Optimizing residential treatment gains for adolescents through tailored behavioral parent training

项目摘要 尽管青少年(11至17岁)获得了治疗收益(例如，减少了内化或外化 在精神病住院治疗(RT)中，他们经历了极大的困难来适应 而且往往得不到长期的治疗收益。RT后，70%的青少年出院到他们的 原籍家族。然而，父母没有得到必要的支持或行为管理 弥补RT和HOME之间差距的技能集。一项新的联邦命令将很快要求家长培训，以及 循证行为管理干预，在RT环境下进行。有青少年的父母进入RT 这是一个难以接触到的人群，技术可能会增加家长培训的机会和接受程度。 为人父母的智慧(PW)是一种基于网络的父母培训，在提高效率方面证明了有效性 减少青少年行为问题的育儿实践。我们之前发现PW是高度可行的 对于父母来说，这些技能被认为是有用的。然而，家长们报告了两个未得到满足的需求：(1)技能 个性化以应用PW技能；(2)增强社区以减少孤立。与 作为顾问委员会(拟议研究中的合作伙伴)，我们与临床医生进行了讨论，扩大了PW 分组(简称PWRT)。PWRT中的讨论组支持程序完成和家长 参与度，提供讨论个性化PW策略、减少隔离和支持父母的场所 通过在RT语境中参与关于育儿的对话。建议的研究旨在：(1)确立 PWRT的可行性和可接受性，(2)评估PWRT是否涉及靶机制(父母自我 效能感、父母教养行为、社会支持、家庭功能)，以及(3)决定预激治疗对 青少年结果(内化和外化行为、安置限制)。60名家长(30 将根据情况随机分配到PWRT或照常治疗(TAU)。每周六周， 家长将完成两个PW单元(每人20分钟)，并通过Zoom参加一个讨论小组(90- 分钟)。PWRT将在RT入院结束时启动，并在出院后继续进行，以弥补 从RT过渡到社区。青少年(n=60)将不接受干预；然而，我们将 评估为未来研究收集青少年数据的可行性。来自父母和青少年的数据将 在基线、基线后6周和6个月收集，以便对 PWRT对维持治疗收益的长期影响。与PAR-21-211一致，我们的团队 研究人员和社区合作伙伴正在收集必要的数据，以进行更大规模的有效性试验 测试PWRT与TAU的可行性、可接受性和初步效果。PWRT是第一批网络- 以支持元素为基础的父母培训，旨在让有青少年的父母参与 RT.通过为家长提供切合实际的教育和支持，家长将拥有 行为管理技能为家庭提供结构，并最终维持RT治疗的收益。

Project Summary Although adolescents (ages 11 to 17) make treatment gains (e.g., reduced internalizing or externalizing behaviors) in psychiatric residential treatment (RT), they experience significant difficulty adapting to the community and often do not sustain treatment gains long term. After RT, 70% of adolescents discharge to their family of origin. However, parents are not provided with the necessary support or behavior management skillset to bridge the gap between RT and home. A new federal mandate will soon require parent training, an evidence-based behavior management intervention, in the RT setting. Parents with adolescents admitted to RT are a difficult-to-reach population, and technology may increase access and uptake of parent training. Parenting Wisely (PW) is a web-based parent training with demonstrated efficacy in increasing effective parenting practices to reduce adolescent behavior problems. We previously found that PW was highly feasible for parents and the skills were perceived as useful. However, parents reported two unmet needs: (1) skill individualization to apply the PW skills and (2) enhanced community to reduce isolation. In collaboration with an advisory board (a partner in the proposed study), we augmented PW with clinician facilitated discussion groups (referred to as PWRT). The discussion groups in PWRT supports program completion and parent engagement, provides a venue to discuss individualizing PW strategies, reduces isolation, and support parents by engaging in conversation about parenting in the RT context. The proposed study aims to: (1) establish feasibility and acceptability of PWRT, (2) evaluate whether PWRT engages target mechanisms (parental self- efficacy, parenting behaviors, social support, family function), and (3) determine the effects of PWRT on adolescent outcomes (internalizing and externalizing behaviors, placement restrictiveness). Sixty parents (30 per condition) will be randomly assigned to PWRT or treatment-as-usual (TAU). Each week for six weeks, parents will complete two PW modules (20 minutes each) and attend one discussion group via Zoom (90- minutes). PWRT will be initiated towards the end of the RT admission and continue post-discharge to bridge the transition from RT to the community. Adolescents (n=60) will not receive intervention; however, we will evaluate the feasibility of adolescent data collection for future studies. Data from parents and adolescents will be collected at baseline, 6-weeks, and 6-months post-baseline to allow for a robust understanding of the longer-term effects of PWRT on treatment gain maintenance. Consistent with PAR-21-211, our team of researchers and community partners is collecting the requisite data for a larger-scale effectiveness trial by testing the feasibility, acceptability, and preliminary effects of PWRT vs. TAU. PWRT is among the first web- based parent training augmented with supportive elements designed to engage parents with adolescents in RT. By providing parents with tailored education and support in PWRT, parents will be equipped with the behavior management skillset to provide structure in the home and ultimately maintain RT treatment gains.