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Parenting with Love and Limits (PLL)

Topic Areas
Scientific Rating
Child Welfare Relevance
Disruptive Behavior Treatment (Child & Adolescent)
2  — Supported by Research Evidence
Medium

About This Program

Target Population: Children and adolescents aged 10-18 who have severe emotional and behavioral problems (e.g., conduct disorder, oppositional defiant disorder, and attention deficit/hyperactivity disorder) and frequently co-occurring problems such as depression, alcohol or drug use, chronic truancy, destruction of property, domestic violence, or suicidal ideation; program also has been used with teenagers with less extreme behaviors and serves both youth in the community and returning home from an out-of-home placement

For children/adolescents ages: 10 – 18

For parents/caregivers of children ages: 10 – 18

Program Overview

PLL combines group therapy and family therapy to treat children and adolescents aged 10-18 who have severe emotional and behavioral problems (e.g., conduct disorder, oppositional defiant disorder, attention deficit/hyperactivity disorder) and frequently co-occurring problems such as depression, alcohol or drug use, chronic truancy, destruction of property, domestic violence, or suicidal ideation. The program also has been used with teenagers with less extreme behaviors. PLL is also used to serve as an alternative to a residential placement for youth as well as with youth returning back from residential placement such as commitment programs, halfway houses, group homes, or foster homes. PLL teaches families how to reestablish adult authority through consistent limits while reclaiming a loving relationship.

PLL must consist of both of the following:

  • Six multifamily sessions, conducted by one clinician and one co-facilitator, that employ group discussions, videotapes, age-specific breakout sessions, and role-play.
  • Six to eight individual family intensive 1- to 2-hour therapy sessions in an outpatient or home-based setting to practice the skills learned in the group setting. The number of sessions can be increased up to 20 for youth with more severe problems such as involvement with the juvenile or criminal justice system. PLL's integration of group sessions and family therapy is designed to help families apply skills and concepts to real-life situations and prevent relapse.

Program Goals

The goals of Parenting with Love and Limits (PLL) are:

  • Treat children and adolescents who have severe emotional and behavioral problems
  • Teach families how to reestablish adult authority through consistent limits while reclaiming a loving relationship

Logic Model

The program representative did not provide information about a Logic Model for Parenting with Love and Limits (PLL).

Essential Components

The essential components of Parenting with Love and Limits (PLL) include:

  • Combining both group and family therapy together over a six- to eight-week period
  • Having a recommended 6 to 8 adolescents and their families per group
  • Using the Stages of Readiness Scale as an overlay to break parental resistance
  • Assessing fidelity using the following 4 scales plus a manualized curriculum:
    • Video supervision using Interpersonal Process Recall (IPR)- Expert Rating Scale
    • Group Fidelity Checklist - (Therapist Adherence Measure)
    • Family Therapy Fidelity Checklist - (Therapist Adherence Measure)
    • Monthly PLL Report - (Therapist Adherence Measure)

Program Delivery

Child/Adolescent Services

Parenting with Love and Limits (PLL) directly provides services to children/adolescents and addresses the following:

  • Severe emotional and behavioral problems (e.g., conduct disorder, oppositional defiant disorder, attention deficit/hyperactivity disorder) and frequently co-occurring problems such as depression, alcohol or drug use, chronic truancy, destruction of property, domestic violence, or suicidal ideation

Parent/Caregiver Services

Parenting with Love and Limits (PLL) directly provides services to parents/caregivers and addresses the following:

  • Has a son or daughter aged 10-18 who has severe emotional and behavioral problems (e.g., conduct disorder, oppositional defiant disorder, attention deficit/hyperactivity disorder) and frequently co-occurring problems such as depression, alcohol or drug use, chronic truancy, destruction of property, domestic violence, or suicidal ideation

Recommended Intensity:

2-hour weekly group sessions with 1 hour of parents and teens meeting together and 1 hour of the parents and teens meeting separately, and 1-2 hour weekly family sessions, as needed

Recommended Duration:

6 weeks for group sessions, and 4 to 20 sessions for family sessions

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster / Kinship Care
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care

Homework

Parenting with Love and Limits (PLL) includes a homework component:

Participants are expected to practice the skills they learn in both group and family sessions at home

Languages

Parenting with Love and Limits (PLL) has materials available in languages other than English:

Dutch, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Rooms to provide individual and group therapy in and measures, laptop, LCD projector, speakers, printer, laminator

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Master's level degree in counseling related field for clinician; Bachelors degree for co-facilitator or case manager

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Type/Location:
  • Initial 5-day onsite clinical training
  • Semimonthly quality assurance and clinical adherence telephone consultations (2 hours each supervision session)
  • Motivational Interview Training (PLL Specific)
  • Outcome research and analysis that includes an independently conducted, published program evaluation on recidivism rates and clinical effectiveness, if qualify
  • One annual onsite visit, if needed, to observe delivery of the model for quality assurance purposes
  • Videotape supervision of therapist to facilitate treatment fidelity
  • Monthly 1-hour session for Community Based Action Team (Case Management) supervision (Reentry Teams Only)
  • Ongoing consultations as needed to answer questions outside the weekly telephone consultations
  • More information on training can be found at www.gopll.com
Number of days/hours:

Five days of clinical training, 48 weeks of telephone consultations

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Parenting with Love and Limits (PLL) as listed below:

There is a PLL Implementation Checklist and the 8 Laws of Transportability. They are available from John Burek via email: jburek@gopll.com.

Formal Support for Implementation

There is formal support available for implementation of Parenting with Love and Limits (PLL) as listed below:

PLL has specific staff dedicated to program implementation assistance, oversight, and supervision. PLL provides each site with a Clinical Supervisor who is dedicated to that site. Additionally, PLL's Director of Implementation, Director of Data and Support Services, and Vice President of Clinical Services, each provide valuable resources to help each site ensure excellence in program implementation and management. As part of PLL implementation procedures, administrators and clinicians at each site are trained and certified in specific areas of program implementation.

Fidelity Measures

There are fidelity measures for Parenting with Love and Limits (PLL) as listed below:

There are four different fidelity measures:

  • Video Supervision Interpersonal Process Recall (IPR) - (Therapist Adherence Measure): The PLL provider submits videotaped sessions from group and coaching sessions to the PLL Supervisor. The PLL Supervisor then reviews the video and scores the therapist based on PLL's scientifically validated fidelity instrument. Once reviewed, the PLL Supervisor selects segments from the video to review with the clinician during supervision sessions.
  • PLL Fidelity Dashboard - (Therapist Adherence Measure): The PLL Fidelity Dashboard is a software application that tracks "real time" client and clinician results. The dashboard tracks such items as completion and attrition rates; referral engagement rates; the number of clients that started the program, dropped out, or are in process; average length of stay; and standardized assessment results along with other results.
  • Group Protocol Checklist - (Therapist Adherence Measure): The Group Protocol Checklist is used to assess treatment fidelity adherence to the PLL group therapy model. Each of the six classes has a scientifically validated checklist of key concepts specific to that class that were either covered or not covered by the therapist. In addition, therapists use a Likert scale to measure how closely they followed the Group Manual.
  • Family Therapy Protocol Checklist - (Therapist Adherence Measure): The Family Therapy Protocol Checklist is a self-report tool used to assess treatment fidelity adherence to the PLL Family Therapy Model. After each family therapy session, the therapist completes each of the areas that assess competency of the major tenets of the PLL Family Therapy Model.

For more information, contact Robert Kelly, Director of Data and Support Services, at Robert@gopll.com or (520) 464-2939.

Implementation Guides or Manuals

There are no implementation guides or manuals for Parenting with Love and Limits (PLL).

Research on How to Implement the Program

Research has not been conducted on how to implement Parenting with Love and Limits (PLL).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Smith, T. E., Sells, S. P., Rodman, J., & Reynolds, L. R. (2006). Reducing adolescent substance abuse and delinquency: Pilot research of a family-oriented psychoeducation curriculum. Journal of Child and Adolescent Substance Abuse, 15, 105-115. doi:10.1300/J029v15n04

Type of Study: One group pretest-posttest study
Number of Participants: Adolescents: 102, Parents: 93

Population:

  • Age — Adolescents: 9-18 Years, Mean=15 years; Parents: Not specified
  • Race/Ethnicity — Adolescents: 82.4% White, 11.8% African American, and 1.0% Mexican-American, Parents: Not specified
  • Gender — 56.9% Male; Parents: Not specified
  • Status — Participants were adolescents and their parents attending a court-ordered substance abuse program

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
Participants were attending a six-week Parenting with Love and Limits® (PLL) program. All adolescent participants had a concurrent diagnosis of substance abuse and oppositional defiant or conduct disorder. Before beginning the intervention, the adolescents received the Substance Abuse Subtle Screening Inventory (SASSI), measuring self-perceptions and attitudes about substance use and abuse. The scale was re-administered after the last class. Juvenile court records were also used to assess re-arrest for substance abuse or conduct-related problems at 6 and 12 months after completing the program. Results showed that self-perception of drug and alcohol use, as measured by the SASSI, was significantly lower after program completion. Arrest records indicated that 15% of the sample relapsed or re-offended during the 12-month follow-up period. This study is limited by lack of an untreated comparison group.

Length of controlled postintervention follow-up: 12 months.

Baruch, G., Vrouva, I., & Wells, C. (2011). Outcome findings from a parent training programme for young people with conduct problems. Child & Adolescent Mental Health, 16(1), 47-54. doi:10.1111/j.1475-3588.2010.00574.x

Type of Study: One group pretest-posttest study
Number of Participants: 123 parents of adolescents with behavior problems

Population:

  • Age — Adolescents: 10-17 years, Mean=14 years; Parents: Not specified
  • Race/Ethnicity — Adolescents: 26.8% Ethnic Minorities, Parents: Not specified
  • Gender — Adolescents: 42.6% Female, Parents: 77.1% Female
  • Status — Participants were parents with adolescents with behavioral problems who attended a mental health center’s parent-training program for the first time between January 2005 and May 2008.

Location/Institution: Brandon Centre for Counselling and Psychotherapy for Young People, London, UK

Summary: (To include basic study design, measures, results, and notable limitations)
The objective of this study was to evaluate the impact of Parenting with Love and Limits® (PLL) parent education group on young people presenting with conduct problems. Measures included the Child Behavior Check List (CBCL), Global Assessment of Functioning Scale, and the Severity of Psychosocial Stressors Scale for Children and Adolescent. The CBCL was the primary outcomes measure. There was a significant reduction in CBCL internalizing, externalizing, and total scores. Withdrawn score pre-treatment was the only independent predictor of reliable change in internalizing and total scores: the higher the score pre-treatment, the greater the chances of reliable improvement in post-treatment scores. Limitations include the large percentage of families that did not complete the outcomes measures and the lack of a control group.

Length of controlled postintervention follow-up: None.

*Sells, S. P., Early, K. W., & Smith, T. E. (2011). Reducing adolescent oppositional and conduct disorders: An experimental design using the Parenting with Love and Limits® Model. Professional Issues in Criminal Justice, 7, 9-30.

Type of Study: Randomized controlled trial using matched pairs
Number of Participants: 38

Population:

  • Age — 12-17 years
  • Race/Ethnicity — 82% African American, 12% Caucasian, and 1% Hispanic
  • Gender — 57% Males and 43% Females
  • Status — Participants were adolescents within the juvenile court system with oppositional defiant or conduct disorder diagnosis.

Location/Institution: Georgia

Summary: (To include basic study design, measures, results, and notable limitations)
The primary goals of the current study were: 1. To examine the extent to which active parent and teen involvement in the six-week Parenting with Love and Limits® (PLL) parent education group reduced adolescents’ conduct disorder behaviors; 2. To determine whether reductions in conduct disorders would be sustained over a 12-month follow-up period as measured by recidivism, or re-arrest rates; and 3. To evaluate whether PLL lowered parent dropout rates and increased levels of motivation, engagement, and group attendance rates. Matched pairs of youth in the juvenile court system were randomly assigned to either PLL or usual probation services. Measures included the Child Behavior Checklist (CBCL), Parent and Adolescent Readiness Scale (PRS), Index of Parental Attitudes (IPA), and the Parent Adolescent Communication Scale (PACS). The PLL group demonstrated a significant reduction in aggressive behaviors, depression, attention-deficit disorder problems, and externalizing problems as measured by the CBCL. Dropout rates in the PLL group among parents and teenagers were extremely low with an 85% attendance rate by the parents and an 80% attendance rate by youths, even though attendance was not court ordered. Compared with the control group, the PLL group significantly improved parents’ readiness to change and resulted in significantly lower recidivism rates (16% PLL vs. 55% control) over a 12- month follow-up period. Limitations include the small number of participants and that the majority of the PLL group was single parent mothers.

Length of controlled postintervention follow-up: 12 months.

Winokur-Early, K., Chapman, S., & Hand, G. (2013). Family-focused juvenile reentry services: A quasi-experimental design evaluation of recidivism outcomes. Journal of Juvenile Justice, 2(2), 1-22.

Type of Study: Nonequivalent control group design using propensity score matching
Number of Participants: 354

Population:

  • Age — 16-18 years
  • Race/Ethnicity — 46.5% White, 44.4% African American, 8.8% Multiracial, 7.1% Hispanic, and 0.3% Native American
  • Gender — 87.6% Male and 12.4% Female
  • Status — Participants were juvenile offenders transitioning from residential commitment back to the community.

Location/Institution: St. Joseph County, Indiana

Summary: (To include basic study design, measures, results, and notable limitations)
This study compared the outcomes of youth receiving Parenting with Love and Limits® (PLL) with those of a matched sample of youth who received standard aftercare programming (comparison group) in the study site before PLL was implemented. Data was collected from the St. Joseph County Probate Court records for the following measures: demographic, rearrest, felony arrest, readjudication, felony readjudication, and recommitment. Results indicate that youth released from PLL had lower rates of reoffending than those receiving standard aftercare, with statistically significant differences found for subsequent rates of juvenile readjudication. Limitations include nonrandomization of subjects, time differences between the samples, relatively small sample size, and use of retrospective court data.

Length of controlled postintervention follow-up: 12 months.

Karam, E. A., Sterrett, E. M., & Kiaer, L. (2017). The integration of family and group therapy as an alternative to juvenile incarceration: A quasi‐experimental evaluation using Parenting with Love and Limits. Family Process, 56(2), 331-347. doi:10.1111/famp.12187

Type of Study: Pretest/posttest with propensity score matched comparison group
Number of Participants: 310

Population:

  • Age — 14-18 years
  • Race/Ethnicity — 70% African American and 30% Caucasian
  • Gender — 74% Male
  • Status — Participants were offenders in the Champaign County, Illinois, juvenile justice system between April 2009 and December 2011.

Location/Institution: Champaign County, Illinois

Summary: (To include basic study design, measures, results, and notable limitations)
The current study evaluated the effectiveness of Parenting with Love and Limits (PLL) for moderate to high-risk juvenile offenders. Measures utilized include Child Behavior Checklist (CBCL) and administrative data on recidivism. Results indicate that youth completing PLL had significantly lower rates of recidivism than the treatment as usual comparison group. Parents also reported statistically significant improvements in youth behavior. Lengths of service were also significantly shorter for the treatment sample than the matched comparison group by an average of 4 months. Limitations include the lack of randomization, an insufficient sample size to examine differences between subgroups, the lack of CBCL data form the comparison group, and the lack of youth self-report measures.

Length of controlled postintervention follow-up: 1 year.

Sterrett-Hong, E., Karam, E., & Kiaer, L. (2017). Statewide implementation of Parenting with Love and Limits among youth with co-existing internalizing and externalizing functional impairments reduces return to service rates and treatment costs. Administration and Policy in Mental Health and Mental Health Services Research, 44, 792-809. doi:10.1007/s10488-016-0788-4

Type of Study: Nonequivalent control group design using propensity score matching
Number of Participants: 592

Population:

  • Age — 14-18 years
  • Race/Ethnicity — 81% Caucasian
  • Gender — 54% Male
  • Status — Participants were juveniles in the Idaho community mental health (CMH) system.

Location/Institution: Idaho

Summary: (To include basic study design, measures, results, and notable limitations)
The current study examined the implementation of Parenting with Love and Limits in a state CMH system to increase efficiency of services to youth with co-existing internalizing and externalizing functional impairments. Measures utilized include the administrative data provided by the Idaho Division of Behavioral Health, the Child And Adolescent Functional Assessment Scale (CAFAS) and the Child Behavior Checklist (CBCL). Results indicate that youth receiving PLL experienced shorter treatment durations and returned to CMH services at significantly lower rates than youth receiving treatment as usual. They also demonstrated significant decreases in internalizing and externalizing symptoms over time. Limitations include the lack of randomization, a lack of information on youth symptomatology, and the lack of youth self-report of functioning.

Length of controlled postintervention follow-up: 1 year.

Additional References

Sells, S. P. (2001). Parenting your out-of-control teenager. New York: St. Martin's Press.

Sells, S. P., Smith, T. E., & Rodman, J. (2006). Reducing substance abuse through Parenting with Love and Limits. Journal of Child and Adolescent Substance Abuse, 15, 105-115.

Sells, S., Sullivan, I., & DeVore, D. (2012). Stopping the madness: A new reentry system for juvenile corrections. Corrections Today, April/May, 40-45.

Contact Information

John Burek
Agency/Affiliation: Parenting With Love and Limits, Inc.
Website: www.gopll.com
Email:
Phone: (800) 735-9525
Fax: (812) 727-2847

Date Research Evidence Last Reviewed by CEBC: February 2021

Date Program Content Last Reviewed by Program Staff: April 2018

Date Program Originally Loaded onto CEBC: December 2009