Promoting Emotional Development Among Young Children Facing Adversity: An Effectiveness Implementation Study in St. Louis Schools

Project Summary Children facing adversity are at high risk for poor socio-emotional and cognitive outcomes and later psychopathology. However, there is increasing evidence that these negative developmental trajectories can be significantly improved by enhancing nurturing caregiving early in development. Despite numerous empirically supported early interventions, these programs are not readily accessible to the majority of US children most in need. Based on this, there is an urgent need to make these interventions feasible and readily available to these communities. To do this we propose to test the effectiveness of a brief 6 session parent-child preventive intervention conducted by video conference in the family's home and study two implementation methods within 3 high-risk school districts. The intervention, entitled “THRIVE,” is a previously tested early parent child intervention piloted in a St. Louis county district which proved feasible, acceptable and appeared effective. Caregiver-child dyads aged 4.0-6.11 meeting inclusion criteria will be randomized to a THRIVE condition or an established online parenting education of comparable length. Although the use of schools as a service delivery platform will increase accessibility, this system presents unique and complex challenges for implementation of a mental health prevention. Therefore, we will use a hybrid effectiveness-implementation design to test the effectiveness of THRIVE compared to Parenting Wisely, while also assessing the impact of two forms of implementation (coaching vs. no coaching) on study outcomes. Assessments of key outcome measures, including child behavior, social, and emotional functioning, child psychopathology, parenting stress, optimism, and depressive symptoms, and changes in parenting and the parent-child dyadic relationship (observational and neural using functional near infrared spectroscopy' fNIRS) will be measured at baseline, post-treatment (P1), and 12-weeks post-treatment (P2). We will also test how the preventive intervention mechanistically targets the quality of the caregiver-child relationship by enhancing caregiver responsiveness and sensitivity via baseline, mid-treatment and post-treatment (P1) assessments. This project provides the first test of a brief parent-child early prevention accessed through schools and delivered in home by video conference with minimal therapist training to enhance access to care. It further examines the cost-effectiveness of therapist coaching as a means to improve implementation and clinical outcomes.