The Other Guys are parents and their children. The tactical TACTs focus on child behavior problems (externalizing, opposition, anxiety, poor self control) and parenting skills (designing and running Skinner Boxes for the child, improving communication skills with the child and between parents). The strategic TACT is aimed at creating families that interact effectively with each other as an enduring style or habit. Thus, this iIntervention is not a highly targeted plan aimed at one or two limited goals; it aims at creating Strongest Families, a much more difficult goal. This program began in Canada, but we’ll look at an application of it in Finland. Begin with the Other Kids.
Children with a high level of childhood disruptive behavior disorder symptoms screened from the population of 4-year-olds attending annual child health clinic checkups in the catchment area located in Southwest Finland from October 1, 2011, through November 30, 2013, were recruited . . . (4) the child had behavioral problems for the last 6 months before screening (score of ≥5 points on the conduct problems subscale of the Strengths and Difficulties Questionnaire [SDQ] corresponding to the 80th percentile cutoff point based on a Finnish population study.
Virtually every child in this region of Finland goes through this kind of screening as part of national policy in that country. The kids are tested on a wide variety of behavior and emotion scales with reports from parents and observations from clinical personnel. Only 4 year old Other Kids with behavior problems in the top 20% of all Kids were recruited into the experiment. About 700 Kids scored this high and 500 of them and their parents agreed to participate. These families were randomized into one of two conditions.
In the Education Control (EC) group, participants were given access to a website that provided a brief introduction to positive parenting strategies and a 45-minute call from a coach who provided positive parenting advice, in addition to the standard care provided by their physicians or obtained by parents.
This is an active, but weak, intervention and a stronger comparison than a wait-list control. The families are receiving good scientific information about effective parenting, but it is limited. Compare this to the Strongest Family condition.
Participants in the SFSW intervention group received an Internet version of the Strongest Families telephone-based program. In this evidence-based program, participants develop skills to strengthen parent-child relationships, reinforce positive behavior, reduce conflict, manage daily transitions, plan for difficult situations, and encourage prosocial behavior.
These participants received considerably more contact and information than the Education group. The parents and kids could access materials (recognizing problems, setting goals, building the Skinner Box, effective communication skills, monitoring) over 11 weeks on the Internet. They also received regular telephone support from a coach – not an MD or clinician, just a trained adult volunteer who talked with parents about specific problems, plans, and outcomes. This graphic will help explain the design outline and timeline.
To assess the impact of the two persuasion treatments, the researchers used a variety of standard measures on kid and parent behavior. Specifically.
The primary outcome measure was the 24-item externalizing scale of the Child Behavior Checklist version for preschool children (CBCL/1.5-5).40 The Cronbach α for the externalizing scale among preschool children has been reported as 0.88.
Secondary outcome measures (CBCL/1.5-5, Parenting Scale, Inventory of Callous-Unemotional Scale, 21-item Depression, Anxiety, and Stress Scale, and satisfaction measures) and quality assurance are described in the eMeasures in Supplement 2. All measures were completed online by the participants at baseline and at the 6- and 12-month follow-ups.
You can easily chase down these scales and read the details, but they quite obviously measure specific kinds of kid misbehaviors (defiance, poor control, anger, anxiety) and parent communication. The face validity on them is good and they have a solid research base behind them. In other words, the measure what they say they measure. Let’s count the change in a large chart with a lot of details, then focus on the headlines.
Take a second to orient to all this. On the left column you see the outcome variables and the words mean pretty much what you think. Across the columns you see the statistical comparison between the Education group and the Strong Family group at 6 months and 12 months for each outcome variable. With nearly 500 cases, you’ve got a lot of statistical power and you see that at 6 months a clear advantage emerges for the Strong Family condition. This advantage sustains at 12 months, but notice that is does not get higher. The persuasion hits pretty fast and levels out. Finally note my red highlights which display the Cohen d effect sizes. Most of the Windowpanes open at Small+ which requires careful counting to detect.
There’s a lot of persuasion in this paper and you need to think about it. Here’s what I see.
1. An iIntervention that actually works. As we’ve seen with many Internet-based persuasion plays in a wide variety of TACTs, we usually find failure. Well, now we’ve got a winner.
2. This iIntervention works in large part because the panthers running it worked hard to keep parents in it. Typically the failure with iInterventions arises because the Other Guys simply won’t stay online and get all of the persuasion in the treatment. Those regular phone contacts with coaches keep more people in the play for a longer period of time and hit it with greater intensity. So, see a crucial caveat. Yes, you can deliver an Internet-based persuasion play that works. But, yes, you also need a lot of directed and personal contact with the Other Guys (through the coaches) to keep the Other Guys online.
3. The effects are Smallish, but are widely replicated. Remember this study took place in Finland, but Strong Families has been running in Canada with evaluation experiments for several years. I think this persuasion play works and that Small Windowpane is real.
Too, we are dealing with a TACT where a little means a lot. These are 4 year old kids who already have a serious behavior problem and have been living largely in the home. Soon they will hit a new Local called school and have to hang out with strangers. If they are already behavior problems at home, there’s a high likelihood those behavior problems will only increase in the new Local. You see the snowball effect as a home problem becomes a school problem that becomes a social problem and now we’re talking about delinquency, drugs, crime, unwanted pregnancies, and the sad litany of societal failure. Improving these problem Other Kids just a little can accumulate over time.
3. If you read the entire paper you will note something the researchers under-report. That weak Education condition also showed improvements in kid misbehavior. By itself, that brief intervention produced about half a Small Windowpane difference. Now, add the Small+ improvement with the Strong Families persuasion and you see that the Windowpane is actually larger than it appears. Here’s an example.
With the Strong Families condition the mean CBCL externalizing score (the first line in the above table) started at 19.8 at baseline and improved to 13.0 at 12 months. The correct analysis is a paired t-test, but I cannot compute that from the available data, so I’ll underestimate the effect with an incorrect unpaired, independent samples t-test. That 6 point change on externalizing (acting out, blaming others) translates into a d of 0.81, a Large Windowpane.
4. Exactly what is the persuasion play with Strongest Families? I cannot access any of the materials used, but I’ve scanned YouTube videos and various websites that describe the information. That shallow look shows me what I call Skinner Boxes or the application of the principles of behavior persuasion from operant conditioning. I also see information about parent communication skills and behavior, particularly focusing on the modeling implication. When parents yell at each other, guess what the kid models? The materials also focus strongly on analysis, planning, executing, and monitoring.
Stated another way, this is a serious, large scale persuasion play. It’s not just a Foot In The Door with a little Implementation Intentions on the side, but a very thorough scientific approach. The program teaches and persuades parents on doing a better job at parenting to change the kid.
On a related tangent, I once taught an interpersonal skill course that is highly similar to what I’ve seen in the Strongest Families description. The course presented several well defined communication skills (active listening, perception checking, descriptive feedback, conflict management), then ran the student through several skill building activities. The course was literally life changing for most of the students. They had never thought about how communication skills can be used to affect interpersonal relationships. Some learned to use the skill as pick up plays because, properly done, these skills will rapidly develop emotional and informational intimacy. Others used the skills as intended: To begin, maintain, and strengthen friend, family, and intimate relationships.
The interesting twist here is that the Strongest Families play proves you can deliver this training and persuasion through the Internet. That’s a big deal.
5. But, the big deal still requires constant one-to-one support from a coach to the parents. See the combination of two different forms of mediated communication. The iParent material allows the Other Guys to hit a website, get lessons on various parenting skills, and use them through a workbook. But! They also have a tutor or mentor or coach who they talk with on a regular basis on the telephone. While both elements are mediated – one through the Internet, the other through a phone – realize the content and function differences. The Internet delivers primarily information and practice. The telephone provides human contact that can adjust to specific needs and provide a lot of persuasion, motivation, and inspiration. I think both media are required in this play.
6. Perhaps the most important news in this play is how it is different from the status quo. If you were a parent with a 4 year old tornado, you’d have to do a lot of work to find help; it would take a long time to get to that help; and it would probably cost extra money to get that help. With this iParent intervention, any parent can access the web and telephone support for free (in Canada and Finland).
If, for example, this program got added to ObamaCare for all families, the costs would be minimal compared to the status quo. The materials already exist. You need trained volunteer adults without any special qualification or credential to work out of a call center. Again, compared to the current status quo – clinics, highly trained and expensive experts, wait-lists – the Strongest Family play would be wildly cheaper, at least as effective, and more widely available. The convenience and cost factor here is decisive.
7. Persuasion Analysis. Realize that this paper is essentially two persuasion campaigns. In the first campaign the researchers change the parent. In the second campaign, the parent changes the kid (and the parents also change themselves as with that modeling example). The first campaign is a flat out Central Route play that requires High WATT parents to seek and scrutinize the Arguments (all the persuasion and skills on the Internet and workbook) and change the way they think, feel, and act as parents with the 4 year old tornado. The second campaign employs a variety of plays that parents run on the Little Kids with both standard Skinner Box plays (When-Do-Gets, reinforcers, schedules, count) and communication persuasion plays that help the Little Kid learn more than just the Skinner Box. This thing is much more complicated than it appears and you need to understand that if you want to make it work for yourself.
Let’s get out of here.
Finally, we’ve found an iIntervention that works. And, it doesn’t require Facebook! Or Lumosity! Or a Warning Label! It does require thinking and working like a panther. While the emotional impact of this Local and TACT (a little Other Guy on the path to social conflict and worse), you still see the cold heart and mind of a persuasion vampire. The play is extremely well defined with specific TACTs and specific training to change those TACTs. The play is easy to implement and easy to count. You can easily monitor the impact for both individuals and for the program. You can quickly discover when an individual is failing and determine likely sources of that failure.
But, see all the hard work in planning and execution here. This is not the simple minded iPersuasion we often observe and count no change. You can’t hit the Like button on Facebook to solve these problems. Everyone involved has to put a lot of WATTage, time, and effort into it.
Other than that, persuading is really easy. Any fool can do it. Just look at Lumosity. Or Facebook. Persuasion is never about the technology, but how you get the technology to work with persuasion science.
Sourander A, McGrath PJ, Ristkari T, et al. Internet-Assisted Parent Training Intervention for Disruptive Behavior in 4-Year-Old Children: A Randomized Clinical Trial. JAMA Psychiatry. Published online February 24, 2016.
P.S. This will never happen in America. The status quo institutions for handling child and parent misbehaviors don’t want this kind of competition because it would seriously hit their bottom lines. You’d need to pass Son of ObamaCare to make it go Boom! Good luck with that.
Instead think Locally. Think about your school district or county. Maybe you could organize the needed resources to change your community rather than trying to change the country. If you do, here’s your first step. Determine every professional who’s already got a job in this business and would feel threatened with the Local iParent persuasion. Then either plan how to get them on-board as expert consultants or isolate them as child-haters. It’s the First Campaign – get the idiots out of the room. Then you run the Second Campaign – building the Strongest Families iParent play in your small Local.
Read the research literature. Social destruction begins young. Intervene with kid and parent as early as possible while you can still make a change for the better . . . or else wait and count the change on crime, drugs, and busted families.
P.P.S. [Unavoidable Professor Poopypants Counting Sidebar.] About the difference between the t-test I ran (unpaired, independent samples) rather than the t-test that is correct (paired t-test). We looked at the change over time in the Strongest Families conditions. That’s a repeated measures design. An important source of effect is the consistency of Other Guy responding over time. Regardless of whether the mean scores changed from time 1 to time 2, you know that the correlation of the scores would be at least Medium, maybe even Large. To do a paired t-test you need not only the two means, but the correlation between time periods.
As Professor Cohen points out in his famous and now standard text on statistical power and effect sizes, you need to correct the t-test for the correlation between the two time periods. That correction almost always increases the Windowpane. Here’s the formula for computing a d effect for a pair t-test.
d = unpaired effect size / square root of 1 – r (the correlation)
Thus, in our example, we found a baseline to 12 month move from 19 to 13.6 in the Strongest Families condition which produced an unpaired effect size of d = .8. Now, assume that the correlation in the Kids score between baseline and 12 months is .5. Our formula becomes
d = .8 / square root of .5.
Do the math on that (.8 / .71) and you get a corrected d of 1.14. That’s a Large+ difference. You see that the larger the correlation between the time periods, the greater the correction and size of the d effect.
Let’s make the math concrete. You’re standing in a very imaginary hallway in front of two doors, Time 1 and Time 2. Every time the 4 year kid behind the door turns on the tornado, a bell rings. You would hear a lot of noise behind the Time 1 door and then something approaching the Sound of Silence behind the Time 2 door with a d = 1.14.
[End of Unavoidable Professor Poopypants Counting Sidebar.]
P.P.P.S. This has nothing to do with that, but I cannot resist. The Sound Of Silence (YouTube) by Simon and Garfunkel, not like I’m trending really old or anything.
You might remember the song from the fabulous movie, The Graduate (YouTube clip), with Mrs. Robinson.