TY - JOUR
T1 - Reducing Preschool Behavior Problems in an Urban Mental Health Clinic
T2 - A Pragmatic, Non-Inferiority Trial
AU - Gross, Deborah
AU - Belcher, Harolyn M.E.
AU - Budhathoki, Chakra
AU - Ofonedu, Mirian E.
AU - Dutrow, Daryl
AU - Uveges, Melissa Kurtz
AU - Slade, Eric
N1 - Funding Information:
This study was funded by a grant from the National Institute of Nursing Research (NINR) of the National Institutes of Health (NIH) under award R01 NR012444 . The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.
Funding Information:
Disclosure: Dr. Gross is entitled to revenue from sales of the Chicago Parent Program described in this article under an agreement with the Rush University Medical Center. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict-of-interest policies. This report has been reviewed for bias by an independent committee before submission to this journal. She has received funding from the Department of Education/Institute of Education Sciences and the NINR/NIH. Dr. Belcher has received funding from the Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation, and the Health Resources and Services Administration. Dr. Budhathoki has received funding support from the Cambia Health Foundation, the National Institute of Allergy and Infectious Diseases/NIH, and the Health Resources and Services Administration. Dr. Uveges has received funding from Sigma Theta Tau International, the Heilbrunn Family Foundation, the Eastern Nursing Research Society, and the Southern Nursing Research Society. Dr. Slade has received funding from the National Institute of Mental Health/NIH, the National Institute on Minority Health and Health Disparities/NIH, and the U.S. Department of Veterans Affairs. Dr. Ofonedu and Mr. Dutrow report no biomedical financial interests or potential conflicts of interest.
Funding Information:
This study was funded by a grant from the National Institute of Nursing Research (NINR) of the National Institutes of Health (NIH) under award R01 NR012444. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. This study was funded by a grant from the National Institute of Nursing Research (NINR) of the National Institutes of Health (NIH) under award R01 NR012444. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. Disclosure: Dr. Gross is entitled to revenue from sales of the Chicago Parent Program described in this article under an agreement with the Rush University Medical Center. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict-of-interest policies. This report has been reviewed for bias by an independent committee before submission to this journal. She has received funding from the Department of Education/Institute of Education Sciences and the NINR/NIH. Dr. Belcher has received funding from the Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation, and the Health Resources and Services Administration. Dr. Budhathoki has received funding support from the Cambia Health Foundation, the National Institute of Allergy and Infectious Diseases/NIH, and the Health Resources and Services Administration. Dr. Uveges has received funding from Sigma Theta Tau International, the Heilbrunn Family Foundation, the Eastern Nursing Research Society, and the Southern Nursing Research Society. Dr. Slade has received funding from the National Institute of Mental Health/NIH, the National Institute on Minority Health and Health Disparities/NIH, and the US Department of Veterans Affairs. Dr. Ofonedu and Mr. Dutrow report no biomedical financial interests or potential conflicts of interest.
Funding Information:
The authors gratefully acknowledge guidance from Walter Hauck, PhD, of Sycamore Consulting, on the non-inferiority design and analyses; Susan Breitenstein, PhD, RN, FAAN, of the Ohio State University, for her assistance with fidelity monitoring; the clinicians and families who participated in this study; and the members of the Data Safety and Monitoring Committee for their oversight and guidance: Louis Fogg, PhD, of Rush University College of Nursing; Laura Gitlin, PhD, of Drexel University College of Nursing and Health Professions; Joyce Harrison, MD, of Johns Hopkins School of Medicine; and Stacy Hodgkinson, PhD, of the Children’s National Medical Center. Dr. Slade gratefully acknowledges support from the University of Maryland Division of Psychiatric Services Research and the U.S. Department of Veterans Affairs VISN5 MIRECC in Baltimore.
Publisher Copyright:
© 2018 American Academy of Child and Adolescent Psychiatry
PY - 2019/6
Y1 - 2019/6
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). Conclusion: 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). Conclusion: 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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U2 - 10.1016/j.jaac.2018.08.013
DO - 10.1016/j.jaac.2018.08.013
M3 - Article
C2 - 30768419
AN - SCOPUS:85061438523
SN - 0890-8567
VL - 58
SP - 572-581.e1
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
IS - 6
ER -