Integrating Computer-Assisted Parent Training Therapy into Community Mental Health Clinic Practice

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Project Summary/Abstract Disruptive behavior disorders (DBDs) including oppositional defiant disorder (ODD) and conduct disorder (CD) are among the most common mental health referrals for children and adolescents. Despite the overwhelming evidence that parents are an essential component in effective treatments for youth behavior problems, there is still a gap in the use of these techniques in community mental health clinics (CMHCs). The use of technology may facilitate the delivery of parent training and broaden the availability of these approaches to improve the integrity of community treatment and meet the needs of families in a more timely and efficient manner. Computerized interventions can be delivered at a lower cost, with less demand on staff time for training, increased protocol fidelity, portability, and ease of use. This would greatly increase the scalability and dissemination potential of such approaches. Despite the apparent logic in using these programs to augment services, there may be barriers to the use of computerized programs by clinicians and parents. Understanding and addressing barriers to the implementation of such approaches has the potential to improve the use of these approaches to meet the needs of underserved youth in CMHCs. This project involves adapting a computerized parenting intervention (Parenting Wisely; PW) that has established efficacy in improving parenting skills and reducing youth behavior problems to a community outpatient treatment facility. The project aims to 1) obtain implementation level data on the acceptability and feasibility of the protocol for parents and providers; 2) provide data on therapeutic mechanisms including therapist fidelity and competency as well as parenting skills and self-efficacy; 3) identify factors that promote or hinder the use and effectiveness of the computer-assisted parent training protocol for providers and parents.; and 4) examine the efficacy of PW compared to treatment as usual on disruptive behavior disorders. An open trial (N=10) will be conducted and modifications to treatment will be made using an iterative process based on interviews with parents and providers. Second, a 2 group randomized trial with 50 parents, 25 in each condition, will compare PW to treatment as ususal (TAU). Follow-up interviews will be conducted at the end of treatment and 3 and 6 months post-treatment. The use of a low-cost, low-intensity electronic intervention aligns with RFA objectives to: 1) conduct “research on interventions with previously demonstrated efficacy, for use … in broader community settings”; 2) conduct “innovative services research directions that require preliminary testing or development”; 3)“address the mechanism by which the adapted intervention or augmentation will enhance outcomes'; and 4) has the potential to inform practice-relevant questions including “improvement in response rate, speed of response …or uptake in community/practice.”