Optimizing residential treatment gains for adolescents through tailored behavioral parent training

项目摘要 虽然青少年（11至17岁）在治疗方面取得了进展（例如，减少内化或外化 行为）在精神病住院治疗（RT），他们经历了显着的困难， 社区，往往不能长期维持治疗收益。RT后，70%的青少年出院 家庭起源。然而，没有向父母提供必要的支持或行为管理 弥补RT和家庭之间的差距的技能。一项新的联邦法令很快将要求对父母进行培训， 循证行为管理干预，在RT设置。青少年接受RT的父母 儿童是一个难以接触到的群体，技术可以增加父母培训的机会和吸收。 父母明智（PW）是一个基于网络的父母培训，在提高有效的 减少青少年行为问题的育儿方法。我们以前发现PW是高度可行的 这些技能被认为是有用的。然而，家长们报告说有两个需求没有得到满足：（1）技能 个性化应用PW技能和（2）增强社区，以减少隔离。协同 一个顾问委员会（拟议研究的合作伙伴），我们通过临床医生促进的讨论来增强PW 组（称为PWRT）。PWRT中的讨论组支持程序完成和父级 参与，提供了一个讨论个性化PW策略的场所，减少了孤立，并支持父母 通过在RT背景下参与关于养育子女的对话。本研究旨在：（1）建立 PWRT的可行性和可接受性，（2）评估PWRT是否涉及靶机制（父母自我- 效能，养育行为，社会支持，家庭功能），（3）确定PWRT对 青少年结果（内化和外化行为，安置限制）。六十位家长（30 每种条件）将随机分配至PWRT或常规治疗（TAU）。每周六周， 家长将完成两个PW模块（每个模块20分钟），并通过Zoom参加一个讨论组（90- 分钟）。PWRT将在RT接收结束时启动，并在出院后继续进行，以连接 从RT到社区的转变青少年（n=60）将不会接受干预;但是，我们将 评估为未来研究收集青少年数据的可行性。来自父母和青少年的数据将 在基线、基线后6周和6个月时收集，以便充分了解 PWRT对治疗增益维持的长期影响。与PAR-21-211一致，我们的团队 研究人员和社区合作伙伴正在收集更大规模有效性试验所需的数据， 测试PWRT与TAU的可行性、可接受性和初步效果。PWRT是第一个网络- 基于父母的培训，增加了旨在使父母与青少年接触的支持性因素， RT.通过为家长提供专门的PWRT教育和支持，家长将配备 行为管理技能，以提供家庭结构，并最终维持RT治疗收益。

Project Summary Although adolescents (ages 11 to 17) make treatment gains (e.g., reduced internalizing or externalizing behaviors) in psychiatric residential treatment (RT), they experience significant difficulty adapting to the community and often do not sustain treatment gains long term. After RT, 70% of adolescents discharge to their family of origin. However, parents are not provided with the necessary support or behavior management skillset to bridge the gap between RT and home. A new federal mandate will soon require parent training, an evidence-based behavior management intervention, in the RT setting. Parents with adolescents admitted to RT are a difficult-to-reach population, and technology may increase access and uptake of parent training. Parenting Wisely (PW) is a web-based parent training with demonstrated efficacy in increasing effective parenting practices to reduce adolescent behavior problems. We previously found that PW was highly feasible for parents and the skills were perceived as useful. However, parents reported two unmet needs: (1) skill individualization to apply the PW skills and (2) enhanced community to reduce isolation. In collaboration with an advisory board (a partner in the proposed study), we augmented PW with clinician facilitated discussion groups (referred to as PWRT). The discussion groups in PWRT supports program completion and parent engagement, provides a venue to discuss individualizing PW strategies, reduces isolation, and support parents by engaging in conversation about parenting in the RT context. The proposed study aims to: (1) establish feasibility and acceptability of PWRT, (2) evaluate whether PWRT engages target mechanisms (parental self- efficacy, parenting behaviors, social support, family function), and (3) determine the effects of PWRT on adolescent outcomes (internalizing and externalizing behaviors, placement restrictiveness). Sixty parents (30 per condition) will be randomly assigned to PWRT or treatment-as-usual (TAU). Each week for six weeks, parents will complete two PW modules (20 minutes each) and attend one discussion group via Zoom (90- minutes). PWRT will be initiated towards the end of the RT admission and continue post-discharge to bridge the transition from RT to the community. Adolescents (n=60) will not receive intervention; however, we will evaluate the feasibility of adolescent data collection for future studies. Data from parents and adolescents will be collected at baseline, 6-weeks, and 6-months post-baseline to allow for a robust understanding of the longer-term effects of PWRT on treatment gain maintenance. Consistent with PAR-21-211, our team of researchers and community partners is collecting the requisite data for a larger-scale effectiveness trial by testing the feasibility, acceptability, and preliminary effects of PWRT vs. TAU. PWRT is among the first web- based parent training augmented with supportive elements designed to engage parents with adolescents in RT. By providing parents with tailored education and support in PWRT, parents will be equipped with the behavior management skillset to provide structure in the home and ultimately maintain RT treatment gains.