Development and Testing of Interventions: Social Disparities in Behavior Problem Interventions: The Case of PMTO
This abstract was presented at the 2018 Society for Prevention Research Annual Meeting which was held May 29 – June 1, 2018 in Washington, DC, US.
Truls Tømmerås Norwegian Center for Child Behavioral Development
Terje Gunnar Ogden The Norwegian Center for Child Behavioral Development; John Kjøbli Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway; Marion S. Forgatch Oregon Social Learning Centre
Introduction: It has been suggested that interventions aimed at improving mental health problems may increase social disparities in health by being less used and having less beneficial outcomes for children from low resource families. Accordingly, social disparities in service use and treatment outcomes are two central factors in health care disparities. We have examined health care disparities in three independent research articles evaluating two Norwegian versions of Parent Management Training - Oregon model (PMTO) aimed at child behavior problems. The overall question is whether PMTO may exacerbate or ameliorate health care disparities?
Methods: We used data from two randomized trials evaluating two versions of PMTO, the preventive Brief Parent Training (BPT: 5 hours; N= 216) and PMTO therapy (group mode; 30 hours; N= 137). In that regard, health care disparities in service use and outcomes were examined in (i) two different PMTO contexts, preventive vs. clinical sample, and (ii), in comparisons between PMTO and non-evidence based regular care treatments. Social disparities in service use were examined using t-tests and hierarchical regression analysis, whereas social disparities in child outcomes (behavior change) and in parent outcomes (parent well-being change; i.e., mental health, somatic health and vitality) were examined by using structural equation models.
Results: First, service use results indicated that PMTO interventions were utilized by participants that overall had lower amounts of social and economic resources compared to other Norwegian families with children. Second, results regarding social disparities in child outcomes showed that children exposed to cumulative lack of family social and economic resources overall experienced more positive behavior change following PMTO, whereas a similar exposure to lack of resources led more negative behavior change in the regular care group. Finally, parent outcome results showed that only the parents in the BPT sample experienced a significant positive effect on change in well-being compared to the regular care group.
Conclusions: Overall, the findings indicate that providing PMTO interventions do not exacerbate social disparities in mental health. To the contrary, providing PMTO interventions seem to ameliorate health care disparities whereas receiving regular care seems to intensify health care disparities. The inverse social gradients found in service use and child outcomes supports this argument, however, only the preventive BPT intervention had effects reducing social risk by improving parent well-being.
