The evidence-based parent training intervention known as Parent Management Training - the Oregon Model (PMTO) is one particularly well-supported treatment approach for addressing child behavioral problems. Yet, there remains a need to further examine how this intervention promotes change. The purpose of this study was to develop a grounded theory describing the process through which parents' experiences in the PMTO intervention led to change in their parenting practices. This study was informed by family systems theory and applied a community-based participatory research approach. Qualitative data were collected through in-depth, individual interviews with 20 parents who had completed the PMTO intervention. Data were analyzed according to the tenets of grounded theory, using the constant comparative method and a sequential process of open, axial, and selective coding. Throughout this process a number of measures were taken to ensure trustworthiness of the research findings. Study findings revealed that parents' process of change took place through their efforts to attempt, appraise, and apply the intervention material within their multiple life contexts. The changes they achieved in their parenting practices led to improvements in themselves, their children, and their family relationships. The contributions of specific content items (i.e., good directions, skill encouragement, limit setting, emotional regulation), particular methods of delivery (i.e., role play, home practice assignments, troubleshooting, visual aids), and the role of the interventionist in facilitating parents' process of change were identified. Parents' experiences of engagement, retention, and resistance in the intervention helped to further explicate this process. The resulting theory can inform further adaptations of PMTO and other evidence-based parent training interventions to help continue to improve the services available to families experiencing child behavioral problems. Additional implications for research are discussed, and recommendations for the practice of family therapy are suggested.
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