Low levels of enrollment and attendance in parent training programs present major problems for researchers and clinicians. The literature on enrollment and attendance in prevention programs is especially limited, and these constructs may be particularly difficult to address in this context. Further, most previous research has not made the distinction between enrollment and attendance. This study describes predictors of enrollment and attendance in a behavioral parent training program intended to prevent conduct problems in preschoolers. Information was gathered from 106 preschoolers, their parents, and their teachers. Parent socioeconomic status (SES), single parent status, ethnicity, child externalizing behavior, parent depressive symptoms, and parent social support were investigated as possible predictors of families' enrollment and attendance. Only 48% of the families that had already provided informed consent and completed demographic questionnaires actually enrolled in the parent training program; parents with lower incomes and lower levels of social support were less likely to enroll. In addition, African-American and Puerto Rican families were less likely to enroll than Caucasian families. The average attendance rate for enrolled parents was 61%; dual parents and parents with children evidencing externalizing behavior problems attended more parent training sessions. Parent depression was not associated with enrollment or attendance. Significant relationships were maintained when controlling for other predictors including SES and when accounting for center-level variance. In addition, three distinct patterns of attendance were observed, which may have practical implications related to retention strategies.
Responsibilization, or the shift of functions and risks from providers and producers to consumers, has become an increasingly common policy in service systems and marketplaces (e.g., financial, health, governmental). Because responsibilization is often considered synonymous with consumer agency and well-being, the authors take a transformative service research perspective and draw on resource integration literature to investigate whether responsibilization is truly associated with well-being. The authors focus on expert services, for which responsibilization concerns are particularly salient, and question whether this expanding policy is in the public interest. In the process, they develop a conceptualization of resource integration under responsibilization that includes three levels of actors (consumer, provider, and service system), the identification of structural tensions to resource integration, and three categories of resource-integration practices (access, appropriation, and management) necessary to negotiate responsibilization. The findings have important implications for health care providers, public and institutional policy makers, and other service systems, all of which must pay more active attention to the challenges consumers face in negotiating responsibilization and the resulting well-being outcomes.
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