Parent Preferences and Family Engagement in a Deliquency Prevention Program

The theory of planned behavior (Schifter & Ajzen, 1985) and principal-agent theory (Jensen & Meckling, 1976) highlight the potential benefits of matching participants with their treatment preferences. In fact, research suggests that a mismatch between preferred and actual treatment is related to lower attendance rates and poorer therapeutic relationships (Kwan, Dimidjian, & Rizvi, 2010; Iacoviello et al., 2007). For children’s mental health services, parents play a major role in their child’s treatment. There is a growing recognition that parents should be involved in the selection of their children’s services (Cunningham et al., 2008; Hoagwood, 2005).

The goal of this pilot study is to discover whether addressing parents’ preferences in prevention designs increases families’ adherence to and engagement with treatment, ultimately improving treatment gains. In total, 134 families with children ages 4 to 12 years (M = 7.58, 49 girls and 85 boys) presenting at community mental health clinics for conduct problems, were invited to join in a delinquency prevention study. Families consenting to participate in the study were randomly assigned to preference (n = 67) or non-preference groups (n = 67). Intervention options included: (i) individual, home-based of the Parent Management-Training Oregon model (PMTO), (ii) individual, clinic-based PMTO, (iii) group, multi-family clinic-based PMTO, and (iv) supportive child psychotherapy. Those in the preference group were able to choose between these four prevention options while families in the non-preference group were randomly assigned to one of these four options.

The primary research question focused on whether families in the preference group had a higher engagement rate than those in the non-preference group. Treatment engagement was operatized as a dichotomous variable: complete the treatment or drop-out from the treatment. Addressed through hierarchical logistic regression, in the first block of the logistic regression, overall the demographic variables (e.g., gender of child, child age, child ethnicity, parent age, parent education, family income) and clinic did not significantly predict parents’ engagement (χ² = 12.71, df = 11, p = .313). After adding the count of preference status and service modality, the second block was statistically significant (χ² = 35.61, df = 15, p = .002). Parents who were randomized to preference group were more likely to complete the interventions than parents in the non-preference group (p = .04) with the predicted odds of 2.98. It suggests that accommodating to parents’ treatment preferences may be promising for increasing families’ engagement in services to benefit children’s mental health.