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）：使能技术和特定挑战主题，06-OD（OBSSR）-101* 使用新技术改进或衡量依从性的回应。这项研究的主要目的是开发和测试一种方法，以增加对有情绪或行为问题儿童的母亲的治疗建议的依从性。父母的精神病理学是儿童精神问题的一个严重风险因素，但大多数接受精神卫生服务的儿童的父母并没有因为自己的问题得到治疗。这种父母的精神病理学，特别是母亲的抑郁症，通过失去工资，增加婚姻紧张和子女严重的不适应给社会带来负担。这项研究的具体目的是增加抑郁母亲对治疗建议的坚持。参与者将是200名在社区精神卫生中心接受精神病治疗的儿童（7-17岁）的母亲。母亲们将被随机分配到增强动机干预组（EMI）或仅提供信息的对照组。EMI是Swartz、Zuckoff及其同事开发的项目的修改版本，他们将动机和人种学访谈结合到一个简短的干预中，（a）激发母亲的“故事”和她对自己核心问题的理解;（B）提供有关他们障碍的心理教育;（c）描述抑郁症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关注;（e）识别潜在的实际（例如，儿童护理）和心理（例如，污名）寻求治疗的障碍;以及（f）鼓励采取下一步行动的承诺（即，预约）。在基线和干预后8周和6个月的评估，将评估母亲的精神疾病，症状，功能和服务利用。儿童的症状，障碍和功能也将被测量。我们假设，与仅提供信息的对照组相比，EM干预组的母亲对治疗建议的依从性显著更高。EM干预对母亲和儿童精神病理学变化的影响也将被研究。这项研究的公共卫生意义是，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。根据《复苏法》的目标，该项目将立即创造三个新的全职工作。如果干预是成功的，那么一个长期的好处可能是增加对精神卫生保健提供者的服务的需求，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.