Comparing Two Parenting Programs for At-Risk Families

比较针对高危家庭的两种育儿计划

• 批准号: 8183550
• 负责人: HAROLYN MILLICENT EDITH BELCHER
• 金额: $ 67.16万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8183550
• 关键词: 5 year old; Affect; African American; Baltimore; Behavior; Buffers; Chicago; Child; Child Behavior; Child Development; Clinic; Clinical; Collaborations; Communities; Cost Effectiveness Analysis; Data; Discipline; Economically Deprived Population; Effectiveness; Effectiveness of Interventions; Experimental Designs; Family; Goals; Gold; Health; Healthcare; Individual; Intake; Intervention; Investments; Knowledge; Latino; Legal Guardians; Length; Life; Low income; Measures; Mental Depression; Mental Health; Minority Groups; Modeling; Outcome; Parent-Child Relations; Parenting behavior; Parents; Participant; Perception; Phase; Policy Making; Population; Poverty; Preschool Child; Problem behavior; Public Health; Randomized; Reporting; Research; Risk; Sampling; Scientist; Self Efficacy; Series; Severities; Societies; Stress; Subgroup; Testing; Time; Training; Training Programs; United States National Institutes of Health; base; brief intervention; comparative effectiveness; compare effectiveness; cost; cost effective; depressive symptoms; design; effectiveness research; ethnic minority population; evidence base; follow-up; improved; innovation; meetings; novel; post intervention; programs; racial and ethnic; satisfaction; social; socioeconomics; stressor; therapy design; treatment effect

DESCRIPTION (provided by applicant): Good parenting early in life can substantially buffer the negative effects of socioeconomic adversity on children's development. However, we do not know the most cost-effective ways to improve parenting quality among highly stressed, impoverished families of young children, a disproportionate number of whom are African-American (AA). This knowledge gap is compounded by the fact that the evidence-based parenting programs typically used to help low-income families were originally developed and tested on White, middle- class parents. This comparative effectiveness research will test the equivalence of two evidence-based parent training (PT) programs designed to improve parenting quality and reduce behavior problems in young children: Parent-Child Interaction Therapy (PCIT), a well-established, individually tailored PT program considered the "gold standard" and the Chicago Parent Program (CPP), a novel group-based PT program developed with an advisory board of AA and Latino parents and shown to improve parenting and reduce behavior problems in ethnic minority families living in urban poverty. We will compare the (1) effectiveness of PCIT and CPP for improving parenting behavior and self-efficacy and reducing child behavior problems in a predominantly AA sample of parents seeking treatment for their young children's (2-5 years) behavior problems; (2) perceived social validity of PCIT and CPP based on parent satisfaction, attendance, and treatment engagement; and (3) cost and consequences of PCIT versus CPP related to treatment effect size, clinical costs, and perceived social validity. CPP is hypothesized to yield comparable treatment effects but at less cost and with greater satisfaction. We will also examine differences in PT program effects to determine whether PCIT or CPP is more effective for some families based on the type and severity of child behavior problems and degree of social risk. Using a randomized experimental design, 210 parents/legal guardians and their 2-5 year old children (>80% AA; 97% low-income) referred for behavior problems to a mental health clinic in East Baltimore will be randomized to PCIT (N=105) or CPP (N=105). Data on child behavior problems; and parent discipline, self-efficacy, behavior, stress, and depression will be obtained at baseline and two post-intervention phases. Social risk will be assessed at intake; parent satisfaction, attendance, and engagement will be assessed post- intervention. Clinical costs related to PT and non-PT treatment will be measured monthly. Hypothesis-testing will employ repeated measures MANOVA. This innovative study was designed in collaboration with mental health clinicians employed in the targeted clinical agency to inform implementation, enhance compatibility with current practice, and promote external validity. It will be the first to compare the effectiveness, cost, and social validity of a brief treatment designed with and for ethnic minority parents of young children against a well- established treatment considered to be the "gold standard." The long-term goal is to inform the way we invest health care dollars for improving health outcomes for young, ethnic minority children living in urban poverty. PUBLIC HEALTH RELEVANCE: This study will compare two evidence-based parenting programs that were originally designed for different racial/ethnic populations and which employ different delivery models (individual versus group). These differences are important because they can affect treatment length, intensity, cost, and acceptability. Should families attain equivalent benefits from both parenting programs but one can achieve this benefit in less time, at less cost, and with greater satisfaction, we can better meet the parenting needs of families with young children living in poverty.

描述(由申请人提供)：早期良好的父母教育可以大大缓解社会经济逆境对儿童发展的负面影响。然而，我们不知道在压力很大的贫困家庭中提高育儿质量的最具成本效益的方法，这些家庭中有不成比例的非裔美国人(AA)。通常用于帮助低收入家庭的循证育儿计划最初是在白人中产阶级父母身上开发和测试的，这一事实加剧了这种知识差距。这项有效性比较研究将测试两个旨在提高育儿质量和减少幼儿行为问题的循证家长培训(PT)计划的等价性：亲子互动治疗(PCIT)和芝加哥家长计划(CPP)，前者是一个久负盛名的、个性化的家长培训计划，被认为是“黄金标准”；另一个是芝加哥家长计划(CPP)，这是一个由AA和拉丁裔父母组成的顾问委员会开发的新型小组家长培训计划，旨在改善父母养育方式，减少生活在城市贫困中的少数族裔家庭的行为问题。我们将比较(1)PCIT和CPP在改善父母行为和自我效能感以及减少儿童行为问题方面的有效性；(2)基于父母满意度、出勤率和治疗参与度的PCIT和CPP的感知社会有效性；(3)PCIT和CPP的成本和后果与治疗效果大小、临床成本和感知的社会有效性相关。假设CPP产生类似的治疗效果，但成本更低，满意度更高。我们还将根据儿童行为问题的类型和严重程度以及社会风险的程度，检查PT计划效果的差异，以确定PCIT或CPP对某些家庭更有效。采用随机实验设计，将210名父母/法定监护人及其2-5岁的孩子(80%AA；97%低收入)转诊到巴尔的摩东部的一家心理健康诊所，随机分为PCIT组(N=105)或CPP组(N=105)。有关儿童行为问题以及父母管教、自我效能、行为、压力和抑郁的数据将在基线和干预后的两个阶段获得。社会风险将在接受时进行评估；父母满意度、出勤率和参与度将在干预后进行评估。与PT和非PT治疗相关的临床费用将按月计算。假设检验将采用重复测量，马诺瓦。这项创新的研究是与受雇于目标临床机构的精神健康临床医生合作设计的，目的是为实施提供信息，增强与当前实践的兼容性，并提高外部有效性。这将是第一次将与少数民族父母一起设计并为年幼儿童设计的短暂治疗与被认为是“黄金标准”的公认治疗方法的有效性、成本和社会有效性进行比较。长期目标是告知我们投资医疗保健资金的方式，以改善生活在城市贫困中的少数民族儿童的健康状况。 公共卫生相关性：这项研究将比较两个基于证据的育儿项目，这两个项目最初是为不同的种族/民族人口设计的，并且采用了不同的交付模式(个人和群体)。这些差异很重要，因为它们会影响治疗的长度、强度、成本和可接受性。如果家庭从两个育儿项目中获得同等的好处，但一个人可以用更少的时间、更少的成本和更大的满意度实现这一好处，我们就可以更好地满足有年幼子女的贫困家庭的育儿需求。