Personalised assessment and intervention packages for children with conduct problems in child mental health services

Aim The overarching aim is to develop an improved treatment for conduct problems in young children that can be readily implemented in the NHS. Objectives 1) Identify key features of children and parents with conduct problems who respond differentuially to parent training. 2) Identify groups with good and poor outcomes from standard parent training for qualitative study, and identify predictors of outcome to improve the efficiency of the proposed randomized controlled trial. 3) Conduct a large qualitative study with parents to identify processes associated with high and low participation in parent training groups, and with good and poor treatment outcomes. 4) Work with parents to develop a new personalized treatment approach for conduct problems. 5) Test the feasibility of the approach. 6) Conduct an internal pilot, and, conditional on success, a full scale RCT, to compare the personalized approach with standard, evidence based group parenting training. Background and Rationale Conduct problems in young children commonly endure and are associated with poor outcomes in adult life. Early treatment is essential. Group parent training programmes have proven effectiveness but also substantial drop out and failure rates. It is crucial to develop a new generation of treatments and there is a strong case for using ideographic approaches to understanding the processes, and for establishing approaches to treatment that take account of diverse needs. Hence we propose a programme to make use of quantitative indices of heterogeneity, alongside qualitative methods, as a basis for personalized treatment. Research Plan Work stream 1 (WS1) – systematic review of treatments for sub-groups of children and parents who differentially respond to parent training.. Work stream 2 (WS2) – prospective study of parent training for parents of 160 children referred with conduct problems followed up at 3 and 6 months. Baseline and follow up assessments will include the Parent Account of Child Symptoms (PACS) a standard interview measure of conduct problems and poor outcome will be defined as 0.4s.d change or lower. This will establish 3 groups for qualitative study, i) 20 parents of children with a good outcome ii) 20 parents who either did not attend any training sessions or who dropped out, iii) 20 parents who attended but whose children did not improve. Economic hardship, parental depression, high callous unemotional traits, marital discord or single parent status, and parental hostility will be examined in logistic regression as predictors of outcome as a basis for creating a screening tool for the RCT. Work stream 3 (WS3) – qualitative study with parents in the 3 groups identified in WS2. Interviews will invite parents accounts of their experience of parent training and explore the reasons for the various outcomes and parents perception of the possible role of factors identified quantitatively in WS2. Work stream 4 (WS4) - will work with parents identified from WS2 and WS3, to develop a personalized approach to treatment. The outcome will be a treatment manual for the personalized approach, a training programme, and a set of criteria for judging fidelity. Work stream 5 (WS5) – feasibility study of the personalized approach with nine CYP-IAPT staff each working with 5 children. Work streams 6 and 7 (WS6, WS7) – internal pilot and, if successful, full scale RCT to compare the personalized approach with standard parent training. From an initial sample of the parents of 150 children the screening procedure devised in WS2 will be used to generate a sample of 90 for randomization and follow up at 3, 6, and 9 months using the same baseline predictors and follow up measures as in WS2. If the pilot supports the feasibility we will proceed to the full scale RCT to generate a total sample of 450 yielding, after screening, 270 for randomization. The primary outcome measure will be