Policy makers, researchers, and clinicians agree that active parent involvement in treatment is critical to the effectiveness of child mental health services, in particular for children with disruptive behavior problems (DBPs). Parents often have difficulty attending and participating actively in treatment [labeled """"""""parent participatory engagement"""""""" (PPE)], and a lack of PPE is linked to poorer child outcomes. The NIMH Child &Adolescent Services Research Program emphasizes research on family engagement and usual care settings, and the recent NIMH Strategic Plan highlights the importance of developing interventions that focus on treatment adherence (Strategy 3.2). This Mentored Patient-Oriented Career Development (K23) award is designed to provide the applicant with knowledge, skills, and pilot data necessary to launch an independent program of research to increase PPE and improve the effectiveness of public sector child mental health care. Through the training activities, the applicant will: 1) obtain mastery of existing PPE research and methods to develop PPE interventions using stakeholder feedback;2) obtain training in a complementary set of transdisciplinary empirically-supported behavior change approaches selected to target PPE (social marketing/health communication, behavioral compliance and theory of planned behavior, Motivational Interviewing, patient activation);3) gain a rich understanding of challenges in addressing PPE in a culturally diverse population;and 4) acquire skills in qualitative methods and multilevel modeling. The applicant will also receive training in the ethical conduct of research. The research plan is organized into two phases implemented with the support of the training plan and a team of mentors, consultants, and clinician and parent contributors. First, a multi-component, multi-media resource toolkit intervention will be developed to promote PPE in the treatment of children with DBPs. The proposed toolkit includes three parent tools to encourage PPE, three clinician tools that complement the parent tools to promote PPE, and several clinician training resources to support PPE and use of toolkit materials. The toolkit will draw on the behavior change approaches from the applicant's training to target a set of overlapping parent cognitive barrier/facilitator factors (motivation, expectations, perceived barriers, empowerment) and quality of care factors (participation in treatment planning, opportunities for ongoing participation, parent-clinician alliance) that are proposed mechanisms of change for improving PPE. Second, the toolkit's potential effectiveness to change parent cognitive barrier/facilitator and quality of care factors, PPE behaviors (attendance, active participation in sessions, adherence to recommendations between sessions), and child/family outcomes will be assessed by a pilot randomized controlled trial comparing the toolkit to a control condition (n=40 families within 10 clinicians for each condition). Toolkit feasibility, acceptability, and fidelity will also be assessed. Data will be used to design a larger scale R01 to test the toolkit's impact on PPE and child/family outcomes in public mental health settings.

Public Health Relevance

The research conducted will develop a set of tools to increase parent participatory engagement (PPE) in child mental health treatment, which is critical for successful treatment of children with disruptive behavior problems. The training and research activities will ensure that the applicant creates a toolkit that is effective and acceptable to parents and clinicians, and will provide a foundation for further studies to promote PPE.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Application #
Study Section
Mental Health Services in Non-Specialty Settings (SRNS)
Program Officer
Hill, Lauren D
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San Diego State University
Schools of Arts and Sciences
San Diego
United States
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Martinez, Jonathan I; Haine-Schlagel, Rachel (2018) Observational Assessment of Engagement Strategies to Promote Parent Homework Planning in Community-Based Child Mental Health Treatment: A Pilot Study. J Child Fam Stud 27:1968-1980
Dickson, Kelsey S; Zeedyk, Sasha M; Martinez, Jonathan et al. (2017) Examining ethnic disparities in provider and parent in-session participation engagement. J Child Serv 12:47-58
Haine-Schlagel, Rachel; Mechammil, Molly; Brookman-Frazee, Lauren (2017) Stakeholder perspectives on a toolkit to enhance caregiver participation in community-based child mental health services. Psychol Serv 14:373-386
Stadnick, Nicole A; Haine-Schlagel, Rachel; Martinez, Jonathan I (2016) Using Observational Assessment to Help Identify Factors Associated with Parent Participation Engagement in Community-Based Child Mental Health Services. Child Youth Care Forum 45:745-758
Haine-Schlagel, Rachel; Roesch, Scott C; Trask, Emily V et al. (2016) The Parent Participation Engagement Measure (PPEM): Reliability and Validity in Child and Adolescent Community Mental Health Services. Adm Policy Ment Health 43:813-823
Haine-Schlagel, Rachel; Martinez, Jonathan I; Roesch, Scott C et al. (2016) Randomized Trial of the Parent And Caregiver Active Participation Toolkit for Child Mental Health Treatment. J Clin Child Adolesc Psychol :1-11
Haine-Schlagel, Rachel; Walsh, Natalia Escobar (2015) A review of parent participation engagement in child and family mental health treatment. Clin Child Fam Psychol Rev 18:133-50
Garland, Ann F; Accurso, Erin C; Haine-Schlagel, Rachel et al. (2014) Searching for elements of evidence-based practices in children's usual care and examining their impact. J Clin Child Adolesc Psychol 43:201-15
Haine-Schlagel, Rachel; Fettes, Danielle L; Garcia, Antonio R et al. (2014) Consistency with evidence-based treatments and perceived effectiveness of children's community-based care. Community Ment Health J 50:158-63
Fawley-King, Kya; Haine-Schlagel, Rachel; Trask, Emily V et al. (2013) Caregiver participation in community-based mental health services for children receiving outpatient care. J Behav Health Serv Res 40:180-90

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