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

高患病率的精神卫生问题需要创新战略，以扩大循证服务的覆盖面。幼儿的破坏性行为问题（dbp）或行为问题是一项重大的公共卫生挑战，不仅非常普遍，而且如果不加以治疗，会增加青少年和成年期不良心理健康和发展结果的风险。需要新的、有效的干预战略，能够以资源有效的方式提供足够的覆盖范围。互联网和在线技术具有帮助实现这一目标的巨大潜力。本项目以已证明对儿童dbp有影响的父母干预措施为基础，在保持项目内容不变的情况下，将在线提供的干预措施与经过验证的员工提供的干预措施进行比较。样本包括有一个3-7岁的孩子有明显的dbp水平的家庭。这两种干预措施都鼓励父亲和母亲（以及家中其他主要照顾者）参与进来。这项创新研究采用了非劣效性试验设计，该设计建立在方学优势的基础上：分层随机分配，充分的统计能力，对干预的保真度的关注，多信息提供者和多来源的结果评估（包括直接观察亲子互动），以及参与者依从性的记录。该项目的目的是：(1)测试在线干预是否与更成熟的工作人员提供的干预一样好，对儿童dbp、养育和父母/家庭压力的影响；(2)对两种干预措施进行严格的价值分析，对提供者和参与者的费用以及实施前和实施阶段进行核算；(3)评估消费者对在线干预与其他干预的满意度，以及消费者对在线干预体验的详细评价，并探讨物流因素、参与者特征和个人偏好与消费者满意度的关系；(4)记录参与者对在线干预的依从性与其他干预的比较，并探讨参与者对每种干预的依从性的相关性。在线交付干预提供了一个交互式网站，旨在通过顺序，个性化，交互式和基于视频的内容吸引和激活参与者。指导干预的概念化强调自我调节过程、父母对目标的规范、实际和直接的养育策略、建模和行动激活。除了揭示可行的在线育儿干预对儿童破坏性行为问题的影响和益处之外，该项目的结果将有助于心理健康领域更好地更普遍地了解在线干预相对于传统干预的潜在优缺点，特别是考虑到资源最小化/有效性分析。

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.