Fostering Mothers Emotionally-Responsive Parenting

 描述(由申请人提供)：这是一份申请，以资助一个新的基于社区的随机临床疗效试验第三阶段，测试从内而外的母亲(MIO)，这是第一个基于证据的父母干预措施，旨在由成瘾顾问在成瘾治疗环境中提供，其中年幼儿童的父母参加治疗。在该奖项的头9年中进行的两项(第一阶段和第二阶段)随机临床疗效试验中，与标准的父母教育计划(PE)相比，MIO证明了在改善育儿、儿童依恋安全和积极影响戒毒方面的有效性。重要的是，分配给MIO的上瘾严重程度高的母亲在所有结果中都有显著的改善。MIO是一种每周一次的个人育儿疗法，旨在加强标准的成瘾治疗，目标是成瘾的母亲在有压力的育儿环境中识别和调节自己的情绪困扰的能力，以便她能够支持她的孩子发展情绪和行为调节能力。这种能力被称为反射功能(RF)，是一种促进禁欲的心理技能，也有助于父母培养年幼孩子的安全依恋。既然MIO已经在两个随机疗效试验中证明了有效性，下一步将是进行一项新的基于社区的第三阶段疗效试验，在该试验中，成瘾顾问接受培训，在成瘾治疗环境中提供MIO和PE，并评估治疗结果和社区环境中的变化机制。这将是实施干预研究新阶段模型的首批研究之一(Onken等人，2014)，在该模型中，在条件下测试有效性之前，首先在高内部有效性(保证治疗保真度)的条件下测试有效的干预 具有很高的外部效度。在试验结束时，如果MIO显示出疗效，我们将拥有所有必要的材料，以便在第四阶段的有效性试验中，在广泛的治疗环境中培训成瘾咨询师。在第一年，我们将进行一项培训试点，在成瘾治疗诊所的14名Addicton咨询师将被随机分配到MIO与PE交付方面的培训，并与真实患者一起完成培训案例，在此期间将测量忠诚度。在2-5年内，160名正在接受成瘾治疗和照顾12-24个月大孩子的母亲将被随机分配到12次MIO VS PE课程中，并由训练有素的成瘾顾问进行培训，并将在治疗期间监测和保持保真度。我们预测：1.在训练有素的成瘾咨询师的指导下，MIO和PE可以被区分；2.分配MIO的母亲在反思功能和戒毒方面表现出更大的改善，她们的孩子在治疗后和随访中将表现出更大的依恋安全感；3.MIO将为成瘾严重程度较高的母亲提供比PE更大的优势；4.更高的治疗保真度将中介更好的治疗结果，RF的改善将中介戒除和儿童依恋安全感的改善。

 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.