Comparing Interventions to Improve the Well-Being of Custodial Grandfamilies

描述（由申请人提供）：尽管先前的研究表明，被监护的祖母（CGM）和孙子（CGC）面临着心理困难的高风险，但实际上，基于坚实的概念框架，对这些弱势家庭进行的社会心理干预的严格研究几乎没有。鉴于初步研究结果表明，父母离异在照顾者角色中CGM的心理困扰与CGC的情绪和行为问题之间起中介作用，本项目通过随机临床试验（RCT）比较两种基于证据的心理教育干预措施在其他照顾者群体中广泛应用的可行性和有效性。CGC的祖母（N = 504）（5 - 12岁）将被随机分配到以下三个条件中的一个：行为父母训练（BPT，源自KEEP项目，用于寄养父母）；认知行为疗法（CBT，源自应对照顾，用于照顾体弱老年人）；最小支持条件（以控制非特异性治疗因素）。拟议的普遍干预措施包括预防和补救目标，并涉及由精神卫生专业人员和祖父母同龄人共同领导的小组形式方法。该随机对照试验将在美国多个地点进行，以确保调查结果的普遍性超越单一地区，并有相同数量的黑人（n = 168）、西班牙裔（n = 168）和白人（n = 168）家庭参与。在随机对照试验之前，将分别与每个种族的cgm （n = 10）和经验丰富的从业者（n = 10）进行焦点小组讨论，目的是评估招募方法、治疗目标和程序的感知重要性和可接受性，包括种族/民族之间可能存在的差异。在测试前、测试后以及6、12、18和24个月的随访期间，RCT的多信息者和多方法评估将包括CGM心理困扰指标（焦虑、抑郁）；CGC调整（内部化和外部化问题）；以及被打乱的养育方式（使用无效的纪律和缺乏教养）。基于著名的家庭压力模型的概念框架，将使用多组结构方程模型分析来实现四个目标：(a)比较CBT和BPT的短期和长期效果；(b)纵向考察父母教养方式、心理困扰和CBT与BPT和CBT改善的CGC调整之间的动态联系；(c)确定关键调节变量（种族/民族、CGC、CGC和CGM的初始心理困难）是否影响随机对照试验结果；(d)检查与拟议干预措施的可接受性和依从性相关的关键因素。通过确定哪些建议的干预措施在特定的亚群体（例如，种族/民族；初始风险）中最有效和最可接受，并通过揭示CGM痛苦、功能失调的养育和CGC调整之间的具体前因后果关系，这些发现将为未来的临床实践提供信息。

DESCRIPTION (provided by applicant): Although prior studies reveal that custodial grandmothers (CGM) and grandchildren (CGC) face high risk for psychological difficulties, virtually no rigorous studies of psychosocial interventions based on solid conceptual frameworks have been conducted with these vulnerable families. In view of preliminary findings that disrupted parenting mediates the relationship between CGM's psychological distress in the caregiver role and CGC's emotional and behavioral problems, this project involves a randomized clinical trial (RCT) of the comparative feasibility and efficacy of two evidenced-based psychoeducational interventions widely used with other caregiver populations. Grandmothers (N = 504) of CGC (age 5 - 12) will be randomly assigned to one of three conditions: Behavioral Parent Training (BPT; derived from Project KEEP for foster parents; Cognitive Behavioral Therapy (CBT; derived from Coping with Caregiving for caregivers of frail elders); Minimal Support Condition (to control for non-specific treatment factors). The proposed universal interventions include prevention and remediation objectives and involve a group format approach with mental health professionals and grandparent peers serving as co-leaders. The RCT will occur in multiple locations across the US to ensure that findings generalize beyond a single area and that equal numbers of Black (n = 168), Hispanic (n = 168), and White (n = 168) families participate. Prior to the RCT, focus groups will be held separately with CGMs of each race (n = 10 apiece) and experienced practitioners (n = 10) with the aim of assessing the perceived importance and acceptability of recruitment methods, treatment goals, and procedures, including possible differences by race/ethnicity. Multiple-informant and multiple-method assessments during the RCT at pretest, posttest and 6, 12, 18, and 24 month follow-ups will include indicators of CGM psychological distress (anxiety, depression); CGC adjustment (internalizing and externalizing problems); and disrupted parenting (use of ineffective discipline and low nurturance). Based on the conceptual framework of the prominent Family Stress Model, multi-group structural equation modeling analyses will be used to achieve four aims: (a) To compare the short and long-term effectiveness of CBT and BPT; (b) to examine longitudinally the dynamic linkages between CGM parenting practices, CGM' psychological distress, and CGC adjustment as modified by BPT and CBT; (c) to determine if key moderating variables (race/ethnicity, CGC, initial psychological difficulties in CGC and CGM influence RCT outcomes; and (d) to examine key factors related to acceptability and adherence to the proposed interventions. The findings will inform future clinical practice with custodial grandfamilies by identifying which of the proposed interventions are most effective and most acceptable among specific sub-groups (e.g., race/ethnicity; initial risk) and by unraveling the specific antecedent-consequent relations among CGM distress, dysfunctional parenting, and CGC adjustment.