Fostering Mothers Emotionally-Responsive Parenting

培养母亲情绪敏感的养育方式

• 批准号: 8912076
• 负责人: NANCY E SUCHMAN
• 金额: $ 61.97万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-08-20 至 2020-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8912076
• 关键词: Abstinence; Address; Adult; Aftercare; Age; Age-Months; Alcohol or Other Drugs use; Award; Behavioral; Caring; Child; Child Care; Child Guidance; Child Rearing; Child Support; Chronic; Classification; Clinic; Communities; Disease; Drops; Drug usage; Effectiveness; Emotional; Enrollment; Evaluation; Family; Fostering; Funding; Future; Future Generations; Impulsivity; Individual; Intervention; Intervention Studies; Investigation; Measures; Mediating; Medical; Modeling; Monitor; Mothers; Outcome; Parenting Education; Parents; Patients; Professional counselor; Randomized; Regulation; Relapse; Science; Secure; Security; Services; Severities; Societies; Staging; Substance abuse problem; Supervision; Testing; Training; Training Programs; Treatment outcome; Underserved Population; Ursidae Family; Woman; addiction; base; clinical efficacy; community based treatment; community setting; cost; design; effectiveness trial; efficacy trial; emotion dysregulation; emotional distress; evidence base; follow up assessment; follow-up; foster parent; high risk; improved; prevent; programs; psychologic; public health relevance; skills; stress tolerance; therapy design; therapy development; transmission process; treatment center; treatment duration

 DESCRIPTION (provided by applicant): This is an application to fund a new Stage III community-based randomized clinical efficacy trial testing Mothering from the Inside Out (MIO), the first evidence-based parenting intervention designed to be delivered by addiction counselors in addiction treatment settings where parents of young children are enrolled in treatment. In two (Stage I and II) randomized clinical efficacy trials conducted during the first 9 years of this award, when compared with a standard parent education program (PE), MIO demonstrated efficacy for improving parenting, child attachment security and for positively impacting abstinence from drug use. Importantly, mothers with high addiction severity assigned to MIO showed notable improvement across all outcomes. MIO is a weekly individual parenting therapy developed as an enhancement to standard addiction treatment that targets the addicted mother's capacity to recognize and regulate her own emotional distress during stressful parenting situations so that she can support her child's developing capacity for emotional and behavioral regulation. This capacity, called reflective functioning (RF), is a psychological skill that promotes abstinence and also helps parents foster their young children's secure attachment. Now that MIO has demonstrated efficacy in two randomized efficacy trials, the next step will be to conduct a new Stage III community-based efficacy trial where addiction counselors are trained to deliver MIO and PE with fidelity in an addiction treatment setting and to evaluate treatment outcomes and mechanisms of change in this community setting. This will be one of the first investigations implementing a new stage model for intervention research (Onken et al., 2014) where efficacious interventions are first tested under conditions of high internal validity (with treatment fidelity assured) before effectiveness is tested under conditions of high external validity. At the end of this trial, if MIO demonstrates efficacy, we will have allthe necessary materials to train addiction counselors across a broad range of treatment settings in a Stage IV effectiveness trial. In the first year, we will conduct a training pilot where 14 addicton counselors in an addiction treatment clinic will be randomly assigned to training in MIO vs PE delivery and complete a training case with a real patient during which fidelity will be measured. In years 2 - 5, 160 mothers in addiction treatment and caring for children ages 12 - 24 months will be randomized to 12 sessions of MIO vs PE with a trained addiction counselor and fidelity will be monitored and maintained for treatment duration. We predict that 1. When delivered by trained addiction counselors, MIO and PE can be discriminated; 2. MIO-assigned mothers will demonstrate greater improvement in reflective functioning and abstinence from substance use and their children will show greater improvement in attachment security at post-treatment and follow up; 3. MIO will confer greater advantage than PE for mothers with high addiction severity; and 4. Higher treatment fidelity will mediate better treatment outcomes and improvements in RF will mediate improvement in abstinence and child attachment security.

 描述（由申请人提供）：这是一份资助一项新的基于社区的第三阶段随机临床疗效试验的申请，该试验测试“由内而外的母亲”（MIO），这是第一个基于证据的育儿干预措施，旨在由成瘾治疗机构中的成瘾咨询师提供，幼儿父母参加治疗。在该奖项颁发的前 9 年期间进行的两项（第一阶段和第二阶段）随机临床疗效试验中，与标准家长教育计划 (PE) 相比，MIO 证明了在改善养育方式、儿童依恋安全性以及对戒毒产生积极影响方面的功效。重要的是，被分配到 MIO 的成瘾严重程度较高的母亲在所有结果上均表现出显着改善。 MIO 是一种每周一次的个人育儿疗法，是作为标准成瘾治疗的增强而开发的，其目标是成瘾母亲在有压力的育儿情况下识别和调节自己情绪困扰的能力，以便她能够支持孩子情绪和行为调节能力的发展。这种能力被称为反思功能（RF），是一种促进禁欲的心理技能，也可以帮助父母培养孩子的安全依恋。既然 MIO 已在两项随机疗效试验中证明了疗效，下一步将进行一项新的基于社区的 III 期疗效试验，其中成瘾咨询师接受培训，可以在成瘾治疗环境中忠实地提供 MIO 和 PE，并评估该社区环境中的治疗结果和变化机制。这将是实施干预研究新阶段模型的首批调查之一（Onken et al., 2014），其中首先在高内部效度（保证治疗保真度）的条件下测试有效的干预措施，然后在条件下测试有效性 具有较高的外部效度。试验结束时，如果 MIO 证明有效，我们将拥有所有必要的材料，在 IV 期有效性试验中对各种治疗环境中的成瘾咨询师进行培训。第一年，我们将进行试点培训，成瘾治疗诊所的 14 名成瘾咨询师将被随机分配接受 MIO 与 PE 交付培训，并与真实患者一起完成一个培训案例，在此期间将测量忠诚度。在第 2 - 5 年，160 名接受成瘾治疗和照顾 12 - 24 个月儿童的母亲将被随机分配到 12 次 MIO 与 PE 疗程，并由经过培训的成瘾咨询师进行，并且在治疗期间将监测和维持忠诚度。我们预测： 1. 当由训练有素的成瘾咨询师提供时，MIO 和 PE 可能会受到歧视； 2. 接受 MIO 的母亲在治疗后和随访中将在反思功能和戒除药物方面表现出更大的改善，并且她们的孩子在依恋安全性方面将表现出更大的改善； 3. 对于成瘾严重程度较高的母亲来说，MIO 比 PE 具有更大的优势； 4. 更高的治疗保真度将带来更好的治疗结果，RF 的改善将促进禁欲和儿童依恋安全性的改善。