Fostering Mothers' Emotionally-Responsive Parenting

描述（由申请人提供）：五年前，我们被资助开发母亲和幼儿计划或MTP（R 01 DA 17294/项目周期：8/20/04 - 12/31/09）。MTP是第一个基于依恋理论原则为滥用药物的母亲开发的育儿干预措施。这也是唯一的父母干预药物滥用的母亲，导致改善产妇的敏感性和反应，婴儿和幼儿的痛苦，在观察到的实验室为基础的互动。我们现在有了进行第二阶段随机临床试验所需的所有研究材料。材料包括：MTP治疗手册、PEP实施指南-比较干预、治疗忠诚度量表和手册、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）的疗效，PEP是一种个人支持性比较干预措施。来自47名随机受试者的意向治疗样本的结果数据显示，MTP在所有有针对性的育儿结果（反思功能的能力，母亲陈述的质量和养育行为）和整体精神病困扰方面的改善比PEP更大。在达到第一阶段研究的目标并获得MTP可行性和前景的证据后，我们现在寻求在全面的第二阶段随机试验中进行MTP的正式确定性疗效测试。在第二阶段调查中，我们将：（1）引入双元适应和儿童依恋的新测量，（2）增加18周的随访期以测试持续的治疗效果，（3）测量主要结构（反思功能，表征，二元调整和儿童依恋）当他们被期望改变时，（4）检查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降低复发的发生率，（6）通过培训四名新的治疗师来扩大MTP治疗师库，（7）通过培训每项措施额外的3名编码员来扩大编码库。将从APT基金会的门诊药物滥用治疗服务中招募150名照顾12至24个月大儿童的母亲作为意向治疗样本，并将其随机分配至12周MTP与PEP组，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. .