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常见的心理健康问题之一，它们对以后的社会情感、行为和学业问题具有重大风险，如滥用药物、犯罪和学业失败。父母如何处理这些具有挑战性的行为强烈地影响着他们孩子的长期发展轨迹。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，从而降低了后来滥用药物和其他行为健康问题的风险。然而，育儿计划的影响范围受到招募、吸引和留住父母方面的重大挑战的限制，以至于大多数可以从育儿援助中受益的父母永远得不到帮助。一种改善育儿实践的公共卫生方法，使循证育儿计划以一系列形式广泛提供和获取，可以减少破坏性行为问题的流行，从而减少人口层面的药物滥用和其他不良后果的风险。作为全人口战略的一部分，以互联网为基础的干预提供了巨大的潜力，可以将循证育儿做法带给在抚养子女方面遇到困难的广泛父母。此外，儿科医生可能是获得循证育儿支持的家庭的天然触点。然而，该领域对互联网加强育儿实践的潜力知之甚少，也不知道儿科从业者可能会如何参与改善在线育儿项目的覆盖范围。这项研究将对Triple P积极育儿计划的互联网版本-Triple P Online System(TPOS)进行实验性评估，该系统以互动、视频丰富和个性化的格式呈现Triple P内容，并将其与通常的社区服务进行比较。将招募30家儿科诊所，涉及华盛顿州西部8个县的100名医生，并随机接受(A)患者进入Triple P在线系统的机会，以及如何有效促进TPO并就其子女的行为问题向父母提供建议的培训，或(B)常规护理社区-等待名单控制，在这一控制中，父母将得到适当的转诊，获得社区服务。从业者将在各自的条件下招募500个3-8岁的家庭 有行为问题的儿童。在基线、干预后和一年的随访中，将获得父母养育实践、家庭功能、儿童破坏性行为问题的衡量标准，以及针对行为问题提供建议的从业者协议。将检查Triple P在线系统在改善这些结果方面的有效性，以及剂量-反应关系。这项研究将进一步加深我们对通过儿科从业者推广基于互联网的育儿计划的潜在价值的理解。最大限度地扩大循证育儿计划的影响范围，有可能降低儿童行为问题的患病率，从而降低药物滥用等以后出现问题的风险。

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.