Johns Hopkins School of Nursing, Baltimore, MD.
Kennedy-Krieger Institute, Baltimore.
J Am Acad Child Adolesc Psychiatry. 2019 Jun;58(6):572-581.e1. doi: 10.1016/j.jaac.2018.08.013. Epub 2018 Nov 12.
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.
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.
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).
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.
Early Parenting Intervention Comparison (EPIC); https://clinicaltrials.gov/; NCT01517867.
本实用、随机、非劣效试验比较了基于小组的家长管理训练与基于掌握的个体辅导家长管理训练在低收入、以非裔美国人为主的样本中的有效性和成本。
在一个城市自费儿童心理健康诊所寻求治疗其 2 至 5 岁儿童行为问题的父母，随机分配到芝加哥家长计划（CPP；n=81）或亲子互动治疗（PCIT；n=80）。同意是在诊所就诊和诊断评估后进行的，家长管理培训由在诊所工作的临床医生提供。主要结局指标是使用儿童行为检查表（CBCL）和每个参与者的平均治疗成本，在基线和干预后随访时评估儿童的外化行为问题。
对 158 位家长的数据进行了分析。大多数是母亲（75.9%）、非裔美国人（70.3%）和经济贫困者（98.7%的医疗补助保险）。儿童中，58.2%是男孩，平均年龄为 3.6 岁（SD=1.03）。根据 CBCL 评分，两种情况下的行为问题都有所改善（CPP 的 Cohen d=0.57，PCIT 的 Cohen d=0.50）。即使在控制治疗时间差异后（90%CI=-1.63 至 4.87），CPP 在随访时也不劣于 PCIT（90%CI=-1.58 至 4.22）。PCIT 的每个参与者的平均治疗费用较高（平均 2151 美元），而 CPP 的平均费用较低（平均 1413 美元，95%CI=-1304 至-170）。
对于生活在城市贫困中的幼儿父母来说，CPP 在减少儿童行为问题方面并不逊于 PCIT。CPP 完成所需的时间更短，成本也比 PCIT 低三分之一。
早期育儿干预比较（EPIC）；https://clinicaltrials.gov/；NCT01517867。
