Trial Outcomes & Findings for Effectiveness of an Online Parenting Training (NCT NCT05111886)

Results Overview

Outcome is reported as the difference in pre- and post-intervention Externalizing Risk Scores, a subscale from the Behavior Assessment System for Children (3rd Edition, Parent Report Form - Preschool), which measures externalizing, internalizing, and adaptive behaviors. The Externalizing Risk Scores subscale measures externalizing behaviors the sum of using 9 items with a four-choice response format, for a raw Externalizing Risk Score range of 0-27. Higher scores indicate worse levels of externalizing behavior functioning. Scores of 0-10 are in the normal risk range, scores of 11-19 are elevated, and scores of 20 or above are extremely elevated. This is administered to parents before and after the intervention window (8 week separation). The change score was calculated as the value at 8 weeks minus value at baseline.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

94 participants

Primary outcome timeframe

8 weeks

Results posted on

2026-02-04

Participant Flow

Participant milestones

Participant milestones
Measure	Primary Care Personnel Training Control Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Control group personnel will receive a written description of the referral process but no training. Written Referral Process: A written summary and process map of the referral process, modeled on the Institute for Healthcare Improvement (IHI) 9-step process for "closing the loop" on referrals. Survey of Experience: Satisfaction with referral process	Parents eHealth GenPMTO Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. eHealth GenPMTO: The GenPMTO is delivered over the phone (not online). This version is up to 6 sessions in length. This brief eHealth version of GenPMTO will be delivered through community therapists. The program will be delivered one-on-one (i.e., between a therapist and a parent or couple). Survey of Experience: Satisfaction with referral process	Primary Care Personnel Training Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Communication Skills Training: The training will focus on communication skills based on key constructs in the Health Belief Model and motivation/resistance research (described in section A3), the training will focus on: (1) conveying the benefits of parenting programs, (2) knowledge of and responses to common perceived barriers to attending parenting programs, and (3) skills and strategies to effectively motivate and refer parents in ways that are least likely to elicit resistance. The in-person training will last 60-90 minutes. It will include a theoretical background and experiential learning; each step of the referral process will be demonstrated and role-played. The investigators will work to ensure that personnel receive continuing education credits for the training. Survey of Experience: Satisfaction with referral process	Parents Control Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. One Session Education about Resources: One online or phone conversation with the therapist in which the therapist guides the parent to the following resources: (a) a book, Raising Cooperative Kids, by GenPMTO co-developer Marion Forgatch; (b) a website, behaviorchecker.org, which includes behavioral "prescriptions" for common behavior issues; and (c) information about Early Childhood and Family Education classes, which are provided for free in Minnesota through public schools. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process
Overall Study STARTED	14	23	21	20	16
Overall Study COMPLETED	14	23	21	16	16
Overall Study NOT COMPLETED	0	0	0	4	0

Reasons for withdrawal

Reasons for withdrawal
Measure	Primary Care Personnel Training Control Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Control group personnel will receive a written description of the referral process but no training. Written Referral Process: A written summary and process map of the referral process, modeled on the Institute for Healthcare Improvement (IHI) 9-step process for "closing the loop" on referrals. Survey of Experience: Satisfaction with referral process	Parents eHealth GenPMTO Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. eHealth GenPMTO: The GenPMTO is delivered over the phone (not online). This version is up to 6 sessions in length. This brief eHealth version of GenPMTO will be delivered through community therapists. The program will be delivered one-on-one (i.e., between a therapist and a parent or couple). Survey of Experience: Satisfaction with referral process	Primary Care Personnel Training Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Communication Skills Training: The training will focus on communication skills based on key constructs in the Health Belief Model and motivation/resistance research (described in section A3), the training will focus on: (1) conveying the benefits of parenting programs, (2) knowledge of and responses to common perceived barriers to attending parenting programs, and (3) skills and strategies to effectively motivate and refer parents in ways that are least likely to elicit resistance. The in-person training will last 60-90 minutes. It will include a theoretical background and experiential learning; each step of the referral process will be demonstrated and role-played. The investigators will work to ensure that personnel receive continuing education credits for the training. Survey of Experience: Satisfaction with referral process	Parents Control Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. One Session Education about Resources: One online or phone conversation with the therapist in which the therapist guides the parent to the following resources: (a) a book, Raising Cooperative Kids, by GenPMTO co-developer Marion Forgatch; (b) a website, behaviorchecker.org, which includes behavioral "prescriptions" for common behavior issues; and (c) information about Early Childhood and Family Education classes, which are provided for free in Minnesota through public schools. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process
Overall Study Lost to Follow-up	0	0	0	4	0

Baseline Characteristics

The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Primary Care Personnel Training n=21 Participants Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Communication Skills Training: The training will focus on communication skills based on key constructs in the Health Belief Model and motivation/resistance research (described in section A3), the training will focus on: (1) conveying the benefits of parenting programs, (2) knowledge of and responses to common perceived barriers to attending parenting programs, and (3) skills and strategies to effectively motivate and refer parents in ways that are least likely to elicit resistance. The in-person training will last 60-90 minutes. It will include a theoretical background and experiential learning; each step of the referral process will be demonstrated and role-played. The investigators will work to ensure that personnel receive continuing education credits for the training. Survey of Experience: Satisfaction with referral process	Primary Care Personnel Training Control n=14 Participants Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Control group personnel will receive a written description of the referral process but no training. Written Referral Process: A written summary and process map of the referral process, modeled on the Institute for Healthcare Improvement (IHI) 9-step process for "closing the loop" on referrals. Survey of Experience: Satisfaction with referral process	Parents eHealth GenPMTO n=23 Participants Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. eHealth GenPMTO: The GenPMTO is delivered over the phone (not online). This version is up to 6 sessions in length. This brief eHealth version of GenPMTO will be delivered through community therapists. The program will be delivered one-on-one (i.e., between a therapist and a parent or couple). Survey of Experience: Satisfaction with referral process	Parents Control n=20 Participants Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. One Session Education about Resources: One online or phone conversation with the therapist in which the therapist guides the parent to the following resources: (a) a book, Raising Cooperative Kids, by GenPMTO co-developer Marion Forgatch; (b) a website, behaviorchecker.org, which includes behavioral "prescriptions" for common behavior issues; and (c) information about Early Childhood and Family Education classes, which are provided for free in Minnesota through public schools. Survey of Experience: Satisfaction with referral process	Therapists n=16 Participants Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process	Total n=94 Participants Total of all reporting groups
Age, Categorical <=18 years	0 Participants n=14 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	0 Participants n=12 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	0 Participants n=23 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	0 Participants n=20 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	0 Participants n=16 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	0 Participants n=85 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.
Age, Categorical Between 18 and 65 years	13 Participants n=14 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	12 Participants n=12 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	23 Participants n=23 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	19 Participants n=20 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	16 Participants n=16 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	83 Participants n=85 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.
Age, Categorical >=65 years	1 Participants n=14 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	0 Participants n=12 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	0 Participants n=23 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	1 Participants n=20 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	0 Participants n=16 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.	2 Participants n=85 Participants • The 'Number analyzed' reported for age reflects the total number who reported their age (e.g., 14 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 16 participants in the therapist condition of 16 total.
Sex: Female, Male Female	14 Participants n=16 Participants • The 'Number analyzed' reported for sex reflects the total number who reported their sex (e.g., 16 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 15 participants in the therapist condition of 16 total.	8 Participants n=12 Participants • The 'Number analyzed' reported for sex reflects the total number who reported their sex (e.g., 16 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 15 participants in the therapist condition of 16 total.	22 Participants n=23 Participants • The 'Number analyzed' reported for sex reflects the total number who reported their sex (e.g., 16 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 15 participants in the therapist condition of 16 total.	19 Participants n=20 Participants • The 'Number analyzed' reported for sex reflects the total number who reported their sex (e.g., 16 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 15 participants in the therapist condition of 16 total.	15 Participants n=15 Participants • The 'Number analyzed' reported for sex reflects the total number who reported their sex (e.g., 16 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 15 participants in the therapist condition of 16 total.	78 Participants n=86 Participants • The 'Number analyzed' reported for sex reflects the total number who reported their sex (e.g., 16 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 15 participants in the therapist condition of 16 total.
Sex: Female, Male Male	2 Participants n=16 Participants • The 'Number analyzed' reported for sex reflects the total number who reported their sex (e.g., 16 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 15 participants in the therapist condition of 16 total.	4 Participants n=12 Participants • The 'Number analyzed' reported for sex reflects the total number who reported their sex (e.g., 16 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 15 participants in the therapist condition of 16 total.	1 Participants n=23 Participants • The 'Number analyzed' reported for sex reflects the total number who reported their sex (e.g., 16 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 15 participants in the therapist condition of 16 total.	1 Participants n=20 Participants • The 'Number analyzed' reported for sex reflects the total number who reported their sex (e.g., 16 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 15 participants in the therapist condition of 16 total.	0 Participants n=15 Participants • The 'Number analyzed' reported for sex reflects the total number who reported their sex (e.g., 16 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 15 participants in the therapist condition of 16 total.	8 Participants n=86 Participants • The 'Number analyzed' reported for sex reflects the total number who reported their sex (e.g., 16 clinicians in the experimental condition of 21 total, 12 clinicians in the control condition of 14 total, 23 parent participants in the eGen condition of 23 total, 20 participants in the control condition of 20 total, and 15 participants in the therapist condition of 16 total.
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=21 Participants	0 Participants n=14 Participants	2 Participants n=23 Participants	0 Participants n=20 Participants	0 Participants n=16 Participants	2 Participants n=94 Participants
Race (NIH/OMB) Asian	2 Participants n=21 Participants	2 Participants n=14 Participants	0 Participants n=23 Participants	0 Participants n=20 Participants	1 Participants n=16 Participants	5 Participants n=94 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=21 Participants	0 Participants n=14 Participants	0 Participants n=23 Participants	0 Participants n=20 Participants	0 Participants n=16 Participants	0 Participants n=94 Participants
Race (NIH/OMB) Black or African American	1 Participants n=21 Participants	1 Participants n=14 Participants	2 Participants n=23 Participants	4 Participants n=20 Participants	4 Participants n=16 Participants	12 Participants n=94 Participants
Race (NIH/OMB) White	11 Participants n=21 Participants	8 Participants n=14 Participants	10 Participants n=23 Participants	7 Participants n=20 Participants	6 Participants n=16 Participants	42 Participants n=94 Participants
Race (NIH/OMB) More than one race	0 Participants n=21 Participants	0 Participants n=14 Participants	0 Participants n=23 Participants	0 Participants n=20 Participants	0 Participants n=16 Participants	0 Participants n=94 Participants
Race (NIH/OMB) Unknown or Not Reported	7 Participants n=21 Participants	3 Participants n=14 Participants	9 Participants n=23 Participants	9 Participants n=20 Participants	5 Participants n=16 Participants	33 Participants n=94 Participants

PRIMARY outcome

Timeframe: 8 weeks

Outcome is reported as the difference in pre- and post-intervention Externalizing Risk Scores, a subscale from the Behavior Assessment System for Children (3rd Edition, Parent Report Form - Preschool), which measures externalizing, internalizing, and adaptive behaviors. The Externalizing Risk Scores subscale measures externalizing behaviors the sum of using 9 items with a four-choice response format, for a raw Externalizing Risk Score range of 0-27. Higher scores indicate worse levels of externalizing behavior functioning. Scores of 0-10 are in the normal risk range, scores of 11-19 are elevated, and scores of 20 or above are extremely elevated. This is administered to parents before and after the intervention window (8 week separation). The change score was calculated as the value at 8 weeks minus value at baseline.

Outcome measures

Outcome measures
Measure	Parents eHealth GenPMTO n=23 Participants Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. eHealth GenPMTO: The GenPMTO is delivered over the phone (not online). This version is up to 6 sessions in length. This brief eHealth version of GenPMTO will be delivered through community therapists. The program will be delivered one-on-one (i.e., between a therapist and a parent or couple). Survey of Experience: Satisfaction with referral process	Primary Care Personnel Training Control n=16 Participants Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Control group personnel will receive a written description of the referral process but no training. Written Referral Process: A written summary and process map of the referral process, modeled on the Institute for Healthcare Improvement (IHI) 9-step process for "closing the loop" on referrals. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process	Parents Control Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. One Session Education about Resources: One online or phone conversation with the therapist in which the therapist guides the parent to the following resources: (a) a book, Raising Cooperative Kids, by GenPMTO co-developer Marion Forgatch; (b) a website, behaviorchecker.org, which includes behavioral "prescriptions" for common behavior issues; and (c) information about Early Childhood and Family Education classes, which are provided for free in Minnesota through public schools. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process
Aim 3: Change in Behavioral Assessment System Child Score	-3.17 score on a scale Standard Deviation 7.51	0.13 score on a scale Standard Deviation 8.76	—	—	—

PRIMARY outcome

Timeframe: 8 weeks

Outcome is reported as the difference in total scale score on the Alabama Parenting Questionnaire (preschool version) (Clerkin et al., 2007). This questionnaire contains 32 items rated on a 5-point scale ranging from "Never" to "Always." Total scores range from 32 to 160 with higher score indicating more involvement and positive parenting. This is administered to parents before and after the intervention window (8 week separation).

Outcome measures

Outcome measures
Measure	Parents eHealth GenPMTO n=23 Participants Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. eHealth GenPMTO: The GenPMTO is delivered over the phone (not online). This version is up to 6 sessions in length. This brief eHealth version of GenPMTO will be delivered through community therapists. The program will be delivered one-on-one (i.e., between a therapist and a parent or couple). Survey of Experience: Satisfaction with referral process	Primary Care Personnel Training Control n=16 Participants Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Control group personnel will receive a written description of the referral process but no training. Written Referral Process: A written summary and process map of the referral process, modeled on the Institute for Healthcare Improvement (IHI) 9-step process for "closing the loop" on referrals. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process	Parents Control Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. One Session Education about Resources: One online or phone conversation with the therapist in which the therapist guides the parent to the following resources: (a) a book, Raising Cooperative Kids, by GenPMTO co-developer Marion Forgatch; (b) a website, behaviorchecker.org, which includes behavioral "prescriptions" for common behavior issues; and (c) information about Early Childhood and Family Education classes, which are provided for free in Minnesota through public schools. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process
Aim 3: Change in Alabama Parenting Questionnaire	-0.65 score on a scale Standard Deviation 1.94	-0.13 score on a scale Standard Deviation 1.41	—	—	—

PRIMARY outcome

Timeframe: 8 weeks

Population: In the active comparator: parents control condition, 1 person was missing data (1/16)

Outcome is reported as the difference in total scores on the Parent Locus of Control measure (Lovejoy et al., 1997). This measure contains 24 items rated on a 5-point scale from strongly disagree (1) to strongly agree (5). Scores range from 24 to 120. High scores on the scale indicate an external locus of parenting control and low scores indicate an internal locus. This is administered to parents before and after the intervention window (8 week separation).

Outcome measures

Outcome measures
Measure	Parents eHealth GenPMTO n=23 Participants Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. eHealth GenPMTO: The GenPMTO is delivered over the phone (not online). This version is up to 6 sessions in length. This brief eHealth version of GenPMTO will be delivered through community therapists. The program will be delivered one-on-one (i.e., between a therapist and a parent or couple). Survey of Experience: Satisfaction with referral process	Primary Care Personnel Training Control n=15 Participants Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Control group personnel will receive a written description of the referral process but no training. Written Referral Process: A written summary and process map of the referral process, modeled on the Institute for Healthcare Improvement (IHI) 9-step process for "closing the loop" on referrals. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process	Parents Control Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. One Session Education about Resources: One online or phone conversation with the therapist in which the therapist guides the parent to the following resources: (a) a book, Raising Cooperative Kids, by GenPMTO co-developer Marion Forgatch; (b) a website, behaviorchecker.org, which includes behavioral "prescriptions" for common behavior issues; and (c) information about Early Childhood and Family Education classes, which are provided for free in Minnesota through public schools. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process
Aim 3: Change in Parent Locus of Control	3.78 score on a scale Standard Deviation 8.05	2.47 score on a scale Standard Deviation 7.98	—	—	—

PRIMARY outcome

Timeframe: 1 year

Percentage of eligible appointments leading to successful referral.

Outcome measures

Outcome measures
Measure	Parents eHealth GenPMTO n=21 Participants Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. eHealth GenPMTO: The GenPMTO is delivered over the phone (not online). This version is up to 6 sessions in length. This brief eHealth version of GenPMTO will be delivered through community therapists. The program will be delivered one-on-one (i.e., between a therapist and a parent or couple). Survey of Experience: Satisfaction with referral process	Primary Care Personnel Training Control n=14 Participants Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Control group personnel will receive a written description of the referral process but no training. Written Referral Process: A written summary and process map of the referral process, modeled on the Institute for Healthcare Improvement (IHI) 9-step process for "closing the loop" on referrals. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process	Parents Control Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. One Session Education about Resources: One online or phone conversation with the therapist in which the therapist guides the parent to the following resources: (a) a book, Raising Cooperative Kids, by GenPMTO co-developer Marion Forgatch; (b) a website, behaviorchecker.org, which includes behavioral "prescriptions" for common behavior issues; and (c) information about Early Childhood and Family Education classes, which are provided for free in Minnesota through public schools. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process
Aim 2: Percentage of Completed Referrals	0.34 % of appts leading to completed referral Standard Deviation 0.94	0.15 % of appts leading to completed referral Standard Deviation 0.37	—	—	—

PRIMARY outcome

Timeframe: 1 year

Population: The percent of sessions attended can only be calculated for clinicians who made at least one referral. Data is analyzed for 12 primary care clinicians in the training condition and 7 primary care clinicians in the control condition. This reflects that 9/21 clinicians in the training condition did not make any referrals, and 7/14 clinicians in the control condition did not make any referrals

For each referred caregiver, the number of sessions attended (0-6) was divided by the total possible number of sessions (6), to calculate the percent of sessions attended. The average was then calculated by referring clinician condition (training or control).

Outcome measures

Outcome measures
Measure	Parents eHealth GenPMTO n=12 Participants Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. eHealth GenPMTO: The GenPMTO is delivered over the phone (not online). This version is up to 6 sessions in length. This brief eHealth version of GenPMTO will be delivered through community therapists. The program will be delivered one-on-one (i.e., between a therapist and a parent or couple). Survey of Experience: Satisfaction with referral process	Primary Care Personnel Training Control n=7 Participants Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Control group personnel will receive a written description of the referral process but no training. Written Referral Process: A written summary and process map of the referral process, modeled on the Institute for Healthcare Improvement (IHI) 9-step process for "closing the loop" on referrals. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process	Parents Control Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. One Session Education about Resources: One online or phone conversation with the therapist in which the therapist guides the parent to the following resources: (a) a book, Raising Cooperative Kids, by GenPMTO co-developer Marion Forgatch; (b) a website, behaviorchecker.org, which includes behavioral "prescriptions" for common behavior issues; and (c) information about Early Childhood and Family Education classes, which are provided for free in Minnesota through public schools. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process
Aim 2: Parent Attendance	22.4 percent Standard Deviation 39.0	20.0 percent Standard Deviation 36.0	—	—	—

PRIMARY outcome

Timeframe: 1 year

Population: Audio-recorded responses were missing for 10 of the 21 primary care clinicians in the experimental condition, and 9 of the 14 primary care clinicians in the control condition

Communication skills rating will be measured using the Support and Guide Observational Coding Scale of audio-recorded provider responses to clinical vignettes, a measure adapted from the Fidelity of Implementation Rating System. The scale measures the communication skills of supporting, guiding, confronting (reverse-coded), teaching (reverse-coded), and tone. Each of these components is averaged across the three vignettes on a 0-3 scale (support, guide, confront, teach), or a 0-2 scale (tone). A total scale is then summed for a total scale score range of 0-14, with higher scores indicating greater communication skills. These vignette prompts are administered to providers before and after the pilot year (1 year separation).

Outcome measures

Outcome measures
Measure	Parents eHealth GenPMTO n=11 Participants Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. eHealth GenPMTO: The GenPMTO is delivered over the phone (not online). This version is up to 6 sessions in length. This brief eHealth version of GenPMTO will be delivered through community therapists. The program will be delivered one-on-one (i.e., between a therapist and a parent or couple). Survey of Experience: Satisfaction with referral process	Primary Care Personnel Training Control n=5 Participants Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Control group personnel will receive a written description of the referral process but no training. Written Referral Process: A written summary and process map of the referral process, modeled on the Institute for Healthcare Improvement (IHI) 9-step process for "closing the loop" on referrals. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process	Parents Control Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. One Session Education about Resources: One online or phone conversation with the therapist in which the therapist guides the parent to the following resources: (a) a book, Raising Cooperative Kids, by GenPMTO co-developer Marion Forgatch; (b) a website, behaviorchecker.org, which includes behavioral "prescriptions" for common behavior issues; and (c) information about Early Childhood and Family Education classes, which are provided for free in Minnesota through public schools. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process
Aim 1: Fidelity of Implementation Rating System	11.26 score on a scale Standard Deviation 4.53	8.9 score on a scale Standard Deviation 2.56	—	—	—

SECONDARY outcome

Timeframe: 8 weeks (Parents) 1 year (Therapists)

Population: Acceptability data was missing for 11 of the 21 primary care clinicians in the experimental condition, and 6 of the 14 primary care clinicians in the control condition. Acceptability data was missing for 5 of the parents in the experimental condition, and 10 of the parents in the control condition. Acceptability data was not missing for any of the therapists.

Average score on the Acceptability of intervention Measure (4 items) (Weiner et al., 2017), which assesses acceptability, or belief that the training is agreeable or satisfactory. Scores are on a 1-5 scale from completely disagree to completely agree, and all four items are averaged for a total score range of 1 to 5. A higher score indicates higher acceptability. This is administered to parents after the intervention window (8 week separation) and to providers and therapists before and after the pilot year (1 year separation).

Outcome measures

Outcome measures
Measure	Parents eHealth GenPMTO n=10 Participants Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. eHealth GenPMTO: The GenPMTO is delivered over the phone (not online). This version is up to 6 sessions in length. This brief eHealth version of GenPMTO will be delivered through community therapists. The program will be delivered one-on-one (i.e., between a therapist and a parent or couple). Survey of Experience: Satisfaction with referral process	Primary Care Personnel Training Control n=8 Participants Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Control group personnel will receive a written description of the referral process but no training. Written Referral Process: A written summary and process map of the referral process, modeled on the Institute for Healthcare Improvement (IHI) 9-step process for "closing the loop" on referrals. Survey of Experience: Satisfaction with referral process	Therapists n=18 Participants Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process	Parents Control n=6 Participants Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. One Session Education about Resources: One online or phone conversation with the therapist in which the therapist guides the parent to the following resources: (a) a book, Raising Cooperative Kids, by GenPMTO co-developer Marion Forgatch; (b) a website, behaviorchecker.org, which includes behavioral "prescriptions" for common behavior issues; and (c) information about Early Childhood and Family Education classes, which are provided for free in Minnesota through public schools. Survey of Experience: Satisfaction with referral process	Therapists n=16 Participants Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process
Intervention Acceptability Measure	3.3 score on a scale Standard Deviation 0.88	3.25 score on a scale Standard Deviation 0.89	4.24 score on a scale Standard Deviation 0.8	3.13 score on a scale Standard Deviation 1.2	4.23 score on a scale Standard Deviation 0.72

SECONDARY outcome

Timeframe: Immediately following training

Population: Appropriateness was only assessed among Primary Care Clinicians in the experimental condition. Of these 21 clinicians, 13 reported on the acceptability.

Average score on two appropriateness items assessing appropriateness of time commitment and expected benefit, generated by the researchers. The first item was "My communication with patients will improve as a result of the training," and the second item was "The time commitment for the training was reasonable." Appropriateness refers to perceived fit of the training for the practice setting and patients. Scores are on a 1-5 scale from completely disagree to completely agree. A higher score indicates higher appropriateness. This is administered to providers immediately after the training.

Outcome measures

Outcome measures
Measure	Parents eHealth GenPMTO n=13 Participants Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. eHealth GenPMTO: The GenPMTO is delivered over the phone (not online). This version is up to 6 sessions in length. This brief eHealth version of GenPMTO will be delivered through community therapists. The program will be delivered one-on-one (i.e., between a therapist and a parent or couple). Survey of Experience: Satisfaction with referral process	Primary Care Personnel Training Control Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Control group personnel will receive a written description of the referral process but no training. Written Referral Process: A written summary and process map of the referral process, modeled on the Institute for Healthcare Improvement (IHI) 9-step process for "closing the loop" on referrals. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process	Parents Control Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. One Session Education about Resources: One online or phone conversation with the therapist in which the therapist guides the parent to the following resources: (a) a book, Raising Cooperative Kids, by GenPMTO co-developer Marion Forgatch; (b) a website, behaviorchecker.org, which includes behavioral "prescriptions" for common behavior issues; and (c) information about Early Childhood and Family Education classes, which are provided for free in Minnesota through public schools. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process
Appropriateness Measure	4.03 score on a scale Standard Deviation 0.43	—	—	—	—

SECONDARY outcome

Timeframe: 1 year

Population: Feasibility was only assessed among Primary Care Clinicians (both arms) and Therapists. Responses to this measure were missing for 11 of the 21 primary care clinicians in the experimental condition, for 6 of the 14 primary care clinicians in the control condition, and for 1 of the 16 therapists. It was not assessed of parents in either arm (active comparator or experimental).

Average score on the Feasibility of Intervention Measure (4 items). Feasibility refers to how well the training can be carried out within the agency/clinic setting. Scores are on a 1-5 scale from completely disagree to completely agree. All four items are averaged for a total score range of 1 to 5. A higher score indicates higher feasibility. This is administered to providers and therapists before and after the pilot year (1 year separation).

Outcome measures

Outcome measures
Measure	Parents eHealth GenPMTO n=10 Participants Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. eHealth GenPMTO: The GenPMTO is delivered over the phone (not online). This version is up to 6 sessions in length. This brief eHealth version of GenPMTO will be delivered through community therapists. The program will be delivered one-on-one (i.e., between a therapist and a parent or couple). Survey of Experience: Satisfaction with referral process	Primary Care Personnel Training Control n=8 Participants Primary care personnel within two Federally Qualified Health Center (FQHC) primary care clinics will be randomly assigned to receive communication skills training or a control condition. Control group personnel will receive a written description of the referral process but no training. Written Referral Process: A written summary and process map of the referral process, modeled on the Institute for Healthcare Improvement (IHI) 9-step process for "closing the loop" on referrals. Survey of Experience: Satisfaction with referral process	Therapists n=15 Participants Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process	Parents Control Parents of 3- to 5-year-olds who receive services from primary care personnel at an Federally Qualified Health Center (FQHC) primary care clinic. Primary care personnel will refer parents of child with externalizing or internalizing behaviors to study therapists. Parents may be assigned to GenPMTO or control after referral. One Session Education about Resources: One online or phone conversation with the therapist in which the therapist guides the parent to the following resources: (a) a book, Raising Cooperative Kids, by GenPMTO co-developer Marion Forgatch; (b) a website, behaviorchecker.org, which includes behavioral "prescriptions" for common behavior issues; and (c) information about Early Childhood and Family Education classes, which are provided for free in Minnesota through public schools. Survey of Experience: Satisfaction with referral process	Therapists Community therapists trained to deliver GenPMTO. Survey of Experience: Satisfaction with referral process
Feasibility Measure	3.4 score on a scale Standard Deviation 0.74	3.44 score on a scale Standard Deviation 0.73	4.24 score on a scale Standard Deviation 0.40	—	—

SECONDARY outcome

Timeframe: 8 weeks, 1 year

Population: Responses to this measure were missing for 10 of the 21 primary care clinicians in the experimental condition, for 2 of the 14 primary care clinicians in the control condition, and for 3 of the 16 therapists. It was not assessed of parents in either arm (active comparator or experimental).

Summed score on the Readiness to Change Assessment, patient preferences (4 items). The patient preferences subscale assesses site readiness to implement new trainings, based on perceived patient preferences. This measure is rated on a 1-5 scale from strongly disagree to strongly agree, with a sixth option for not applicable. Summed scores range from 4 to 20; High scores indicates greater acceptability. This is administered to providers and therapists before and after the pilot year (1 year separation).