Comparing Interventions to Improve the Well-Being of Custodial Grandfamilies

说明(申请人提供)：尽管先前的研究表明，监护祖母(CGM)和孙子(CGC)面临心理困难的高风险，但几乎没有对这些脆弱家庭进行基于坚实概念框架的严格的心理社会干预研究。鉴于父母教养中断在CGM的照顾者角色中的心理困扰与CGC的情绪和行为问题之间的关系的初步发现，本项目涉及一项随机临床试验(RCT)，以比较两种在其他照顾者群体中广泛使用的循证心理教育干预的可行性和有效性。CGC(5-12岁)的祖母(N=504)将被随机分配到以下三种条件之一：行为父母培训(BPT；源自寄养父母项目Keep；认知行为疗法(CBT；源于照顾体弱老人的照顾者)；最低支持条件(以非特定治疗因素为对照)。拟议的普遍干预措施包括预防和补救目标，并采用小组形式的方法，由心理健康专业人员和祖父母同龄人担任共同领导人。RCT将在全美多个地点进行，以确保研究结果超越单一地区，并确保同等数量的黑人(n=168)、西班牙裔(n=168)和白人(n=168)家庭参与其中。在区域工作队之前，将单独举行焦点小组，每个种族(n=10人)和有经验的从业者(n=10人)将分别举行重点小组，目的是评估招募方法、治疗目标和程序的重要性和可接受性，包括种族/族裔可能存在的差异。在RCT的前测、后测以及6、12、18和24个月的随访中，多信息者和多种方法的评估将包括CGM心理困扰(焦虑、抑郁)、CGC调整(内部化和外部化问题)和父母教养中断(使用无效的纪律和低养成)的指标。根据卓越家庭压力模型的概念框架，将使用多组结构方程模型分析来实现四个目标：(A)比较基于家庭的护理方法和基于家庭的护理方法的短期和长期效果；(B)从纵向上考察CGM的育儿做法、CGM的心理困扰和经BPT和CBT修改的CGC调整之间的动态联系；(C)确定关键调节变量(种族/族裔、CGC、CGC和CGM的初始心理困难)是否影响RCT结果；以及(D)检查与可接受性和遵守拟议干预措施相关的关键因素。这些发现将通过确定哪些建议的干预措施在特定的亚组中最有效和最可接受(例如，种族/民族；初始风险)，并通过解开CGM痛苦、功能失调的父母养育和CGC调整之间的特定前因后果关系，为未来监护祖父母的临床实践提供信息。

DESCRIPTION (provided by applicant): Although prior studies reveal that custodial grandmothers (CGM) and grandchildren (CGC) face high risk for psychological difficulties, virtually no rigorous studies of psychosocial interventions based on solid conceptual frameworks have been conducted with these vulnerable families. In view of preliminary findings that disrupted parenting mediates the relationship between CGM's psychological distress in the caregiver role and CGC's emotional and behavioral problems, this project involves a randomized clinical trial (RCT) of the comparative feasibility and efficacy of two evidenced-based psychoeducational interventions widely used with other caregiver populations. Grandmothers (N = 504) of CGC (age 5 - 12) will be randomly assigned to one of three conditions: Behavioral Parent Training (BPT; derived from Project KEEP for foster parents; Cognitive Behavioral Therapy (CBT; derived from Coping with Caregiving for caregivers of frail elders); Minimal Support Condition (to control for non-specific treatment factors). The proposed universal interventions include prevention and remediation objectives and involve a group format approach with mental health professionals and grandparent peers serving as co-leaders. The RCT will occur in multiple locations across the US to ensure that findings generalize beyond a single area and that equal numbers of Black (n = 168), Hispanic (n = 168), and White (n = 168) families participate. Prior to the RCT, focus groups will be held separately with CGMs of each race (n = 10 apiece) and experienced practitioners (n = 10) with the aim of assessing the perceived importance and acceptability of recruitment methods, treatment goals, and procedures, including possible differences by race/ethnicity. Multiple-informant and multiple-method assessments during the RCT at pretest, posttest and 6, 12, 18, and 24 month follow-ups will include indicators of CGM psychological distress (anxiety, depression); CGC adjustment (internalizing and externalizing problems); and disrupted parenting (use of ineffective discipline and low nurturance). Based on the conceptual framework of the prominent Family Stress Model, multi-group structural equation modeling analyses will be used to achieve four aims: (a) To compare the short and long-term effectiveness of CBT and BPT; (b) to examine longitudinally the dynamic linkages between CGM parenting practices, CGM' psychological distress, and CGC adjustment as modified by BPT and CBT; (c) to determine if key moderating variables (race/ethnicity, CGC, initial psychological difficulties in CGC and CGM influence RCT outcomes; and (d) to examine key factors related to acceptability and adherence to the proposed interventions. The findings will inform future clinical practice with custodial grandfamilies by identifying which of the proposed interventions are most effective and most acceptable among specific sub-groups (e.g., race/ethnicity; initial risk) and by unraveling the specific antecedent-consequent relations among CGM distress, dysfunctional parenting, and CGC adjustment.