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Developmental DelayACCESSNCT03260816

Advancing Child Competencies by Extending Supported Services (ACCESS) for Families Program

A study testing Internet-delivered Parent-Child Interaction Therapy (I-PCIT) and Referrals as Usual (RAU) in people with Developmental Delay and Disruptive Behavior, run by Florida International University at 3 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The Advancing Child Competencies by Extending Supported Services (ACCESS) for Families Program is a study funded by the National Institutes of Health to explore behavior and developmental problems among young children aging out of Early Steps (Part C). Read more about this study

Who is it for?
Ages 30 to 60 months
Conditions the study is for
Developmental Delay, Disruptive Behavior
What is being tested?
Internet-delivered Parent-Child Interaction Therapy (I-PCIT) and Referrals as Usual (RAU)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
150 participants
Where
3 sitesUnited States
Study dates
16 Mar 2016to 21 Dec 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 30 to 60 months
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Young children aging out of Part C EI services (mean age = 34.50 months) and at least 1 primary caretaker, which in most cases will be the mother
  • Elevated Child Behavior Checklist Externalizing Problems scale at least in the borderline clinical range (i.e., T-score = 60)
  • English-speaking or Spanish-speaking primary caretaker and child.

Who cannot join

  • Child receiving an unstable dose of medication (i.e., changes within the past 4 weeks) to manage behavior difficulties
  • History of severe physical impairment (e.g., deafness, blindness) in the child or primary caretaker
  • Severe autism spectrum disorder impairment (i.e., Social Responsiveness Scale, Second Edition > 75)
  • Significant cognitive delay in the parent (i.e., estimated IQ score < 70 on the two-subtest [vocabulary and matrix reasoning] version of the Wechsler Abbreviated Scale of Intelligence for those speaking English or an average standard score < 4 on the vocabulary and matrix reasoning subtests of the Escala de Inteligencia Wechsler Para Adultos - Third Edition for those speaking Spanish)

Trial locations and contacts

3 sites in 1 country.

United States3 sites
  • University of Miami, Early Steps North

    Miami, Florida, 33136

  • Florida International University

    Miami, Florida, 33199

  • Nicklaus Children's Hospital, Early Steps South

    Palmetto Bay, Florida, 33157

Other trials in United States

About this study

The Advancing Child Competencies by Extending Supported Services (ACCESS) for Families Program is a study funded by the National Institutes of Health to explore behavior and developmental problems among young children aging out of Early Steps (Part C). All families will participate in five evaluations in their home to learn more about their child's behavior and development. Families also may receive treatment designed to help change their child's behaviors that will be conducted over the Internet using a tablet.

Read the detailed description

The proposed study will evaluate, via a randomized controlled trial, the incremental utility of I-PCIT for disruptive behavioral problems in traditionally underserved young children with developmental delay (DD) from predominantly economically disadvantaged and ethnic and racial minority backgrounds. Specifically, the investigators are interested in the impact of I-PCIT on child disruptive behavior problems, parenting practices, parental distress, and pre-academic skills relative to traditional referrals as usual (RAU) among youth aging out of Part C EI services and transitioning from home-based family services to school-based special education services. A secondary goal is to evaluate potential moderators and mediators that explain under which circumstances, for whom, and through which pathways I-PCIT is most effective for young children with DD. Our primary aims are (1) to evaluate the immediate and one-year impact of I-PCIT on (1a) disruptive behavior problems in young children with DD, as well as (1b) parenting practices and (1c) parental distress in parents of young children with DD; (2) to evaluate the impact of I-PCIT on pre-academic skills among young children with DD; and (3) to evaluate (3a) family retention, (3b) engagement, and (3c) satisfaction associated with I-PCIT in young children with DD. Our secondary aim is to examine potential moderators and mediators of response to I-PCIT for disruptive behavior problems in young children with DD. Specifically, the investigators are interested in the extent to which technological literacy and access (4a) moderate I-PCIT efficacy, such that I-PCIT efficacy will be weaker among families with poorer technological literacy and/or access, and the extent to which traditional barriers to care (4b) moderate I-PCIT efficacy, such that the incremental efficacy of I-PCIT over RAU will be strongest among families with geographic, transportation and/or childcare obstacles to in-person services. Finally, the investigators hypothesize that I-PCIT will yield changes in child behavior and pre-academic skills indirectly through direct effects on parenting practices (4c). Specifically, changes in parental consistency, warmth, follow-through, and effective discipline will mediate observed I-PCIT efficacy, such that these treatment-related parenting changes will account for observed differences in child disruptive behavior problems and pre-academic skills.

Being tested
Internet-delivered Parent-Child Interaction Therapy (I-PCIT), Referrals as Usual (RAU)
Keywords
Preschoolers, Developmental Delay, Disruptive Behavior, Early Intervention, Parent-Child Interaction Therapy (PCIT), Telehealth, Telemental Health, Telepsychiatry
Medical subject headings
Learning Disabilities, Problem Behavior

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Internet-delivered Parent-Child Interaction Therapy (I-PCIT)Behavioural

    Families assigned to the Internet-delivered Parent-Child Interaction Therapy (I-PCIT) group will receive Internet-delivered weekly sessions of a short-term parent-training intervention emphasizing positive attention, consistency, problem-solving, and communication. Using videoconferencing, webcams, and wireless Bluetooth earpieces, I-PCIT therapists provide in-the-moment feedback to parents during live parent-child interactions.

  • Referrals as Usual (RAU)Other

    Families assigned to RAU will participate in services referred by their Early Steps team, as per usual care.

Study groups in NCT03260816
Study groupRoleWhat they receive
Internet-Delivered Parent TrainingExperimentalFamilies will receive weekly sessions of Internet-delivered Parent-Child Interaction Therapy (I-PCIT), a short-term parent-training intervention emphasizing positive attention, consistency, problem-solving, and communication. Using videoconferencing, webcams, and wireless Bluetooth earpieces, I-PCIT therapists provide in-the-moment feedback to parents during live parent-child interactions.
Receives: Behavioral: Internet-delivered Parent-Child Interaction Therapy (I-PCIT)
Referrals as Usual (RAU)Active comparatorFamilies in the referrals as usual (RAU) group will be referred to services as usual in their Early Intervention exit interview, which includes a variety of clinic-based mental health services at local community agencies. At each assessment, the access and extent of participation in other services will be monitored.
Receives: Other: Referrals as Usual (RAU)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Child Behavior Checklist, Ages 1.5-5 (CBCL, 1.5-5)

    The Child Behavior Checklist 1.5-5 (CBCL/1.5-5; Achenbach \& Rescorla, 2001) is a 99-item caregiver- report questionnaire of behavioral, emotional, and social problems in children between the ages of 18 months and 5 years. In the current study the externalizing behavior problem scale will be used to screen children into the study (T- score = 60), and the following subscales will be used as outcomes: aggressive behavior, attention problems, attention-deficit/hyperactivity problems, emotionally reactive, and oppositional defiant problems.

    Measured: Change from Week 0, Week 8, Week 21, Week 42 and Week 68

Secondary outcomes (21)
  1. Body Mass Index (BMI)

    A weight-to-height ratio, calculated by dividing one's weight in kilograms by the square of one's height in meters.

    Measured: Baseline (Week 0), Post (Week 21), Follow-Up One (Week 42) and Follow-Up Two (Week 68)

  2. Sutter-Eyberg Behavior Inventory, Revised (SESBI-R)

    The Sutter-Eyberg Student Behavior Inventory-Revised (SESBI-R; Eyberg \& Pincus, 1999) is a teacher rating scale of disruptive behaviors at school in children as young as 2 years, and the Intensity and Problem scales will be used as outcome measures for participants in school to assess generalization of improvement in child disruptive behavior to the classroom setting.

    Measured: Change from Week 0, Week 8, Week 21, Week 42 and Week 68

  3. Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB): Temper Loss Scale

    The Temper Loss Scale of the Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB; Wakschlag et al., 2014) assesses temper loss in terms of tantrum features and anger regulation.

    Measured: Change from Week 0, Week 8, Week 21, Week 42 and Week 68

  4. Impossibly Perfect Circle (IPC)

    Children will complete a self-regulation task called the Impossibility Perfect Circles (IPC; Goldsmith \& Reilly, 1993) task in which the child is asked to draw a perfect circle several times. The purpose of this task is to code how well the child is regulating their behaviors and emotions during challenging tasks.

    Measured: Change from Week 0, Week 8, Week 21, Week 42 and Week 68

  5. Child Rearing Inventory (CRI)

    The Child Rearing Inventory (CRI; Brestan et al., 2003) is an 11-item caregiver-report measure of caregivers' ability to tolerate misbehavior and will also be used as an outcome measure of parenting practices.

    Measured: Change from Week 0, Week 8, Week 21, Week 42 and Week 68

  6. Parenting Practices Inventory (PPI)

    The Parenting Practices Inventory (PPI; Webster-Stratton et al., 2004)) is a 72-item caregiver-report questionnaire designed to measure caregiver disciplinary styles and strategies. The PPI is designed to measure parenting practices using the following subscales: appropriate discipline, harsh and inconsistent discipline, positive verbal discipline, monitoring, physical punishment, praise and incentives, and clear expectations.

    Measured: Change from Week 0, Week 8, Week 21, Week 42 and Week 68

  7. Parent-Child Book Reading

    The caregiver-child book- reading procedure will consist of one age-appropriate book (The Way I Feel by Janan Cain; Cain, 2005) which also has Spanish version (Asi me siento yo by Janan Cain; Cain, 2009). Caregivers will be instructed to describe the books to their children like they would normally for 5 minutes. This book is intended to elicit emotion talk as it includes emotional content, but also depicted multiple scenes, events, and objects that caregivers could talk about in addition to or instead of emotions, thereby permitting the capture of differences in caregivers' predilection to discuss emotions with their children.

    Measured: Change from Week 0, Week 21, Week 42 and Week 68

  8. Family Impact Questionnaire (FIQ)

    The Family Impact Questionnaire (FIQ; Donenberg \& Baker, 1993) is a 50-item caregiver-report questionnaire of stress and strain, selected over other measures as an outcome of caregiver distress because it has been Child Disruptive Symptoms.

    Measured: Change from Week 0, Week 8, Week 21, Week 42 and Week 68

  9. Depression, Anxiety, Stress Scale- 21 (DASS-21)

    The Depression, Anxiety, Stress Scale-21 (DASS21; Lovibond \& Lovibond, 1995) is a clinical assessment that measures the three related states of depression, anxiety and stress.

    Measured: Change from Week 0, Week 8, Week 21, Week 42 and Week 68

  10. Bracken School Readiness Assessment-3 (BSRA-3)

    Bracken School Readiness Assessment-3 (BSRA-3; Bracken, 2007) is an individual cognitive test designed for children examining the areas of colors, letters, numbers/counting, sizes, comparisons, and shapes.

    Measured: Change from Week 0, Week 21, Week 42 and Week 68

  11. Preschool Language Scale-5 (PLS-5)

    The Preschool Language Scale-5 (PLS-5; Zimmerman, Steiner, \& Pond, 2011) is an assessment of developmental language skills, specifically auditory comprehension and expressive communication.

    Measured: Change from Week 0, Week 21, Week 42 and Week 68

  12. Clinical Global Impression (CGI-I)

    The Clinical Global Impression - Improvement scale (CGI-I; Guy, 1976) is a 7-point scale that requires the clinician to assess how much the patient's illness has improved or worsened relative to a baseline state at the beginning of the intervention.

    Measured: Week 21

  13. Technology Experience and Attitude Rating Scale (TEARS)

    The Technology Experience and Attitude Rating Scale (TEARS) will be administered to assess caregiver and child technology use and literacy as a potential moderator of treatment response.

    Measured: Change in weekly ratings from Week 0 to Week 21

  14. Therapy Attitude Inventory (TAI)

    The Therapy Attitude Inventory (TAI; Brestan et al. 2000) is a 10-item parent-report of satisfaction with the process and outcome of parent-training interventions.

    Measured: Week 21

  15. Client Satisfaction Questionnaire-8 (CSQ-8)

    The Client Satisfaction Questionnaire-8 (CSQ-8; Nguyen et al., 1983) is an 8-item generic measure of clients' perceptions of the value of services received.

    Measured: Week 21

  16. Telepresence in Videoconferencing Scale

    The Telepresence in Videoconferencing Scale will be administered to assess caregiver experience interacting within video web-conferencing platform.

    Measured: Week 21

  17. Barriers to Treatment Participation Scale (BTPS)

    The Barriers to Treatment Participation Scale (BTPS; Kazdin et al. 1997) is a 44-item measure of perceived barriers to treatment participation.

    Measured: Week 21

  18. Parental Attitudes Toward Psychological Services Inventory (PATPSI): Stigmatization Scale and Help-Seeking Attitudes Scale

    Two scales from the Parental Attitudes Toward Psychological Services Inventory (PATPSI; Turner, 2012) will be administered: help- seeking attitudes scale and the stigmatization scale. The PATPSI is a measure to assess caregivers' attitudes toward outpatient mental health services.

    Measured: Baseline (Week 0)

  19. Child's Sleep Habits Questionnaire

    The Children's Sleep Habits Questionnaire (CSHQ; Owens et al. 2000) is a 33-item parent questionnaire designed to examine sleep behavior in young children and thus screen for the most common sleep problems.

    Measured: Change from Week 0, Week 8, Week 21, Week 42 and Week 68

  20. Dyadic Parent-Child Interaction Coding System-IV (DPICS-4)

    The Dyadic Parent-Child Interaction Coding System-4th Ed (DPICS-IV; Eyberg et al., 2013) is a structured behavioral observation coding system assessing caregiver-child interactions. Observed parenting behaviors will be coded during a 5-min child-led play and combined into two categories of positive (praises, behavior descriptions, and reflections) and negative (questions, commands, and negative talk) verbalizations, reflecting behaviors caregivers are taught to use and avoid in PCIT. Additionally, child compliance will be assessed during a 5-min caregiver-led play and 5-min clean up situation and will be examined as an objective outcome of child behavior. The positive and negative caregiver verbalizations will be examined as both outcomes and candidate mediators of treatment, and child compliance will be examined as an outcome.

    Measured: Change from Week 0, Week 8, Week 21, Week 42 and Week 68

  21. Eyberg Child Behavior Inventory (ECBI)

    The Eyberg Child Behavior Inventory (ECBI; Eyberg \& Pincus, 1999) is a 36-item caregiver-report of disruptive behavior problems in children as young as 2 years. The Intensity and Problem scales will be used to assess changes in child disruptive behavior.

    Measured: Change from Week 0, Week 8, Week 21, Week 42 and Week 68

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Aug 2017
  2. Study start16 Mar 2016
  3. Primary completion21 Dec 2020
  4. Study completion21 Dec 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized control trial in which participants are randomly assigned to either receive Internet-delivered Parent-Child Interaction Therapy (I-PCIT) or referrals as usual (RAU).
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
150 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03260816
Sponsor's protocol ID
IRB-15-0134
Other IDs
R01HD084497
Acronym
ACCESS
Status last verified
Jun 2022
First submitted
17 Aug 2017
Last updated
3 Jun 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: We will use a controlled access approach, using a robust system to review requests and provide secure access to de-identified data.

Publications

  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA Preschool Forms & Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.

  • Myers K, Cain S; Work Group on Quality Issues; American Academy of Child and Adolescent Psychiatry Staff. Practice parameter for telepsychiatry with children and adolescents. J Am Acad Child Adolesc Psychiatry. 2008 Dec;47(12):1468-83. doi: 10.1097/CHI.0b013e31818b4e13.

    PubMed 19034191
  • Bracken, B. A. (2007). Bracken School Readiness Assessment. San Antonio, TX: Psychological Corporation.

  • Brestan , E. V. , Eyberg , S. M. , Algina , J. , Bennett Johnson , S. , & Boggs , S. R. ( 2003 ). How annoying is it? Defining parental tolerance for child misbehavior. Child and Family Behavior Therapy, 25, 1-15.

  • Brestan, E. V., Jacobs, J. R., Rayfield, A. D., & Eyberg, S. M. (2000). A consumer satisfaction measure for parent-child treatments and its relation to measures of child behavior change. Behavior Therapy, 30, 17-30.

  • Cain, J. (2005). The Way I Feel. Chicago, IL: Parenting Press.

  • Cain, J. (2009). Asi Me Sientol. Chicago, IL: Parenting Press.

  • Donenberg G, Baker BL. The impact of young children with externalizing behaviors on their families. J Abnorm Child Psychol. 1993 Apr;21(2):179-98. doi: 10.1007/BF00911315.

    PubMed 8491931
  • Eyberg, S. M., & Funderburk, B. W. (2011). Parent-Child Interaction Therapy Protocol. Gainesville, FL: PCIT International.

  • Eyberg, S. M., Nelson, M. M., Ginn, N. C., Bhuiyan, N., & Boggs, S. R. (2013). Dyadic Parent- Child Interaction Coding System (DPICS): Comprehensive manual for research and training. Gainesville, FL: PCIT International.

  • Eyberg, S. M., & Pincus, D. (1999). Eyberg Child Behavior Inventory and Sutter-Eyberg Student Behavior Inventory: Professional manual. Odessa, FL: Psychological Assessment Resources.

  • Goldsmith, H.H., Reilly, J (1993). Laboratory Assessment of Temperament Preschool Version. University of Oregon.

  • Guy, W. (1976). ECDEU assessment manual for psychopharmacology. Rockville, MD: US Department of Heath, Education, and Welfare Public Health Service Alcohol, Drug Abuse, and Mental Health Administration.

  • Hall, L. (1983). Social supports, everyday stressors, and maternal mental health (Unpublished doctoral dissertation). University of North Carolina at Chapel Hill.

  • Jensen PS, Eaton Hoagwood K, Roper M, Arnold LE, Odbert C, Crowe M, Molina BS, Hechtman L, Hinshaw SP, Hoza B, Newcorn J, Swanson J, Wells K. The services for children and adolescents-parent interview: development and performance characteristics. J Am Acad Child Adolesc Psychiatry. 2004 Nov;43(11):1334-44. doi: 10.1097/01.chi.0000139557.16830.4e.

    PubMed 15502592

Questions about this trial

What is this clinical trial studying?

A study testing Internet-delivered Parent-Child Interaction Therapy (I-PCIT) and Referrals as Usual (RAU) in people with Developmental Delay and Disruptive Behavior, run by Florida International University at 3 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 3 Jun 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Child Behavior Checklist, Ages 1.5-5 (CBCL, 1.5-5) (time frame: Change from Week 0, Week 8, Week 21, Week 42 and Week 68). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03260816, which also lists 31 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Jun 2022.

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