Fostering Mothers' Emotionally-Responsive Parenting

描述（由申请人提供）：五年前，我们获得资助发展母亲和幼儿计划或MTP （R01 DA17294 /项目期间：8/20/04 - 12/31/09）。MTP是基于依恋理论的原则为滥用药物的母亲开发的第一个育儿干预。在观察到的基于实验室的互动中，这也是对滥用药物的母亲唯一的养育干预，导致母亲对婴儿和幼儿痛苦的照顾敏感性和反应性的改善。我们现在有了进行二期随机临床试验所需的所有研究材料。资料包括：MTP治疗手册、PEP -比较干预实施指南、治疗保真度量表和手册、MTP治疗师培训计划、结果评估和措施。我们还完成了一项随机临床试验，初步测试了MTP与家长教育计划（PEP）的效果，PEP是一种个人支持的比较干预。来自47名随机受试者意向治疗样本的结果数据显示，MTP在所有目标育儿结果（反思功能能力、母亲陈述质量和照顾行为）和整体精神困扰方面都比PEP有更大的改善。在达到I期研究的目标并有证据表明MTP的可行性和前景后，我们现在寻求在一项全面的II期随机试验中对MTP进行正式的确定疗效试验。在第二阶段调查中，我们会：(1)引入新的二元调整和儿童依恋的测量方法；(2)增加一个18周的随访期来测试持续治疗的效果；(3)测量主要构式（反思功能、表征、二元调整和儿童依恋）在预期改变时的变化；(4)检验MTP治疗模型中提出的变化的时间机制；(5)确定二元调整的改善是否会降低复发的发生率；(6)通过培训4名新的治疗师来扩大MTP治疗师池；(7)通过每个测量额外培训3名编码员来扩大编码池。150名照顾12至24个月大儿童的母亲将从APT基金会的门诊药物滥用治疗服务中招募到意向治疗样本，并将随机分为12周的MTP和PEP，并随访33周。

DESCRIPTION (provided by applicant): Five years ago we were funded to develop the Mothers and Toddlers Program or MTP (R01 DA17294 / Project Period: 8/20/04 - 12/31/09). MTP is the first parenting intervention developed for substance abusing mothers that is based on the principles of attachment theory. It is also the only parenting intervention for substance abusing mothers that has led to improvement in maternal caregiving sensitivity and responsiveness to infant and toddler distress in observed lab-based interactions. We now have all the research materials we need to conduct a Stage II randomized clinical trial. Materials include: the MTP treatment manual, instructions for conducting PEP - the comparison intervention, treatment fidelity scales and manual, MTP therapist training program, outcome assessments and measures. We have also completed a randomized clinical trial - a preliminary test of the efficacy of MTP in comparison with the Parent Education Program (PEP), an individual supportive comparison intervention. Outcome data from the intention-to-treat sample of 47 randomized subjects shows that MTP led to greater improvement than PEP in all targeted parenting outcomes (capacity for reflective functioning, quality of maternal representations and caregiving behavior) and global psychiatric distress. Having met the objectives of the Stage I investigation and having evidence of MTP's feasibility and promise, we now seek to conduct a formal definitive efficacy test of MTP in a full-scale Stage II randomized trial. In the Stage II investigation, we will: (1) Introduce new measures of dyadic adjustment and child attachment, (2) Add an 18 week follow up period to test for sustained treatment effects, (3) Measure major constructs (reflective functioning, representations, dyadic adjustment, and child attachment) when they are expected to change, (4) Examine temporal mechanisms of change proposed in the MTP treatment model (5) Determine whether improvements in dyadic adjustment reduces incidence of relapse, (6) Broaden the MTP therapist pool by training four new therapists and (7) Broaden the coding pool by training 3 additional coders per measure. One hundred and fifty mothers caring for children ages 12 to 24 months of age will be recruited from outpatient substance abuse treatment services at the APT Foundation into the intention-to-treat sample and will be randomized to 12 weeks of MTP vs. PEP and followed for 33 weeks. .