Promoting Parent Participatory Engagement in Youth Mental Health Services

描述（由申请人提供）：政策制定者、研究人员和临床医生一致认为，家长积极参与治疗对儿童心理健康服务的有效性至关重要，尤其是对有破坏性行为问题（dbp）的儿童。父母往往难以出席并积极参与治疗[被称为“父母参与性参与”（PPE）]，而缺乏PPE与儿童预后较差有关。NIMH儿童与青少年服务研究项目强调对家庭参与和常规护理环境的研究，而最近的NIMH战略计划强调了开发专注于治疗依从性的干预措施的重要性（战略3.2）。这个以病人为导向的职业发展指导奖（K23）旨在为申请人提供必要的知识、技能和试点数据，以启动一个独立的研究项目，以增加个人防护和提高公共部门儿童精神卫生保健的有效性。通过培训活动，申请人将：1)掌握现有的PPE研究和利用利益相关者反馈制定PPE干预措施的方法；2)获得针对PPE（社会营销/健康沟通、行为依从性和计划行为理论、动机性访谈、患者激活）的一套互补的跨学科经验支持的行为改变方法的培训；3)深入了解在多元文化人群中应对个人防护的挑战；4)掌握定性方法和多层次建模的技能。申请人还将接受有关研究伦理行为的培训。研究计划分为两个阶段，在培训计划和由导师、顾问、临床医生和家长组成的团队的支持下实施。首先，将开发一个多组件、多媒体资源工具包干预措施，以促进个人防护在治疗dbp儿童中的应用。建议的工具包包括三个鼓励个人防护的父工具，三个补充父工具以促进个人防护的临床医生工具，以及一些临床医生培训资源，以支持个人防护和工具包材料的使用。该工具包将借鉴来自申请人培训的行为改变方法，针对一组重叠的家长认知障碍/促进因素（动机、期望、感知障碍、授权）和护理质量因素（参与治疗计划、持续参与的机会、家长-临床医生联盟），这些因素是改善个人防护的拟议变革机制。其次，该工具包在改变父母认知障碍/促进因素和护理质量因素、个人防护用品行为（出勤、积极参与会议、在会议之间遵守建议）以及儿童/家庭结果方面的潜在有效性将通过一项随机对照试验进行评估，该试验将工具包与对照条件（n=40个家庭，每种条件10名临床医生）进行比较。工具包的可行性、可接受性和保真度也将被评估。数据将用于设计更大规模的R01，以测试该工具包对公共精神卫生机构中个人防护装备和儿童/家庭结果的影响。

DESCRIPTION (provided by applicant): Policy makers, researchers, and clinicians agree that active parent involvement in treatment is critical to the effectiveness of child mental health services, in particular for children with disruptive behavior problems (DBPs). Parents often have difficulty attending and participating actively in treatment [labeled "parent participatory engagement" (PPE)], and a lack of PPE is linked to poorer child outcomes. The NIMH Child & Adolescent Services Research Program emphasizes research on family engagement and usual care settings, and the recent NIMH Strategic Plan highlights the importance of developing interventions that focus on treatment adherence (Strategy 3.2). This Mentored Patient-Oriented Career Development (K23) award is designed to provide the applicant with knowledge, skills, and pilot data necessary to launch an independent program of research to increase PPE and improve the effectiveness of public sector child mental health care. Through the training activities, the applicant will: 1) obtain mastery of existing PPE research and methods to develop PPE interventions using stakeholder feedback; 2) obtain training in a complementary set of transdisciplinary empirically-supported behavior change approaches selected to target PPE (social marketing/health communication, behavioral compliance and theory of planned behavior, Motivational Interviewing, patient activation); 3) gain a rich understanding of challenges in addressing PPE in a culturally diverse population; and 4) acquire skills in qualitative methods and multilevel modeling. The applicant will also receive training in the ethical conduct of research. The research plan is organized into two phases implemented with the support of the training plan and a team of mentors, consultants, and clinician and parent contributors. First, a multi-component, multi-media resource toolkit intervention will be developed to promote PPE in the treatment of children with DBPs. The proposed toolkit includes three parent tools to encourage PPE, three clinician tools that complement the parent tools to promote PPE, and several clinician training resources to support PPE and use of toolkit materials. The toolkit will draw on the behavior change approaches from the applicant's training to target a set of overlapping parent cognitive barrier/facilitator factors (motivation, expectations, perceived barriers, empowerment) and quality of care factors (participation in treatment planning, opportunities for ongoing participation, parent-clinician alliance) that are proposed mechanisms of change for improving PPE. Second, the toolkit's potential effectiveness to change parent cognitive barrier/facilitator and quality of care factors, PPE behaviors (attendance, active participation in sessions, adherence to recommendations between sessions), and child/family outcomes will be assessed by a pilot randomized controlled trial comparing the toolkit to a control condition (n=40 families within 10 clinicians for each condition). Toolkit feasibility, acceptability, and fidelity will also be assessed. Data will be used to design a larger scale R01 to test the toolkit's impact on PPE and child/family outcomes in public mental health settings. PUBLIC HEALTH RELEVANCE: The research conducted will develop a set of tools to increase parent participatory engagement (PPE) in child mental health treatment, which is critical for successful treatment of children with disruptive behavior problems. The training and research activities will ensure that the applicant creates a toolkit that is effective and acceptable to parents and clinicians, and will provide a foundation for further studies to promote PPE.