Holy Family Home Foundation Brgy. Cabug Bacolod City March 11, 2013 Dr. Virginia P.

Resurreccion, CESO III Director VI CHED HERO VI Jaro, Iloilo City Dear Madam:

I am ANABEL L. CORNELIO, 22 years old, single and a graduating student of the University of Negros Occidental Recoletos, Bacolod City, taking up Bachelor of Science in Social work. I would like to request that my Form 137 A issued by my Alma Mater Rufina E. Nessia National High School ( Sum - ag National High School Extension), be corrected, more particularly, my date of birth from May 18, 1990 to May 25, 1990 and my place of birth from Taytay,Dalanan Barrio to Paglaum, Taytay Palawan. Attached herewith is my Certificate of Live Birth issued and authenticated by the National Statistic Office. May this letter of intent be given immediate action because I will be graduating this coming March 23, 2013.

Very truly yours,

ANABEL L. CORNELIO Student

Republic of the Philippines) City of Bacolod ) S.S X - - - - - - - - - - - - - - - - - - -X

JOINT AFFIDAVIT

WE AMIE TIBUS MAGALONA, married, resident of Brgy. Cabug, Bacolod City, Philippines, and AZUCENA J. CAPATAR, single, resident of Bacolod City , Philippines, both of legal ages and Filipinos, after having been duly sworn to in accordance with law, depose and say; That we are the Social Worker and Benefactor of the Holy Family Home Bacolod Foundation, Inc. run by the Capuchin Sisters who are the guardian of ANABEL L. CORNELIO: That we know the fact of birth of Anabel L. Cornelio who was born on May 25,1990 at Paglaum, Taytay, Palawan and whose Parents are Jimmy Cornelio and Elena Lobrero; That she studied her secondary education at Rufina E. Nessia National High School ( Sum - ag National High School Extension) at Brgy. Cabug, Bacolod City; That she was issued by the said school Form 137 A but some entries were erroneous, more particularly her date of birth which is stated as May 18, 1990 instead of May 25,1990 and her place of birth is stated as Tatay, Dalanan Barrio instead of Paglaum, Taytay, Palawan; That we are not in any way related to Anabel Lobrero Cornelio neither by affinity nor consanguinity but only to attest the truth that she was born on May 25,1990 Paglaum, Taytay, Palawan; IN WITNESS HEREOF, we hereunto set our hands this 11 th day of March, 2013 at Bacolod City Philippines.

AMIE TIBUS MAGALONA Affiant

AZUCENA J. CAPATAR Affiant

SUBSCRIBED AND SWORN TO before me this day of March 14, 2013 at Bacolod City, Philippines. Affiant exhibited to me their company Identification Card No. INTER 527 and PRC No. 0011571

Republic of the Philippines) City of Bacolod ) S.S X------------------ x A F F I D A V I T

I, ANABEL L. CORNELIO, 22 years old, single, student Filipino and resident of Brgy. Cabug Bacolod City, Philippines, after having been duly sworn to in accordance with law, depose and say: That I am up to the present under the guardianship of the Capuchin Sisters of the Holy Family Foundation, Inc. Brgy. Cabug, Bacolod City; That I was born on May 25,1990 at Paglaum, Taytay,Palawan and my parents are Jimmy Cornelio and Elena Lobrero; That I studied my secondary education at Rufina E. Nessia National High School ( Sum ag national High School Extension), Brgy. Cabug, Bacolod, City and I was issued Form 137 A and I discovered that some entries were erroneous, more particularly my date of birth which is stated as May 18, 1990 and my place of birth as Taytay, Dalanan Barrio; That I am graduating student of the University of Negros Occidental Recoletos, Bacolod City, taking up Bachelor of Science in Social Work; That my true and correct date of birth is May 25, 1990 and not May 18, 1990 and my place of birth is Paglaum, Taytay, Palawan and not Taytay, Dalanan Barrio; That I execute this sworn statement in order to correct the entries in my Form 137 A; IN WITNESS HEREOF, I hereunto set my hands this 11th day of March 14,, 2012 at Bacolod City, Philippines.

ANABEL L. CORNELIO Affiant SUBSCRIBED AND SWORN TO before me this day 14thth day of March, 2013 at Bacolod City, Philippines. Affiant has shown me her UNO R School identification Card.

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Engagement and Effectiveness of Parent Management Training (Incredible Years) for Solo High-Risk Mothers: A Multiple Baseline Evaluation
Lees, Dianne G; Ronan, Kevin R . Behaviour Change 25. 2 (2008): 109-128.
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The effectiveness of The Incredible Years parent-training program with a small sample of four high risk solomothers in a public clinic setting was assessed. All families had a number of risk factors for early drop-out and poor outcomes. Mindful of resource limitations in the public setting, economical strategies were used to enhance attendance rates and engagement. For the outcome evaluation, a multiple baseline across participants design was used. Participants attended a 2-hour group treatment session weekly for twenty weeks, with booster sessions at 2 months and 4 months following

treatment. Participants had sons aged between 6 years and 9 years diagnosed with ADHD. Family functioning was assessed from a pretreatment interview schedule, measures of child behaviour and parent and family functioning. Participants also completed program satisfaction and program evaluation measures. Results showed: (a) all mothers engaged with and finished the program, (b) improvement in family functioning, (c) improvements in some teacher and parentreports of child behaviour, (d) increased parenting confidence, (e) reduced stress and depression levels for most parent participants, and (f) reports of better parent.child relationships. Additionally, participants all reported being highly satisfied with the program. Findings overall support the use of easy to do engagement strategies and the use of the Incredible Years parent-training program as an effective, low cost and early step intervention for families at higher risk in a day-to-day practice setting. The use of this intervention in an overall stepped care approach is considered and discussed. * Keywords: parent training, incredible years, engagement, solo mothers Attention-deficit/hyperactivity disorder (ADHD) is a commonly diagnosed behavioural disorder of childhood that is characterised by symptoms of inattention, hyperactivity, and impulsivity. There has been a dramatic increase in diagnoses of ADHD in recent years (Barkley, 1999). Currently, it is the most common diagnosis given to children in child and adolescent mental health services in New Zealand (Ministry of Health, 2001). Prevalence rates for ADHD in New Zealand are around 5% of school-aged children with rates for boys three times higher than for girls (Ministry of Health, 2001). Similar prevalence rates are found in the United States, the United Kingdom, and other places internationally (Barkley, 1999). Children with ADHD often have pronounced difficulties and impairments across multiple settings such as in the home, at school, and with their peers. They can also experience long-term adverse effects on academic, vocational, psycho - social, and psychiatric outcomes (Barkley, 1998; Jensen et al., 2005). Children with ADHD use mental health services more frequently than the general population, and the cost of caring for these children in primary paediatric settings is estimated to be at least twice that of the general population (Jensen et al., 2005; Power, Russell, Soffer, Blom-Hoffman & Grim, 2002). The impact of difficult child behaviour on family functioning has a compounding effect on the physical, emotional, and psychological welfare of the child, the family unit, and the wider community. Additionally, untreated behaviour problems increase the risk of negative outcomes in adulthood (Breen & Barkley, 1998; Reyno & McGrath, 2006). Indeed, apart from the impact on the child, recent research has confirmed earlier findings that parents of children with ADHD experience elevated stress levels, and have fewer effective parenting practices compared to parents of children without this disorder (Treacy, Tripp, & Barid, 2005). To address parenting issues and these other factors, an effective, low cost intervention strategy would obviously be a useful addition to the range of services available in everyday settings. Combined Pharmacological and Psychosocial Treatment According to authorities, including the National Institute of Mental Health web site, stimulant medication is reported to be the single most effective treatment in the short term for ADHD (Barkley, 1999; http://www.nimh.nih.gov), but reliance on pharmacological therapy alone may not be sufficient, given that the disorder is complex and stimulant medication may have limited long-term efficacy. Combined pharmacological and psychosocial treatments have the potential to target not only the core symptoms of ADHD but the associated social, academic, and family factors as well (Cunningham, 1999; Pelham, Wheeler, & Chronis, 1998).

Additionally, Jensen and colleagues (2005) found that the cost effectiveness of treating ADHD varies depending on the child's comorbidity status. Their research suggested that it is most cost effective to target combined medical management and behavioural treatment for children with complicated ADHD, particularly those with both internalising (e.g., anxiety and depression) and externalising (e.g., conduct disorder and oppositional defiant disorder) comorbid disorders. Parenting Factors Parenting is a difficult and challenging task, made more so in the case of solo parenting (Cairney, Boyle, Offord, & Racine, 2003; Herbert, 1995; Mash & Johnston, 1990). Raising a child with ADHD often puts added stress on the family system (Treacy et al., 2005). Pertinent to this study, mothers of children with ADHD are generally more depressed, socially isolated, and restricted in the parenting role compared to mothers of children without ADHD (Mash & Johnston, 1990). For example, parents experiencing high levels of stress in their parenting role are more likely to make negative appraisals of their child's behaviour, become overly directive in their parenting style, and view themselves as less skilled and less knowledgeable about parenting practices (Mash & Johnston, 1990; see also Treacy et al., 2005). A recent study found that maternal depression longitudinally predicted onset of conduct problems in ADHD children whereas positive parenting practices predicted a reduced level of conduct-related disturbance (Chronis et al. 2007). Parent Training in a Clinical Care Context: Risk for Drop-out and Poor Outcomes Parent training is a model that has been extensively researched in terms of its efficacy (Kazdin, 1997; Mash & Johnston, 1990; Reyno & McGrath, 2006; Treacy et al., 2005). There have been many studies that successfully used a parent-training model, mainly for mild to moderately disruptive behaviours in earlier childhood (Reyno & McGrath, 2006). While there are numerous parent-training programs available, few have been as well researched and empirically supported as the Webster-Stratton's Incredible Years program. The Incredible Yearsparent-training program is designed to help parents avoid the development of serious child behaviour problems before they result in peer rejection, well established negative reputations, school problems, and academic failure (WebsterStratton & Handcock, 1998). This program has been shown to be effective in a number of countries including the United States, Wales, the Netherlands, Canada, and Britain in the treatment of noncompliant and younger children at risk for conduct disorder as well as those with ADHD (Jones, Daley, Hutchings, Bywater, & Eames, 2007; Scott, Doolan, Spender, Jacobs, & Aspland, 2001; Webster-Stratton, 1994). Owing to its format, it is also designed to be cost effective. However, as risk factors accumulate in a family with a disruptive child, treatment strategies often need to take account of an increased potential for both early drop-out and attenuated outcomes (Ronan & Curtis, in press). A major problem in child and family mental health settings is early drop-out (Nock & Kazdin, 2005), including in parent-training programs generally (e.g., Prinz & Miller, 1994) and Webster-Stratton's more specifically (e.g., Webster-Stratton & Hammond, 1990). Consequently, to capitalise on an evidencebased model of practice in a day-to-day setting, a major prerequisite is ensuring attendance and participation. Reyno and McGrath (2006; see also Lundahl, Rissu, & Lovejoy, 2006) identified risk factors both for early drop out and reduced treatment effectiveness in parenting programs. Families in the current study all had a number of these risk factors present (e.g., solo parenting, low socioeconomic status [SES], low level of education, negative life events/stresses, maternal depression, more severe child disruption). Additionally, while the Incredible Years has some established efficacy, it has not been trialled specifically in a public clinic setting for ADHD children and solo parents. Given the increasing call for

evidence-based practice in clinical care settings (Weisz, Jensen-Doss, & Hawley, 2006), and the fact that this study was carried out in a public mental health service, this study was designed as a pilot to a larger effort to assess treatment effectiveness. The present study had two main aims. The first was to engage participants and help them remain motivated to attend, participate, and finish the program, in light of the evidence indicating risk of drop-out in parent-training programs (Reyno & McGrath, 2006). The second and overall aim was to assess the impact the Incredible Years parent-training program had on the functioning of these parents, their child with ADHD, and their families. Method Design A single participant design was chosen because it allows for the assessment of change in each participant's behaviour over time by repeated measure of dependent variables over the course of the treatment program: 'For parents, teacher, therapist, and others charged with changing behaviour, change makes itself known only through multiple measures taken over prolonged observational periods' (Morgan & Morgan, 2001, p. 122). Participants serve as their own controls and this is viewed as the most relevant comparison because behaviour change is measured against his or her own baseline (Morgan & Morgan, 2001). In this way, single case designs are compatible with clinic care setting needs and a 'local science' model of service delivery (e.g., Blampied, 1999, 2000; Stricker & Trierwiler, 2006). Additionally, a multiple baseline across participants design was used to assess further the controlling effects of intervention (Barlow & Hersen, 1984). Multiple baseline designs are designed to be userfriendly in practice contexts (Hayes, 1981; see also Feather & Ronan, 2006). They are able to demonstrate experimentally that the effects of treatment are likely not a function of other influences, including a number of threats to internal validity (Blampied, 1999). Successive replications demonstrate support for the intervention being responsible for any changes observed (Kazdin, 2003). Participants had varied baseline periods prior to commencement of treatment that ranged from 4 days to 24 days. A nonconcurrent procedure was used as these were varying baselines and the intervention started at the same time for all participants (Watson & Workman, 1981). This procedural strategy is compatible with an effectiveness-based research agenda (Hayes, 1981; see also Feather & Ronan, 2006), and it reduces the requirement that participants begin assessment concurrently. This makes it possible to include data from clients assessed at different times. Pretreatment assessment included the battery of measures described in a subsequent section. It also included a pretreatment interview to explain the research project and obtain consent, establish goals for treatment, and identify any barriers to attending the program. Daily and weekly baseline measures (described below) provided information on family and child functioning prior to intervention. Child behaviours were collected daily during baseline, across the twenty week treatment period, and again for a 2-week period at 4-month follow-up. Family functioning scores were collected weekly beginning at baseline and continuing during treatment, and again at 4-month follow-up. All child behaviour and parent functioning measures were collected again at posttreatment and at 4-month follow-up. Trends in the continuous data were identified to assess the impact of treatment over time. Other data collected at pretreatment, posttreatment, and follow-up were used to help identify the overall magnitude and rate of change. At posttreatment, evaluations also included additional satisfaction and program evaluation measures.

Recent meta-analyses of parent-training programs identified a number of factors that mitigate outcomes and predict drop-out (Lundahl et al., 2006; Reyno & McGrath, 2006). Each family in the current study had multiple risk factors for dropout and poor outcomes (e.g., solo parenting, low SES, maternal depression, severe child behaviour). Thus, in addition to an assessment of the effectiveness of parent-training for high risk families, a first aim of the current study was to assess whether mothers would engage with, attend regularly, complete, and be satisfied with the program. To assist with motivation, but mindful of keeping costs low, a variety of strategies were used to increase engagement as well as assist with improving outcomes (Ronan & Curtis, in press). These were: * assessing for obstacles to attendance (Kazdin, 1997; Nock & Kazdin, 2005) * weekly phone check-in, and ongoing assessment of progress (Dishion & Kavanagh, 2003) * a planned home visit (known to improve attendance) (Dishion & Kavanagh, 2003) * weekly goal setting and evaluation of previous week's homework and goals * planned booster sessions. Participants Participants were four parents whose children met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV; APA, 1994) criteria for attention deficit hyperactivity disorder (ADHD). They were referred through the Child and Adolescent Mental Health Specialist Service (CAMHSS) of a public hospital setting. Participants were part of a group of nine parents who attended the training program. All four participants were of European descent, had no tertiary training, and were all solo mothers. At an intake interview, they all reported they had experienced depression, had abused drugs and alcohol in the past, and three of the four participants identified psychiatric history in their wider family. They also reported lack of employment (n = 4) and a lack of family and social support (n = 4). However, one participant did report a friend encouraged her to participate in the current program. Participants reported no difficulties during their pregnancy and stated that their children's developmental milestones were normal. It is also of note that during the time of the study, all families experienced a significant transition. They either moved (n = 3) and/or changed schools (n = 3). Children Children were male between 6 years and 9 years of age (6, 8, 8, 9 years) and all met the DSM IV criteria for ADHD (see next section). The children were all on stimulant medication monitored by a psychiatrist and a case manager. All children were reported by their mothers at intake to have major behavioural difficulties in the home and school environment, including maintaining friendships. Additionally, they all experienced some mild learning difficulties and teachers reported they were behind in reading and writing skills for their age. Assessment ADHD diagnosis was established by a child psychiatrist according to the criteria set out in the DSM IV (APA, 1994), and was supported by intake interview information and observation, along with parent and teacher comments and rating profiles on Conners' Rating scales.

Child Behaviour Measures Child behaviour was assessed from parent and teacher rating scores on well validated established measures: Conners' Parent and Teacher Rating scales (Conners, 1997) and the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997). These were collected at baseline, posttreatment, and follow-up. In addition, parentscollected daily records of child behaviour for varying baseline periods prior to the commencement of the training program, throughout the 20-week treatment period and for a 2-week period at 4-month follow-up. Daily Behaviour Record A checklist of ten child behaviours was established for this research. It included both positive behaviours (completes tasks on time, complies with requests, plays nicely with siblings, respects feelings for others, waits his turn to speak) and negative behaviours reflecting aspects of hyperactivity, impulsivity and attention deficit (interrupting demanding attention; argues and talks back to adults; hitting, kicking, biting; being hyperactive and running around; yelling and temper tantrums). The checklist was used to record frequency of behaviours daily using a Likert scale of 1 (not at all) to 7 (a lot). Participants began daily recordings from the beginning of baseline and continued through the 20-week training program and again for 2 weeks at 4-month follow-up. Baseline daily scores are reflected in the figures seen in the results while treatment and follow up daily scores were averaged across the week to assess change over those periods.1 Weekly Family Functioning Measures Parents identified three target difficulties in family functioning they wished to address, and rated each issue on a Likert scale of 1 (least quality) to 7 (best quality). These ratings were assessed weekly from baseline through course completion, and again at 4-month follow-up. Parent Functioning Measures Parent functioning was assessed using established measures: the Beck Depression Inventory (BDI-II; Beck & Steer, 1987) and the Parental Stress Index (PSI; Abidin, 1983). Group Goals In an initial session, the group of parents identified a set of goals related to family functioning (17 items in total) that they wished to achieve during the training program. Each participant scored the items on a 1-7 Likert scale at midtreatment (week 10), posttreatment (week 20), and at 4-month follow-up. Parent Satisfaction and Program Evaluation At posttreatment, all participants completed a standardised satisfaction questionnaire and a program evaluation that evaluated a number of aspects of the course including content, facilitators' role, skills learned, and future expectancies (Webster-Stratton, 1999). The Training Program Treatment involved parents attending a 20-week Parent Management Training Program. Sessions were 2 hours in duration and were held weekly except for a 2-week break for one school vacation. Planned booster sessions were carried out at 2 months posttreatment, and again at 4-month follow-

up. Assessments that were noncontinuous were carried out at pre- and posttraining and 4-month follow-up. Continuous evaluation was done across variable baseline intervals, across treatment, and across a 2- week interval at 4-month follow-up. The training protocol used in this research was an integrated combination of the Basic School Aged ParentTraining, Advanced Parent Training, and Supporting Your Child's Education Program. This combination was in accordance with an already established protocol developed by Webster-Stratton, combined in a logical sequence after training and consultation with C. Webster-Stratton (personal communication, June, 2001). All sessions were audio-taped and 25% were randomly selected and rated according to adherence to the prescribed protocols set out in the treatment manual. Rating was carried out by a senior clinical psychologist not involved with the intervention, but with several years experience in parent-training and manualised interventions. No protocol violations were found. Intervention and Ongoing Engagement Each session included a review of the previous session, collaborative learning on the new topic, videovignettes showing examples of parents and children interacting, group discussion, and opportunities to role-play and practice new strategies. Participants set weekly individual goals that were then evaluated the following week. A homework activity designed for mastery (e.g., setting up a reward chart) (Kazantzis, Deane, Ronan, & L'Abate, 2005) and to reinforce new techniques was provided, along with a fridge magnet summary of the main points to help remind parents of the new learning. Participants were also encouraged to read the relevant chapter from the accompanying parent book (Webster-Stratton, 1992). Each participant recorded daily measures of child behaviour and weekly measures of family functioning. Midweek phone calls from the therapist served to encourage parents, assess any difficulty they might have been experiencing, and to ensure the daily measures were being recorded. Assessing for obstacles to attendance at intake revealed that one participant required regular assistance with transport. Finally, all participants were home visited at least once during the initial phase of the treatment period. Results All parents attended and finished the program. Results first document attendance and satisfaction followed by child, family, and parent outcomes. In terms of outcomes, those continuously evaluated either daily (child behaviour) or weekly (family functioning) are presented first followed by other outcome indicators measured at pretest, posttest, and follow-up. Attendance and Parents' Satisfaction Questionnaire There was a relatively high rate of attendance with all participants attending at least sixteen of the twenty sessions (range = 16-19). All parents completed the program. The Parent Satisfaction Questionnaire completed at the conclusion of the training program rated items on a 1-7 Likert scale (1 = least satisfied, 7 = most satisfied). As seen in Table 1, all items related to levels of satisfaction with the program were rated at 4 and above indicating a general level of satisfaction. Items relating to parenting confidence were all rated above 5 indicating above average levels of confidence in managing challenging behaviour. All participants scored a high level of satisfaction with the course with regard to recommending the program to a friend (all rated a 7) and overall feeling about the value of the treatment program for their child and family (one rated a 6; the others, 7). Finally, all parents attended all planned booster sessions.

Daily Behaviour Measure Parents monitored daily positive and negative child behaviours for varied baseline periods and throughout the treatment period for all participants. There was no fully consistent trend across baseline for all children. All children showed some fluctuations in positive behaviours during treatment and there was a general trend towards increased frequency of positive behaviours by posttreatment. Negative behaviours showed mixed results with improvements for child D and C but little change for child A and B across treatment. Generally, positive behaviours tended to improve early in the treatment period while negative behaviours seemed more resistant to initial treatment effects (see Figures 1-8).2 At 4-month follow-up, scores of daily child behaviour were collected over a 2-week period. During the 2-week period, child B and D showed continued improvement in the daily behaviour measures, child C showed fluctuations in behaviour and data were not able to be collected for child A. Child A was in the care of his father at follow-up (who agreed to fill out the Conners measure but no other indices, including daily measures). However, of note, the mother was still engaged with the service and participated in planned booster sessions. Weekly Family Functioning Figures 9, 10, 11 and 12 show the changes in family functioning over the treatment period and at follow-up for each family. Each participant identified three areas of family functioning to target for improvement during the training. Overall, treatment impact was seen across treatment and follow-up intervals. For participants A and B, all three functions increased steadily during treatment, and at follow-up, all items were at the maximum best score. For Participant C, one function, ('yelling') was unstable and showed no overall improvement. The other two functions had an overall improvement at posttreatment and continued to improve across follow-up. For participant D, all three measures fluctuated during the treatment period with a general trend towards improved family functioning. By follow-up, all functions had improved. Child Behaviour Measures Strengths and Difficulties Questionnaire Parent scores on the Strengths and Difficulties Questionnaire for Total Difficulties did not reflect any major trends across pre and posttreatment across participants. However, by follow-up, there was an overall improvement in impact scores for all participants, and two of these (B and D) had scores in the normal range. Conners' Parent and Teacher Questionnaires Conners' Parent T scores for two participants (B and D) showed an overall improvement in behaviour between pretreatment and follow-up. For the two other participants (A and C), the improvement was very slight. Teacher T scores indicated the greatest improvement was across treatment for each child except child A (no improvement). Parent scores overall tended to reflect more problems than teacher scores (except child B), and teachers reported more overall improvement than parents. Parent Functioning Measures

Parenting Stress Index (PSI) Parent stress levels were expected to decline following treatment. Two participants (A and C) showed a decline in PSI scores across treatment, and there was overall improvement in stress levels at followup for three participants (A, B and D). Participant C continued to have high PSI scores throughout the treatment and remained in the clinically significant range at follow-up. Beck Depression Inventory (BDI) It was expected that depression levels would improve with treatment and this was evident for participants A, B and D (see Table 4). Participant C's level of depression increased across treatment and at follow-up was in the severe depression range. Thus, in this case, while improvements were seen on family functioning and child behaviour indices, indicators of maternal depression at this final gate necessitated referral to a next step, and more intensive, intervention. Treatment Group Goals The group identified 17 goals and rated their achievement for each item on a 1-7 Likert scale (1 = worst, 7 = best). As seen in Table 4, most goals by midtreatment were not yet mastered. All participants rated some improvement on all goals by the end of treatment period. By follow-up, all participants reported achieving 10 or more goals. Discussion The results of this study provide evidence to support the Incredible Years parent training as having a number of beneficial effects on the functioning of families of solo mothers with children diagnosed with ADHD. The improvement in (a) targeted family functioning problems, (b) teacher reports of child behaviours, (c) number of goals achieved related to child behaviours, and (d) the improvement in stress and depression scores for most participants provides support for the effectiveness of this program as carried out in a public health setting. Additionally, all participants reported (a) improvement in parent-child relationships, and (b) increased confidence in parenting ability. Findings also demonstrated that these mothers all engaged with the program in the sense that they attended most sessions, they all completed training and booster sessions, and they all reported high levels of satisfaction with the program. Thus, despite the absence of universal change on all indicators, overall findings support the inclusion of low cost parent training for solo mothers in a public mental health setting as part of an overall continuum of universal through targeted and intensive services. We first consider treatment findings and then focus on motivation and engagement. Family functioning showed improvement across treatment. In particular, targeted areas of family functioning, explicit treatment goals, and general levels of maternal stress and depression improved in most cases. This is consistent with other studies showing that parent functioning can be improved with parent training (Kazdin, 1997; Renyo & McGrath, 2006; Treacey et al., 2005). Even in the case of Family A, where consistent improvement in parent reports of child behaviour was not seen, all three targeted family functioning goals markedly improved. A number of factors could account for some equivocal parent report findings. For example, families were all selected from the wait list of referrals to this clinic that, based on referral criteria, puts them in the top 3% of families in terms of dysfunction and the single case study design magnifies individual cases. In addition, parental psychopathology has been found to increase negative ratings of child behaviour (Breen & Barkley, 1988; Marsh & Johnston, 1990; Treacy et al., 2005). The fact that Parent C reported increased levels of stress and depression may have influenced her ratings on various indicators. An alternative

explanation to the pattern of parent reports is that children may not have improved where indicated. Nevertheless, the strength of this explanation is attenuated by the fact that daily and weekly reports tended to reflect improvements, at least for some behaviours. In this context, a further explanation is that daily or weekly ratings, including those that reflect positive features, might be less prone to bias and worth considering for use in practice settings in that light. Teacher ratings provided some evidence supportive of parent-training effectiveness in three of four cases. While parents reported feeling better about their parenting skills and more positive about specific features of their child's daily problems and family factors, their perceptions of overall child behaviour as reflected on the Conner's rating scales was not as positive overall as teachers, including prior to parent training. Parents often lack the opportunity to compare their child's behaviour with a number of other age related peers, whereas teachers have ready comparisons in the classroom and may have more realistic and perhaps more objective expectations of age appropriate behaviour. Overall, with respect to its effectiveness, research from United Kingdom, Canadian, and United States samples supports the efficacy of the program in modifying behaviour of children with disruptive problems (Herbert, 1995; Scott et al., 2001; Webster-Stratton, 1994). Taken together, the findings here support the use of the Incredible Years parent training in a public clinic setting to improve important aspects of functioning in families with high risk solo mothers and children with moderate to severe levels of ADHD. Given recent meta-analytic findings reflecting poorer outcomes as a function of solo parenting, low SES, more severe forms of child behaviour, and a number of other relevant risk factors (Reyno & McGrath, 2006), these findings are encouraging, particularly in supporting such an intervention as a cost-effective first line approach in an overall continuum of care. In terms of engagement, overall findings support the use of a weekly phone check-in and other strategies to encourage parents and keep them connected to the program. Compared to findings on drop-out in (a) child and family mental health generally (i.e., 40-60% drop-out rate; Nock and Kazdin, 2005), and (b) group-basedparent-training program specifically (e.g., up to 70% drop-out in higher risk families, Dishion & Kavanagh, 2003), this program saw 100% completion by mothers with many risk factors for drop out (Reyno & McGrath, 2006). Of course, enthusiasm must be tempered based on the sample size. Nevertheless, findings here are consistent with other recent findings demonstrating the value of emphasising attention to potential barriers inparent-training programs. For example, Nock and Kazdin (2005) found that as little as 5 minutes to 45 minutes of therapy time devoted to motivation and engagement over the course of individually delivered parenttraining increased completion rates by 21%. Dishion and Kavanagh (2003) reported that one home visit increased participation in a parent-training program from 30% to as high as 70% to 80% in families of higher risk adolescents. Thus, there is merit in raising the profile of engagement strategies in practice settings and in future research. One question for future research includes what strategy, or combination of strategies, maximises participation for high risk families while keeping costs contained. Another issue for future research is to evaluate engagement with next step - more intensive interventions - to evaluate their role in assistingparents and their children. Limitations of Current Research Research shows that change occurs more predictably when parents are supported and encouraged by another adult in the home environment (Webster-Stratton, 1998). Only one participant (participant A) reported having a support person in the community to encourage her. This social support aspect might be given more emphasis in future training programs and related research on engagement and outcomes particularly with solo parents or those with low levels of support available. Second, given

that this study was aimed at solomothers, there were no fathers in the research group. Typically, fathers of children with ADHD are more verbose in their parenting style and tend to use more physical punishment than fathers of children without this disorder (Mash & Johnston, 1990; Treacy et al., 2005). Recent findings have indicated no significant difference in parenting stress between mothers and fathers of children with ADHD and that fathers reported a significantly smaller social support network compared to mothers (Treacy et al., 2005). Targeting fathers or perhaps other male role models, along with other forms of support in future studies would clarify whether the addition of such a component could assist a solo mother. A third limitation was a lack of independent child observations. Though adding to costs, including such observations would provide a different perspective on child behaviour in the home. Additionally, there was no formal educational assessment carried out for the participants' children as part of this research. It is well established that children with ADHD often have associated learning and or social difficulties. Finally, the baseline measures included multiple and varied intervals that were predetermined by the start date of the program. Clinical practicalities meant the intervals could not be extended to establish unequivocal stability in behaviour prior to treatment. However, in the majority of instances, a reasonable level of stability was indicated. Future Research and Conclusion The role of group-delivered parenting interventions in a continuum of stepped care services (e.g., Ronan & Curtis, in press) might be clarified in future research. Given the low cost and increased efficiency compared to more intensive interventions (e.g., intensive, home-based service delivery for individual families, e.g., Curtis, Ronan, & Borduin, 2004), such a program might reduce the need for more intensive services for some, particularly in cases where parents can be engaged and have 'buy in' to those services. As one example, implementing the teacher training program in combination with parent training (resulting in consistent practice across settings) might very well result in greater change but would also add to the cost. Webster-Stratton (2000) found that teachers and parents from combined interventions reported a significantly higher level of collaboration, stronger home-school connections and children with fewer behaviour problems. Despite an increased cost, the effectiveness of the Incredible Years intervention would be expected to be enhanced if both parents and teachers worked together collaboratively (Power et al., 2002) and might be indicated in some cases. Research would help to clarify these issues. This study made no attempt to monitor medication. A further study could work in close liaison with medical colleagues to track changes in medication over the treatment period. It would be anticipated that children might be managed on lower doses of stimulant medication when behavioural strategies are effectively in place (Jensen et al., 2005). Footnote Endnotes 1 Daily scores were averaged weekly across treatment and follow-up to increase interpretability of figures. Original daily scores are available from senior author. 2 Gaps in graph lines meant data were not able to be collected. References References

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Address for correspondence: Dianne Lees, Child and Adolescent Specialist Services, Tauranga Hospital, Private Bag 12024, Tauranga 3112, New Zealand. E-mail: Dianne.Lees@bopdhb.govt.nz Word count: 6593 Copyright Australian Academic Press 2008

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Cite Title Engagement and Effectiveness of Parent Management Training (Incredible Years) for Solo High-Risk Mothers: A Multiple Baseline Evaluation Author Lees, Dianne G; Ronan, Kevin R Publication title Behaviour Change Volume 25 Issue 2 Pages 109-128 Number of pages 20 Publication year 2008 Publication date 2008 Year 2008 Publisher Australian Academic Press Place of publication Bowen Hills Country of publication Australia Publication subject Medical Sciences--Psychiatry And Neurology ISSN 08134839 Source type Scholarly Journals Language of publication English Document type General Information

ProQuest document ID 219335667 Document URL http://search.proquest.com/docview/219335667?accountid=34542 Copyright Copyright Australian Academic Press 2008 Last updated 2010-06-09 Database ProQuest Social Science Journals

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Single parent family Dating (Social) Search

Single parent seeks same

Neblett, Andrea. Today's Parent 20. 9 (Oct 2003): 111-112+.
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Enter the Web; with its forums, chat groups and dating sites, it has newspaper personals beat. But can you really meet that special someone online? Thousands seem to think so. And while online romance brings some safety concerns (see below for ways to protect yourself), this isn't the biggest issue for e-daters. "There is still a stigma," says Denise Hannah from Georgetown, Ontario. "When I tell friends I've done it, they ask me why, and if I can't just meet somebody." Hannah even unintentionally embarrassed another single parent in her neighbourhood when she casually mentioned she'd seen his profile on one site. MINI MATCHMAKERS: Simple truth: Our children want us to be happy. Once they accept that the breakup is permanent, they might do some matchmaking of their own, like Marianne Curtis's children did. "They'd give me the scoop on male teachers at parent-teacher interviews," says the Landmark, Manitoba, mom with a laugh. She didn't respond, though, even when the kids invited one teacher over to the house to do the odd repair job. [Bill Dyck] would say Curtis did the right thing. "Sometimes children hear mom or dad complain about loneliness, and want to help them," he says. But kids need to take care of themselves, not rescue theirparents. Also, they'll bear a heavy burden if their lovematch doesn't work out in the long run. Still, it doesn't hurt to keep your eyes open at your little one's ball games, school fairs and concerts. as author [Meg Schneider] writes in Sex & the Single Parent: A Guide for Parents Who Find Themselves Back in the Dating Game, after a breakup you're trying to figure out who you are, and who you'll become. It can be a scary process. Will you be able to trust again? Will anyone want you with children in tow? Will you be alone forever? Take a deep breath; you've got some healing to do. Marriage and family counsellor [Charlotte Dyck] explains, "Emotional recovery is crucial. Without it, you'll get hooked into the same old loop, and your next relationship will be very similar." Key steps:

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TranslateFull text Turn on search term navigation "She's friendly, attractive, single and wondering why a smart and interesting woman like her can't meet her type of man. (Maybe you're like her. Then again, maybe you'd like to meet her.)" Bold white letters in a black box on a number 10 envelope taunted me each time I passed my dining table. For about two weeks the envelope lay there unopened. It wasn't the first time I'd kept one of

these promo pieces. Why didn't I toss it? What could a dating service possibly offer me that I couldn't do for myself? [Graph Not Transcribed] In truth, I was kidding myself. As a single parent for the last 14 years, I can't claim that my dating adventures have had Harlequin begging for the rights; they've been mostly left to kismet, half-hearted and excuse-ridden. I was too busy. My daughter might feel cheated. How many toads could one girl stand? It simply wasn't worth the aggravation. After a breakup, pain, anger and disbelief are our constant companions. We see what we've lost and our self-esteem sinks into an abyss. Meanwhile, we struggle to be strong for our kids -- to keep things "normal." We cook dinner, drop them off at playgroup or soccer, listen to the details of their day. A new relationship? Who has the time or energy? But the call for companionship and intimacy is insistent. So we begin the dating dance. Again. With about one-and-a-half million of us solo parents out there (over 80 percent women), according to Statistics [Not Transcribed] and with the romantic landscape changing as fast as J-Lo can line up a new beau, what are the best ways for a single mom or dad to connect with a new mate? a little help from your friends After a split, friends and family provide the shoulders we need to cry on; they can also be great sources for us to find new love, says Bill Dyck, a marriage and family therapist in Vancouver. The hard part is letting them know we're looking--and what for. "We want to maintain a certain image with our friends," explains Dyck. "And we think as adults we should be able to handle our own problems." Even people who know you well don't necessarily know the kind of person you'll click with. Dennis Palmer(1), a single father from Richmond Hill, Ontario, clued in quickly when he was seated beside the only single woman at a friend's dinner party. Sparks didn't exactly fly. While the conversation went smoothly, they were clearly at different stages in their lives. [Graph Not Transcribed] This sort of cross-purpose connection isn't unusual, especially if you're not direct with your friends. "Talk to them about finding someone who will match you well; similar interests, experiences or same stage of life," Dyck suggests. He warns single parents to be careful. If you do start seeing someone who's recently divorced or separated, don't slip into rescue mode. You may have done your recovery work (see "Knowing When You're Ready," p.XX), while he is still resolving custody, financial and emotional issues. HOT TIP: The road to dating disappointment is paved with good intentions; to give your hook-ups a chance, be sure to let friends know not to over-sell you. love online Enter the Web; with its forums, chat groups and dating sites, it has newspaper personals beat. But can you really meet that special someone online? Thousands seem to think so. And while online romance brings some safety concerns (see below for ways to protect yourself), this isn't the biggest issue for e-daters. "There is still a stigma," says Denise Hannah from Georgetown, Ontario. "When I tell friends I've done it, they ask me why, and if I can't just meet somebody." Hannah even

unintentionally embarrassed another single parent in her neighbourhood when she casually mentioned she'd seen his profile on one site. The reactions don't surprise Meg Schneider, a divorced mom in New York and co-author of Sex & the SingleParent: A Guide for Parents Who Find Themselves Back in [Not Transcribed] Dating Game. Her advice? Don't be swayed by naysayers. "Single parents who put themselves out there in a safe way should feel proud," says Schneider: "They're not waiting for life to happen to them." Few sites cater specifically to single parents, but criteria searches are easy--narrowing profiles for kids, age, location and so on. General sites offer thousands of profiles--Match.com and Lavalife.com are two of the biggest. If you want to fish from a smaller pond, you might consider a targeted site such as Indianmatches.com for people of Indian origin, or AveMariaSingles.com for Catholics. Before signing on to any service, check out its security policy; at a bare minimum, it should allow you to send e-mails anonymously to start. Lots of sites offer free searches, but some like Lavalife.com charge a nominal fee. Hannah recently became a member and likes the set-up. "You have to purchase credits (a dollar or two for five) to send someone an e-mail the first time," she explains. Follow-up contact is free. Though the charge is small, Hannah feels it helps filter out replies that aren't at least a little serious. If you find it unnerving waiting for a response to your profile, flip the script, like Waterloo, Ontario, mom Susanne Dusselier did. She started scoping out men's profiles at Yahoo! personals, e-mailing a few promising candidates with specific questions, including how they feel about kids, and how long they've been divorced or separated. And what if a reply is less than honest? As Hannah points out, people also lie on the phone or in bars. It's not how, but who, you meet. Ultimately, of course, getting to know a person means moving beyond e-mail. Bill Dyck and his wife, Charlotte, also a marriage and family counsellor, applaud parents who use the Internet to search for new mates. But they warn that the technology can create a false sense of closeness. "Real intimacy requires being together on a physical level," Charlotte says. Once you feel safe, it's time to move on to meeting. Choose a public place and limit the time--say, coffee from two till three, even mini-golf if you'd rather have something to do. "After about an hour," says Dusselier, "you can tell if there's a connection, that certain vibe." Most reputable sites spell out tips so you're not clueless your first time. Here are a few: - Don't give out your full name, your children's names or your address. - Don't be pressured into revealing anything. - If you decide to post a photograph, use a current one. - If you decide to meet, tell someone or bring a friend along. HOT TIP: No fireworks after a date or two? It's not impolite to end it where you started--with an email. Be direct, but kind. call in the pros With the computer just a fingertip away, you might ignore other avenues, like a dating service or agency. It's usually a last resort, admits Luci Parker, a senior consultant at The Allied Network, a

Toronto matchmaking service. (It's Allied's envelope that decorated my dining table.) The majority of the agency's 12,000 or so clients are single parents, suggesting that we're serious daters and we've got less time to make those love connections. [Graph Not Transcribed] Parker--whose cozy office is stacked with volumes of thank-you notes, wedding invitations and honeymoon postcards from grateful clients--says about 85 percent of Allied's clients form relationships lasting a year or more. She credits the realistic expectations most bring. "They want someone who is sincere, honest and looking for a companion." Some still have pipe dreams, though. "Everyone's ten years younger in their mind, so they want someone who's that age," she laughs. Matchmaking agencies vary widely in what they charge--from a few hundred to a few thousand dollars--for services that include a set number of introductions. Reputable services will conduct a personal interview with probing questions--how you relate to your ex, for example--and a check on your financial background. When the agency identifies a compatible match, "We call both parties and tell them about each other," explains Parker. "They get to approve the match, so confidentiality remains high." All agencies are not created equal; protect yourself with these precautions: - Check if the agency provides a contract outlining what they'll do for you. Read it carefully before signing. No contract? Skip it. - Ask how the agency screens clients. - Make sure you get to preapprove all matches, and check that no one will see your info without your permission. HOT TIP: Develop a relationship with your consultant so she'll keep you top of mind. Let her know if anything in your life changes that can affect how you're matched. workplace wooing "Very dangerous...." "A minefield...." "Excellent hunting ground." These are just a few comments from a 2001 Workopolis.com survey in which a startling 63 percent of respondents said they had had a romance with a co-worker. Love on the job isn't quite as taboo as it was 12 years ago when Anita Hill and Clarence Thomas put sexual harassment on the global radar. More singles are taking the risk to find a mate--like Petra Haertel, a furniture company employee in Winnipeg, who dated her supervisor. "We'd known each other for about three years and he was the shoulder I leaned on during my separation," she says. For busy parents, falling for a colleague isn't hard to understand. We're clocking longer hours and enjoying more relaxed work environments. But while few workplaces have policies, human resources students at Toronto's George Brown College conducted a survey in 2002 that shows some might be needed. Students uncovered stories about lovers' quarrels, bitter breakups and employees using love and sex to get promotions. The result? Poisoned atmospheres, resentment and low morale. So, if you've got your eye on the cutie in the next cubicle, take heed:

- Spill the beans to bosses and co-workers once you're an item, says Liz Ryan, a US organizational consultant who has been featured in Fortune and USA Today. Secrecy and denial could fuel gossip and resentment. - Stay professional. Keep the relationship away from your job, advises Bill Dyck. "Develop a strategy about how you'll do it." From the beginning, talk about how you'll handle a breakup, for instance. - PDAs (public displays of affection) are a no-no, says Ryan. Keep the hugs for after hours. - All sources agree -- it's a bad idea to date a boss or subordinate. In such cases, one partner should find another job. Hot tip: Assume nothing about your partner's comfort level; discuss whether you'll arrive at work together, or display photos of you two with the kids. passion potpourri There's no guarantee that you're looking for love in all the right places, so here are a few spots you shouldn't rule out. SPEED DATING: Started in Los Angeles to help young Jewish singles connect, speed dating has spilled into the general scene. Basically, singles meet in a group and pair off for set intervals of a few minutes each. You talk, maybe you click. At the end of the evening, you let organizers know who you'd like to see again; if the other person feels the same way, you'll both get contact into and take it from there. "It's a way of adapting to our busy lives," says Charlotte Dyck. COMMUNITY ACTIVITIES: Even if the mate of your dreams doesn't show up in your Mexican cooking class or investment seminar, widening your social life may prime the pump for future love connections. Besides, a regular evening out can be a healthy routine for you -- and a reminder to the kids that you have a life. Just don't sign up for something in the hopes of meeting that perfect person, warns Bill Dyck; make sure it's something you actually want to do. MINI MATCHMAKERS: Simple truth: Our children want us to be happy. Once they accept that the breakup is permanent, they might do some matchmaking of their own, like Marianne Curtis's children did. "They'd give me the scoop on male teachers at parent-teacher interviews," says the Landmark, Manitoba, mom with a laugh. She didn't respond, though, even when the kids invited one teacher over to the house to do the odd repair job. Bill Dyck would say Curtis did the right thing. "Sometimes children hear mom or dad complain about loneliness, and want to help them," he says. But kids need to take care of themselves, not rescue theirparents. Also, they'll bear a heavy burden if their lovematch doesn't work out in the long run. Still, it doesn't hurt to keep your eyes open at your little one's ball games, school fairs and concerts. [Graph Not Transcribed] Getting back into the dating scene after a breakup can be daunting. We're balancing butterflies and anticipation with practicality -- and our responsibility toward our kids. Still, it's probably more rewarding than trying to sort out the love lives of the Coronation Street gang. Finding someone new may take five dates or 50. And staying open to all possibilities is my new mantra -- which I'm writing down while carefully filing away that envelope on my table for future reference. knowing, when you're ready

as author Meg Schneider writes in Sex & the Single Parent: A Guide for Parents Who Find Themselves Back in the Dating Game, after a breakup you're trying to figure out who you are, and who you'll become. It can be a scary process. Will you be able to trust again? Will anyone want you with children in tow? Will you be alone forever? Take a deep breath; you've got some healing to do. Marriage and family counsellor Charlotte Dyck explains, "Emotional recovery is crucial. Without it, you'll get hooked into the same old loop, and your next relationship will be very similar." Key steps: [Symbol Not Transcribed] [filled square] Give yourself time to grieve. Don't get involved--emotionally or sexually--too soon after a divorce. [Symbol Not Transcribed] [filled square] Work through what happened and why, and accept your part. [Symbol Not Transcribed] [filled square] Lean on friends. Or consider group or individual counselling. [Symbol Not Transcribed] [filled square] Take a hard look at your emotional triggers. Practise not reacting to them. [Symbol Not Transcribed] [filled square] Be realistic about your communication and conflict-resolution skills. Where do they need work? What will you do differently next time? what about the kids? it hits you like a redwood log: This new relationship is serious. The next big step is bringing your new partner into the fold. According to Meg Schneider, author of Sex & the Single Parent: A Guide for Parents Who Find Themselves Back in the Dating Game, expect your kids' feelings to fluctuate: One minute they're doing their best NFL-type blocking, next they're daydreaming about the good days to come. Here's how to help them adjust: [Symbol Not Transcribed] [filled square] Go slowly. Your child needs to get to know your new partner gradually. Group settings with other adults are a good idea, like a family barbecue or birthday party. [Symbol Not Transcribed] [filled square] If tantrums, nasty comments or accusations persist, pay attention. Your feelings count too, but you may be pushing things too quickly. [Symbol Not Transcribed] [filled square] Let the kids know your new relationship doesn't make you love them less, nor will your partner replace their mom or dad. [Symbol Not Transcribed] [filled square] Maintain family routines. [Symbol Not Transcribed] [filled square] Don't ask the kids to keep your relationship a secret from your ex. [Symbol Not Transcribed] [filled square] Let your new partner and your child build their own relationship. (1) Name changed by request. Word count: 2620 Copyright Rogers Publishing Limited Oct 2003

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Single parent family; Dating (Social) Classification 9172: Canada Title Single parent seeks same Author Neblett, Andrea Publication title Today's Parent Volume 20 Issue 9 Pages 111-112+ Publication year 2003 Publication date Oct 2003 Year 2003 Publisher Rogers Publishing Limited Place of publication Toronto Country of publication Canada Publication subject Children And Youth - About ISSN 08239258 Source type Magazines Language of publication English Document type General_Information ProQuest document ID 232903752 Document URL http://search.proquest.com/docview/232903752?accountid=34542 Copyright

Copyright Rogers Publishing Limited Oct 2003 Last updated 2010-06-10 Database ProQuest Research Library

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Behavioral Health Services in Separate CHIP Programs on the Eve of Parity

Garfield, Rachel L ; Beardslee, William R ; Greenfield, Shelly F ; Meara, Ellen .Administration and Policy in Mental Health and Mental Health Services Research 39. 3 (May 2012): 147-157.

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The Children's Health Insurance Program (CHIP) plays a vital role in financing behavioral health services for low-income children. This study examines behavioral health benefit design and management in separate CHIP programs on the eve of federal requirements for behavioral health parity. Even before parity implementation, many state CHIP programs did not impose service limits or cost sharing for behavioral health benefits. However, a substantial share of states imposed limits or cost sharing that might hinder access to care. The majority of states use managed care to administer behavioral health benefits. It is important to monitor how states adapt their programs to comply with parity.

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Cite Title Behavioral Health Services in Separate CHIP Programs on the Eve of Parity Author Garfield, Rachel L 1 ; Beardslee, William R; Greenfield, Shelly F; Meara, Ellen

Henry J. Kaiser Family Foundation, 1330 G Street, NW, Washington, DC, 20005,

USA, rachelg@kff.org Correspondence author Garfield, Rachel L Author e-mail address rachelg@kff.org Publication title Administration and Policy in Mental Health and Mental Health Services Research Volume 39 Issue 3 Pages 147-157 Number of pages

11 Publication year 2012 Year 2012 Publisher Springer Science+Business Media Country of publication Netherlands Publication subject Public Health And Safety ISSN 0894-587X Source type Scholarly Journals Summary language English Language of publication English Document type Journal Article DOI http://dx.doi.org/10.1007/s10488-011-0340-5 Update 2012-04-01 Accession number 16516210 ProQuest document ID 1002576812 Document URL http://search.proquest.com/docview/1002576812?accountid=34542 Last updated 2012-05-03 Database 2 databases View list

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