Technology-Enhanced Program for Child Disruptive Behavior Disorders: Development and Pilot Randomized Control Trial

Abstract

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.

Incorporating Mobile Phone Technologies to Expand Evidence-Based Care

“…Those who have implemented BPT with a family of a young child with oppositional defiant or conduct disorder, however, know that tracking time is rarely, if ever, the biggest challenge to parents' effective use of the time-out skill in session or at home (Jones, 2014; Jones et al, 2013, 2014; Jones, Forehand, McKee, Cuellar, & Kincaid, 2010). Rather, parents more typically deal with challenges such as the child refusing to go to the time-out chair, refusal to leave the time-out chair, and/or continued or escalating problem behavior in the time-out chair (McMahon & Forehand, 2003).…”

“…Next, therapists should consider the diverse functionalities of mobile phones and, most important, the processes by which client use of the intended functionality is hypothesized to enhance the reach and impact of service delivery (see Jones et al, 2013, 2014; Riley et al, 2011; Ritterband et al, 2009; Venkatesh, Morris, Davis, & Davis, 2003, for reviews). This point relates to the possible range of functionalities afforded by the client's mobile phone platform (e.g., traditional mobile phone vs. smartphone), as well as the extent to which the functionalities allow the therapist to connect with the client in real time (e.g., videoconferencing) and/or asynchronously (e.g., text messages, email; Lovell, 2010; Tate & Zabinski, 2004; Titov, 2010).…”

“…Accordingly, Jones and colleagues (2010, 2013, 2014) developed a smartphone-enhanced program that aimed to supplement BPT via increased connection between the family and the therapist and treatment program (e.g., between session video-call check-in, text message reminders about appointments and home practice), as well as increased support for skill building between sessions (e.g., modeling of skills via a skills video series, video recording home practices for therapist review and feedback). The pilot randomized controlled trial ( n = 10 families in standard BPT; n = 9 in smartphone-enhanced BPT) suggested promise for the smartphone-enhanced BPT program to increase family engagement (e.g., smartphone-enhanced BPT families were more likely to come to sessions than standard BPT families) and, in turn, to enhance treatment outcomes (e.g., smartphone-enhanced BPT families evidenced greater effect sizes for treatment than standard BPT families; Jones et al, 2014). Moreover, the smartphone-enhanced BPT families required fewer sessions to complete the mastery-based BPT program than the standard BPT families, suggesting the potential cost-effectiveness of a smartphone-enhanced approach.…”

Future Directions for the Implementation and Dissemination of Statewide Developmental-Behavioral Pediatric Integrated Health Care

“…In addition, accessibility of expertise may be limited in many areas, which introduces another barrier to effective integration, particularly in rural areas (elaborated next). Advances in telehealth technology and policy are quickly eroding barriers to access, however, and demonstration of effective service provision via these communication modalities is beginning to emerge (e.g., Comer et al, 2014;Gladstone et al, 2014;Jones et al, 2014;Myers, Stoep, Zhou, McCarty, & Katon, 2015).…”

Broadening the reach of evidence-based parenting interventions: Evaluation of a brief online version of the Triple P – Positive Parenting Program

“…However, there is a lack of randomised controlled trials, particularly in the area of prevention and treatment of child emotional and behaviour problems. Some researchers have supplemented their original therapist-led interventions with technology enhancements (Helping the Noncompliant Child, Jones, Forehand, et al, 2014), provided programs on DVDs (Parenting Wisely, Gordon, 2000) or lent pre-loaded computers to trial participants, augmented with professional consultation via email, phone calls, and home visits (Incredible Years, Taylor et al, 2008). Yet there is a dearth of self-administered interventions delivered via the Internet.…”