Personalizing Parent Training Interventions for Culturally Diverse Families

 描述(由申请人提供)：行为父母培训(BPT)干预已被证明对有外在行为问题的幼儿有效。然而，并不是所有的家庭都受益，特别是少数民族家庭不太可能登记、参与和 在BPT方面有所提高。这项拟议研究的总体目标是开发和试点测试一种个性化工具Persin，该工具可用于在亲子互动治疗(PCIT)中增加对不同文化背景的家庭的适应，PCIT是一种基于证据的幼儿BPT干预措施。个性化可能会对公共卫生产生重大影响，因为这种方法对个别家庭特有的特征做出了反应，因此可以在包括非西班牙裔白人在内的一系列种族群体中使用。我们建议通过个性化父母解释模型(PEM)参数来最大化Persin的影响，这些参数已被发现在不同种族之间存在差异，并已被经验证明影响治疗参与度和/或结果。在研究的第一阶段，我们将建立在我们以前的经验基础上，从文化上适应BPTS，并调查治疗师-客户解释模型匹配，以开发PERSIN。首先，我们将编制一套可靠、简洁和易于使用的评估工具，临床医生可以使用这些工具来确定父母对每个已识别的PEM个性化参数的立场。其次，我们将确定一组最初的干预适应，这些干预适应对每个个性化参数的极端得分做出反应。第三，我们将征求三个少数民族(拉丁裔、亚裔和非裔美国人)的BPT文化适应专家小组的反馈意见，并根据他们的意见修改Persin。第四，我们将对具有PCIT专业知识的临床医生和不同的家庭进行关键的线人访谈，以评估他们对每种调整的可能有效性、吸引力和可行性的看法，我们将根据这些反馈改进Persin。最后，PCIT的创建者Sheila Eyberg博士将提供最终的保真度检查，以确保Persin的适配与干预的基本理论模型一致，Persin将被编程用于平板电脑。在第二阶段，我们将对PERSIN PCIT进行试点测试，样本为(N=28)个具有来自不同种族背景的外部化项目的学龄前儿童家庭，以确定PERSIN是否可以忠实地实施，是否可以显著增加PEM治疗匹配，以及PEM治疗匹配与PCIT的参与度和结果相关。将对Persin PCIT和先前试验中的标准PCIT的治疗要素进行比较，以确定这两种治疗条件是否可以可靠地相互区分。试点试验的结果将被用作更大的R01应用的基础，以比较PCIT Persin与PCIT的标准版本，并在多元文化人群中照常治疗。

 DESCRIPTION (provided by applicant): Behavioral Parent Training (BPT) Interventions have proven efficacy for young children with externalizing behavior problems. However, not all families benefit, and ethnic minority families in particular are less likely to enroll, engage, and improve in BPT. The overarching goal of the proposed study is to develop and pilot test a personalization instrument, PersIn, that can be used to increase fit for culturally diverse familie in Parent Child Interaction Therapy (PCIT), an evidence based BPT intervention for young children. Personalization has the potential for significant public health impact because the approach is responsive to characteristics specific to individual families, and therefore can be used across a range of ethnic groups, including non-Hispanic Whites. We propose to maximize the impact of PersIn by personalizing on Parent Explanatory Model (PEM) parameters that have been found to vary across ethnic groups and which have been empirically demonstrated to impact treatment engagement and/or outcomes. In the first phase of the study, we will build on our previous experience culturally adapting BPTs and investigating therapist-client explanatory model match to develop PersIn. First, we will compile a proposed set of reliable, brief, and easy to use assessment instruments that clinicians could use to determine the parents' standing on each of the identified PEM personalization parameters. Second, we will identify an initial set of intervention adaptations that respond to extreme scores on each of these personalization parameters. Third, we will solicit feedback from a panel of experts in the cultural adaptation of BPT for each of three ethnic minority groups (Latino-, Asian-, and African-American) and modify PersIn according to their input. Fourth, we will conduct key informant interviews with clinicians with expertise with PCIT with diverse families to assess their perception of the likely effectiveness, appeal, and feasibility of each of the adaptations, and we will refine PersIn based on this feedback. Finally, Dr. Sheila Eyberg, creator of PCIT, will provide a final fidelity check o ensure that PersIn adaptations are consistent with the underlying theoretical model of the intervention and PersIn will be programmed for use on a tablet computer. In the second phase, we will conduct a pilot test of PersIn + PCIT with a sample of (N=28) families with a preschooler with externalizing programs from a wide range of ethnic backgrounds to determine if PersIn can be implemented with fidelity, can measurably increase PEM-treatment match, and that PEM-treatment match is related to engagement and outcomes in PCIT. A comparison between treatment elements of PersIn + PCIT and standard PCIT from a previous trial will be conducted to determine whether the two treatment conditions can be reliably differentiated from one another. Results from the pilot trial will be used as the basis of a larger R01 application to compare PCIT + PersIn to the standard version of PCIT and treatment as usual among a multicultural population.