Objective Early onset Disruptive Behavior Disorders (DBDs) are overrepresented in low-income families; yet, these families are less likely to engage in Behavioral Parent Training (BPT) than other groups. This project aimed to develop and pilot test a technology-enhanced version of one evidence-based BPT program, Helping the Noncompliant Child (HNC). The aim was to increase engagement of low-income families and, in turn, child behavior outcomes, with potential cost-savings associated with greater treatment efficiency. Method Low-income families of 3-to-8 year old children with clinically-significant disruptive behaviors were randomized to and completed standard HNC (n =8) or technology-enhanced HNC (TE-HNC) (n = 7). On average, caregivers were 37 years old, female (87%), and most (80%) worked at least part-time. Half (53%) of the youth were boys, average age of the sample was 5.67 years. All families received the standard HNC program; however, TE-HNC also included the following smartphone-enhancements: (1). Skills video series; (2). Brief daily surveys; (3). Text message reminders; (4). Video recording home practice; and (5). Mid-week video calls. Results TE-HNC yielded larger effect sizes than HNC for all engagement outcomes. Both groups yielded clinically significant improvements in disruptive behavior; however, findings suggest that the greater program engagement associated with TE-HNC boosted child treatment outcome. Further evidence for the boost afforded by the technology is revealed in family responses to post-assessment interviews. Finally, cost analysis suggests that TE-HNC families also required fewer sessions than HNC families to complete the program, an efficiency that did not compromise family satisfaction. Conclusions TE-HNC shows promise as an innovative approach to engaging low-income families in BPT with potential cost-savings and, therefore, merits further investigation on a larger scale.

African American youth from single mother homes continue to be overrepresented in statistics on risk behavior and delinquency, a trend that many be attributed to father-absence, socioeconomic disadvantage, and compromises in parenting more typical of single than two-parent families. Yet, this risk-focused perspective ignores a long-standing strength of the African American community, the involvement and potential protective impact of extended family members in childrearing. This study describes the experiences of 95 African American single mothers and their non-marital coparents who participated in a study of African American single mother families with an 11 to 16 year old child. Specifically, the study examines: 1) the extent to which nonmarital coparents are involved in childrearing; 2) the relative levels of risk (i.e., depression, mother-coparent conflict) and protective (i.e., parenting) associated with maternal and coparent involvement; and 3) how similarly and/or differently coparent and mother variables operate with regard to youth externalizing problems. Findings reveal that a range of family members and other adults actively participate in childrearing in African American single mother families, coparents do not differ from mothers on certain study variables (i.e., depression and mother-coparent conflict) but do for others (parenting), and coparent involvement is associated with youth adjustment in ways that are similar to our more established understanding of maternal involvement. The potential clinical implications of the findings are discussed and future research directions are highlighted.

Mindfulness has been established as a critical psychosocial variable for the well-being of individuals; however, less is understood regarding the role of mindfulness within the family context of parents, coparents, and children. This study tested a model examining the process by which parent dispositional mindfulness relates to parenting and coparenting relationship quality through mindful parenting and coparenting. Participants were 485 parents (59.2% mothers) from three community samples of families with youth across three developmental stages: young childhood (3 – 7 yrs.; n = 164), middle childhood (8 – 12 yrs.; n = 161), and adolescence (13 – 17 yrs.; n = 160). Path analysis using maximum likelihood estimation was employed to test primary hypotheses. The proposed model demonstrated excellent fit. Findings across all three youth development stages indicated both direct effects or parent dispositional mindfulness, as well as indirect effects through mindful parenting and mindful coparenting, with parenting and coparenting relationship quality. Implications for intervention and prevention efforts are discussed.

Despite high pre-exposure prophylaxis (PrEP) acceptability among people who inject drugs (PWID) and PrEP providers, PrEP uptake is low and little is known about how to promote PrEP among PWID. This qualitative study with providers in North Carolina explored views on PrEP delivery approaches for PWID. Interviewers conducted semistructured interviews with 10 PrEP providers and 10 harm reduction (HR) providers. Interviews were transcribed and analyzed. Many participants expressed acceptability for providing PrEP referrals at syringe exchange sites, stationing PrEP providers at syringe exchange sites to provide PrEP prescriptions, and providing standing orders for PrEP at syringe exchange sites. Barriers were identified, including low PrEP awareness and limited resources. Many advocated for co-location of HR and PrEP services and scaled-up outreach services. PrEP providers emphasized maintenance of clinical requirements, while HR providers emphasized flexibility when treating PWID. Promoting PrEP uptake and adherence among PWID likely requires integration of HR and PrEP services.

Ownership of mobile phones is on the rise, a trend in uptake that transcends age, region, race, and ethnicity, as well as income. It is precisely the emerging ubiquity of mobile phones that has sparked enthusiasm regarding their capacity to increase the reach and impact of health care, including mental health care. Community-based clinicians charged with transporting evidence-based interventions beyond research and training clinics are in turn, ideally and uniquely situated to capitalize on mobile phone uptake and functionality to bridge the efficacy to effectiveness gap. As such, this article delineates key considerations to guide these frontline clinicians in mobile phone-enhanced clinical practice, including an overview of industry data on the uptake of and evolution in the functionality of mobile phone platforms, conceptual considerations relevant to the integration of mobile phones into practice, representative empirical illustrations of mobile-phone enhanced assessment and treatment, and practical considerations relevant to ensuring the feasibility and sustainability of such an approach.

A distinction between parental behavioral control and psychological control has been elucidated in the literature, yet far less is known about the role of psychological control in youth adjustment broadly or risky behavior in particular. We examined the interrelationship of maternal psychological control, youth psychosocial adjustment, and youth risk behaviors among African American single mother-youth (11-16-year old) dyads (n = 194), families in which youth are more vulnerable to adjustment problems and risky behavior than Caucasian youth or youth from intact homes. Higher levels of maternal psychological control were associated with increased youth psychosocial adjustment problems as well as increased youth risk behavior, after statistically controlling for one domain of behavioral control, parental knowledge about a child's whereabouts and activities. Furthermore, youth externalizing problems mediated the relation between psychological control and risk behavior. The findings suggest that parenting programs targeting risk behavior among African American youth may benefit from including psychological control among the parenting dimensions that are targeted.

Low-income families are more likely to have a child with an early-onset Behavior Disorder (BD); yet, socioeconomic strain challenges engagement in Behavioral Parent Training (BPT). This study follows a promising pilot to further examine the potential to cost-effectively improve low-income families’ engagement in and the efficiency of BPT. Low-income families were randomized to (a) Helping the Noncompliant Child (HNC; McMahon & Forehand, 2003), a weekly, mastery-based BPT program that includes both the parent and child or (b) Technology-Enhanced HNC (TE-HNC), which includes all of the standard HNC components plus a parent mobile application and therapist web portal that provide between-session monitoring, modeling, and coaching of parent skill use with the goal of improved engagement in the context of financial strain. Relative to HNC, TE-HNC families had greater homework compliance and mid-week call participation. TE-HNC completers also required fewer weeks to achieve skill mastery and, in turn, to complete treatment than those in HNC without compromising parent satisfaction with treatment; yet, session attendance and completion were not different between groups. Future directions and clinical implications are discussed.

Behavioral Parent Training (BPT) is the standard of care for early onset (3 to 8 years old) disruptive behavior disorders (DBDs). Preliminary evidence suggests that BPT may also produce cascading treatment effects for comorbid and interrelated symptomatology in children, primarily internalizing problems, as well as symptomatology in multiple systems of the family, including caregiver depressive symptomatology. What is less well understood, however, is why and how BPT functions to impact these multiple symptom clusters within and between family members. Accordingly, this manuscript aims to serve as a conceptual and theoretical consideration of the mechanisms through which BPT may produce generalized treatment effects among children with early onset DBDs and internalizing problems, as well as the psychosocial difficulties among their caregivers. It is our intention that the hypothesized mechanisms highlighted in this review may guide advances in clinical research, as well as assessment and practice.