A pilot test of a brief eHealth parent-focused prevention intervention with parents referred from primary care clinics

ABSTRACT Evidence-based parent-focused prevention programs prevent future mental illness but are not widely available nor well-attended. To address this this critical gap, research must test more accessible delivery strategies. Thus, the long-term goal of this study is to prevent significant behavioral health problems by increasing the reach and accessibility of an evidence-based parenting program, GenerationPMTO (GenPMTO). GenPMTO has been rigorously tested with in-person delivery; however, logistical barriers like a large time-commitment and the need for childcare limit engagement in in-person parenting programs. Delivering programs online (i.e., eHealth) can overcome these barriers, increasing feasibility for parents. To increase reach, these programs must be paired with frequently-accessed service settings. Primary care clinics are frequently accessed and trusted settings; however, primary care personnel are not trained to address behavioral health or parenting topics and pediatric referrals are often not made or completed. To integrate parenting programs with primary care, training for primary care personnel and a well-defined referral process are needed. Therefore, this study has two objectives: In chronological order, the first objective is to develop (Aim 1) and pilot test (Aim 2) a referral process and a brief communication skills training for primary care providers to equip them to effectively refer parents to eHealth GenPMTO, thereby increasing reach. Aim 1 uses an expert consensus method to develop a feasible training and referral process. Aim 2 is a test of the acceptability of the referral process and a pilot test of the training; primary care personnel (n=35) will be randomized to receive the training or a control condition in which they receive written information about referring parents to GenPMTO therapists. Acceptability, appropriateness, and feasibility of the training and referral process will be evaluated through a mixed methods approach. The collaborating clinics in this study are part of a Federally Qualified Health Center, facilitating reach within an under-served population of parents. The second objective of the study is to pilot test the effectiveness of brief eHealth GenPMTO (Aim 3) within a primary-care-referred population. Although GenPMTO has been rigorously tested, a brief eHealth version has not been tested, nor has GenPMTO been examined for effectiveness among a primary care population. In Aim 3, n=60 parents referred by their primary care provider (which occurs in Aim 2) will be assigned to GenPMTO or a single-session control condition in which they are directed to existing parenting resources. Parents of 3-5-year-old children with moderate behavioral concerns will be eligible for referral. Pilot effectiveness outcomes include parenting behaviors and child externalizing and internalizing symptoms. Acceptability, appropriateness, and feasibility of brief eHealth GenPMTO will be evaluated through a mixed methods approach. This study lays groundwork for a fully- powered hybrid effectiveness-implementation trial.