Measuring change in parenting programs

Participants are parents of children aged between 3 and 9 years 11 months of age who are referred (or self-refer) to the Sydney Child Behaviour Research Clinic, and would like assistance managing child disruptive behaviour. The aim of this study is to conduct a RCT of Measurement-Based Care (MBC; Session-by-session measures plus feedback to parents and clinicians – the intervention group) versus Measurement as Usual (MAU; measures completed pre, post and three-month follow-up – the comparator arm) for improving symptoms of child disruptive behaviour disorders (DBDs) and parent engagement in a behavioural parent training (BPT) intervention provided via telehealth. Participants who meet inclusion criteria will complete a baseline assessment, which will involve completing online questionnaires and a diagnostic interview with a clinician. Once baseline assessment has been completed, participants will be randomly allocated to the MBC or MAU groups. All families will complete an 8-10 session individually-tailored BPT program. The BPT intervention is Integrated Family Intervention for Child Conduct Problems (Dadds & Hawes, 2006), a program consisting of 8 to 10 weekly 1 hour treatment sessions focusing on managing child aggression, non-compliance and disruptive behaviour. Parents are empowered to strengthen and develop strategies that encourage positive child behaviour by giving attachment rich positive reinforcement and rewards, and discourage challenging behaviour through the provision of consistent, attachment and emotionally neutral behaviour management strategies. The program also includes modules that address parental mental health, partner support and family communication. It can be individually tailored by adjusting the pace of the intervention depending on rate of change during the program, targeting specific goals for families, covering module content that is relevant for the family (e.g., partner support only for two-parent families). The program will be individual tailored based on clinical formulation and progress during the parenting intervention. Parenting skills will be taught through active skills training via modelling, rehearsal and feedback. For two parent families, both parents (or other key caregivers) are encouraged to attend and participate in all sessions. Families randomly allocated to the MBC group will complete brief session-by-session measures on child symptoms, functioning, goal attainment, implementation of parenting strategies and therapeutic alliance. These measures will be completed via the NovoPsych platform (novopsych.com.au). The MBC measures are automatically scored with feedback provided to the treating psychologist, who will in turn, share this feedback with the participating parents in order to facilitate tracking of progress in treatment and to prompt collaborative decision making. All but one of the session-by-session measures are completed before the session, with clinicians providing an email reminder to participants. The measure of therapeutic alliance is completed at the end of the session. Participants randomly allocated to the MAU group will not complete these session-by-session measures, but families in both MBC and MAU groups will complete diagnostic and questionnaire measures at pre-, post- and three-month follow-up. The diagnostic and questionnaire measures completed at pre-, post- and three-month follow-up in both groups are different from the session-by-session measures completed in the MBC group, with the exception of one measure, the Pediatric Symptom Checklist-17, which is completed as both a session-by-session measure for the MBC group and as an outcome measure at pre-, post- and three-month follow-up for both groups. To assess intervention adherence, each session will be video-recorded and coded for adherence to the MBC and MAU groups (time spent providing feedback, discussing progress etc). Clinicians will also complete session-by-session measures to indicate whether they shared feedback and discussed progress with the family.