Moderators and predictors of clinical outcome in a randomized trial for behavior problems in pediatric primary care

Area of Science:

• Pediatric Psychology
• Primary Care Behavioral Health
• Clinical Trial Research

Background:

• Pediatric behavioral problems are a significant concern in primary care settings.
• Integrating mental health services into pediatric practice is crucial for effective treatment.
• Existing interventions require evaluation for moderator, predictor, and treatment parameter effects.

Purpose of the Study:

• To compare a modular protocol for on-site, nurse-administered intervention (PONI) with enhanced usual care (EUC) for pediatric behavioral problems.
• To identify moderator, predictor, and treatment parameter variables influencing intervention outcomes.
• To evaluate effectiveness across child dysfunction, child health, and oppositional defiant disorder remission.

Main Methods:

• A clinical trial involving 163 children referred for behavior problems across six primary care offices.
• PONI utilized seven adapted treatment modules; EUC involved facilitated community provider referral.
• Outcomes assessed via parent-rated child dysfunction, child-rated child health, and diagnostic interviews for remission.

Main Results:

• PONI was more effective for Caucasian children's dysfunction; EUC was more effective for non-Caucasian children's dysfunction.
• Child health improvement was predicted by depression, anxiety severity, and family conflict.
• Longer exposure to cognitive-behavioral treatment in PONI correlated with better child health, but other parameters did not.

Conclusions:

• Both PONI and EUC demonstrated robust effects on multiple outcomes across various child, parent, family, and treatment variables.
• Specific relationships were identified, suggesting targeted approaches may enhance treatment efficacy.
• Findings support the integration of mental health services within pediatric primary care settings.