Technology to Enhance Treatment for Early Conduct Problems in Low Income Families

描述（由申请人提供）：没有一种方法被证明可以显著提高行为父母培训（BPT）项目的交付或结果，该项目适用于患有破坏性行为障碍（DBD）的低收入青年家庭，这一群体在DBD统计数据中被过度代表。这项资助是为了响应“利用先进的健康技术来推动心理健康改善（R01）”（RFA-MH-13-060）而提交的，旨在复制和扩展试点研究（R34MH082956; Jones， PI）的发现，该研究表明，技术尚未开发的潜力可以影响一个基于证据的BPT项目的服务交付，“帮助不合规儿童”（HNC），面向患有DBD的低收入青年家庭。为了复制和扩展R34试验结果，我们提出了一项足够有力的随机对照试验（RCT），比较：1)。技术增强HNC （TE-HNC）至2)。HNC标准。所有低收入家庭都将接受HNC项目的核心干预组成部分，包括积极的、指导性的技能建设和实践，旨在打破与儿童不服从、攻击和对立行为（DBD的特征）的发病、维持和恶化相关的亲子互动的强制性循环。此外，其中一组将通过智能手机获得技术改进，鉴于低收入家庭智能手机的使用、拥有和成本效益增加，智能手机是一种理想的配送工具。本研究的目的是比较TE-HNC与HNC在以下方面的差异：1)提高HNC在父母教养和儿童行为方面的治疗效果；2)增加家庭对高技能国家服务的参与，并将高技能国家技能推广到家庭；3)随着时间的推移，HNC治疗效果的恶化逐渐减少；4)提高HNC服务提供的效率，进而增加成本效益。因此，在将不同治疗组的核心治疗内容等同起来的同时，我们解决了一个基本的、未经研究的问题，即技术是否有潜力显著改善传统的BPT给药系统，以更好地吸引和影响患有DBD的低收入青年家庭。为了解决这个问题，我们将复制和扩展我们成功和有前途的R34试验RCT基础设施，以招募122个有DBD儿童的低收入家庭，我们将对每个入组家庭进行为期一年的随访。数据监测组（DMG）将监测招募、治疗保真度、评估和人类受试者保护。开发创新、有效和具有成本效益的方法来改善向患有DBD的低收入青年家庭提供的BPT服务，具有重大的个人、家庭和公共卫生意义。这个试验的结果

DESCRIPTION (provided by applicant): No single approach has been shown to significantly enhance the delivery or outcomes of Behavioral Parent Training (BPT) programs for low-income families of youth with Disruptive Behavior Disorders (DBD), a group that is overrepresented in statistics on DBD. This grant, submitted in response to "Harnessing Advanced Health Technologies to Drive Mental Health Improvement (R01)" (RFA-MH-13-060), aims to replicate and extend pilot study (R34MH082956; Jones, PI) findings demonstrating the untapped potential for technology to influence service-delivery of one evidence-based BPT program, "Helping the Noncompliant Child" (HNC), to low-income families of youth with DBD. In order to replicate and extend the R34 pilot findings, we propose a sufficiently powered randomized control trial (RCT) comparing: 1). Technology-Enhanced HNC (TE-HNC) to 2). Standard HNC. All low-income families will receive the core intervention components of the HNC program, including active, directive skill-building and practice aimed at disrupting the coercive cycle of parent-child interactions associated with the onset, maintenance, and exacerbation of child noncompliance, aggression, and oppositional behavior that characterize DBD. In addition, one group will receive the technology- enhancements via smartphones, an ideal delivery vehicle given the increased access to, ownership, and cost- effectiveness of smartphones for low-income families. The study aims are to compare TE-HNC with HNC in: 1). increasing therapeutic gains in HNC on parenting and child behavior; 2). increasing engagement of families in HNC services and generalization of HNC skills to the home; 3). decreasing deterioration in HNC treatment gains over time; and 4). increasing efficiency and, in turn, incremental cost-effectiveness of HNC service delivery. Thus, while equating the core therapeutic content across treatment groups, we address the fundamental, unexamined question of whether technology has the potential to significantly improve upon the traditional BPT delivery system to better engage and impact low income families of youth with DBD. In order to address this question, we will replicate and extend our successful and promising R34 pilot RCT infrastructure to recruit 122 low-income families of children with DBD and we will follow each enrolled family for one year. The Data Monitoring Group (DMG) will monitor recruitment, treatment fidelity, assessments, and human subjects protections. The development of innovative, efficacious, and cost-effective approaches to improving BPT service delivery to low income families of youth with DBD has substantial personal, familial, and public health implications. The results from this trial have the potential to transform service delivery and outcomes for this vulnerable and underserved group.