A pilot test of a brief eHealth parent-focused prevention intervention with parents referred from primary care clinics

摘要 以证据为基础的以父母为中心的预防计划可以预防未来的精神疾病，但并不普遍 也没人来为了解决这一关键差距，研究必须测试更容易获得的交付策略。 因此，本研究的长期目标是通过增加 以证据为基础的育儿计划的覆盖范围和可及性，GenerationPMTO（GenPMTO）。GenPMTO 已经通过亲自交付进行了严格的测试;然而， 以及对儿童保育的需求限制了人们参与面对面的育儿计划。在线交付程序（即， 电子健康）可以克服这些障碍，增加父母的可行性。为了扩大覆盖面，这些项目 必须与经常访问的服务设置配对。初级保健诊所经常被访问， 值得信赖的环境;然而，初级保健人员没有接受过解决行为健康或养育问题的培训 主题和儿科转诊往往没有作出或完成。将育儿计划与小学教育相结合， 需要对初级保健人员进行培训，并制定明确的转诊程序。因此本研究 有两个目标：按时间顺序，第一个目标是开发（目标1）和试点测试（目标2） 为初级保健提供者提供转诊程序和简短的沟通技能培训，使他们能够有效地 将家长介绍给eHealth GenPMTO，从而扩大覆盖面。Aim 1使用专家共识方法， 制定可行的培训和转介程序。目标2是测试转介程序的可接受性， 培训的试点测试;初级保健人员（n=35）将随机接受培训或对照 在这种情况下，他们收到书面信息，介绍父母到GenPMTO治疗师。 培训和推荐流程的可接受性、适当性和可行性将通过 混合方法。这项研究中的合作诊所是联邦合格健康中心的一部分， 促进在服务不足的父母群体中的普及。研究的第二个目的是进行试点测试 在初级保健转诊人群中，简要的eHealth GenPMTO（目标3）的有效性。虽然 GenPMTO已经过严格的测试，一个简短的eHealth版本还没有经过测试，GenPMTO也没有 在初级保健人群中进行有效性检查。在目标3中，n=60名父母由他们的主要 护理提供者（发生在目标2中）将被分配到GenPMTO或单次会话控制条件， 这些都是现有的育儿资源。3-5岁儿童中度 行为上的问题将有资格被转介。试点效果结果包括养育行为和 儿童外化和内化症状。简要电子健康的可接受性、适当性和可行性 将通过混合方法对GenPMTO进行评价。这项研究为全面- 动力混合动力的有效性-实施试验。

ABSTRACT Evidence-based parent-focused prevention programs prevent future mental illness but are not widely available nor well-attended. To address this this critical gap, research must test more accessible delivery strategies. Thus, the long-term goal of this study is to prevent significant behavioral health problems by increasing the reach and accessibility of an evidence-based parenting program, GenerationPMTO (GenPMTO). GenPMTO has been rigorously tested with in-person delivery; however, logistical barriers like a large time-commitment and the need for childcare limit engagement in in-person parenting programs. Delivering programs online (i.e., eHealth) can overcome these barriers, increasing feasibility for parents. To increase reach, these programs must be paired with frequently-accessed service settings. Primary care clinics are frequently accessed and trusted settings; however, primary care personnel are not trained to address behavioral health or parenting topics and pediatric referrals are often not made or completed. To integrate parenting programs with primary care, training for primary care personnel and a well-defined referral process are needed. Therefore, this study has two objectives: In chronological order, the first objective is to develop (Aim 1) and pilot test (Aim 2) a referral process and a brief communication skills training for primary care providers to equip them to effectively refer parents to eHealth GenPMTO, thereby increasing reach. Aim 1 uses an expert consensus method to develop a feasible training and referral process. Aim 2 is a test of the acceptability of the referral process and a pilot test of the training; primary care personnel (n=35) will be randomized to receive the training or a control condition in which they receive written information about referring parents to GenPMTO therapists. Acceptability, appropriateness, and feasibility of the training and referral process will be evaluated through a mixed methods approach. The collaborating clinics in this study are part of a Federally Qualified Health Center, facilitating reach within an under-served population of parents. The second objective of the study is to pilot test the effectiveness of brief eHealth GenPMTO (Aim 3) within a primary-care-referred population. Although GenPMTO has been rigorously tested, a brief eHealth version has not been tested, nor has GenPMTO been examined for effectiveness among a primary care population. In Aim 3, n=60 parents referred by their primary care provider (which occurs in Aim 2) will be assigned to GenPMTO or a single-session control condition in which they are directed to existing parenting resources. Parents of 3-5-year-old children with moderate behavioral concerns will be eligible for referral. Pilot effectiveness outcomes include parenting behaviors and child externalizing and internalizing symptoms. Acceptability, appropriateness, and feasibility of brief eHealth GenPMTO will be evaluated through a mixed methods approach. This study lays groundwork for a fully- powered hybrid effectiveness-implementation trial.