Collaborative Problem Solving vs. Positive Solutions for Families in Preschool Parent Groups

Comparison of Collaborative Problem Solving (CPS) and Positive Solutions for Families Groups for Parents of Head Start Preschoolers

The main objectives of this study are to evaluate the feasibility, acceptability, and effects of a CPS parent group on outcomes for a sample of parents of children ages 3 to 5 compared to outcomes after attending a parenting group that promotes behavioral (operant) parenting. We hypothesize that guardians in the CPS group will report a better understanding of how neurocognitive skills relate to children's behaviors, greater improvements in child functioning and behavior, and greater reductions in parents' stress than those in the comparison group.

Collaborative Problem Solving (CPS) is an evidence-based approach for treating children with behavioral challenges. Unlike traditional models of discipline that use power, control and incentives to facilitate compliance, CPS does not assume that a challenging child lacks motivation for compliance, but instead that the child is motivated to behave well, but simply cannot consistently do so, due to lagging skills in one or more critical neurocognitive domains, such as those related to language and communication skills, attention and working memory skills, emotion- and self-regulation skills, cognitive flexibility skills, and/or social thinking skills. The goal of the intervention is to improve these lagging neurocognitive skills by helping adults and children work toward mutually satisfactory solutions to problems, thereby enhancing flexibility and frustration tolerance in both interaction partners. Any caregiver can use CPS with any child, and CPS can be taught to mental health providers (e.g., therapists, direct care staff), educators (e.g., teachers, administrators), or parents. Common ways to teach CPS to parents include family therapy (one provider teaching one family) or in parent group training (one provider teaching six to ten parents). Although preschool-aged children have been included in past CPS-related research, they have not been studied separately, and research has not assessed the appropriateness of the current CPS approach for very young children. To address this gap in research, this study will support the development of a parent group curriculum specifically targeting guardians of preschool-aged children, as well as a randomized efficacy trial to evaluate the feasibility, acceptability, and effects of a CPS parent group. Outcome measures from the CPS group will be compared with those from a group that promotes operant behavioral parenting. Approximately sixty participating guardians will be randomly assigned to attend one of two types of weekly 2-hour groups, each lasting six weeks: either a Collaborative Problem Solving group (N=30; 3 groups) or a Positive Solutions for Families group, a group routinely offered at Head Start programs (N=30; 3 groups). Participants will complete surveys prior to beginning the groups (baseline), upon completion of the group sessions (discharge), and six months after the conclusion of the groups (follow up). Results from these surveys will be compared between groups.

Parent training, Preschoolers, Behavior problems, Oppositional Defiant Disorder, ODD, Conduct Disorder, CD, Children, Parenting, Collaborative Problem Solving, CPS, Disruptive behavior

Participants will attend parent group sessions led by trained group leaders and learn the Collaborative Problem Solving approach.

Participants will attend parent group sessions and learn the Positive Solutions for Families approach, a group that is usually offered by Head Start.

CPS is an approach for understanding and reducing challenging behavior in youth. Under CPS, caregivers are taught to understand and identify the specific neurocognitive skill deficits that underlie their child's challenging behavior. Then the caregivers are taught to interact with the child in a way that solves chronic behavior problems while building the lagging neurocognitive skills to avoid future problems.

Positive Solutions for Families groups provide information for families on how to promote children's social and emotional skills, understand their problem behavior, and use positive approaches to help children learn appropriate behavior.

Therapy Attitude Inventory (The TAI is a self-report questionnaire that we will use to measure satisfaction with the parenting groups. We will compare the scores on this measure between the two groups.)

Parenting Styles and Dimensions Questionnaire (Measures parenting philosophy and includes scores for authoritative style, authoritarian style, and permissive style.)

Difficulties in Emotion Regulation Scale (Measures emotion regulation skills including nonacceptance of emotional responses, difficulties engaging in goal-directed behaviors, impulse control difficulties, lack of emotional awareness, limited access to emotion regulation strategies, and lack of emotional clarity.)

Parent Child Relationship Inventory (Measures how parents view the task of parenting and how they feel about their children. Measures parental support, satisfaction with parenting, communication, limit setting, parent response consistency, and parent social desirability.)

Think:Kids Measure of Change Over Time (Measures perceptions of parent-child relationship quality, parenting philosophy, and predictability of youth's challenging behavior.)

Inclusion Criteria: Guardian of a child between the ages of three and five currently enrolled at participating Head Start center Speaking and writing English at level necessary to complete study requirements Exclusion Criteria: A diagnosis of significant Autism that currently impacts day to day functioning A diagnosis of a psychotic disorder including schizophrenia, schizoaffective disorder, schizophreniform disorder An intellectual disability that impairs day to day functioning Participation in a similar parenting group at the Head Start site within the last year

The approach being studied here, Collaborative Problem Solving, is updated and disseminated from Think:Kids at Massachusetts General Hospital.