A pilot test of a brief eHealth parent-focused prevention intervention with parents referred from primary care clinics

摘要 以循证为基础、以家长为中心的预防计划预防未来的精神疾病，但并不广泛使用 也没有得到很好的照顾。为了解决这一关键差距，研究必须测试更容易获得的交付策略。 因此，这项研究的长期目标是通过增加 循证育儿计划--世代PMTO(GenPMTO)的覆盖面和可获得性。通用PMTO 已经经过了面对面交付的严格测试；然而，物流障碍，如大量的时间承诺 而对儿童保育的需求限制了亲身育儿计划的参与度。在线传送节目(即， EHealth)可以克服这些障碍，增加父母的可行性。为了扩大覆盖范围，这些计划 必须与经常访问的服务设置配对。初级保健诊所经常被访问，并且 受信任的环境；然而，初级保健人员没有接受过解决行为健康或育儿问题的培训 主题和儿科转诊通常没有完成或完成。将育儿计划与小学教育相结合 护理、对初级保健人员的培训和明确的转诊程序是必要的。因此，这项研究 有两个目标：按时间顺序，第一个目标是制定(目标1)和试行试验(目标2)a 转介流程和为初级保健提供者提供的简短沟通技能培训，使他们能够有效地 向家长推荐eHealth GenPMTO，从而扩大覆盖范围。目标1使用专家共识方法来 制定可行的培训和推荐流程。目标2是对转介过程的可接受性的测试，以及 培训的试点测试；初级保健人员(n=35)将随机接受培训或对照组 他们收到关于将父母转介给GenPMTO治疗师的书面信息的情况。 培训和转介过程的可接受性、适当性和可行性将通过 混合方法的方法。这项研究中的合作诊所是联邦合格健康中心的一部分， 促进在服务不足的父母群体中提供服务。这项研究的第二个目标是试行 Brief eHealth GenPMTO(目标3)在初级保健转诊人群中的有效性。虽然 GenPMTO已经过严格的测试，一个简短的eHealth版本还没有测试过，GenPMTO也没有经过测试 检查初级保健人群的有效性。在目标3中，n=60名家长由他们的小学老师介绍 护理人员(发生在AIM 2中)将被分配到GenPMTO或中的单次会话控制条件 他们被定向到现有的育儿资源。3-5岁儿童的父母患有中度 行为问题将有资格被转介。试点成效结果包括育儿行为和 儿童外化和内化症状。简明电子健康的可接受性、适当性和可行性 GenPMTO将通过混合方法进行评估。这项研究为全面-- 动力型混合动力有效性--实施试验。

ABSTRACT Evidence-based parent-focused prevention programs prevent future mental illness but are not widely available nor well-attended. To address this this critical gap, research must test more accessible delivery strategies. Thus, the long-term goal of this study is to prevent significant behavioral health problems by increasing the reach and accessibility of an evidence-based parenting program, GenerationPMTO (GenPMTO). GenPMTO has been rigorously tested with in-person delivery; however, logistical barriers like a large time-commitment and the need for childcare limit engagement in in-person parenting programs. Delivering programs online (i.e., eHealth) can overcome these barriers, increasing feasibility for parents. To increase reach, these programs must be paired with frequently-accessed service settings. Primary care clinics are frequently accessed and trusted settings; however, primary care personnel are not trained to address behavioral health or parenting topics and pediatric referrals are often not made or completed. To integrate parenting programs with primary care, training for primary care personnel and a well-defined referral process are needed. Therefore, this study has two objectives: In chronological order, the first objective is to develop (Aim 1) and pilot test (Aim 2) a referral process and a brief communication skills training for primary care providers to equip them to effectively refer parents to eHealth GenPMTO, thereby increasing reach. Aim 1 uses an expert consensus method to develop a feasible training and referral process. Aim 2 is a test of the acceptability of the referral process and a pilot test of the training; primary care personnel (n=35) will be randomized to receive the training or a control condition in which they receive written information about referring parents to GenPMTO therapists. Acceptability, appropriateness, and feasibility of the training and referral process will be evaluated through a mixed methods approach. The collaborating clinics in this study are part of a Federally Qualified Health Center, facilitating reach within an under-served population of parents. The second objective of the study is to pilot test the effectiveness of brief eHealth GenPMTO (Aim 3) within a primary-care-referred population. Although GenPMTO has been rigorously tested, a brief eHealth version has not been tested, nor has GenPMTO been examined for effectiveness among a primary care population. In Aim 3, n=60 parents referred by their primary care provider (which occurs in Aim 2) will be assigned to GenPMTO or a single-session control condition in which they are directed to existing parenting resources. Parents of 3-5-year-old children with moderate behavioral concerns will be eligible for referral. Pilot effectiveness outcomes include parenting behaviors and child externalizing and internalizing symptoms. Acceptability, appropriateness, and feasibility of brief eHealth GenPMTO will be evaluated through a mixed methods approach. This study lays groundwork for a fully- powered hybrid effectiveness-implementation trial.