Fostering Mothers Emotionally-Responsive Parenting

 描述（由申请人提供）：这是一项申请，旨在资助一项新的第三阶段基于社区的随机临床疗效试验，测试由内而外的母亲（MIO），这是第一个基于证据的育儿干预措施，旨在由成瘾辅导员在成瘾治疗环境中提供，其中幼儿的父母参加治疗。在该奖项的前9年进行的两项（第一阶段和第二阶段）随机临床疗效试验中，与标准的父母教育计划（PE）相比，MIO证明了改善育儿，儿童依恋安全性和积极影响戒毒的有效性。重要的是，被分配到MIO的成瘾严重程度高的母亲在所有结果中都表现出显着的改善。MIO是一种每周一次的个别育儿疗法，作为标准成瘾治疗的增强，针对成瘾母亲在压力育儿情况下识别和调节自己情绪困扰的能力，以便她可以支持孩子的情绪和行为调节能力的发展。这种能力被称为反射功能（RF），是一种促进禁欲的心理技能，也有助于父母培养幼儿的安全依恋。既然MIO已经在两项随机疗效试验中证明了疗效，下一步将是进行一项新的III期社区疗效试验，在该试验中，成瘾咨询师接受培训，在成瘾治疗环境中忠实地提供MIO和PE，并评估治疗结果和这种社区环境中的变化机制。这将是实施干预研究新阶段模型的首批研究之一（Onken等人，2014年），其中有效的干预措施首先在高内部效度条件下进行测试（确保治疗保真度），然后在条件下测试有效性。 外部效度高。在试验结束时，如果MIO证明有效，我们将拥有所有必要的材料，在第四阶段有效性试验中在广泛的治疗环境中培训成瘾咨询师。在第一年，我们将进行一项培训试点，其中成瘾治疗诊所的14名成瘾咨询师将被随机分配到MIO与PE交付的培训中，并与真实的患者一起完成培训案例，在此期间将测量保真度。在第2 - 5年，160名接受成瘾治疗和照顾12 - 24个月儿童的母亲将随机接受12次MIO与PE治疗，由经过培训的成瘾顾问进行治疗，并在治疗期间监测和维持忠诚度。我们预测，1。当由训练有素的成瘾咨询师提供时，MIO和PE可以区分; 2. MIO分配的母亲将表现出更大的改善，在反思功能和物质使用的禁欲和他们的孩子将表现出更大的改善，在治疗后和随访的附件安全; 3。对于成瘾严重程度高的母亲，MIO比PE具有更大的优势;和4。更高的治疗保真度将介导更好的治疗结果，RF的改善将介导禁欲和儿童依恋安全性的改善。

 DESCRIPTION (provided by applicant): This is an application to fund a new Stage III community-based randomized clinical efficacy trial testing Mothering from the Inside Out (MIO), the first evidence-based parenting intervention designed to be delivered by addiction counselors in addiction treatment settings where parents of young children are enrolled in treatment. In two (Stage I and II) randomized clinical efficacy trials conducted during the first 9 years of this award, when compared with a standard parent education program (PE), MIO demonstrated efficacy for improving parenting, child attachment security and for positively impacting abstinence from drug use. Importantly, mothers with high addiction severity assigned to MIO showed notable improvement across all outcomes. MIO is a weekly individual parenting therapy developed as an enhancement to standard addiction treatment that targets the addicted mother's capacity to recognize and regulate her own emotional distress during stressful parenting situations so that she can support her child's developing capacity for emotional and behavioral regulation. This capacity, called reflective functioning (RF), is a psychological skill that promotes abstinence and also helps parents foster their young children's secure attachment. Now that MIO has demonstrated efficacy in two randomized efficacy trials, the next step will be to conduct a new Stage III community-based efficacy trial where addiction counselors are trained to deliver MIO and PE with fidelity in an addiction treatment setting and to evaluate treatment outcomes and mechanisms of change in this community setting. This will be one of the first investigations implementing a new stage model for intervention research (Onken et al., 2014) where efficacious interventions are first tested under conditions of high internal validity (with treatment fidelity assured) before effectiveness is tested under conditions of high external validity. At the end of this trial, if MIO demonstrates efficacy, we will have allthe necessary materials to train addiction counselors across a broad range of treatment settings in a Stage IV effectiveness trial. In the first year, we will conduct a training pilot where 14 addicton counselors in an addiction treatment clinic will be randomly assigned to training in MIO vs PE delivery and complete a training case with a real patient during which fidelity will be measured. In years 2 - 5, 160 mothers in addiction treatment and caring for children ages 12 - 24 months will be randomized to 12 sessions of MIO vs PE with a trained addiction counselor and fidelity will be monitored and maintained for treatment duration. We predict that 1. When delivered by trained addiction counselors, MIO and PE can be discriminated; 2. MIO-assigned mothers will demonstrate greater improvement in reflective functioning and abstinence from substance use and their children will show greater improvement in attachment security at post-treatment and follow up; 3. MIO will confer greater advantage than PE for mothers with high addiction severity; and 4. Higher treatment fidelity will mediate better treatment outcomes and improvements in RF will mediate improvement in abstinence and child attachment security.