Project Grant K23MH134189

STOP, FOCUS, PLAN, AND CHANGE: A TRANSLATIONAL APPROACH TO PREDICT PARENT AND CHILD RESPONSES TO A BRIEF, TELEHEALTH PARENT TRAINING - PROJECT SUMMARY / ABSTRACT THE PURPOSE OF THIS K23 MENTORED PATIENT-ORIENTED RESEARCH CAREER DEVELOPMENT AWARD IS TO PROVIDE THE APPLICANT WITH ADVANCED TRAINING TO LAUNCH AN INDEPENDENT RESEARCH PROGRAM FOCUSED ON IMPROVING THE EFFECTIVENESS OF PARENTING INTERVENTIONS FOR EARLY CHILDHOOD POPULATIONS. PARENTING INTERVENTIONS ARE THE FIRST LINE OF TREATMENT FOR EARLY CHILDHOOD MENTAL HEALTH CONCERNS DUE TO THEIR BENEFITS ON PARENTING STRESS AND PRACTICES AS WELL AS MOST CHILD EMOTIONAL AND BEHAVIORAL PROBLEMS. HOWEVER, PARENTING INTERVENTIONS HAVE SUBSTANTIAL ENGAGEMENT ISSUES, AND MANY CHILDREN SHOW LIMITED TO NO BENEFIT. THE OBJECTIVES OF THIS K23 ARE TO (A) IDENTIFY PREDICTORS OF SUBOPTIMAL RESPONSE TO A PARENTING INTERVENTION WITH WELL-ESTABLISHED EFFICACY (I.E., BEHAVIORAL PARENT TRAINING [BPT]) AND (B) TO IDENTIFY WAYS TO MODIFY PARENTING INTERVENTIONS TO BENEFIT THOSE PARENTS, GUIDED BY THEIR INPUT. THE CENTRAL HYPOTHESIS IS THAT GREATER PARENTAL EXECUTIVE FUNCTIONING (EF) DIFFICULTIES WILL BE LINKED TO MORE ADVERSE SOCIAL DETERMINANTS OF HEALTH (SDOHS), AND BOTH WILL DIMINISH PARENT AND CHILD RESPONSES TO A BRIEF PARENTING INTERVENTION DELIVERED THROUGH TELEHEALTH. PARENTS OF CHILDREN 3 TO 7 YEARS WITH EXTERNALIZING CONCERNS WILL BE RECRUITED FROM TWO SITES - A CHILDREN'S HOSPITAL AND A GROUP OF HEAD START PROGRAMS - TO RECEIVE BPT FROM TRAINED CLINICIANS. MULTIPLE METHODS WILL BE USED AT BASELINE TO MEASURE CANDIDATE PREDICTORS (I.E., PARENTAL EF, ADVERSE SDOHS) IN ECOLOGICALLY VALID WAYS. A MIXED METHODS APPROACH WILL INTEGRATE QUALITATIVE AND QUANTITATIVE RESULTS AND GUIDE IDENTIFICATION OF POTENTIAL ADAPTATIONS TO PARENTING INTERVENTIONS NEEDED TO ACHIEVE THEIR INTENDED BENEFITS. THE RESEARCH PROJECT AIMS TO (1) DEVELOP AND TEST AN ECOLOGICALLY VALID MEASURE OF PARENTAL EF DURING PARENT-CHILD INTERACTIONS, (2) CHARACTERIZE THE ROLES THAT PARENTAL EF AND SDOH HAVE ON TREATMENT RESPONSE FOR PARENT (I.E., PARENTING STRESS, HARSH PARENTING) AND CHILD OUTCOMES (I.E., EXTERNALIZING CONCERNS), AND (3) IDENTIFY POTENTIAL ADAPTATIONS TO IMPROVE INTERVENTION EFFECTS AMONG NON- RESPONDERS. UNDER THE MENTORSHIP OF A HIGH-QUALITY TEAM INCLUDING DRS. LAURA ANTHONY, TINA STUDTS, AND SUSAN MIKULICH, THE APPLICANT WILL ACQUIRE ADVANCED TRAINING IN THE FOLLOWING AREAS: 1) ACQUIRE SKILLS IN DEVELOPING AND ADAPTING REAL-WORLD MEASURES TO USE IN CLINICAL TRIALS, 2) ADVANCE KNOWLEDGE OF HOW SDOHS INFLUENCE PARENTING INTERVENTIONS, 3) GAIN COMPETENCIES IN MIXED METHODS RESEARCH, AND 4) LEARN CLINICAL TRIAL METHODOLOGIES. THIS PROJECT AND TRAINING WILL ENABLE THE PI TO BECOME AN INDEPENDENT SCIENTIST FOCUSED ON DISCOVERING WAYS TO IMPROVE THE EFFECTIVENESS OF PARENTING INTERVENTIONS. THE PROPOSED TRAINING PLAN AND RESEARCH AIMS WILL PROVIDE THE PI A FOUNDATION TO CONDUCT A LARGE-SCALE TRIAL (R01) TESTING IF TAILORING DELIVERY METHODS (E.G., INDIVIDUAL OR GROUP FORMAT; IN-PERSON OR TELEHEALTH SETTING), DOSE (E.G., LENGTHEN SESSIONS), OR CONTENT (E.G., TARGET PARENTAL EF) IMPROVES THE EFFECTIVENESS OF PARENTING INTERVENTIONS FOR NON-RESPONDERS. FINDINGS WILL HAVE SIGNIFICANT IMPLICATIONS FOR INTERVENTIONS THAT INVOLVE PARENTS WHILE TREATING YOUTH MENTAL HEALTH CONCERNS.