Promoting Parent Participatory Engagement in Youth Mental Health Services

描述(由申请人提供)：政策制定者、研究人员和临床医生一致认为，积极的父母参与治疗对儿童心理健康服务的有效性至关重要，特别是对有破坏性行为问题(DBP)的儿童。父母往往难以参加和积极参与治疗[标记为“父母参与性参与”(PPE)]，缺乏PPE与较差的儿童结局有关。NIMH儿童和青少年服务研究计划强调对家庭参与和日常护理环境的研究，最近的NIMH战略计划强调了制定注重治疗依从性的干预措施的重要性(战略3.2)。这项以患者为导向的指导职业发展(K23)奖项旨在为申请者提供必要的知识、技能和试点数据，以启动一项独立的研究计划，以增加个人防护能力并提高公共部门儿童心理健康护理的有效性。通过培训活动，申请者将：1)掌握现有的个人防护研究和使用利益相关者反馈制定个人防护干预措施的方法；2)获得针对个人防护的一套补充的、有经验支持的行为改变方法的培训(社会营销/健康沟通、行为合规性和计划行为理论、激励性访谈、患者激励)；3)对在不同文化背景的人群中解决个人防护的挑战有丰富的了解；以及4)获得定性方法和多层次建模方面的技能。申请者还将接受研究道德行为方面的培训。研究计划分为两个阶段，在培训计划和由导师、顾问、临床医生和家长贡献者组成的团队的支持下实施。首先，将开发一种多组件、多媒体资源工具包干预，以促进个人防护措施在儿童DBPS治疗中的应用。拟议的工具包包括三个鼓励PPE的母工具，三个补充促进PPE的母工具的临床医生工具，以及几个支持PPE和使用工具包材料的临床医生培训资源。该工具包将利用申请者培训中的行为改变方法，针对一系列重叠的父母认知障碍/促进者因素(动机、期望、感知障碍、赋权)和护理质量因素(参与治疗计划、持续参与的机会、家长-临床医生联盟)，这些因素是改善个人防护能力的拟议改变机制。其次，该工具包在改变父母认知障碍/促进者和护理质量因素、个人防护行为(出勤率、积极参加会议、在会议之间遵守建议)以及儿童/家庭结果方面的潜在有效性将通过一项试点随机对照试验进行评估，该试验将工具包与对照条件(n=40个家庭，每种情况下10名临床医生)进行比较。还将评估工具包的可行性、可接受性和保真度。数据将被用来设计一个更大的R01量表，以测试该工具包对公共精神卫生环境中个人防护能力和儿童/家庭结果的影响。

DESCRIPTION (provided by applicant): Policy makers, researchers, and clinicians agree that active parent involvement in treatment is critical to the effectiveness of child mental health services, in particular for children with disruptive behavior problems (DBPs). Parents often have difficulty attending and participating actively in treatment [labeled "parent participatory engagement" (PPE)], and a lack of PPE is linked to poorer child outcomes. The NIMH Child & Adolescent Services Research Program emphasizes research on family engagement and usual care settings, and the recent NIMH Strategic Plan highlights the importance of developing interventions that focus on treatment adherence (Strategy 3.2). This Mentored Patient-Oriented Career Development (K23) award is designed to provide the applicant with knowledge, skills, and pilot data necessary to launch an independent program of research to increase PPE and improve the effectiveness of public sector child mental health care. Through the training activities, the applicant will: 1) obtain mastery of existing PPE research and methods to develop PPE interventions using stakeholder feedback; 2) obtain training in a complementary set of transdisciplinary empirically-supported behavior change approaches selected to target PPE (social marketing/health communication, behavioral compliance and theory of planned behavior, Motivational Interviewing, patient activation); 3) gain a rich understanding of challenges in addressing PPE in a culturally diverse population; and 4) acquire skills in qualitative methods and multilevel modeling. The applicant will also receive training in the ethical conduct of research. The research plan is organized into two phases implemented with the support of the training plan and a team of mentors, consultants, and clinician and parent contributors. First, a multi-component, multi-media resource toolkit intervention will be developed to promote PPE in the treatment of children with DBPs. The proposed toolkit includes three parent tools to encourage PPE, three clinician tools that complement the parent tools to promote PPE, and several clinician training resources to support PPE and use of toolkit materials. The toolkit will draw on the behavior change approaches from the applicant's training to target a set of overlapping parent cognitive barrier/facilitator factors (motivation, expectations, perceived barriers, empowerment) and quality of care factors (participation in treatment planning, opportunities for ongoing participation, parent-clinician alliance) that are proposed mechanisms of change for improving PPE. Second, the toolkit's potential effectiveness to change parent cognitive barrier/facilitator and quality of care factors, PPE behaviors (attendance, active participation in sessions, adherence to recommendations between sessions), and child/family outcomes will be assessed by a pilot randomized controlled trial comparing the toolkit to a control condition (n=40 families within 10 clinicians for each condition). Toolkit feasibility, acceptability, and fidelity will also be assessed. Data will be used to design a larger scale R01 to test the toolkit's impact on PPE and child/family outcomes in public mental health settings.