Effectiveness Trial of Methods for Engaging Parents Into Parenting Interventions

说明(由申请人提供)：育儿技能干预已被证明有助于预防药物使用和精神健康障碍(NCR/IOM，2009年；Sandler等人，2011年)。不幸的是，这些干预措施的公共卫生潜力严重有限，因为很少有家长参与其中。这项拟议的研究是一项基于理论的参与包的随机有效性试验，在有效性试验中发现，与对照参与条件相比，参与循证育儿干预的初始比率(48%比25%)几乎翻了一番。参与包对启动的影响是通过目标动机结构(即父母态度、感知障碍)的变化来调节的。参与一揽子计划通过减少单亲家庭和讲英语的墨西哥裔美国家庭参与的差距，以及通过增加在课堂上遇到行为问题(BP)儿童的父母的参与，增加了高需要家庭的参与，这些家庭不太可能参与育儿干预。拟议的试验测试了这一参与方案的效果，当通过与大型公立学区的伙伴关系在自然服务提供条件下实施时。幼儿园和一年级学生(N=1350)的家长将在三个时间点接受采访：考试前、订婚后和育儿后计划。数据也将从教师、小组组长和客观评分者那里收集。该项目有四个具体目标：1.使用拆卸设计比较接洽包组件的有效性。幼儿园和一年级的教室将被随机分配到以下五种情况之一：1)标准宣传册；2)宣传册+家庭推荐传单；3)宣传册+教师认可；4)宣传册+组长互动电话(GLEC)；5)宣传册+推荐传单+教师认可+GLEC。2.检查社会文化变量(家庭结构和社会经济地位；父母种族和主要语言)，并作为参与条件对入学和入会影响的调节变量，对儿童BP进行基线调整。3.检查动机投入部分的曝光量和实施变异性是否解释了每种条件下的注册率和入学率的变异性。4.测试参与包对育儿和子女结果的影响的中介模型。与宣传册条件相比，随机分配到完全参与一揽子计划的教室中的家庭预计会表现出更高的启动率，从而在循证父母干预--三P积极父母计划(Sanders，2008)中表现出更多的出席率；这反过来应该会导致在药物滥用(即儿童BP、育儿障碍)和儿童心理健康问题的风险因素方面，从三P前到三P后有更大的改善。这一发现将表明，这一激励增强的参与方案可以显著增加以证据为基础的育儿干预措施对公共健康的影响，以防止药物使用和精神健康障碍。

DESCRIPTION (provided by applicant): Parenting skills interventions have been shown to help prevent substance use and mental health disorders (NCR/IOM, 2009; Sandler et al., 2011). Unfortunately, the public health potential of these interventions is severely limited because few parents engage in them. The proposed research is a randomized effectiveness trial of a theory-based engagement package that has been found in an efficacy trial to nearly double the rate of initiation into an evidence-based parenting intervention compared to a control engagement condition (48% vs. 25%). Engagement package effects on initiation were mediated by changes in targeted motivational constructs (i.e., parental attitudes, perceived obstacles). The engagement package increased participation for high-need families by reducing disparities in engagement for single-parent and English-Speaking Mexican American families, who have been less likely to participate in parenting interventions, and by increasing engagement among parents of children experiencing behavior problems (BPs) in the classroom. The proposed trial tests the effects of this engagement package when implemented under natural service delivery conditions through a partnership with a large, public school district. Parents of kindergarten and 1st grade students (N = 1,350) will be interviewed at three time-points: pre-test, post-engagement, and post-parenting program. Data will also be collected from teachers, group leaders and objective raters. The project has four specific aims: 1. Compare the effectiveness of engagement package components using a dismantling design. Kindergarten and 1st grade classrooms will be randomly assigned to one of five conditions: 1) standard brochure; 2) brochure + family testimonial flyer; 3) brochure + teacher endorsement; 4) brochure + group leader engagement call (GLEC); 5) brochure + testimonial flyer + teacher endorsement + GLEC. 2. Examine socio-cultural variables (family structure and SES; parent ethnicity and primary language) and baseline child BPs as moderators of the effects of engagement condition on enrollment and initiation. 3. Examine whether amount of exposure and implementation variability of the motivational engagement components accounts for variability in enrollment and initiation rates within each condition. 4. Test a mediation model of the effects of the engagement package on parenting and child outcomes. Compared to the brochure condition, families from classrooms randomly assigned to the full engagement package are expected to show higher initiation rates and consequently greater session attendance in an evidence-based parenting intervention, the Triple P Positive Parenting Program (Sanders, 2008); which in turn, should lead to greater improvements from pre- to post-Triple P on risk factors for substance abuse (i.e., child BPs, parenting dysfunction) and child mental health problems. Such a finding would suggest that this motivationally-enhanced engagement package could substantially increase the public health impact of evidence-based parenting interventions that prevent substance use and mental health disorders.