Reducing Preschool Behavior Problems in an Urban Mental Health Clinic: A Pragmatic, Non-Inferiority Trial

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 58; no. 6; pp. 572 - 581.e1
• Main Authors: Gross, Deborah, Belcher, Harolyn M.E., Budhathoki, Chakra, Ofonedu, Mirian E., Dutrow, Daryl, Uveges, Melissa Kurtz, Slade, Eric
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2019; Elsevier BV
• Subjects: African Americans; Baltimore - epidemiology; Behavior problems; Behavior Rating Scales; Check Lists; Child & adolescent mental health; Child & adolescent psychiatry; Child Behavior; Child Behavior Checklist; Child Behavior Disorders - diagnosis; Child Behavior Disorders - economics; Child Behavior Disorders - ethnology; Child Behavior Disorders - therapy; Child, Preschool; Children; Children & youth; Coaching; Cost analysis; Cost-Benefit Analysis; Fee-for-Service Plans - economics; Female; Health Care Costs; Health services utilization; Help seeking behavior; Humans; Inferiority; Low income groups; low-income families; Male; Management Development; Management development programmes; Medicaid; Mental disorders; Mental Health; Mental Health Services - economics; Mothers; Outcome Measures; Parent management training; parent training; Parent-Child interaction therapy; Parent-Child Relations; Parenthood education; Parenting - ethnology; Parenting - psychology; Parents; Parents & parenting; Parents - education; Parents - psychology; Poverty - ethnology; Poverty - psychology; pragmatic trial; Pragmatics; preschool behavior problems; Program Evaluation; Semiotics; Urban poverty; Baltimore; parent training; low-income families; pragmatic trial; preschool behavior problems
• ISSN: 0890-8567; 1527-5418
• DOI: 10.1016/j.jaac.2018.08.013

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.
Clinical trial registration information: Early Parenting Intervention Comparison (EPIC); https://clinicaltrials.gov/; NCT01517867.