Multi-court Trial of NBP to Prevent Substance Abuse and Mental Health Disorders (MTC)
Condition: Divorce; Drug Abuse; Mental Health Disorder
MeSH terms: Substance-Related Disorders; Mental Disorders
Study type: Interventional

Summary: 
      This application requests funding to conduct a randomized effectiveness trial of The New
      Beginnings Program (NBP) delivered through a partnership of domestic relations courts,
      community service providers and the NBP research team. This is the first attempt to offer the
      population of families seeking divorce an evidence-based prevention program shown to have
      long-term effects on youth problem outcomes. It is estimated that over a third of U.S.
      children experience parental divorce, which confers elevated risk for multiple problems in
      childhood and adulthood including substance use and abuse, smoking, mental health problems,
      high risk sexual behavior, and physical health problems. Efficacy trials of the NBP found
      positive effects at post-test, 6-year and 15-year follow-ups. For example, at 6-year
      follow-up the participation in NBP led to reductions in marijuana, drug and alcohol use and a
      37% reduction in prevalence of diagnosed mental disorder; and reductions in externalizing
      problems, internalizing problems and high risk sexual behavior. Positive effects also
      occurred for grade point average (GPA) and self esteem. For many of the effects of the NBP,
      the effects were stronger for youth who were at higher risk at program entry. Many of the
      program effects were mediated through the program effects to strengthen parenting. Funded by
      an Advanced Center for Intervention and Services Research grant (NIMH P30 MH068685) the
      investigators modified the NBP to translate it from a prototype tested in efficacy trials
      into a program that can be effectively delivered by community service providers and one that
      is appropriate across diverse cultural groups, and fathers as well as mothers. Pilot testing
      of the modified NBP and training and monitoring systems has demonstrated that they are highly
      acceptable to parents and providers. The investigators also developed and experimentally
      tested a system of parent recruitment that was found to be effective in getting parents to
      enroll (sign up to participate) in the NBP but, similar to other prevention parenting
      programs, initiation (attendance at one or more sessions) in the NBP in the pilot was low.
    

Detailed description: 
      SPECIFIC AIMS This application requests funding to conduct a randomized effectiveness trial
      of The New Beginnings Program (NBP), a prevention program for divorced families, as delivered
      through a partnership of domestic relations courts, community service providers and the NBP
      research team. This partnership would be the first systematic attempt to offer the population
      of families seeking divorce an evidence-based prevention program shown to have long-term
      effects to reduce youth problem outcomes. It is estimated that over a third of U.S. children
      experience parental divorce which confers elevated risk for multiple problems in childhood,
      adolescence and adulthood including substance use and abuse, cigarette smoking, mental health
      problems, high risk sexual behavior, and physical health problems. When evaluated in efficacy
      trials, the NBP has been shown to have positive program effects at post-test, 6-year and
      15-year follow-ups. For example, at 6-year follow-up the participation in NBP led to
      reductions in marijuana, drug and alcohol use; a 37% reduction in prevalence of diagnosed
      mental disorder; and reductions in externalizing problems, internalizing problems and high
      risk sexual behavior. Positive program effects also occurred for grade point average (GPA)
      and self esteem. For many of the short- and long-term effects of the NBP, the effects were
      stronger for youth who were at higher risk at program entry. Mediational analyses have shown
      that program effects on short-term and 6-year youth outcomes were mediated through the
      program effects to strengthen parenting. Funded by an Advanced Center for Intervention and
      Services Research grant (NIMH P30 MH068685) the investigators modified the NBP to translate
      it from a prototype tested in efficacy trials into a program that can be effectively
      delivered by community service providers and one that is appropriate for diverse cultural
      groups, a broad age range of youth, and fathers as well as mothers. The investigators also
      revised the methods for training, technical assistance and ongoing monitoring of
      implementation. Pilot testing of the modified NBP and training and monitoring systems has
      demonstrated that they are highly acceptable to parents and providers. The investigators also
      developed and experimentally tested a system of parent recruitment that builds on an
      infrastructure that exists in domestic relations courts in 46 states. This strategy was
      effective in getting parents to enroll (sign up to participate) in the NBP but, similar to
      other prevention parenting programs, initiation (attendance at one or more sessions) in the
      NBP in the pilot was low.

      The Specific Aims are to:

        1. Examine whether 1380 children in 920 divorcing families randomly assigned to the NBP or
           workshop controls, show greater improvement when assigned to the NBP on measures of
           positive parenting, youth substance use and mental health problems compared to controls.
           Assessments will occur at pre-test, post-test and 6-month follow-up. The study will also
           test whether program effects on youth outcomes at the 6-month follow-up are mediated by
           program-induced effects on positive parenting at post-test. This will be the first
           experimental evaluation of the effectiveness of an evidence-based parenting program to
           prevent substance use and mental health problems of youth from divorcing families when
           delivered through a partnership of the courts and community service providers.

        2. Test whether the effects of the NBP are moderated by level of child risk at program
           entry, youth age, parent gender or parent's ethnicity [i.e., Mexican American (MA) vs.
           non-Hispanic Caucasians (NHW)]. Based on previous trials of the NBP, a significant
           program x baseline risk interaction is predicted with stronger program effects expected
           at higher levels of child risk. Because the program was modified and pilot tested to
           make it appropriate across ethnic groups, parent gender, and age of child, testing the
           interaction effect for these three variables is viewed as exploratory and no significant
           interactions are predicted.

        3. Examine whether variability in implementation accounts for variability in parenting and
           youth outcomes. Multiple dimensions of implementation that have been found to relate to
           outcomes of prevention parenting programs will be measured (e.g., fidelity, group leader
           process quality, additive adaptation, participant responsiveness) and their unique
           contribution to program effects will be assessed. The investigators will also test
           whether gender or ethnicity moderate the relations between each dimension of
           implementation and outcomes.

        4. Experimentally test whether a brief telephone engagement interview increases initiation
           (i.e. attending at least one session) relative to a standard informational contact. The
           effect of the engagement interview will be tested for the overall sample, and separately
           for males and females, and MA and NHW.

      The results of this study have significant public health implications to reduce substance
      abuse and mental health problems of youth who experience parental divorce, a highly prevalent
      stressful event. Further, the proposed study addresses three issues that have substantial
      implications for the effectiveness of parent-focused preventive interventions: subgroup
      differences in program benefits, relations of dimensions of implementation to outcomes and
      engagement of parents in evidence-based parenting programs.
    

Intervention name(s): New Beginnings Program
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention