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

描述(由申请人提供)：本提案是对挑战领域(06)：支持技术和特定挑战主题的回应，06-OD(OBSSR)-101*使用新技术来提高或衡量遵从性。这项研究的主要目的是开发和测试一种方法，以提高有情绪或行为问题儿童的母亲对治疗建议的依从性。父母的精神病态是儿童精神问题的一个严重危险因素，然而，接受精神健康服务的儿童的大多数父母没有得到针对他们自己的问题的治疗。这种父母的精神病态，特别是母亲的抑郁，通过失去工资，增加婚姻压力，以及子女严重的适应不良，给社会带来了负担。这项拟议的研究的具体目的是提高抑郁症母亲对治疗建议的依从性。参与者将是200名在社区精神卫生中心接受精神治疗的儿童(7-17岁)的母亲。母亲们将被随机分配到增强动机干预(EMI)组或仅限信息控制组。EMI是由Swartz、Zuckoff和他的同事开发的项目的修改版本，他们将励志访谈和人种学访谈结合成一个简短的干预，(A)引发母亲的“故事”和她对核心问题的理解；(B)提供关于他们的障碍的心理教育；(C)描述抑郁对儿童的影响以及母亲和儿童症状改善之间的潜在联系；(D)获得他们先前的治疗史、希望和对推荐治疗的担忧；(E)确定寻求治疗的潜在实际障碍(如儿童保育)和心理障碍(如耻辱)；和(F)促使承诺采取下一步措施(即预约)。基线和干预后8周和6个月的评估将评估母亲的精神障碍、症状、功能和服务利用情况。儿童的症状、障碍和功能也将被测量。我们假设EM干预组的母亲比单纯信息控制组的母亲对治疗建议的遵守程度要高得多。还将研究EM干预对母亲和儿童精神病理变化的影响。这项研究的公共卫生影响是，更多需要心理健康服务的人将接受并坚持这些服务，可能会对他们的孩子的适应产生积极的影响。与《复苏法案》的目标一致，该项目将立即创造三个新的全职工作岗位。如果干预成功，那么更长期的好处可能是对精神卫生保健提供者服务的需求增加，从而扩大劳动力。

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.