Disruptive behaviors of childhood are among the most common reasons for referral of children to mental health professionals. Behavioral parent training (BPT) is the most efficacious intervention for these problem behaviors, yet BPT is substantially underutilized beyond university research and clinic settings. With the aim of addressing this research-to-practice gap, this article highlights the considerable, but largely unrealized, potential for technology to overcome the two most pressing challenges hindering the diffusion of BPT: (1). The dearth of BPT training and supervision opportunities for therapists who work with families of children with disruptive behaviors and; (2). The failure to engage and retain families in BPT services when services are available. To this end, this review presents a theoretical framework to guide technological innovations in BPT and highlights examples of how technology is currently being harnessed to overcome these challenges. This review also discusses recommendations for using technology as a delivery vehicle to further advance the field of BPT and the potential implications of technological innovations in BPT for other areas of children’s mental health are discussed.

Objective Early onset Disruptive Behavior Disorders (DBDs) are overrepresented in low-income families; yet, these families are less likely to engage in Behavioral Parent Training (BPT) than other groups. This project aimed to develop and pilot test a technology-enhanced version of one evidence-based BPT program, Helping the Noncompliant Child (HNC). The aim was to increase engagement of low-income families and, in turn, child behavior outcomes, with potential cost-savings associated with greater treatment efficiency. Method Low-income families of 3-to-8 year old children with clinically-significant disruptive behaviors were randomized to and completed standard HNC (n =8) or technology-enhanced HNC (TE-HNC) (n = 7). On average, caregivers were 37 years old, female (87%), and most (80%) worked at least part-time. Half (53%) of the youth were boys, average age of the sample was 5.67 years. All families received the standard HNC program; however, TE-HNC also included the following smartphone-enhancements: (1). Skills video series; (2). Brief daily surveys; (3). Text message reminders; (4). Video recording home practice; and (5). Mid-week video calls. Results TE-HNC yielded larger effect sizes than HNC for all engagement outcomes. Both groups yielded clinically significant improvements in disruptive behavior; however, findings suggest that the greater program engagement associated with TE-HNC boosted child treatment outcome. Further evidence for the boost afforded by the technology is revealed in family responses to post-assessment interviews. Finally, cost analysis suggests that TE-HNC families also required fewer sessions than HNC families to complete the program, an efficiency that did not compromise family satisfaction. Conclusions TE-HNC shows promise as an innovative approach to engaging low-income families in BPT with potential cost-savings and, therefore, merits further investigation on a larger scale.

Positive parenting behavior is a robust predictor of child and adolescent psychosocial adjustment; however, contextual factors that relate to parenting itself are not well understood. This limited understanding is, in part, related to the fact that although theories have been put forth to explain the link between ecological context and parenting, there has been little integration of key concepts across these theories or empirical examination to determine their soundness. This review aims to begin to fill this gap by focusing on one contextual influence on parenting in particular, neighborhood context. Specifically, this review utilizes three constructs to provide a framework for integrating and organizing the literature on parenting within the neighborhood context: Danger (capturing crime and concerns for safety), Disadvantage (assessing the absence of institutional and economic resources), and Disengagement (noting the absence of positive social processes in the community). Findings from this review suggest evidence for an association between neighborhood context and positive parenting. Yet these results appear to vary, at least to some extent, depending on which neighborhood construct is examined, the way positive parenting is assessed, and specific sample demographics, including family income and youth gender and age. Findings from this review not only summarize the research to date on neighborhood and parenting, but provide a foundation for future basic and applied work in this area.

No abstract

The majority (67%) of African American youth live in single-parent households, a shift in the family structure that has been linked to increased risk for both internalizing and externalizing problems behaviors. Although the majority of single mothers endorse the assistance of another adult or family member in childrearing, relatively little is known about who is engaged in this non-marital coparenting role (i.e., grandmother, father/social father, aunt, and female family friend) and how it relates to coparenting quality, maternal parenting, and youth psychosocial outcomes (i.e., internalizing and externalizing problems). This question, which is critical to the advancement of family-focused programming for youth in these families, is addressed in this study. The participants examined in the current study were 159 African American single-mother child dyads. Adolescents' maternal grandmothers constituted the largest proportion of coparents in the sample (37.2%), followed by the mothers' female family friends (22.5%), adolescents' maternal aunts (12.7%), and adolescents' fathers/social fathers (11%). Differences emerged among groups of coparents in support and conflict with the mother. Specifically, grandmothers, aunts, and female family friends provided significantly more instrumental support than fathers. Furthermore, grandmothers and fathers had more conflict with the mother, both generally and specifically in front of the child, than aunts or female family friends. In turn, these differences were associated directly and indirectly through maternal parenting with internalizing and externalizing problems. Clinical implications and future directions are discussed.

A distinction between parental behavioral control and psychological control has been elucidated in the literature, yet far less is known about the role of psychological control in youth adjustment broadly or risky behavior in particular. We examined the interrelationship of maternal psychological control, youth psychosocial adjustment, and youth risk behaviors among African American single mother-youth (11-16-year old) dyads (n = 194), families in which youth are more vulnerable to adjustment problems and risky behavior than Caucasian youth or youth from intact homes. Higher levels of maternal psychological control were associated with increased youth psychosocial adjustment problems as well as increased youth risk behavior, after statistically controlling for one domain of behavioral control, parental knowledge about a child's whereabouts and activities. Furthermore, youth externalizing problems mediated the relation between psychological control and risk behavior. The findings suggest that parenting programs targeting risk behavior among African American youth may benefit from including psychological control among the parenting dimensions that are targeted.

Disruptive behavior disorders (DBD) in children can lead to delinquency in adolescence and antisocial behavior in adulthood. Several evidence-based behavioral parent training (BPT) programs have been created to treat early onset DBD. This paper focuses on one such program, Helping the Noncompliant Child (HNC), and provides detailed cost estimates from a recently completed pilot study for the HNC program. The study also assesses the average cost-effectiveness of the HNC program by combining program cost estimates with data on improvements in child participants’ disruptive behavior. The cost and effectiveness estimates are based on implementation of HNC with low-income families. Investigators developed a Microsoft Excel-based costing instrument to collect data from therapists on their time spent delivering the HNC program. The instrument was designed using an activity-based costing approach, where each therapist reported program time by family, by date, and for each skill that the family was working to master. Combining labor and non-labor costs, it is estimated that delivering the HNC program costs an average of $501 per family from a payer perspective. It also costs an average of $13 to improve the Eyberg Child Behavior Inventory intensity score by 1 point for children whose families participated in the HNC pilot program. The cost of delivering the HNC program appears to compare favorably with the costs of similar BPT programs. These cost estimates are the first to be collected systematically and prospectively for HNC. Program managers may use these estimates to plan for the resources needed to fully implement HNC.

Children from low-income families are more likely to develop early-onset disruptive behavior disorders (DBDs) compared to their higher income counterparts. Low-income families of children with early-onset DBDs, however, are less likely to engage in the standard-of-care treatment, behavioral parent training (BPT), than families from other sociodemographic groups. Preliminary between-group findings suggested technology-enhanced BPT was associated with increased engagement and boosted treatment outcomes for low-income families relative to standard BPT. The current study used a case series design to take this research a step further by examining whether there was variability in use of, and reactions to, the smartphone enhancements within technology-enhanced BPT and the extent to which this variability paralleled treatment outcome. Findings provide a window into the uptake and use of technology-enhanced service delivery methods among low-income families, with implications for the broader field of children’s mental health.