Advancing Child Competencies by Extending Supported Services (ACCESS) for Families Program
Condition: Developmental Delay; Disruptive Behavior
MeSH terms: Problem Behavior
Study type: Interventional

Summary: 
      The Advancing Child Competencies by Extending Supported Services (ACCESS) for Families
      Program is a study funded by the National Institutes of Health to explore behavior and
      developmental problems among young children aging out of Early Steps (Part C). All families
      will participate in five evaluations in their home to learn more about their child's behavior
      and development. Families also may receive treatment designed to help change their child's
      behaviors that will be conducted over the Internet using a tablet.
    

Detailed description: 
      The proposed study will evaluate, via a randomized controlled trial, the incremental utility
      of I-PCIT for disruptive behavioral problems in traditionally underserved young children with
      developmental delay (DD) from predominantly economically disadvantaged and ethnic and racial
      minority backgrounds. Specifically, the investigators are interested in the impact of I-PCIT
      on child disruptive behavior problems, parenting practices, parental distress, and
      pre-academic skills relative to traditional referrals as usual (RAU) among youth aging out of
      Part C EI services and transitioning from home-based family services to school-based special
      education services. A secondary goal is to evaluate potential moderators and mediators that
      explain under which circumstances, for whom, and through which pathways I-PCIT is most
      effective for young children with DD. Our primary aims are (1) to evaluate the immediate and
      one-year impact of I-PCIT on (1a) disruptive behavior problems in young children with DD, as
      well as (1b) parenting practices and (1c) parental distress in parents of young children with
      DD; (2) to evaluate the impact of I-PCIT on pre-academic skills among young children with DD;
      and (3) to evaluate (3a) family retention, (3b) engagement, and (3c) satisfaction associated
      with I-PCIT in young children with DD. Our secondary aim is to examine potential moderators
      and mediators of response to I-PCIT for disruptive behavior problems in young children with
      DD. Specifically, the investigators are interested in the extent to which technological
      literacy and access (4a) moderate I-PCIT efficacy, such that I-PCIT efficacy will be weaker
      among families with poorer technological literacy and/or access, and the extent to which
      traditional barriers to care (4b) moderate I-PCIT efficacy, such that the incremental
      efficacy of I-PCIT over RAU will be strongest among families with geographic, transportation
      and/or childcare obstacles to in-person services. Finally, the investigators hypothesize that
      I-PCIT will yield changes in child behavior and pre-academic skills indirectly through direct
      effects on parenting practices (4c). Specifically, changes in parental consistency, warmth,
      follow-through, and effective discipline will mediate observed I-PCIT efficacy, such that
      these treatment-related parenting changes will account for observed differences in child
      disruptive behavior problems and pre-academic skills.
    

Intervention name(s): Internet-delivered Parent-Child Interaction Therapy (I-PCIT); Referrals as Usual (RAU)
Intervention type(s): Behavioral; Other
Intervention description(s): Families assigned to the Internet-delivered Parent-Child Interaction Therapy (I-PCIT) group will receive Internet-delivered weekly sessions of a short-term parent-training intervention emphasizing positive attention, consistency, problem-solving, and communication. Using videoconferencing, webcams, and wireless Bluetooth earpieces, I-PCIT therapists provide in-the-moment feedback to parents during live parent-child interactions.; Families assigned to RAU will participate in services referred by their Early Steps team, as per usual care.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized control trial in which participants are randomly assigned to either receive Internet-delivered Parent-Child Interaction Therapy (I-PCIT) or referrals as usual (RAU).
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Preschoolers; Developmental Delay; Disruptive Behavior; Early Intervention; Parent-Child Interaction Therapy (PCIT); Telehealth; Telemental Health; Telepsychiatry