Comparing Two Parenting Programs for At-Risk Families

比较针对高危家庭的两种育儿计划

基本信息

批准号：
8514735
负责人：
HAROLYN MILLICENT EDITH BELCHER
金额：
$ 59.79万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-01 至 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8514735
关键词：
5 year old Affect African American Baltimore Behavior Buffers Chicago Child Child Behavior Child Development Clinic Clinical Collaborations Communities Cost Effectiveness Analysis Data Discipline Economically Deprived Population Effectiveness Effectiveness of Interventions Experimental Designs Family Goals Gold Health Healthcare Individual Intake Intervention Investments Knowledge Latino Legal Guardians Length Life Low income Measures Mental Depression Mental Health Minority Groups Modeling Outcome Parent-Child Relations Parenting behavior Parents Participant Perception Phase Policy Making Population Poverty Preschool Child Problem behavior Public Health Randomized Reporting Research Risk Sampling Scientist Self Efficacy Series Severities Societies Stress Subgroup Testing Time Training Training Programs United States National Institutes of Health base brief intervention comparative effectiveness compare effectiveness cost cost effective depressive symptoms design effectiveness research ethnic minority population evidence base follow-up improved innovation meetings novel post intervention programs racial and ethnic satisfaction social socioeconomics stressor therapy design treatment effect

项目摘要

DESCRIPTION (provided by applicant): Good parenting early in life can substantially buffer the negative effects of socioeconomic adversity on children's development. However, we do not know the most cost-effective ways to improve parenting quality among highly stressed, impoverished families of young children, a disproportionate number of whom are African-American (AA). This knowledge gap is compounded by the fact that the evidence-based parenting programs typically used to help low-income families were originally developed and tested on White, middle- class parents. This comparative effectiveness research will test the equivalence of two evidence-based parent training (PT) programs designed to improve parenting quality and reduce behavior problems in young children: Parent-Child Interaction Therapy (PCIT), a well-established, individually tailored PT program considered the "gold standard" and the Chicago Parent Program (CPP), a novel group-based PT program developed with an advisory board of AA and Latino parents and shown to improve parenting and reduce behavior problems in ethnic minority families living in urban poverty. We will compare the (1) effectiveness of PCIT and CPP for improving parenting behavior and self-efficacy and reducing child behavior problems in a predominantly AA sample of parents seeking treatment for their young children's (2-5 years) behavior problems; (2) perceived social validity of PCIT and CPP based on parent satisfaction, attendance, and treatment engagement; and (3) cost and consequences of PCIT versus CPP related to treatment effect size, clinical costs, and perceived social validity. CPP is hypothesized to yield comparable treatment effects but at less cost and with greater satisfaction. We will also examine differences in PT program effects to determine whether PCIT or CPP is more effective for some families based on the type and severity of child behavior problems and degree of social risk. Using a randomized experimental design, 210 parents/legal guardians and their 2-5 year old children (>80% AA; 97% low-income) referred for behavior problems to a mental health clinic in East Baltimore will be randomized to PCIT (N=105) or CPP (N=105). Data on child behavior problems; and parent discipline, self-efficacy, behavior, stress, and depression will be obtained at baseline and two post-intervention phases. Social risk will be assessed at intake; parent satisfaction, attendance, and engagement will be assessed post- intervention. Clinical costs related to PT and non-PT treatment will be measured monthly. Hypothesis-testing will employ repeated measures MANOVA. This innovative study was designed in collaboration with mental health clinicians employed in the targeted clinical agency to inform implementation, enhance compatibility with current practice, and promote external validity. It will be the first to compare the effectiveness, cost, and social validity of a brief treatment designed with and for ethnic minority parents of young children against a well- established treatment considered to be the "gold standard." The long-term goal is to inform the way we invest health care dollars for improving health outcomes for young, ethnic minority children living in urban poverty.

描述（由申请人提供）：生命早期良好的养育可以大大缓解社会经济逆境对儿童发展的负面影响。然而，我们不知道在压力很大、贫困的幼儿家庭中提高养育质量的最具成本效益的方法，其中非裔美国人 (AA) 的比例不成比例。通常用于帮助低收入家庭的循证育儿计划最初是在白人中产阶级父母身上开发和测试的，这一事实加剧了这种知识差距。这项比较有效性研究将测试两种旨在提高养育质量和减少幼儿行为问题的循证家长培训 (PT) 计划的等效性：亲子互动疗法 (PCIT)，一项完善的、个性化定制的 PT 计划被认为是“黄金标准”的芝加哥家长计划 (CPP) 是一项新颖的基于团体的 PT 计划，由 AA 和拉丁裔家长组成的顾问委员会共同开发，并被证明可以改善养育方式并减少生活在城市贫困的少数族裔家庭的行为问题。我们将比较 (1) PCIT 和 CPP 在改善养育行为和自我效能以及减少儿童行为问题方面的有效性，其中主要是 AA 样本的父母为幼儿（2-5 岁）的行为问题寻求治疗； (2) 基于家长满意度、出勤率和治疗参与度的 PCIT 和 CPP 感知社会有效性； (3) PCIT 与 CPP 的成本和后果与治疗效果大小、临床成本和感知的社会有效性相关。假设 CPP 可以产生类似的治疗效果，但成本更低，满意度更高。我们还将检查 PT 计划效果的差异，根据儿童行为问题的类型和严重程度以及社会风险程度来确定 PCIT 或 CPP 对于某些家庭是否更有效。采用随机实验设计，210 名家长/法定监护人及其 2-5 岁的孩子（>80% AA；97% 低收入）因行为问题转介到东巴尔的摩的心理健康诊所，将被随机分配到 PCIT（N =105) 或 CPP (N=105)。有关儿童行为问题的数据；家长纪律、自我效能、行为、压力和抑郁将在基线和两个干预后阶段获得。入学时将评估社会风险；干预后将评估家长满意度、出勤率和参与度。与 PT 和非 PT 治疗相关的临床费用将每月进行一次测量。假设检验将采用重复测量多元方差分析。这项创新研究是与目标临床机构雇用的心理健康临床医生合作设计的，旨在为实施提供信息，增强与当前实践的兼容性，并提高外部有效性。这将是第一个将由幼儿的少数族裔父母设计的短期治疗与被认为是“黄金标准”的完善治疗的有效性、成本和社会有效性进行比较的项目。长期目标是告知我们如何投资医疗保健资金，以改善生活在城市贫困中的少数民族儿童的健康状况。