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中最普遍的心理健康状况之一，它们对以后的社会情感、行为和学业问题（如药物滥用、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会强烈影响孩子的长期发展轨迹。以证据为基础的育儿计划在减少早期破坏性行为问题方面显示出很大的价值，从而降低后来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面临重大挑战，育儿项目的影响范围有限，因此，大多数本可以从育儿援助中受益的父母从未得到过帮助。改善育儿实践的公共卫生方法，使以证据为基础的育儿计划以各种形式广泛提供和可获得，可以减少破坏性行为问题的流行，从而降低人口水平的药物滥用和其他不良后果的风险。作为全民战略的一部分，基于互联网的干预提供了巨大的潜力，可以将基于证据的育儿实践带给在抚养子女方面面临挑战的广大父母。此外，儿科医生可以成为一个自然的接触点，为家庭提供基于证据的育儿支持。然而，这个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提高在线育儿计划的覆盖面。本研究将实验性地评估基于互联网的3p积极育儿计划，即3p在线系统（TPOS），该系统以交互式、视频丰富和个性化的形式呈现3p内容，具有3个灵活剂量级别，并将其与通常的社区服务进行比较。将在华盛顿西部8个县招募30家儿科诊所，涉及100名医生，并随机接受(a)他们的病人可以访问三重P在线系统，并接受培训，了解如何有效地促进TPOS，并就孩子的行为问题向父母提供建议；或(b)常规护理社区候补名单控制，其中父母将获得适当的社区服务转诊帮助。从业人员将在各自条件下招募500个3-8岁的家庭

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.