Comparing Interventions to Improve the Well-Being of Custodial Grandfamilies

比较改善监护祖家庭福祉的干预措施

• 批准号: 8417664
• 负责人: Gregory C Smith
• 金额: $ 56.92万
• 依托单位: KENT STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-24 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8417664
• 关键词: Address; Adherence; Age; Anxiety; Area; Behavior; Behavioral; Belief; Birth; Caregivers; Caring; Characteristics; Child; Child health care; Clinical; Cognitive Therapy; Development; Discipline; Distress; Educational Intervention; Effect Modifiers (Epidemiology); Effectiveness; Emotional; Ensure; Equation; Ethnic Origin; Evidence based intervention; Face; Family; Focus Groups; Frail Elderly; Future; Gender; Goals; Health; Health Professional; Health Promotion; Hispanics; Impairment; Intervention; Intervention Studies; Investigation; Knowledge; Lead; Light; Location; Measurement; Mediating; Mental Depression; Mental Health; Methods; Modeling; Outcome; Outcome Measure; Parenting behavior; Parents; Patients; Perception; Personal Satisfaction; Population; Populations at Risk; Poverty; Prevention; Preventive; Problem behavior; Procedures; Process; Psychosocial Assessment and Care; Race; Randomized; Randomized Clinical Trials; Reliance; Research; Research Design; Risk; Risk Factors; Risk Reduction Behavior; Role; Services; Solid; Stress; Subgroup; Symptoms; System; Target Populations; Testing; Time; Training; Training Programs; Treatment Efficacy; Treatment Factor; Treatment outcome; Underrepresented Minority; United States National Institutes of Health; Work; abuse neglect; base; caregiving; clinical practice; comparative; coping; design; disorder prevention; emotional adjustment; evidence base; experience; foster parent; grandchild; grandparent; health disparity; high risk; improved; informant; innovation; intervention effect; member; peer; programs; psychoeducational intervention; psychologic; psychological distress; public health relevance; racial difference; remediation; skills; social; sound; theories; therapy design; therapy development; universal prevention

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.

描述（由申请人提供）：虽然先前的研究表明，监护祖母（CGM）和孙子（CGC）面临心理困难的高风险，几乎没有严格的研究，心理社会干预的基础上坚实的概念框架已与这些弱势家庭进行。鉴于初步的研究结果，中断养育调解CGM的心理困扰的照顾者的角色和CGC的情绪和行为问题之间的关系，该项目涉及一个随机临床试验（RCT）的比较可行性和有效性的两个证据为基础的心理教育干预措施广泛用于其他照顾者人群。CGC（5 - 12岁）的祖母（N = 504）将被随机分配到三个条件之一：行为父母培训（BPT;来自项目KEEP的养父母;认知行为疗法（CBT;来自应对照顾体弱老人的照顾者）;最小支持条件（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，并涉及一种小组形式的方法，由精神卫生专业人员和祖父母同龄人担任共同领导人。随机对照试验将在美国多个地点进行，以确保研究结果推广到单个地区之外，并且同等数量的黑人（n = 168）、西班牙裔（n = 168）和白色（n = 168）家庭参与。在RCT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，旨在评估招募方法、治疗目标和程序的重要性和可接受性，包括种族/种族的可能差异。在RCT期间，在预测、后测和6、12、18和24个月随访时进行的多信息提供者和多方法评估将包括CGM心理困扰（焦虑、抑郁）指标; CGC调整（内化和外化问题）;和中断的养育（使用无效的纪律和低养育）。本研究以家庭压力模型为概念框架，采用多组结构方程模型分析，旨在实现以下四个目标：（a）比较CBT和BPT的短期和长期效果;（B）纵向考察CGM父母教养方式、CGM心理困扰和经BPT和CBT修正的CGC调节之间的动态联系;（c）确定关键调节变量（种族/民族、CGC、CGC和CGM中的初始心理困难）是否影响RCT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。这些发现将通过确定哪些拟议的干预措施在特定的亚组（例如，种族/民族;初始风险），并解开特定的前因-后果之间的关系CGM的困扰，功能失调的父母，和CGC的调整。