Comparing Two Parenting Programs for At-Risk Families

描述（由申请人提供）：早年良好的父母教育可以极大地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压力、贫困的幼儿家庭的养育质量，其中不成比例的是非裔美国人（AA）。通常用于帮助低收入家庭的循证育儿计划最初是在中产阶级白人父母身上开发和测试的，这一事实加剧了这种知识差距。这项比较有效性研究将测试两种基于证据的父母培训（PT）计划的等效性，这些计划旨在提高育儿质量，减少幼儿的行为问题：亲子互动治疗（PCIT）是一个完善的、个性化的PT项目，被认为是“黄金标准”；芝加哥家长项目（CPP）是一个由AA和拉丁裔父母组成的顾问委员会开发的基于群体的PT项目，被证明可以改善生活在城市贫困中的少数民族家庭的养育方式，减少行为问题。我们将比较(1)在主要为幼儿（2-5岁）行为问题寻求治疗的父母中，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；(2)基于家长满意度、出勤率和治疗参与的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效度相关。假设CPP产生类似的治疗效果，但成本更低，满意度更高。我们还将根据儿童行为问题的类型和严重程度以及社会风险程度，检查PT项目效果的差异，以确定PCIT或CPP对某些家庭是否更有效。采用随机实验设计，210名父母/法定监护人及其2-5岁儿童（80% AA， 97%低收入）因行为问题被转诊至东巴尔的摩一家心理健康诊所，将被随机分为PCIT组（N=105）或CPP组（N=105）。关于儿童行为问题的数据；父母管教、自我效能、行为、压力和抑郁将在基线和干预后的两个阶段得到。社会风险将在摄入时进行评估；干预后将评估家长的满意度、出勤率和参与度。与PT和非PT治疗相关的临床费用将按月计算。假设检验将采用重复测量方差分析。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，并提高外部效度。这将是第一个比较为少数民族儿童父母设计的简短治疗的有效性、成本和社会有效性，以及被认为是“黄金标准”的成熟治疗。长期目标是告知我们如何投资保健资金，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.