A randomized preference trial to inform personalization of a parent training program implemented in community mental health clinics

Abstract

Incorporating participant preferences into intervention decision-making may optimize health outcomes by improving participant engagement. We describe the rationale for a preference-based approach to the personalization of community-based interventions. Compensating for the limitations of traditional randomized controlled trials (RCTs) and partially randomized preference trials (PRPTs), we employed a doubly randomized preference trial in the present study. Families (N=129) presenting to community mental health clinics for child conduct problems were randomized to choice or no-choice conditions. Within each condition, parents were again randomized, or offered choices between home-and clinic-based, individual and group versions of a parent training program or services-as-usual. Participants were assessed at baseline, and treatment retention data were gathered. Families assigned to the choice condition were significantly less likely to drop out of treatment than those in the no-choice condition. In the choice condition, in-home treatment was the preferred modality, and across conditions, families were less likely to be retained in group and clinic modalities. Research on preferences may boost participant engagement and inform shared decision-making.

What approaches for promoting shared decision‐making are used in child mental health? A scoping review

“…Mobilizing patients to engage was a feature of two retrieved records: an approach aimed at increasing motivational readiness of young people to engage in decision‐making (Adelman et al, : record 20 ) and a parent training programme for parents of young people with conduct disorder, in which parents explicitly picked the treatment they wanted (He et al, : record 19 ). The approach aimed at increasing motivational readiness for decision‐making contained one of the essential elements of SDM: “expressing values.” An evaluation found that there were no differences in motivational readiness, ability to participate, or participation between participants who received the intervention and those that did not (Adelman et al, ).…”

Moving Toward a Precision-Based, Personalized Framework for Prevention Science: Introduction to the Special Issue

“…Outcome intent-to-treat analyses of child behavioral adjustment gathered from parents and teachers six months following discharge indicated partial support for the effects of choice: teacher-reported improvements in child hyperactivity/inattention problems favored the choice condition. Prior analyses also showed improved adherence among those in the choice condition (He, Gewirtz, Lee, Morrell, & August, 2016). Contrary to hypotheses, however, teacher reports of hyperactivity/inattention problems also favored children in the no-choice condition assigned to child psychotherapy.…”

“…It stands to reason, that offering parents a voice in decisions about interventions for their children can increase healthy outcomes (Cunningham, 2007). Gewirtz and colleagues have initiated a program of research that examines the impact of affording parents their preferred ‘choice’ of intervention modality in a parent training intervention (He, Gewirtz, Lee, Morrell, & August, 2016). Although multiple potential designs have been utilized for examining choice, a doubly randomized preference trial is the optimal design for examining whether providing choice of interventions improves adherence and/or post-treatment outcomes (Marcus, Stuart, Wang, Shadish, & Steiner, 2012).…”

Do Parent Preferences for Child Conduct Problem Interventions Impact Parenting Outcomes? A Pilot Study in Community Children's Mental Health Settings

“…One possible explanation is that the lack of treatment engagement among the PMTO modalities in the no‐choice condition leads to poor parenting outcomes. Participants receiving the PMTO modalities in the no‐choice group dropped out more than those receiving the PMTO in the choice group (He et al., ). Participants randomized to SAU completed more sessions than those randomized to PMTO modalities (7 vs. 0–4).…”

“…No statistical differences in demographics were found for parents who remained in the study and parents who dropped out of the study. The retention rate of families in treatment was quite low (He et al., ): just 34.1% completed treatment.…”