6, and progestogen antagonist sessions are often spaced weeks apart (Bryan et al., 2012). While such brief and targeted services appropriately complement the fast-paced nature of primary care service delivery, they require a high degree of flexibility and an ability to adapt evidence-based treatments. Parent management training (PMT)

is a general term for interventions that teach parents skills for managing their children’s disruptive behavior ( Kazdin, 1997). PMT interventions are based on the premise that child disobedience, defiance, and coercion are often learned behavior problems inadvertently reinforced and modeled by parents who punish too harshly or fail to set firm limits ( Kazdin, 1987 and Patterson, 1982). There are several brands of PMT, but common to all is a focus on techniques derived from operant learning

principles, which often include components such as (a) praise, (b) selective attention, (c) time-out, and (d) token reward systems ( Eyberg, 1988, Adriamycin Forehand and McMahon, 1981 and Webster-Stratton, 1987). In most programs, parents first learn skills designed to promote positive parent-child relationships and prosocial child behavior, followed by skills designed to promote effective parental discipline and a decrease in child misbehavior ( Cavell, 2000). PMT has been widely evaluated and outcome trials yield supportive results across a range of ages and problem behaviors (Brestan and Eyberg, 1998, Hautmann et al., 2009, Kazdin and Weisz, 1998 and van de Wiel et al., 2002). Outcomes point generally to reductions in problem behavior as reported by multiple informants (e.g., children, parents, and teachers), decreases in problem behavior to nonclinical levels, and maintenance of treatment gains over time (Kazdin, 1997). Meta-analytic studies provide strong evidence in support of DCLK1 PMT’s efficacy (e.g., Serketich & Dumas, 1996). Serketich and Dumas found that posttreatment effect sizes ranged from 0.73 to 0.84. Recent meta-analytic studies yielded more limited effect sizes (e.g., 0.30 to .47 for child outcomes), but demonstrate clear evidence for the efficacy of PMT when used to treat child behavior problems (Kaminski et al., 2008, Lundahl et al., 2006, Maughan

et al., 2005, McCart et al., 2006 and Piquero et al., 2009). Berkout and Gross (2013) provide a comprehensive overview of studies that examine well-known, established treatment protocols (e.g., the Incredible Years program, Parent Child Interaction Therapy [PCIT], Triple P–Positive Parenting Program) used to target externalizing behavior problems in primary care settings. Results across studies were promising in terms of reducing problematic behaviors in children. Most studies utilized modified or truncated versions of the original manualized protocols in order to adapt to primary care settings. Still, many aspects of these protocols do not readily lend themselves to adaptation of the integrated behavioral health care (IBHC) service delivery approach previously described.