Parenting Clinical Trial
Official title:
Integrating Computer-Assisted Parent Training Therapy Into Community Mental Health Clinic Practice
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.
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.
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