Fostering Mothers' Emotionally-Responsive Parenting

描述（由申请人提供）：五年前，我们获得资助开发母婴计划或 MTP（R01 DA17294 / 项目期间：2004 年 8 月 20 日 - 2009 年 12 月 31 日）。 MTP 是第一个针对药物滥用母亲开发的基于依恋理论原理的育儿干预措施。这也是针对药物滥用母亲的唯一育儿干预措施，在观察到的基于实验室的互动中，提高了母亲护理的敏感性和对婴儿和幼儿痛苦的反应能力。我们现在拥有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、进行 PEP 的说明 - 比较干预、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 - 与家长教育计划 (PEP)（一项个人支持性比较干预措施）相比，MTP 功效的初步测试。来自 47 名随机受试者的意向治疗样本的结果数据表明，MTP 在所有目标养育结果（反思功能、母亲代表质量和护理行为）和整体精神困扰方面比 PEP 带来了更大的改善。在实现了第一阶段研究的目标并获得了 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对 MTP 进行正式的明确疗效测试。在第二阶段调查中，我们将：(1) 引入新的二元调整和儿童依恋措施，(2) 增加 18 周的随访期，以测试持续的治疗效果，(3) 在主要结构（反思功能、表征、二元调整和儿童依恋）预期发生变化时对其进行测量，(4) 检查 MTP 治疗模型中提出的变化的时间机制 (5) 确定二元调整的改进是否会降低复发率，(6)通过培训四名新治疗师来扩大 MTP 治疗师库，并且 (7) 通过每项措施额外培训 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，并将随机分配到 12 周的 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. .