Design of the Psychoeducational Support Program to Promote Parent Resilience “Better
Yourself. Don’t Throw in the Towel!”
María Cantero-García
1, Helena Garrido-Hernansaiz
2&
Jesús Alonso-Tapia
31
Facultad de Ciencias Biomédicas y de la Salud. Universidad Europea de Madrid & Área de Salud, Universidad Internacional de Valencia. Valencia
2
Centro Universitario Cardenal Cisneros. Universidad de Álcala de Henares.
Madrid.
3
Universidad Autónoma de Madrid. Facultad de Psicología. Madrid
Spain
Correspondencia: María Cantero García. Universidad Internacional de Valencia C/ Pintor Sorolla, 21 CP: 46002 (Valencia) E-mail: [email protected]
© Universidad de Almería and Ilustre Colegio Oficial de la Psicología de Andalucía Oriental (Spain))
Abstract
Introduction: Children's and adolescents' behavioral problems are one of the main concerns in today's society families. Confronted with these problems, there are families that can very well cope with them and get ahead, whereas other families are overwhelmed without knowing how to act. This difference may be related the non appropriate use of emotional self-regulation strategies or confrontation strategies and also low levels of resilience.
Method: In order to overcome such issues, we designed a program aiming to improve families' capabilities to deal with the mentioned behavioral problems, as well as confrontation strategies and parents' levels of emotional regulation (we used cognitive behavioral techniques as well as techniques of acceptance and commitment).
Results: The main objective of this study was to evaluate the effectiveness of this program.
Sixty-one parents took part in our study, forty-one in the experimental group and twenty in the control group. To determine our program effectiveness, we evaluate changes: a) concerning parents: Knowledge of strategies to cope with problems, perceived family climate, and levels of resilience, anxiety/stress and depression, b) concerning children: Perceived family climate.
Discussion or Conclusion: Results suggest that our intervention produced a significant reduction in the levels of anxiety, depression as well as an improvement in the perceived family climate.
Keywords: coping strategies; coping assessment, resilience, behavior problems, intervention
Resumen
Introducción. Los problemas de conducta de niños y/o adolescentes constituyen una de las preocupaciones de las familias en la sociedad actual. Ante esta problemática, hay familias que son capaces de afrontar estos problemas y salir adelante, mientras otras se ven desbordadas, sin saber cómo actuar. Esta diferencia puede relacionarse con un uso inadecuado de estrategias de autorregulación emocional, estrategias de afrontamiento eficaces y niveles bajos de resiliencia.
Método. Para ayudar a superar tales carencias se diseñó un programa orientado a mejorar las habilidades de las familias para el manejo de los problemas de comportamiento de sus hijos, así como, las estrategias de afrontamiento y regulación emocional de los padres (se utilizaron técnicas cognitivas conductuales, así como, técnicas de aceptación y compromiso).
Resultados. Los resultados revelaron que el programa de intervención provocó una disminución significativa en los niveles de ansiedad, depresión, así como una mejora en el clima familiar percibido. El objetivo del presente estudio fue evaluar la efectividad del mismo.
Participaron 61 padres, 41 en el grupo experimental y 20 en el de control. Para determinar la efectividad del programa se evaluaron los cambios: a) en los padres: en conocimiento de las estrategias de actuación, en el clima familiar percibido, y los niveles de resiliencia, ansiedad/estrés y depresión; b) en los hijos: percepción del clima familiar.
Discusión y conclusiones. Los resultados revelaron que el programa de intervención provocó una disminución significativa en los niveles de ansiedad, depresión, así como una mejora en el clima familiar percibido.
Palabras Clave: estrategias de afrontamiento, resiliencia, problemas de comportamiento, intervención
Introduction
The behavioral problems displayed by children constitute an important stressor in the family environment (Herreros, Sánchez, Rubio & Gracia, 2004). These problems and the way to deal with them interfere with the family climate, increasing the stress associated with parenting and reducing emotional well-being and levels of parental resilience.
One of the forms of intervention with the best results to treat behavior problems are Parent Training Programs (Chorpita et al., 2011; Forehand, Jones and Parent, 2013; Morales Chainé, Martínez, Martín del Campo and Nieto, 2016). The main objective of these programs is to teach parents techniques for behavior modification, such as reinforcing good behavior and other non-punitive strategies (Robles and Romero, 2011). The different programs focus on teaching strategies such as: Setting limits appropriately, managing behavior problems through techniques such as time out. Among them are: Triple–P (Sanders, Dadds and Turners, 2003), Incredible Year (Webster Stratom et al, 2003), Coping Power (Lochman and Wells, 2002;
Lochman et al., 2007), EmPeCemos (Romero, Villar , Luengo, Gómez-Fraguela and Robles, 2009), Living Adolescence in Family: A parental support program in adolescence (Rodríguez, Martín and Rodrigo, 2015). More recently, other programs are adding other components such as anger management, social skills, communication skills and / or conflict resolution (Lozano and Valero, 2017).
Furthermore, most of these programs have focused on treating behavior problems from a pathological point of view, forgetting in most cases to work on the strengths and potential of parents in a preventive way, as indicated in the Recommendation Rec (2006) 19 of the Committee of Ministers to the Member States on policies to support the positive exercise of parenting (Council of Europe, 2006). Furthermore, the lack of programs aimed at working on coping strategies and emotional self-regulation, as well as strategies for managing behavior problems to improve the sense of parental self-efficacy is still notorious. For this reason, the design of the psychoeducational intervention program is necessary: “Better Yourself. Don’t Throw in the Towel!”
The selection of coping strategies to be used in the program (positive thinking, relaxation, guilt management, stopping rumination, and seeking help) is supported by studies such as those by Alonso-Tapia, Garrido-Hernansaiz, Rodríguez-Rey, Ruiz and Nieto (2017),
who show that working with this type of coping strategies contributes to the improvement of levels of resilience and emotional well-being. In addition, along this line and following authors such as Azar and Cote (2002), parental skills have been worked (eg, impulse control, self- control skills, interpersonal problem solving, empathy, emotional recognition). On the other hand, the strategies related to parental self-efficacy have been validated in the programs mentioned above.
The program designed is based on Recommendation Rec (2006) 19 of the Committee of Ministers to the Member States on policies to support the positive exercise of parenting (Council of Europe, 2006). In addition, it uses the experiential methodology, which has been validated in parental education programs (Galbraith and Fouch, 2007; Martín, Máiquez, Rodrigo, Correa and Rodríguez, 2004; Rodrigo, Martín, Máiquez and Rodríguez, 2005). The meaning of the experiential methodology implies following a process of reflection and analysis of educational practices, of the consequences of these in family life or in the development of children to finally promote the verbalization of the objectives of the process exchange. The experiential methodology, as collected by Máiquez et al., (2000) generates the opportunity to know a wide range of varied experiences, through which it is tried to promote changes at the cognitive, emotional and behavioral level in families. From this model, the aim is to optimize capacities and not only to compensate for deficits, based on the idea that the way of acting of parents in upbringing and education plays a central role. In this way, we find the need to develop activities that encourage participation and the exchange of experiences among participants (Rodrigo, Máiquez and Martín, 2015). Throughout the sessions, group techniques typical of the experiential methodology will be used, such as the case study technique, guided discussion, role-playing, homework assignments and / or commitments. In addition, other types of dynamics and activities are developed for each specific session. All these activities and techniques are adapted to the objectives of each session.
With this methodology, the role of the facilitator is to help build knowledge in the group in a shared way, starting from the previous experiences of the participants (Martínez-González, Rodríguez-Ruiz, Álvarez-Blanco and Becedóniz-Vázquez, 2016; Rodrigo, Máiquez and Martín, 2015), and for this a series of principles must be taken into account such as: Regulating the emotional climate of the group, building knowledge as one more member, working from the needs, experiences and family concerns, encourage negotiation and consensus-building
among group members, support personal initiative and reinforce feelings of belonging to the group.
Objectives and hypotheses
Taking these strengths as the basis of the intervention and starting from the analysis of the environment and the importance of working on coping strategies and parental self-efficacy, this intervention has been developed and put to the test, the objectives of which are to investigate: a) if it is possible to teach parents coping strategies for managing the stress generated by their children's behavior problems, and strategies for managing these problems so that they increase their sense of self-efficacy when dealing with them; b) if that teaching has an influence on their levels of resilience, emotional well-being and family climate; c) if the change produced in the family climate is perceived by the children; d) if the variables age of the parents, age of the children, type of family, etc. modulate the greater or lesser effectiveness of the program.
The achievement of the stated objectives can be manifested by different indicators, so the occurrence of changes in the following variables will be evaluated: 1) the knowledge of the parents about the strategies to be used to manage the behavior problems of the children, 2) the improvement in the use of coping strategies and emotional self-regulation, 3) the changes in the life satisfaction and the mental health of the parents (stress, anxiety and depression), as well as the increase in their parental competence, 4) the improvement in the family climate perceived not only by the parents but also by the children, and 5) the degree of satisfaction with the program. The general hypothesis is that the changes in the dependent variables will occur in the expected direction and will be significantly greater in the experimental group than in the control group. In addition, we hope that the study will allow us to know the strengths and weaknesses of the intervention, with a view to its future improvement.
Method
Participants
Sixty-one parents from seven secondary education centers in the Community of Madrid participated, they were chosen through a non-probabilistic convenience sampling. Of the seven centers, three were public centers, another two were subsidized centers and two were private centers. Of the total enrolled, those belonging to six centers (n = 41) were assigned to the
experimental group and those belonging to the seventh center (public) (n = 20) were assigned to the waiting list control group. All participants in both groups completed all assessments.
Of the 61 participants, 47 are women and 14 men, aged between 31 and 54 years (M = 44.26 years; SD = 4.64). Regarding educational level, 70.5% have university studies, 22.9%
have high school or vocational training and 6.6% have primary or secondary education. 80% of the participants have a paid job. 88.5% of participants are married, 3.3% are single, and 8.2%
are separated or divorced. The number of children of the participants ranged between 1 and 3 (M = 2; SD = .48) with ages between 9 and 15 years (M = 11.38; SD = 1.64). 44% are girls and 56% boys. All the participants have Spanish nationality.
Instruments
Intervention materials.
To facilitate learning, the procedure used in the design of this program has involved paying attention to the structure, duration and distribution of the sessions, the methodology, and the dynamics of the sessions. The program is carried out in groups. The duration of each session is 90 minutes, and its distribution is weekly, since a week seems an appropriate time for parents to reflect on the topics worked in each session and try to put the skills and proposed strategies into practice, so that they can prove their effectiveness (Rodrigo, Máiquez & Martín, 2015).
Regarding its structure, each session consists of the following phases: 1) Entrance, greet and welcome the participants. 2) Review of what was discussed in the previous session, identify the perceived difficulties in putting it into practice. 3) Presentation of new content. 4) Introduction of parenting skills associated with the content of each session. 5) Summary of what was discussed. Delivery of the synthesis to remember. 6) Farewell and closing.
Since the first objective is to help parents learn strategies that allow them to manage their children's behavior problems in the first place, the following strategies of proven effectiveness have been selected: Use of reinforcement, alternatives to punishment and strategies to family conflict resolution (Martínez-González, Rodríguez-Ruiz, Ál-varez-Blanco, Becedóniz-Vázquez, 2016; Ponzetti, 2016; Rodrigo, Máiquez and Martín, 2015).
Likewise, since the second objective is to help parents acquire and / or improve their strategies for coping with stress and self-regulation of their emotions, so that their resilience is enhanced, the following coping strategies have been selected for inclusion in the program:
Positive thinking, relaxation, guilt management, stopping rumination, and asking for help, the effectiveness of which has been justified previously. These strategies have been worked in direct relation to the children's behavior problems.
The training of the two types of strategies listed constitutes the content of the program, which has been organized in 10 sessions. Each session (from 1 to 6) is divided into two parts.
In the first part, we work on the different techniques that will allow us to improve parental self- efficacy, as well as improve the family climate and reduce the behavioral problems of the children. The second part of the session, (and from sessions 7 to 10), is aimed to work on the different coping strategies that contribute to improving levels of resilience and parental emotional well-being. In addition, it consists of two extra sessions, one before the intervention and one after the evaluation.
In the first place, it is developed a zero session or initial session whose main objective is to promote the familiarization of the facilitator with the group of participants and vice versa, as well as establishing the first norms of the group (confidentiality, respect, etc.). Also, the families are presented with the objectives-contents of the program and a brief reflection is given on the importance of working on behavior problems. We briefly describe each of the sessions below.
Session 1.- The behavior of our children. The objective of this session is to reflect on the importance of knowing the behavior of children, as well as the characteristics of their evolutionary stage. The importance of addressing the behavior in specific terms is emphasized, avoiding labeling the child with negative attributes (eg, “You have a pretty messy room” instead of “You are a mess”). In addition, throughout this session it is intended that parents identify the spiral of negative interactions that may be affecting relationships with their child (and the need to pay attention to positive behaviors is emphasized. As a conclusion, they discuss, model and practice appropriate forms of praise.In addition, in the second part of the session, the parents begin to work on self-knowledge, self-praise and the importance of self-care.
Session 2. - We put ourselves in our children's shoes. - Educating in and from assertiveness and empathy is one of the fundamental processes involved in the development of family relationships. Throughout this session, we reflect on the characteristics that differentiate an assertive person from an aggressive or passive person, in addition, we continue working on
parental self-knowledge, as well as the importance of putting ourselves in the place of children to better understand their way of acting.
Session 3. - We learn to communicate as a family. - This session is dedicated to enhancing the communication skills that are necessary for a good family functioning. These strategies will be the foundation and support for other parenting strategies that we will see in later sessions. In the last part of this session, we continue working on the issue of parental self- care and the importance of values.
Session 4. - We regulate behavior I. In this session we work on the transmission of effective orders, the establishment of reasonable and predictable limits, and ignoring unimportant disturbing behaviors. Parents learn to give orders and make requests appropriately, avoiding excessive unnecessary instructions, in chains or as questions. The “ignoring”
technique is presented as a technique for responding to misbehavior. In the second part of this session, we work on the issue of guilt.
Session 5. - We regulate behavior II. This session is dedicated to the use of negative consequences for misbehavior. Parents learn to recognize the characteristics that define effective consequences (immediacy, consistency, proportionality) and learn mainly to establish and put into practice a particular type of consequence: Logical and natural consequences. In addition, they learn to establish a system of reasonable, predictable and appropriate consequences for the child's age and ability (withdrawal of privileges, extra work). The “time out technique” is presented as an alternative to physical punishment. However, it is emphasized that the use of negative consequences should be reduced to a minimum, in favor of forms of interaction based on the reinforcement of behavior. This session addresses the expectations of parents about the behaviors they wish to promote in their children and delves into the appropriate use of tangible reinforcement as a complement to praise. Parents design a system for those behaviors that they wish to establish or consolidate in their children. The second part of this session addresses the topic of forgiveness.
Session 6. - Without stress, we are better. Approaching stressful situations and their consequences for family dynamics, as well as working on techniques for their management are some of the aspects that will be worked on in this session. Throughout this session, they will learn about different techniques to deal with the stress caused by their children's behavior
problems in a healthier way. In the second part of this session, we will work on the importance of self-control and emotional self-regulation.
Session 7. - We think and feel positive. Throughout this session, firstly, we will work on the resolution of conflicts in the family. Secondly, we will work on the importance of changing negative thoughts for more optimistic ones, the importance of changing irrational ideas and maladaptive self-instructions. In a more operative way, the issue of acceptance is worked.
Session 8. - We overcome difficulties without throwing in the towel. Throughout the session, the participants reflect on the concept of resilience and the importance of keeping in mind the aspects dealt with in the different sessions (acceptance, non-rumination, relaxation, positive thinking, self-blame, forgiveness), as well as the different coping strategies focused on the problem (retrying, asking for help, seeking solutions) and coping styles to improve their emotional and family well-being.
Session 9. - With H for Humor and L for Love. In this penultimate session, we will work on humor as a coping strategy to reduce tension in times of stress. It is about making families aware of the importance of taking things with a sense of humor, as well as its benefits.
Session 10. - Final session. The final session is dedicated to recapitulating the techniques learned, both for managing children's behaviors and for improving the emotional well-being of parents. Once again, we highlight the importance of parental well-being in order to act effectively. Finally, parents are prepared to face the behavioral problems that may arise once the program ends, different strategies will be presented to prevent relapses and self-efficacy will be promoted to face the challenges posed by the education of their children. In this last session, the final evaluation of the program is also carried out.
Evaluation materials.
The evaluation of the program is supported by studies such as Grant et al. (2018) and the proposal by Alonso-Tapia (2012, p. 341), whose scheme is presented in Figure 1.
Figure 1. Elements to consider when evaluating programs (Alonso-Tapia, 2012)
This proposal includes the necessary elements to consider in an intervention program (Flay et al., 2005; Gottfredson et al., 2015): 1) Learning evaluation: “It assesses the learning achieved by the recipients in relation to the objectives achieved ”. 2) Transference evaluation:
“It assesses if the participants use this knowledge in the appropriate context”. 3) Impact evaluation: “It assesses whether a program can have an impact on other characteristics of the participants different from those trained or on other people”, in this case, if the effects are perceived by the children. 4) Quality perception evaluation: “It assesses the perception that participants have of the program in matters related to satisfaction, organization, etc.”. Based on this proposal, the variables to be measured and the instruments used to measure them have been selected, included in Table 1 together with the description and reliability of the scales that comprise them.
Table 1. Instruments used for the evaluation of the intervention.
Instruments Psychometric properties
LEARNING EVALUATION Questionnaire of previous
knowledge on behavior management and coping with stress. (Cantero-García &
Alonso-Tapia, 2018c)
It consists of 22 items with three response options. Table 2 shows an example of its items. It has been developed for this study.
TRANSFERENCE EVALUATION
Family climate questionnaire, parental perspective (Cantero- García & Alonso-Tapia, 2017a)
It includes 20 items formulated in a positive and negative way, grouped into four subscales and one general. They refer to four types of reactions:
punishment vs. reasoning, stress and positive attitude. The reliability indices are: general scale of Family Climate (ω: .94) reasoning vs.
punishment (ω: .84); patience (ω: .81); stress (ω: .88) and positive attitude (ω: .87). The items are answered on a five-point Likert scale, being 1 (totally disagree) and 5 (totally agree).
Coping Strategies
Questionnaire for children's behavior problems (CAF).
(Cantero-García & Alonso- Tapia, 2018a)
The instrument includes 36 items grouped into 12 basic categories — three per category—, in turn, grouped into three categories that collect coping styles. The items formulated both positively and negatively are answered on a Likert scale, indicating the degree of agreement from 1 (totally disagree) to 5 (totally agree). The reliability of the scales is good and ranges between .64 and .91.
IMPACT EVALUATION Questionnaire of perception of
the behavior problems of the children.
(Cantero- García & Alonso- Tapia, 2017b)
It includes 10 items that refer to the different behavior problems that children present. Items are measured on Likert scales, indicating the degree to which they manifest, being 1 (very little) and 5 (a lot).
Table 1 (continues). Instruments used for the evaluation of the intervention.
Instruments Psychometric properties
IMPACT EVALUATION
Family climate questionnaire, children's perspective.
(Cantero- García y Alonso-Tapia, 2017c)
It evaluates the perception of the children on the way of acting of the parents before the behavior problems. It includes 20 items that refer to four strategies:
positive attitude, reasoning vs. punishment, patience and stress. The items formulated both positively and negatively are answered by indicating the degree of agreement on a five-point Likert scale (1 being totally in disagreement and 5 totally agreeing). The internal consistency of the full scale, evaluated using Cronbach's α index, was .84. The individual scales obtained the following reliability indices: punishment vs. reasoning, α: .55; patience, α: .67;
stress, α: .77 and positive attitude, α = .61. On the criterion scale, Cronbach's α was .74, which indicates that it is acceptable.
Resilience Scale (BRS) (Smith et al., 2008)
Parental Resilience Scale in the face of children's behavior problems. (BRS-PC)
(Cantero-García y Alonso-Tapia, 2018b)
BRS: It includes six items formulated both positively and negatively. The items are answered on a Likert scale indicating the degree of agreement from 1 (totally disagree) to 5 (totally agree). Reliability in the original sample was = .83 and .81 in the sample of this study.
BRS-PC: It includes six items formulated both positively and negatively. The items are answered on a Likert scale indicating the degree of agreement from 1 (totally disagree) to 5 (totally agree). Reliability was evaluated using Cronbach's α, obtaining a value of α = .84, indicative of good reliability.
STAI (Spielberg et al., 1982)
Assess your anxiety. 40-item instrument. The items are answered on a 4-point Likert scale (0 = almost never / not at all; 1 = somewhat / sometimes; 2 = quite / often; 3 = a lot / almost always). In samples of the Spanish population, levels of internal consistency have been found that oscillate, both for the total score and for each of the subscales, between .84 and .93.
BDI-II (Beck et al., 1978)
Assess depression. 21-item instrument. Each item is valued from 0 to 3 points depending on the chosen alternative and, after directly adding the score of each item, a total score can be obtained that varies from 0 to 63. The internal consistency is .89, which indicates a very good internal consistency.
PROGRAM QUALITY PERCEPTION EVALUATION AND SATISFACTION Session tracking sheets (Cantero-
García, 2018)
They evaluate step by step the evaluation of the implementation of the program by the parents. It consists of 12 items. Each item is valued from 0 to 5 (0 being very bad and 5 very good).
Program evaluation questionnaire (Cantero-García, 2018)
They evaluate the parents' assessment and satisfaction with the whole program.
It consists of 38 items and 9 open questions. Each item is valued on a scale from 0 to 5 (zero being very bad and 5 very good).
Table 2. Example of an item on the Knowledge Questionnaire on the management of children's behavior.
Think that your child makes the following comment when faced with an order: “I don't do it, I don't feel like it.” Which of the following ways of acting is more appropriate?
a. Okay, I'll take care of it. I prefer not to listen to you anymore, but this is not happening again.
b. You are stupid, I told you to do it and end of the question, you have to listen to me, I am your father / mother.
c. I understand that you don't feel like doing it, but you have to do it as soon as possible. I give you two minutes.
Procedure
The study was approved by the Ethics Committee of the third author's university. For the selection of the sample, families of the Community of Madrid were contacted through educational centers and parents' associations, to whom a letter of introduction was delivered.
Once the program was presented, it was disseminated through posters, leaflets, etc., in such a way that interested families communicated their willing to participate in the program to the parents' association of the center. The requirements to be able to participate in the program were 1) having children with behavior problems of the ages described above, and 2) the children were not under pharmacological treatment to control those problems. In the initial session, the informed consent of all the participating families was obtained, as well as the authorization for the participation of their children.
Once the groups from each of the six centers that defined the intervention group had been formed, an opening ceremony was held with University personnel, staff from the Educational Center and the participating families. Then the application of the program was started. At the end of the intervention, a closing ceremony was held with the delivery of diplomas to the families, thanking their participation and acknowledging their involvement.
Data analysis
First, the pretest equivalence of the intervention group and the control group with respect to demographic variables was verified using t-tests for differences in means in continuous or dichotomous variables such as age or sex and χ2 tests for differences in proportions in categorical variables with three or more levels, such as educational level or
marital status. These tests revealed that there were no significant differences between the two groups regarding the age and sex of the participants, their level of education, their marital status, the number of children, the age of the children or having a paid job. There was a slightly significant difference regarding the sex of the children (p = .034), indicating that in the control group there was a higher proportion of children (75%) than in the intervention group (46.3%).
Second, the pretest equivalence of the intervention group and the control group with respect to the dependent variables was verified using t-tests for differences of means. The results indicated that there were no differences (p> .05) except in the case of two components of the Family Climate Questionnaire Perceived by Parents (RPCD): Motivation (p = .001) and positive attitude (p = .03). In both variables, the control group showed a higher mean in the previous evaluation.
To determine the changes in the different variables evaluated using the design described above, a two-factor analysis of variance (ANOVA) with repeated measures was performed for each one of them. As for the data on perception of the quality of the program and satisfaction with it, descriptive analyzes were carried out. For all analyzes, the SPSS v. 22
Results
Learning assessment: Change in knowledge.
Table 3 shows the results of the ANOVA, which are also presented in Figure 2, as well as the means and standard deviations of each group corresponding to each of the components of the knowledge questionnaire. As it is shown, the effect of the occasion x condition interaction has been significant in the expected direction. However, the effect size (η2 = .09) is moderate (IBM Knowledge Center, 2018).
Table 3. ANOVA of the effects of the program on parents' knowledge of behavior management guidelines and self-regulation strategies.
Source of variation SS DF MS F p η2
Intra- subject
s
Occasion 20.73 1 20.73 5.94 .01 .09
Occasion * condition 20.73 1 20.73 5.94 .01 .09 Error (occasion) 205.78 59 3.49
Inter- subject
s
Condition 319.09 1 319.69 19.74 .00 .25
Error 953.37 59 16.15
Descriptive statistics
Before After
Average SD Average SD
Control 13.75 4.25 13.75 4.25
Experimental 16.32 3.13 18.07 1.40
Figure 2. Averageknowledge about managing behavior problems
Transference evaluation: Change in the use of knowledge.
Table 4 shows the average and standard deviations for each group corresponding to each of the components of the Parent Perceived Family Climate Questionnaire (RPCD). The effects of the interaction occasion by condition that show the relative change between the experimental
and control groups were significant and in the expected direction in the motivation scales (F / gl 1: = 8.456, p = .005; η2 = .12), control (F / gl 1: = 6.927, p = .011; η2 = .10), cooperation (F / gl 1: = 1.920, p = .17; η2 = .32), positive thinking (F / gl 1: = .87, p = .004; η2 = .12) and positive attitude (F / gl 1: = 9.846, p = .003; η2 = .14), and the effect sizes were moderate.
Table 4. Transference Evaluation; RPCD parental perspective. Average and standard deviations
Pre Post
Variables G1 Average SD Average SD Motivation C 4.18 .67 4.16 .70
E 3.43 1 4.13 .73
Control C 2.88 1 2.68 .96
E 2.47 .89 3.03 .83 Cooperation C 2.50 .36 3.71 .91 E 2.57 .62 4.08 .53 Positive Thinking C 3.96 .55 3.95 .57 E 3.78 .77 4.44 .50 Positive Acttitude C 4.13 .62 4.11 .48 E 3.72 .66 4.26 .46
1 G: Group; C: Control; E: Experimental.
Table 5 shows the average and standard deviations of each group corresponding to the Coping Strategies Questionnaire (CAF-PC), as well as the indices corresponding to the components of the CAF-PC. Table 5 shows the F values and the partial values of η2 corresponding to the effect of the occasion-by-condition. As it is shown, only the coping strategies self-blame, relaxation, waiting and positive thinking have shown significant changes in the expected direction in the experimental group.
Table 5. Transference Evaluation; CAF-PC. Average and standard deviations
Pre Post
Variables G1 Average SD Average SD
Self-blame C 3.05 .57 3.16 .46
E 3.21 .68 2.57 .73
Impulsiveness C 3.18 .46 3.11 .47
E 3.21 .49 2.94 .42
Rumination C 2.98 .66 2.95 .74
E 3.26 .67 3.47 .44
Isolation C 2.41 .55 2.43 .58
E 2.67 .66 2.57 .68
Relaxation C 3.05 .69 2.93 .68
E 2.93 .73 3.50 .91
Wait C 2.81 .75 2.75 .77
E 2.74 .79 3.38 1
Happy Thinking C 3.15 .48 3.11 .52
E 3.15 .62 2.91 .51
Avoid Thinking C 3.06 .73 3.03 .68
E 3.21 .68 3.17 .52
Retry C 3.20 .65 3.23 .57
E 3.01 .79 3.52 .58
Problem solving C 2.81 .38 2.80 .39
E 2.95 .43 2.75 .36
Help Search C 2.43 .65 2.50 .79
E 2.47 .62 2.50 .48
Positive Thinking C 3.18 .41 3.21 .46
E 3.30 .60 2.83 .63
Negative Self-Regulation of Emotions C 2.90 .86 2.91 .77
E 3.09 .60 2.89 .54
Positive Self-Regulation of Emotions C 3.02 .10 2.95 .11
E 3.01 .07 3.24 .08
Problem-Centerded Coping C 2.90 .08 2.93 .09
E 2.93 .06 2.90 .06
1 G: Group. C: Control. E: Experimental.
Impact Assessment
Impact perceived by the children.
Table 6 shows the average and standard deviations of each group corresponding to the Family Climate Questionnaire Perceived by the Children (CFPH). The effects of the occasion- by-condition interaction showing the relative change between the experimental and control groups were significant and in the expected direction on the patience scales (F / gl 1: = 1.155,
p = .028; η2 = .019 ), shrieking (F / gl 1: = .518, p = .047; η2 = .009) and reasoning (F / gl 1: = 1.365, p = .024; η2 = .023) but the effect size is not significant.
Table 6. Impact: Average and standard deviations in the Family Climate perceived by the children.
Pre Post
Variables G1 Average SD Average SD
Patience C 4.06 .58 4.42 .62
E 4.29 .57 4.41 .60 Positive Actitude C 3.91 .46 4.16 .50 E 3.85 .74 4.21 .65
Shrieking C 3.13 .79 2.93 .87
E 2.97 .89 2.58 .99
Reasoning C 3.95 .52 4.24 .64
E 4.20 .61 4.24 .64 Satisfaction C 3.80 .93 4.11 .83 E 4.22 .73 4.46 .59
1 G: Group. C: Control. E: Experimental.
Impact perceived by parents.
Brief Resilience Scale (BRS). The participants in the experimental group have changed their perception of resilience to a greater extent, the change has occurred in the expected direction, however, the effect size is not significant (F / df 1: = 2.301, p =. 135; η2 = .038)
Parental Resilience Questionnaire against Children's Behavior Problems (BRS-PC). The participants of the experimental group have changed to a greater extent their perception of resilience in the face of their children's behavior problems (F / df1: = 1.268, p = .265; η2 = .021) and the change has occurred in the expected direction; however, the size of the effect is not significant.
Parental Stress Questionnaire. The effect of the occasion-by-condition interaction was not significant (p> .05). The participants in the experimental group did not change their perception of parental stress to a greater extent.
Anxiety Inventory (STAI). Figure 3 shows the average of each group. The effect of the occasion-by-condition interaction is significant and in the expected direction (F / gl 1: = 8.202, p = .006; η2 = .12).
Figure 3. Average anxiety levels: STAI-Trait questionnaire.
Depression Inventory (BDI). Figure 4 shows the means of each group. The effect of the occasion x condition interaction has been significant and in the expected direction (F / df 1: = 14.143, p <.001) with a moderate effect size (η2 = .19).
Figure 4. Mean levels of depression: BDI questionnaire
Program quality perception evaluation. The satisfaction scores have been grouped into three main sections: 1) general satisfaction with the quality of the program and what has been
learned, 2) satisfaction with the way of teaching, 3) and satisfaction with the techniques used.
In all cases, the variables are evaluated on a five-point scale, from 1 (very bad) to 5 (very good).
Regarding general satisfaction with the program, as well as the four facets, Table 7 shows it is very good. The same happens with the way of teaching (Table 7). And regarding satisfaction with the quality of the techniques taught, the assessment has been very positive: 1) praise (M = 4.84, SD = .37), 2) sandwich technique (M = 4.55, SD = .55) , 3) the use of the messages “I”
(M = 4.50, SD = .55), 4) the technique of ignoring unimportant behaviors (M = 4.66, DT = .58), 5) the use of the awards (M = 4.39, SD = .63), 6) the establishment of norms and limits (M = 4.71, SD = .61), 7) the five-minute complaint technique (M = 4.45, SD = .68), 8) the conflict resolution technique “I win-you win” (M = 4.47, SD = .64), 9) the special moment with my children (M = 4.74, SD = .55) , 10) the exercises to work on the different coping strategies (M
= 4.61, SD = .49), 11) the meditations (M = 4.42, SD = .68), 12) the reflections with the rest of the group (M = 4.66, SD = .63), and 13) the exercises that have been worked to improve my well-being (M = 4.79, SD = .47).
Table 7. Satisfaction: Average and standard deviations in satisfaction with the program and with the way of teaching
Variables Average SD
Overall satisfaction with the program 4.73 .19
Satisfaction with the reduction of the child's behavior problems 4.45 .53
Parents' personal satisfaction 4.60 .40
Ability to handle the child's behavior problems 4.29 .51
Program recommendation 4.92 .27
Satisfaction with the way of teaching 4.63 .36
Discussion and Conclusions
The objective of the present study was to verify if the application of the training program
“Better Yourself. Don't Throw in the Towel!”, designed to promote the improvement of strategies for coping with stress and the strategies for managing behavior problems of the children and, with it, the sense of self-efficacy, facilitated the increase of the parents' resilience, as well as the reduction of the levels of anxiety and depression.
To achieve the stated objective, the developed program incorporates strategies for managing behavior problems that are usually included in training programs for parents with children with behavior problems (Kaminskiet al., 2008) but, in addition, it trains specific strategies for coping and self-regulating emotions. Another of this program contributions is the incorporation of different techniques and tasks to guarantee the application of the guidelines worked in the different sessions, for which self-registration and feedback on the skills taught were used. These methods indicated here are rarely used in training programs, as shown by some review studies (Lozano and Valero, 2017; Vives-Montero, Cortés-Pendón, López-Rubio and Ascanio, 2017 ).
The hypotheses proposed for this study have to do firstly with the learning of the knowledge imparted in the program, secondly, with the transference of it, thirdly, with its impact and, finally, with the program quality perception and satisfaction.
First, the learning-related hypotheses suggested that parents' knowledge of the strategies to use to manage their children's behavior problems, and their knowledge of how to manage stress, would improve significantly. The results support this hypothesis. As indicated by the results of this study, this knowledge improves after the application of the training program, since the knowledge of the experimental group about the guidelines to improve their children’s behavioral problems, as well as for their stress management were significantly higher than those in the control group. The results obtained in this study are similar to those found in previous ones (Bloomfield and Kendall, 2012; Borrego and Burrell, 2010, Sanders, Baker and Tuner, 2012; Vives et al., 2017; Wilson, Havighurst and Harley, 2012).
Second, with regard to the hypotheses related to the transference, it was expected that the parents would improve the use of coping strategies and emotional self-regulation, as well as their perception of the family climate. The results show that, of all the coping strategies worked in the program, only self-blame, relaxation, wait, and positive thinking have shown significant changes. However, despite the fact that the coping strategies used by parents facing their children's behavior problems have improved, the levels of resilience have not. This result may be due to the duration of the intervention, since ten sessions may not be sufficient to fully address the different coping strategies.
In relation to the family climate perceived by the parents, the results show that the changes are significant in terms of motivation, control and positive thinking in relation to their children's behavior problems. These results are in line with previous studies (Martínez-González, Rodríguez-Ruiz, Álvarez-Blanco, Becedóniz-Vázquez, 2016; Ponzetti, 2016; Robles and Romero, 2011, Rodrigo, Máiquez and Martín, 2015) in which the perception of control, increased motivation, positive thinking, self-esteem and assertiveness after receiving parental training are confirmed.
Third, the program was expected to have a positive and significant impact on: a) reduction of parental stress, levels of anxiety and depression, b) the family climate perceived by the children. It should be noted that only parental stress, anxiety and depression experienced this decrease. In the rest of variables there have been no changes. These results may be related to the sample size, the duration of the sessions and the duration of the program in general, as well as the ideal situation within the family to deal with it competently. Future lines of research should take these aspects into account and include more sessions or extend their duration to work on aspects that influence these variables, as well as the specific way of working on them.
Fourth, it was expected that the perception of parents about their children's behavior problems in the family environment would improve after the application of the program;
however, the changes detected were not significant. This may be due to the timing of the post- test evaluation. We consider that it would be necessary to carry out a follow-up in the coming months to see if these results have been consolidated.
Finally, a high degree of satisfaction with the program as a whole and with the different characteristics of the program in particular could be expected. The results have shown that the satisfaction of the experimental group is high. Furthermore, this high degree of satisfaction with the program, together with the fact that many of the changes referred to in the first three hypotheses were not significant, suggests that more continuity would be appropriate. The methodology followed, the application and the systematic nature of the sessions have contributed to these results. These data are in line with those collected by studies such as the ones of Dretzke et al., (2005), Lundhal, Risser and Lovejoy (2006), McCart, Priester, Davies and Azen (2006) which indicate that the parental education programs that follow this methodology are one of the most effective interventions to work on the parental competencies of parents with pre-adolescents and adolescents. Therefore, we can point out that the assessment
of the implementation process of the program “Better Yourself. Don't Throw in the Towel!”
has shown: 1) that this is feasible and conforms to the criteria and recommendations proposed in the scientific literature; 2) that it allows the improvement of some of the educational practices of the parents facing their child's behavior problems 2) and many of the parents' coping and self-regulation strategies; 3) that its methodology, content, work materials and training techniques are accepted and perceived as useful by the participants; 4) that it generates a low drop-out rate and high attendance and involvement and 5) that it generates a high satisfaction among the participants. In general, it can be concluded that the program is presented as an effective tool in the intervention of the levels of some coping strategies that will influence the resilience of parents and the behavioral problems of their children in pre-adolescence and adolescence.
However, this study has certain limitations that deserve attention. In the first place, the number of mothers participating in the training program is considerably higher than the number of fathers, which is why it has been possible to generate gender bias. In addition, it should be noted that 70% of the participants had university studies, which indicates that the sample is biased towards a high educational level and has been able to influence the results in some ways, so they should be generalized with extreme caution. Additionally, almost 90% of the families participating in the intervention program were formed by married parents. In this sense, it would be necessary to explore in future research if there are any differences in the results when applying these programs at different educational levels and types of families (e.g., single-parent families or families with separated or divorced parents). It is also necessary to draw attention to the fact that, although the intervention group was conformed in a balanced way by two centers of each type (public, private and subsidized), the control group consisted of participants from a public center, with a higher proportion of sons and a higher initial motivation and positive attitude. These questions may have had implications when it comes to generating the results contrasts. We recommend that future investigations obtain a larger sample that allows a control group more equivalent to the experimental one.
An important strength of this study is that it presents a complete evaluation system of the described program, based on previously validated instruments. That evaluation proposal could be constituted as an evaluation system based on evidence, initially used in this pilot study with a smaller sample. In the future, successive applications of the program should make use of it to standardize the identification of the capacity for change that the program promotes.
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Received: 21-02-2020 Accepted: 07-07-2020
