Online vs Staff Delivery: Child & Family Outcomes, Value Analysis, Satisfaction

高流行率的精神健康问题需要创新战略，以扩大循证服务的覆盖范围。幼儿的破坏性行为问题(DBP)或行为问题是一个重大的公共卫生挑战，不仅非常普遍，而且如果不加以治疗，会增加青春期和成年期不良心理健康和发育结果的风险。需要新的、有效的干预战略，这些战略能够以资源有效的方式提供足够的覆盖范围。互联网和在线技术有相当大的潜力来帮助实现这一目标。在已证明对儿童DBP产生影响的育儿干预措施的基础上，该项目将在线提供的干预措施与经过充分验证的工作人员提供的干预措施进行比较，保持计划内容不变。样本包括有3-7岁孩子的家庭，这些家庭的DBPs水平很高。这两种干预措施都鼓励父亲和母亲(以及家中的其他主要照顾者)参与其中。这项创新的研究利用了基于方法优势的非劣势试验设计：分层随机分配、足够的统计能力、对干预的保真度的关注、对结果的多信息者和多来源的评估(包括对亲子互动的直接观察)，以及对参与者遵守情况的记录。该项目的目标是：(1)测试在线干预在对儿童DBP、育儿和父母/家庭压力的影响方面是否与更成熟的工作人员提供的干预一样好；(2)进行严格的价值分析，比较两种干预措施，包括提供者和参与者的费用以及实施前和实施阶段；(3)与其他干预措施相比，评估消费者对在线干预的满意度，以及消费者对在线干预体验的详细评价，并探索物流因素、参与者特征和个人偏好如何与消费者满意度相关；以及，(4)与其他干预相比，记录参与者对在线干预的依从性，并探索每个干预的参与者依从性的相关性。在线提供的干预提供了一个互动网站，旨在通过序列化、个性化、交互式和基于视频的内容来吸引和激活参与者。指导干预的概念化强调自我调节过程、父母指定目标、实用而直接的父母养育策略、建模和行动激活。除了阐明可行的在线育儿干预措施对儿童破坏性行为问题的影响和好处外，该项目的结果还将帮助心理健康领域更全面地了解在线干预措施相对于传统干预措施的潜在优势和劣势，特别是在资源最小化/有效性分析的情况下。

High-prevalence mental health problems require innovative strategies to broaden reach of evidence-based services. Disruptive behavior problems (DBPs), or conduct problems, in young children represent a major public health challenge that is not only highly prevalent but also, left untreated, heighten risk for adverse mental health and developmental outcomes in adolescence and adulthood. New, efficacious intervention strategies that can be delivered with sufficient reach in a resource effective manner are needed. Internet and online technology has considerable potential to help achieve such a goal. Building on parenting interventions that have demonstrated impact on childhood DBPs, this project compares an Online-Delivered Intervention to a well-validated Staff-Delivered Intervention, holding program content constant. The sample includes families with a 3-7 year old child who has a pronounced level of DBPs. Both interventions encourage fathers as well as mothers (and other key caregivers in the home) to participate. This innovative study makes use of a non-inferiority trial design that builds on methodological strengths: stratified random assignment, adequate statistical power, attention to fidelity of intervention, multi-informant and multi-source assessment of outcomes (including direct observation of parent-child interaction), and documentation of participant adherence. The aims of the project are: (1) to test whether the online intervention is as good as the more established staff-delivered intervention with respect to impact on childhood DBPs, parenting, and parent/family stress; (2) to conduct a rigorous value analysis comparing the two interventions, accounting for provider and participant expenses as well as pre-implementation and implementation phases; (3) to assess consumer satisfaction for the online intervention in comparison to the other intervention, as well as detailed consumer appraisal of the online intervention experience, and to explore how logistical factors, participant characteristics, and personal preferences are related to degree of consumer satisfaction; and, (4) to document participant adherence to the online intervention in comparison to the other intervention, and explore correlates of participant adherence for each intervention. The Online-Delivered Intervention provides an interactive website designed to engage and activate the participant through sequenced, personalized, interactive, and video-based content. The conceptualization that guides the intervention emphasizes a self-regulatory process, parent specification of goals, practical and straightforward parenting strategies, modeling, and action activation. Beyond shedding light on the impact and benefits of a viable online parenting intervention for childhood disruptive behavior problems, the results from this project will help the mental health field to better understand more generally the potential advantages and disadvantages of online interventions over traditionally delivered interventions, particularly in light of resource minimization/effectiveness analysis.