Reducing Preschool Behavior Problems in an Urban Mental Health Clinic: A Pragmatic, Non-Inferiority Trial

Deborah Ann Gross, Harolyn M Edith Belcher, Chakra B. Budhathoki, Mirian E. Ofonedu, Daryl Dutrow, Melissa Kurtz Uveges, Eric Slade

Research output: Contribution to journalArticle

Abstract

Objective: This pragmatic, randomized, non-inferiority trial compared the effectiveness and cost of group-based parent management training with mastery-based individual coaching parent management training in a low-income, predominantly African-American sample. Method: Parents seeking treatment for their 2- to 5-year-old children's behavior problems in an urban fee-for-service child mental health clinic were randomized to the Chicago Parent Program (CPP; n = 81) or Parent–Child Interaction Therapy (PCIT; n = 80). Consent followed clinic intake and diagnostic assessment and parent management training was delivered by clinicians employed at the clinic. Primary outcome measures were externalizing child behavior problems, assessed at baseline and postintervention follow-up, using the Child Behavior Checklist (CBCL) and average per-participant treatment cost. Results: Data from 158 parents were analyzed. Most were mothers (75.9%), African American (70.3%), and economically disadvantaged (98.7% Medicaid insured). Of children, 58.2% were boys, and mean age was 3.6 years (SD 1.03). Based on CBCL scores, behavior problems improved in the 2 conditions (Cohen d = 0.57 for CPP and 0.50 for PCIT). CPP was not inferior to PCIT (90% CI −1.58 to 4.22) at follow-up, even after controlling for differences in treatment length (90% CI −1.63 to 4.87). Average per-participant treatment cost was higher for PCIT (mean $2,151) than for CPP (mean $1,413, 95% CI −1,304 to −170). Conclusions: For parents of young children living in urban poverty, CPP is not inferior to PCIT for decreasing child behavior problems. CPP requires less time to complete and costs a third less than PCIT. Clinical trial registration information: Early Parenting Intervention Comparison (EPIC). https://clinicaltrials.gov/; NCT01517867.

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Urban Health
Child Behavior
Mental Health
Parents
Checklist
African Americans
Health Care Costs
Fee-for-Service Plans
Parenting
Medicaid
Vulnerable Populations
Poverty
Cost-Benefit Analysis
Problem Behavior
3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid
Therapeutics
Mothers
Outcome Assessment (Health Care)
Clinical Trials
Costs and Cost Analysis

Keywords

  • low-income families
  • parent training
  • pragmatic trial
  • preschool behavior problems

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

Cite this

@article{8b5f7026ff0d44369ea4bdc82f21cc69,
title = "Reducing Preschool Behavior Problems in an Urban Mental Health Clinic: A Pragmatic, Non-Inferiority Trial",
abstract = "Objective: This pragmatic, randomized, non-inferiority trial compared the effectiveness and cost of group-based parent management training with mastery-based individual coaching parent management training in a low-income, predominantly African-American sample. Method: Parents seeking treatment for their 2- to 5-year-old children's behavior problems in an urban fee-for-service child mental health clinic were randomized to the Chicago Parent Program (CPP; n = 81) or Parent–Child Interaction Therapy (PCIT; n = 80). Consent followed clinic intake and diagnostic assessment and parent management training was delivered by clinicians employed at the clinic. Primary outcome measures were externalizing child behavior problems, assessed at baseline and postintervention follow-up, using the Child Behavior Checklist (CBCL) and average per-participant treatment cost. Results: Data from 158 parents were analyzed. Most were mothers (75.9{\%}), African American (70.3{\%}), and economically disadvantaged (98.7{\%} Medicaid insured). Of children, 58.2{\%} were boys, and mean age was 3.6 years (SD 1.03). Based on CBCL scores, behavior problems improved in the 2 conditions (Cohen d = 0.57 for CPP and 0.50 for PCIT). CPP was not inferior to PCIT (90{\%} CI −1.58 to 4.22) at follow-up, even after controlling for differences in treatment length (90{\%} CI −1.63 to 4.87). Average per-participant treatment cost was higher for PCIT (mean $2,151) than for CPP (mean $1,413, 95{\%} CI −1,304 to −170). Conclusions: For parents of young children living in urban poverty, CPP is not inferior to PCIT for decreasing child behavior problems. CPP requires less time to complete and costs a third less than PCIT. Clinical trial registration information: Early Parenting Intervention Comparison (EPIC). https://clinicaltrials.gov/; NCT01517867.",
keywords = "low-income families, parent training, pragmatic trial, preschool behavior problems",
author = "Gross, {Deborah Ann} and Belcher, {Harolyn M Edith} and Budhathoki, {Chakra B.} and Ofonedu, {Mirian E.} and Daryl Dutrow and Uveges, {Melissa Kurtz} and Eric Slade",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jaac.2018.08.013",
language = "English (US)",
journal = "Journal of the American Academy of Child and Adolescent Psychiatry",
issn = "0890-8567",
publisher = "Elsevier Limited",

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TY - JOUR

T1 - Reducing Preschool Behavior Problems in an Urban Mental Health Clinic

T2 - A Pragmatic, Non-Inferiority Trial

AU - Gross, Deborah Ann

AU - Belcher, Harolyn M Edith

AU - Budhathoki, Chakra B.

AU - Ofonedu, Mirian E.

AU - Dutrow, Daryl

AU - Uveges, Melissa Kurtz

AU - Slade, Eric

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: This pragmatic, randomized, non-inferiority trial compared the effectiveness and cost of group-based parent management training with mastery-based individual coaching parent management training in a low-income, predominantly African-American sample. Method: Parents seeking treatment for their 2- to 5-year-old children's behavior problems in an urban fee-for-service child mental health clinic were randomized to the Chicago Parent Program (CPP; n = 81) or Parent–Child Interaction Therapy (PCIT; n = 80). Consent followed clinic intake and diagnostic assessment and parent management training was delivered by clinicians employed at the clinic. Primary outcome measures were externalizing child behavior problems, assessed at baseline and postintervention follow-up, using the Child Behavior Checklist (CBCL) and average per-participant treatment cost. Results: Data from 158 parents were analyzed. Most were mothers (75.9%), African American (70.3%), and economically disadvantaged (98.7% Medicaid insured). Of children, 58.2% were boys, and mean age was 3.6 years (SD 1.03). Based on CBCL scores, behavior problems improved in the 2 conditions (Cohen d = 0.57 for CPP and 0.50 for PCIT). CPP was not inferior to PCIT (90% CI −1.58 to 4.22) at follow-up, even after controlling for differences in treatment length (90% CI −1.63 to 4.87). Average per-participant treatment cost was higher for PCIT (mean $2,151) than for CPP (mean $1,413, 95% CI −1,304 to −170). Conclusions: For parents of young children living in urban poverty, CPP is not inferior to PCIT for decreasing child behavior problems. CPP requires less time to complete and costs a third less than PCIT. Clinical trial registration information: Early Parenting Intervention Comparison (EPIC). https://clinicaltrials.gov/; NCT01517867.

AB - Objective: This pragmatic, randomized, non-inferiority trial compared the effectiveness and cost of group-based parent management training with mastery-based individual coaching parent management training in a low-income, predominantly African-American sample. Method: Parents seeking treatment for their 2- to 5-year-old children's behavior problems in an urban fee-for-service child mental health clinic were randomized to the Chicago Parent Program (CPP; n = 81) or Parent–Child Interaction Therapy (PCIT; n = 80). Consent followed clinic intake and diagnostic assessment and parent management training was delivered by clinicians employed at the clinic. Primary outcome measures were externalizing child behavior problems, assessed at baseline and postintervention follow-up, using the Child Behavior Checklist (CBCL) and average per-participant treatment cost. Results: Data from 158 parents were analyzed. Most were mothers (75.9%), African American (70.3%), and economically disadvantaged (98.7% Medicaid insured). Of children, 58.2% were boys, and mean age was 3.6 years (SD 1.03). Based on CBCL scores, behavior problems improved in the 2 conditions (Cohen d = 0.57 for CPP and 0.50 for PCIT). CPP was not inferior to PCIT (90% CI −1.58 to 4.22) at follow-up, even after controlling for differences in treatment length (90% CI −1.63 to 4.87). Average per-participant treatment cost was higher for PCIT (mean $2,151) than for CPP (mean $1,413, 95% CI −1,304 to −170). Conclusions: For parents of young children living in urban poverty, CPP is not inferior to PCIT for decreasing child behavior problems. CPP requires less time to complete and costs a third less than PCIT. Clinical trial registration information: Early Parenting Intervention Comparison (EPIC). https://clinicaltrials.gov/; NCT01517867.

KW - low-income families

KW - parent training

KW - pragmatic trial

KW - preschool behavior problems

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