Department of Family Social Science & Institute of Child Development, University of Minnesota, 290 McNeal Hall, 1985 Buford Ave, St. Paul, MN, 55108, USA.
Department of Psychiatry, University of Minnesota, 2312 S 6th St. Minneapolis, St. Paul, MN, 55454, USA.
Prev Sci. 2019 Jan;20(1):78-88. doi: 10.1007/s11121-018-0865-x.
Empowering consumers to be active decision-makers in their own care is a core tenet of personalized, or precision medicine. Nonetheless, there is a dearth of research on intervention preferences in families seeking interventions for a child with behavior problems. Specifically, the evidence is inconclusive as to whether providing parents with choice of intervention improves child/youth outcomes (i.e., reduces externalizing problems). In this study, 129 families presenting to community mental health clinics for child conduct problems were enrolled in a doubly randomized preference study and initially randomized to choice or no-choice conditions. Families assigned to the choice condition were offered their choice of intervention from among three different formats of the Parent Management Training-Oregon Model/PMTO (group, individual clinic, home based) and services-as-usual (child-focused therapy). Those assigned to the no-choice condition were again randomized, to one of the four intervention conditions. Intent-to-treat analyses revealed partial support for the effect of parental choice on child intervention outcomes. Assignment to the choice condition predicted teacher-reported improved child hyperactivity/inattention outcomes at 6 months post-treatment completion. No main effect of choice on parent reported child outcomes was found. Moderation analyses indicated that among parents who selected PMTO, teacher report of hyperactivity/inattention was significantly improved compared with parents selecting SAU, and compared with those assigned to PMTO within the no-choice condition. Contrary to hypotheses, teacher report of hyperactivity/inattention was also significantly improved for families assigned to SAU within the no-choice condition, indicating that within the no-choice condition, SAU outperformed the parenting interventions. Implications for prevention research are discussed.
赋予消费者在自身护理方面积极决策的权力是个性化或精准医学的核心原则。然而，针对寻求干预儿童行为问题的家庭的干预偏好研究却很少。具体来说，关于提供父母干预选择是否能改善儿童/青少年的结果（即减少外化问题）的证据尚无定论。在这项研究中，129 个家庭因儿童行为问题到社区心理健康诊所就诊，他们参加了一项双重随机偏好研究，并最初随机分为选择或无选择条件。被分配到选择条件的家庭可以从三种不同形式的父母管理培训-俄勒冈模式/PMTO（小组、个体诊所、家庭）和常规服务中选择干预措施（以儿童为中心的治疗）。被分配到无选择条件的家庭再次随机分配到四个干预条件之一。意向治疗分析显示，父母选择对儿童干预结果的影响有一定的支持。选择条件的分配预测了教师报告的治疗完成后 6 个月儿童多动/注意力不集中结果的改善。未发现选择对父母报告的儿童结果的主要影响。调节分析表明，在选择 PMTO 的父母中，与选择常规服务的父母相比，教师报告的多动/注意力不集中显著改善，与无选择条件下分配到 PMTO 的父母相比也显著改善。与假设相反，在无选择条件下分配到常规服务的家庭中，教师报告的多动/注意力不集中也显著改善，这表明在无选择条件下，常规服务优于父母干预。讨论了对预防研究的影响。
