Deborah Jean Jones - US grants

Adolescent exposure to violence, either as a witness or victim, is increasingly common and associated with a wide range of negative outcomes for youth, including increased likelihood of engaging in HIV/AIDS risk behaviors, such as low rates of condom use, having sex with multiple partners, and engaging in sexual behaviors while under the influence of alcohol or other substances. The public health importance of research to date on violence exposure and HIV/AIDS risk behaviors should not be minimized; however, several methodologicallimitations of this research, most notably the reliance on retrospective, cross- sectional, or short-term longitudinal designs, as well as the narrow focus on only one type of violence exposure or one HIV/AIDS risk behavior, significantly limit the policy implications of this work for HIV/AIDS prevention efforts. Utilizing advances in quantitative methods, in combination with the methodological rigor of the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a set of collaborating child abuse and neglect projects following 1,354 children in 5 locations acrossthe United States, the proposed K01 project aims to examine different developmental trajectories of violence exposure among maltreated youth, the extent to which specific trajectories better predict levels of involvement in HIV/AIDS risk behaviors in adolescence, and the role of contextual variables in moderating these trajectories. In turn, findings from the proposed analyses,as well as feedback from families of youth at-risk for violence exposure and the practitioners who serve them, will inform the development of a manualized HIV/AIDS prevention program targeting families of youth at high-risk for cumulative and chronic exposure to violence. The prevention program and associated manual will serve as the foundation for a subsequent grant application which will aim to pilot test the efficacy of the prevention program in a randomized clinical trial. Consistent with Health Protection Goals outlined by the Centers for Disease Control and Prevention, the research plan, training activities, and mentorship afforded by this K01 will increase the number of adolescents who are prepared to be healthy, safe, independent and productive members of society by addressing two major public issues of relevance for adolescent children, the rising rates of youth violence exposure in the U.S. and the associated risk for engaging in behaviors linked with the transmission of HIV/AIDS.

DESCRIPTION (provided by applicant): Low-income youth are overrepresented in the statistics on early onset oppositional defiant disorder (ODD) and conduct disorder (CD);however, low-income parents are least likely to engage in or be retained in the evidence-based behavioral parent training programs, which have proven to disrupt the escalation of ODD and CD behaviors. Consistent with Program Announcement (PAR-06-248), "From Intervention Development to Services: Exploratory Research Grants," this R34 project aims to develop and pilot-test use of Smartphone technology to enhance the engagement and retention of low-income parents of children (3 to 8 years old) with ODD and early CD behaviors in one evidence-based parent training program, Helping the Noncompliant Child (HNC;McMahon &Forehand, 2003). The Smartphone-enhanced HNC treatment program will be developed, and then tested in a pilot controlled trial in order to examine feasibility, cost-effectiveness, and consumer satisfaction, as well as trends in engagement and retention of parents and changes in parent and child behavior. Given that the early onset of ODD and CD behavior is the single most important predictor of delinquency, substance abuse, and violence for boys and girls in adolescence, the development of novel approaches to engage and retain low-income parents in evidence-based parent training programs is of critical public health importance.

DESCRIPTION (provided by applicant): 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.

Project Summary The eight-million (16%) U.S. children who have a Behavior Disorder (BD), as well as the ten-fold increase in education, health care, and criminal justice costs associated with BDs, highlight the critical role of early intervention. Yet, there is variability in the potency and efficiency of Behavioral Parent Training (BPT) for early- onset (3 to 8 y.o.) BDs, suggesting the likelihood of a yet to be identified causal mechanism underlying treatment process and outcomes. One likely candidate, emotion regulation (ER), has been implicated in a broad range of adult and child outcomes, including early-onset BDs. For example, parental difficulties with ER, as well as difficulties helping children to navigate and regulate emotion, are linked to the etiology, maintenance, and severity of early-onset BDs. Preliminary data suggest that interpersonal ER processes may also underlie variability in the potency and efficiency of BPT for families of children with early-onset BDs. As such, this NIMH Exploratory and Developmental Research Grant (Parent R21) aims to further explore the interrelationship of interpersonal ER processes as a causal mechanism for BPT outcomes via the following aims: 1). Describe the dynamic nature of ER processes in families of children with early-onset BDs. 2). Examine the interrelationship of general ER, moment-by-moment ER in the parent-child context, and BPT potency and efficiency; and 3). Use exploratory findings to inform the development and testing of personalized BPT approaches based on the interrelationship of general ER, moment-by-moment ER in the parent-child context, and BPT potency and efficiency.