Fostering Mothers' Emotionally-Responsive Parenting

描述(由申请者提供)：五年前，我们获得了开发母亲和幼儿计划或MTP的资金(R01 DA17294/项目周期：8/20/04-12/31/09)。MTP是第一个基于依恋理论原理为物质滥用母亲开发的育儿干预措施。这也是对滥用药物的母亲进行的唯一育儿干预，在观察到的基于实验室的互动中，它提高了母亲照顾婴儿和幼儿痛苦的敏感度和反应能力。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、进行PEP-对照干预的说明、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，在所有目标育儿结果(反思功能的能力、母亲陈述的质量和照料行为)和全球精神痛苦方面，MTP比PEP导致更大的改善。在达到了第一阶段调查的目标，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第二阶段随机试验中对MTP进行正式的最终疗效测试。在第二阶段调查中，我们将：(1)推出新的向量适应和儿童依恋措施，(2)增加18周的随访期以测试持续的治疗效果，(3)当主要结构(反射功能、表征、向量适应和儿童依恋)预计将发生变化时测量它们，(4)检查MTP治疗模型中提出的时间变化机制，(5)确定改善向量适应是否降低复发发生率，(6)通过培训四名新的治疗师来扩大MTP治疗师队伍，以及(7)通过每项措施培训3名额外的编码员来扩大编码库。150名照顾12至24个月大孩子的母亲将从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中，并将被随机分为12周的MTP与PEP，并跟踪观察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. .