Parents' Adherence to Treatment Recommendations: Do It for the Children

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DESCRIPTION (provided by applicant): This proposal is in response to Challenge Area (06): Enabling Technologies and Specific Challenge Topic, 06-OD(OBSSR)-101* Using new technologies to improve or measure adherence. The primary aim of this research is to develop and test a method for increasing adherence to treatment recommendations for mothers of children with emotional or behavior problems. Parental psychopathology is a serious risk factor for psychiatric problems in children, yet most parents of children receiving mental health services do not get treatment for their own problems. Such parental psychopathology, particularly maternal depression, places a burden on society through lost wages, increased marital strain, and serious maladjustment in their offspring. The specific aim of the proposed research is to increase depressed mothers' adherence to recommendations for treatment. Participants will be 200 mothers of children (7-17 years old) receiving psychiatric treatment in a community mental health center. Mothers will be randomly assigned to either the Enhanced Motivation Intervention (EMI) or an information only control group. The EMI is a modified version of the program developed by Swartz, Zuckoff, and colleagues who combined motivational and ethnographic interviewing into a brief intervention that (a) elicits the mother's "story" and her understanding of her central problems; (b) provides psychoeducation about their disorder; (c) describes the effects of depression on children and the potential link between improvements in mothers' and children's symptoms; (d) obtains their prior treatment history, hopes, and concerns about the recommended treatment; (e) identifies potential practical (e.g., child care) and psychological (e.g., stigma) barriers to treatment seeking; and (f) elicits a commitment to take the next step (i.e., make an appointment). Evaluations at baseline and 8-weeks and 6-months post intervention, will assess mothers' psychiatric disorders, symptoms, functioning, and service utilization. Children's symptoms, disorders, and functioning also will be measured. We hypothesize that adherence to treatment recommendations will be significantly greater for mothers in the EM intervention group compared to mothers in the information only control group. The impact of the EM intervention on changes in mothers' and children's psychopathology also will be examined. The public health implications of this research are that more individuals in need of mental health services will receive and adhere to them, possibly resulting in a positive effect on their children's adjustment. Consistent with the goals of the Recovery Act, the project would immediately create three new full-time jobs. If the intervention is successful, then a longer-term benefit could be an increase in the demand for the services of mental health care providers, thereby expanding the work force.