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

描述(由申请人提供)：没有任何单一的方法可以显著提高针对患有破坏性行为障碍(DBD)的低收入家庭的父母行为培训(BPT)方案的交付或结果，在DBD的统计数据中，这一群体的比例过高。这笔赠款是根据“利用先进卫生技术推动精神健康改善(R01)”(RFA-MH-13-060)提交的，旨在复制和扩展先导研究(R34MH082956；Jones，Pi)的研究结果，证明技术尚未开发的潜力影响服务的提供--向患有DBD的低收入青年家庭提供一个基于证据的BPT计划--“帮助不合规的儿童”(HNC)。为了复制和扩展R34试验的结果，我们提出了一个充分有效的随机对照试验(RCT)来比较：1)。技术增强型HNC(TE-HNC)到2)。标准HNC。所有低收入家庭都将接受HNC计划的核心干预部分，包括积极的、指导性的技能建设和实践，旨在打破亲子互动的强制循环，这些互动与儿童不服从、攻击性和对立行为的开始、维持和加剧有关，这些行为是DBD的特征。此外，其中一组人将通过智能手机获得技术增强，这是一种理想的递送工具，因为低收入家庭更容易获得、拥有更多智能手机，而且成本效益更高。本研究的目的是比较TE-HNC和HNC在以下方面的差异：1)。增加HNC在育儿和儿童行为方面的治疗收益；2)。增加家庭对HNC服务的参与，并将HNC技能推广到家庭；3)随着时间的推移，减少HNC治疗效果的恶化；以及4)。提高HNC服务交付的效率，进而提高成本效益。因此，在将核心治疗内容等同于各治疗组的同时，我们解决了一个根本的、未经检验的问题，即技术是否有潜力显著改进传统的BPT交付系统，以更好地参与和影响患有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景的R34试点RCT基础设施，以招募122个患有DBD儿童的低收入家庭，我们将对每个登记的家庭进行为期一年的跟踪调查。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，以改善对患有DBD的低收入青年家庭的BPT服务，具有重大的个人、家庭和公共卫生影响。这项试验的结果 有可能改变这一弱势和服务不足群体的服务提供和结果。

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.