Integrating Computer-Assisted Parent Training Therapy Into Community Mental Health Clinic Practice
试验速览
- 阶段
- 不适用
- 入组人数
- 80
- 试验地点
- 1
- 主要终点
- Change in Evidence-Based Practice Attitude Scale
研究概览
简要总结
This study will evaluate a low-cost, low-intensity, computer-based model for delivering parenting skills to parents of adolescents in a community mental health clinic. This intervention has the potential to improve public health and community practice by making empirically-supported treatment techniques more available. We believe this approach will improve the efficiency of treatment delivery by integrating computerized and therapist delivered approaches, and there is potential for significant improvements in efficacy of parent training with this model.
详细描述
This study will evaluate a low cost, low intensity, technology based model for delivering parenting skills to parents of adolescents in a community mental health clinic (CMHC). Specifically, we will test a computer-assisted protocol of Parenting Wisely, a computer based parenting program with previously established efficacy. Such an intervention is consistent with NIMH strategic plan objective 3.3: "to strengthen the application of mental health interventions in diverse care settings by examining community and intervention delivery approaches and how they may affect intervention outcomes." Although this is a pilot effectiveness study, we will gather information to inform future implementation efforts including the feasibility and acceptability of the intervention. Additionally, we will conduct qualitative interviews with relevant stakeholders (providers/program managers) to better understand barriers and facilitators of adoption and sustainability. This goal will help increase the likelihood of a successful, future larger trial across multiple CMHCs due to its focus on external validity and implementation barriers when making critical design decisions. This approach mitigates a major criticism of traditional efficacy/effectiveness studies, i.e. that the methods do not translate well to the community due to cost and resource constraints, as well as contextual factors.
The intervention has the potential to improve public health and community practice by making empirically supported treatment techniques more available in CMHCs and improving the efficiency of treatment delivery by integrating computerized and therapist delivered approaches. Specifically, this study has the potential to advance treatment by: 1) understanding factors that enhance or impede computer assisted parent training in the community setting; 2) addressing a high-needs underserved population with significant public health relevance; 3) engaging the target mechanism of therapist fidelity, competency, and alliance as well as parenting skills and self-efficacy that have been shown to influence adolescent behavior problems; 4) increasing access to and engagement in an evidence-based treatment that can be personalized to the specific parenting skills of a family by the selection of modules in PW; and 5) enhancing the ease of dissemination and implementation. Furthermore, we believe this approach has the potential for improving response rate, because the parenting skills will be delivered with greater fidelity than would be typical of therapists teaching parenting in sessions in CHMCs. This improvement should also result in an improved response in adolescent behavior. We believe this is true because: 1) meta-analyses typically report moderate effect sizes for parent training at the end of treatment; 2) parent training is underemployed in community clinics; 3) fidelity to treatment protocols is often poor which has been shown to diminish effectiveness of treatment; and 4) frequent staff turnover creates high resource demands. Thus, we believe this approach is not only efficient but that there is potential for significant improvements in efficacy of parent training with this model.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 12 Years 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •be the parent or legal guardian of an adolescent aged 12-17 years
- •have an adolescent with clinically elevated disruptive behaviors as indicated by parent report on the Child Behavior Checklist (CBCL; Achenbach, 2000; Aggressive Problems or Oppositional/Defiant Problems T score > 70)
- •be willing to receive a parenting intervention
- •be fluent in English or Spanish
- •be willing to provide written consent and teen willing to provide written assent
排除标准
- •severe clinical presentations, such as psychosis or developmental delay, at a level that would interfere with the ability to assent or complete assessments
研究组 & 干预措施
Treatment As Usual (TAU)
The TAU condition consists of the standard treatment elements offered to all Gateway (study site) patients, and will be received by patients in both the PW and the TAU-only condition. TAU services during the adolescent's treatment are typically eclectic and mainly entail meeting with the adolescent alone to provide support and psychoeducation, with occasional family therapy sessions. Medication management is offered as needed.
Parenting Wisely (PW)
In addition to TAU services, the PW arm includes in-person sessions where parents complete computer-administered PW sessions, in-person session including therapist coaching to reinforce PW material and personalize treatment by applying PW skills to individual issues, and access to PW material remotely so parents can access information and skills from home as needed.
干预措施: Parenting Wisely (Behavioral)
结局指标
主要结局
Change in Evidence-Based Practice Attitude Scale
时间窗: Change from Baseline Evidence-Based Practice Attitude Scale at 3 months and 6 months
A 15 question reliable tool to evaluate the attitudes of providers who specialize in child and adolescent mental health toward Evidence Based Practice.
Change in Psychometric Analysis of the Perceptions of Computerized Therapy Questionnaire-Patient Version
时间窗: Change from Baseline Psychometric Analysis of the Perceptions of Computerized Therapy at 6 months
The PCTQ-P is an instrument for assessing consumers' perceptions of computer-based therapies that are distinguishable from traditional help-seeking attitudes. There are 35 items that can be divided in 6 sub-scales to measure subtle perceptions; relative advantage, compatibility, complexity, observability, trial-ability and future use intentions.
Consumer Satisfaction Questionnaire
时间窗: 3 months after start of intervention
The CSQ asks parents to rate their satisfaction with treatment delivery, their child's treatment progress, and their ability to manage their child's problems. Parents rate 11 items along a 7-point scale and answer 5 open-ended questions about their experience in treatment
Change in Psychometric Analysis of the Perceptions of Computerized Therapy Questionnaire- Clinician Version
时间窗: Change from Baseline Psychometric Analysis of the Perceptions of Computerized Therapy at 3 months and 6 months
an instrument for assessing clinicians' perceptions of computer-based therapies that are distinguishable from traditional help-seeking attitudes. There are 35 items that can be divided in 6 subscales to measure subtle perceptions; relative advantage, compatibility, complexity, observability, trial-ability and future use intentions.
Change in Perceived Characteristics of Intervention Scale
时间窗: Change from Baseline Perceived Characteristics of Intervention Scale at 3 months and 6 months
The PCIS is a 20 question reliable assessment measure of perceived characteristics of interventions, and will be specified towards the intervention, Parenting Wisely.
Change in Qualitative Interviews
时间窗: Change from Baseline Qualitative Interviews at 3 months and 6 months
Qualitative feedback from interviews with parents, providers, and program managers will also be conducted. All quaAlitative interviews will be videotaped, transcribed verbatim and coded for nonverbal behaviors in addition to verbal content. We will use an interview guide to ensure the adequacy and quality of data. The guide will be refined to reflect unanticipated topics that arise and integrate these emergent topics and questions\[40\]. We will approach the interview as a collaborative process with participants and interviewers will encourage each participant to talk freely about the therapeutic process, coverage of parenting skills, and topic areas in PW. Broad questions will be followed by probes and unstructured questions based on areas raised by participants to encourage elaboration and clarification but limit influence from the interviewer.
Change in Pediatric Symptom Checklist
时间窗: Change from Screening Pediatric Symptom Checklist at 3 months and 6 months
A well-known measure to help primary care providers assess the likelihood of finding any mental health disorder in their patient. The questionnaire consists of 17 items on behavior or emotional problems.
次要结局
- Parenting Self Efficacy(Baseline assessment, 3 months after start of intervention, 6 months after start of intervention)
- Parent Monitoring Questionnaire(Baseline assessment, 3 months after start of intervention, 6 months after start of intervention)
- Working Alliance Inventory(3 months after start of intervention.)
- McMaster Family Assessment Device(Baseline assessment, 3 months after start of intervention, 6 months after start of intervention)
- Issues Checklist(Baseline assessment, 3 months after start of intervention, 6 months after start of intervention)
- Child and Adolescent Services Assessment (CASA)(Baseline assessment, 3 months after start of intervention, 6 months after start of intervention)
- Parent-Adolescent Communication Scale(Baseline assessment, 3 months after start of intervention, 6 months after start of intervention)
- FAsTask Video Code(Baseline assessment, 3 months after start of intervention, 6 months after start of intervention)
- Disruptive Behavior Disorder Rating Scale(Baseline assessment, 3 months after start of intervention, 6 months after start of intervention)
研究者
Jennifer Wolff
Staff Psychologist
Rhode Island Hospital