Comparing Two Parenting Programs for At-Risk Families

描述（由申请人提供）：在生命早期良好的养育可以大大缓冲社会经济逆境对儿童发展的负面影响。然而，我们不知道最具成本效益的方法来提高高度紧张，贫困家庭的幼儿，其中一个不成比例的非裔美国人（AA）的养育质量。通常用于帮助低收入家庭的循证育儿计划最初是在白色中产阶级父母身上开发和测试的，这一事实加剧了这种知识差距。这项比较有效性的研究将测试两个以证据为基础的父母培训（PT）计划的等效性，这些计划旨在提高养育质量并减少幼儿的行为问题：亲子互动治疗（PCIT），一个完善的，个性化定制的PT计划被认为是“黄金标准”和芝加哥家长计划（CPP），一个新的小组为基础的PT计划开发与AA和拉丁裔父母的咨询委员会，并显示，以改善养育和减少行为问题，少数民族家庭生活在城市贫困。我们将比较（1）PCIT和CPP在改善父母行为和自我效能以及减少儿童行为问题方面的有效性，这些儿童行为问题主要来自于寻求治疗幼儿行为问题的AA父母样本。（2）基于父母满意度、出勤率和治疗参与度的PCIT和CPP的感知社会效度;（3）PCIT与CPP的成本和后果与治疗效果大小、临床成本和感知社会有效性有关。假设CPP产生类似的治疗效果，但成本更低，满意度更高。我们还将研究PT计划效果的差异，以确定PCIT或CPP是否对某些家庭更有效，这取决于儿童行为问题的类型和严重程度以及社会风险的程度。采用随机实验设计，将210名因行为问题被转诊至东巴尔的摩精神健康诊所的父母/法律的监护人及其2-5岁儿童（>80% AA; 97%低收入）随机分配至PCIT（N=105）或CPP（N=105）组。将在基线和两个干预后阶段获得儿童行为问题和父母纪律、自我效能、行为、压力和抑郁的数据。社会风险将在入学时进行评估;父母满意度，出勤率和参与度将在干预后进行评估。将每月测量与PT和非PT治疗相关的临床成本。假设检验将采用重复测量MANOVA。这项创新研究是与目标临床机构的心理健康临床医生合作设计的，旨在为实施提供信息，增强与当前实践的兼容性，并促进外部有效性。这将是第一个比较有效性，成本和社会有效性的简短治疗设计与少数民族父母的幼儿与一个既定的治疗被认为是“黄金标准。“长期目标是为我们投资医疗保健资金的方式提供信息，以改善生活在城市贫困中的年轻少数民族儿童的健康状况。

DESCRIPTION (provided by applicant): Good parenting early in life can substantially buffer the negative effects of socioeconomic adversity on children's development. However, we do not know the most cost-effective ways to improve parenting quality among highly stressed, impoverished families of young children, a disproportionate number of whom are African-American (AA). This knowledge gap is compounded by the fact that the evidence-based parenting programs typically used to help low-income families were originally developed and tested on White, middle- class parents. This comparative effectiveness research will test the equivalence of two evidence-based parent training (PT) programs designed to improve parenting quality and reduce behavior problems in young children: Parent-Child Interaction Therapy (PCIT), a well-established, individually tailored PT program considered the "gold standard" and the Chicago Parent Program (CPP), a novel group-based PT program developed with an advisory board of AA and Latino parents and shown to improve parenting and reduce behavior problems in ethnic minority families living in urban poverty. We will compare the (1) effectiveness of PCIT and CPP for improving parenting behavior and self-efficacy and reducing child behavior problems in a predominantly AA sample of parents seeking treatment for their young children's (2-5 years) behavior problems; (2) perceived social validity of PCIT and CPP based on parent satisfaction, attendance, and treatment engagement; and (3) cost and consequences of PCIT versus CPP related to treatment effect size, clinical costs, and perceived social validity. CPP is hypothesized to yield comparable treatment effects but at less cost and with greater satisfaction. We will also examine differences in PT program effects to determine whether PCIT or CPP is more effective for some families based on the type and severity of child behavior problems and degree of social risk. Using a randomized experimental design, 210 parents/legal guardians and their 2-5 year old children (>80% AA; 97% low-income) referred for behavior problems to a mental health clinic in East Baltimore will be randomized to PCIT (N=105) or CPP (N=105). Data on child behavior problems; and parent discipline, self-efficacy, behavior, stress, and depression will be obtained at baseline and two post-intervention phases. Social risk will be assessed at intake; parent satisfaction, attendance, and engagement will be assessed post- intervention. Clinical costs related to PT and non-PT treatment will be measured monthly. Hypothesis-testing will employ repeated measures MANOVA. This innovative study was designed in collaboration with mental health clinicians employed in the targeted clinical agency to inform implementation, enhance compatibility with current practice, and promote external validity. It will be the first to compare the effectiveness, cost, and social validity of a brief treatment designed with and for ethnic minority parents of young children against a well- established treatment considered to be the "gold standard." The long-term goal is to inform the way we invest health care dollars for improving health outcomes for young, ethnic minority children living in urban poverty.