No single approach has been shown to significantly enhance the delivery or outcomes of Behavioral Parent Training (BPT) programs for low-income families of youth with Disruptive Behavior Disorders (DBD), a group that is overrepresented in statistics on DBD. This grant, submitted in response to "Harnessing Advanced Health Technologies to Drive Mental Health Improvement (R01)" (RFA-MH-13-060), aims to replicate and extend pilot study (R34MH082956;Jones, PI) findings demonstrating the untapped potential for technology to influence service-delivery of one evidence-based BPT program, "Helping the Noncompliant Child" (HNC), to low-income families of youth with DBD. In order to replicate and extend the R34 pilot findings, we propose a sufficiently powered randomized control trial (RCT) comparing: 1). Technology-Enhanced HNC (TE-HNC) to 2). Standard HNC. All low-income families will receive the core intervention components of the HNC program, including active, directive skill-building and practice aimed at disrupting the coercive cycle of parent-child interactions associated with the onset, maintenance, and exacerbation of child noncompliance, aggression, and oppositional behavior that characterize DBD. In addition, one group will receive the technology- enhancements via smartphones, an ideal delivery vehicle given the increased access to, ownership, and cost- effectiveness of smartphones for low-income families. The study aims are to compare TE-HNC with HNC in: 1). increasing therapeutic gains in HNC on parenting and child behavior;2). increasing engagement of families in HNC services and generalization of HNC skills to the home;3). decreasing deterioration in HNC treatment gains over time;and 4). increasing efficiency and, in turn, incremental cost-effectiveness of HNC service delivery. Thus, while equating the core therapeutic content across treatment groups, we address the fundamental, unexamined question of whether technology has the potential to significantly improve upon the traditional BPT delivery system to better engage and impact low income families of youth with DBD. In order to address this question, we will replicate and extend our successful and promising R34 pilot RCT infrastructure to recruit 122 low-income families of children with DBD and we will follow each enrolled family for one year. The Data Monitoring Group (DMG) will monitor recruitment, treatment fidelity, assessments, and human subjects protections. The development of innovative, efficacious, and cost-effective approaches to improving BPT service delivery to low income families of youth with DBD has substantial personal, familial, and public health implications. The results from this trial have the potential to transform service delivery and outcomes for this vulnerable and underserved group.

Public Health Relevance

Technology has the potential to transform child mental health treatment. The proposed R01 aims to utilize smartphones to enhance service-delivery and outcomes in one area of children's mental health, Behavioral Parent Training (BPT) for low-income families of youth with Disruptive Behavior Disorders (DBD). However, it is critical to note that the smartphone-enhancements tested in this R01 could be replicated with other technology platforms, across the range of BPT programs, and in other areas of child mental health.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZMH1-ERB-I (01))
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Sherrill, Joel
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University of North Carolina Chapel Hill
Schools of Arts and Sciences
Chapel Hill
United States
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Jones, Deborah J (2014) Future directions in the design, development, and investigation of technology as a service delivery vehicle. J Clin Child Adolesc Psychol 43:128-42
Forehand, Rex; Lafko, Nicole; Parent, Justin et al. (2014) Is parenting the mediator of change in behavioral parent training for externalizing problems of youth? Clin Psychol Rev 34:608-19