-efficacy to not become demora-lized and increased their willingness to learn and use new skills.

The hypothesis that PW would reduce child problem behavior was sup-ported. Participants reported a significant decrease in child problem behavior(moderate to large effect sizes) in both treatment formats and these reduc-tions were maintained at follow-up. These findings confirm previousresearch on PW reporting significant reductions in child problem behavior(Carr & Friedman, 2002; Gordon et al., 2008; Kacir & Gordon, 1999; O’Neill& Woodward, 2002; Pushak & Pretty, 2008; Segal et al., 2003).

The hypothesis that group format participants would be more satisfiedthan individual format participants was not supported. Participants whocompleted the individual format were significantly more satisfied (93%)than the group format participants (85%). Almost all of the participantswho reported no criticism of the program completed the individual format.Although these differences are statistically significant, it is noteworthy thatboth groups of participants were very satisfied. The overall satisfaction rateof 89% in this study is similar to previous research on PW (Hein et al., 2002;Paull, Caldwell, & Klimm, 2001). Restrictions on discussion time in the cur-rent study may have contributed to a lower satisfaction rating for the groupformat. Almost a third of these parents were critical of the limited groupdiscussion time. These findings contrast previous research which foundhigher satisfaction with a group discussion format of program delivery com-pared to individual delivery (Webster-Stratton et al., 1988). In the aforemen-tioned study, the absence of personal contact and feedback was reported tobe a limitation of the individual format. Individual use of PW may have an


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advantage over self-administered, linear programs, because the program isinteractive and parents receive feedback on their choices. The computer-generated feedback may compensate the absence of therapist involvementand feedback, and may increase parent’s sense of competence and thusimprove outcomes.

The hypothesis that attrition for PW compared to other parent trainingprograms, was supported. Only four people, representing a 5% drop-outrate, failed to complete the program. Of course, it must be acknowledged,any program requiring attendance to only two sessions will likely result inless attrition than programs requiring a greater time commitment. This modeof program delivery and the small number of sessions required, did notappear to compromise outcomes as treatment gains were similar to thoseachieved by other lengthy programs.

Methodological Considerations

Despite random allocation, there is a significant difference between scoreson the child behavior measures at pretest. These differences may haveoccurred because a small number of participants originally allocated to thetreatment groups could not commence the program immediately, due to cir-cumstances occurring in their lives at the time. Those that could not com-mence for more than 3 months were again asked to complete outcomemeasures which included them as part of the waitlist control group. Thesefamilies and the other families in the waitlist control condition were con-tacted at 3-month follow-up and provided an opportunity to be randomlyassigned to either the individual or group format of the program. Data fromthese families were included in both treatment and control conditions.

No analysis was completed on demographic characteristics or pre- andposttest scores for the 21 families who failed to complete the 3-monthfollow-up measures compared to the rest of the sample. These familiesmay not have maintained treatment gains which may have lowered effectsize calculations for the entire sample.

Inclusion of observed measures of child behavior would increase thequality of this evaluation.

Conclusions

This evaluation revealed the PW parenting program was effective in increas-ing parental satisfaction, efficacy, and reducing child problem behavior in anAustralian sample. These improvements were maintained up to 3-monthsfollow-up. The results of this study indicate completing the program via indi-vidual format enhanced treatment gains compared to the group format. Part-icipants also found the program enjoyable and satisfying, and most statedthey would recommend it to others. This evaluation increases the empirical

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support for self-administered parent training programs and these programsmay achieve superior gains with parental sense of competence thantherapist-led interventions. There is a need for empirically validated pro-grams that increase parental attendance, reduce drop-out rates, and enhancecost-effectiveness. PW is an effective program that shows great promise inmeeting these needs.

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Documents

Parenting Wisely: Parent Training via CD-ROM with an Australian Sample