Evaluating an Online Parenting Support System Disseminated by Pediatric Practices

描述（由申请人提供）：破坏性行为问题是幼儿最普遍的心理健康状况之一，它们对以后的社会情感，行为和学术问题，如药物滥用，青少年犯罪和学业失败具有重大风险。父母如何处理这些具有挑战性的行为强烈影响着孩子的长期轨迹。循证育儿计划在减少早发性破坏性行为问题方面显示出很大的价值，从而降低了以后滥用药物和其他行为健康问题的风险。然而，由于在招募、吸引和留住父母方面存在重大挑战，育儿计划的覆盖面有限，因此大多数可以受益于育儿援助的父母从未获得过援助。改善育儿实践的公共卫生方法，使基于证据的育儿计划以一系列形式广泛提供和获得，可以减少破坏性行为问题的流行，从而增加药物滥用和其他不良后果的人口风险。作为全民战略的一部分，基于互联网的干预措施具有巨大潜力，可以将循证育儿做法带给在抚养子女方面遇到挑战的广大父母。此外，儿科医生可以成为一个自然的接触点，为达到家庭与证据为基础的育儿支持。然而，该领域对互联网加强育儿实践的潜力知之甚少，也不知道儿科医生如何参与改善在线育儿计划的覆盖面。这项研究将实验性地评估基于互联网的Triple P积极育儿计划的版本，Triple P在线系统（TPOS），该系统以交互式，视频丰富和个性化的格式呈现Triple P内容，具有3个级别的灵活剂量，并将其与通常的社区服务进行比较。将招募30家儿科诊所，涉及华盛顿西部8个县的100名从业人员，并随机接受（a）患者访问Triple P在线系统，并接受如何有效促进TPOS和就儿童行为问题向父母提供建议的培训，或（B）社区护理-等待名单控制，其中将协助父母进行适当的社区服务转介。从业人员将根据各自的条件招募500个3-8岁的家庭 有严重行为问题的孩子在基线、干预后和1年随访时，将获得父母养育行为、家庭功能、儿童破坏性行为问题和从业者行为问题建议方案的测量结果。将检查Triple P在线系统在改善这些结局方面的疗效以及剂量-反应关系。这项研究将进一步我们的理解，促进基于互联网的育儿计划，通过儿科医生的潜在价值。最大限度地扩大循证育儿计划的覆盖面，有可能减少儿童行为问题的发生，从而减少日后出现药物滥用等问题的风险。

DESCRIPTION (provided by applicant): Disruptive behavior problems are among the most prevalent mental health conditions for young children, and they carry significant risks for later socioemotional, conduct, and academic problems, such as substance abuse, delinquency, and school failure. How parents handle these challenging behaviors strongly influences their children's long-term trajectory. Evidence-based parenting programs have shown much value in reducing early-onset disruptive behavior problems, thereby reducing risks for later substance abuse and other behavioral health problems. The reach of parenting programs is limited, however, by significant challenges in recruiting, engaging, and retaining parents, such that most parents who could benefit from parenting assistance never receive it. A public health approach for improving parenting practices that makes evidence- based parenting programs widely available and accessible in a range of formats could reduce the prevalence of disruptive behavior problems, and thus the population-level risk for substance abuse and other adverse outcomes. Internet-based intervention offers significant potential as part of a population-wide strategy for bringing evidence-based parenting practices to a broad range of parents experiencing challenges in raising their children. Furthermore, pediatricians could be a natural touch point for reaching families with evidence- based parenting supports. The field knows little, however, about the potential of the internet to strengthen parenting practices, or about how pediatric practitioners might be engaged in improving the reach of an online parenting program. This study will experimentally evaluate an internet-based version of the Triple P Positive Parenting Program, the Triple P Online System (TPOS), which presents the Triple P content in an interactive, video-enriched, and personalized format with 3-levels of flexible dosage, and will compare it against usual community services. Thirty pediatric clinics involving 100 practitioners in 8 counties across western Washington will be recruited and randomized to receive (a) access for their patients to the Triple P Online System and training in how to effectively promote TPOS and advise parents on their children's behavior problems or (b) Usual Care Community-Waitlist Control, in which parents will be assisted with an appropriate referral for services in the community. Practitioners will recruit into their respective conditions 500 families of 3-8 year-old children with elevated behavior problems. Measures of parents' parenting practices, family functioning, children's disruptive behavior problems, and practitioners' protocols for advising on behavior problems will be obtained at baseline, post-intervention, and 1-year follow-up. The efficacy of the Triple P Online System in improving these outcomes will be examined, as well as dosage-response relationships. This study will further our understanding of the potential value of promoting internet-based parenting programs through pediatric practitioners. Maximizing the reach of evidence-based parenting programs has the potential to reduce the prevalence of children's behavior problems, and thus reduce risks for later problems such as substance abuse.