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Early Childhood DevelopmentPANTHERSNCT04594902

The PANTHERS (Parents and iNfants Together in Home-based Early Remote Services) Project

A study testing Infant Behavior Program (IBP) and Enhanced Pediatric Primary Care (EPPC) in people with Early Childhood Development and Behavior Problems, run by Florida International University at 2 sites in United States.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

The PANTHERS (Parents And iNfants Together in Home-based Early Remote Services) Projects is a study funded by the National Institute of Child Health and Human Development to evaluate the efficacy and maintenance of a remote home-based preventive intervention, the Infant Behavior Program (IBP), to decrease behavior… Read more about this study

Who is it for?
Ages 12 to 18 monthsHealthy volunteers can take part
What is being tested?
Infant Behavior Program (IBP) and Enhanced Pediatric Primary Care (EPPC)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
288 participants
Where
2 sitesUnited States
Study dates
8 Mar 2021to 7 Sep 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

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 12 to 18 months
  • All sexes
  • Healthy volunteers accepted
  • Child

Who may be able to join

  • Infants ages 12 to 18 months and at least one primary caretaker, who is at least 18-years-old and in most cases will be the mother
  • Elevated score (> 75th percentile) on the problem scale of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA; Briggs-Gowan et al., 2004)
  • An English-speaking or Spanish-speaking primary caregiver.

Who cannot join

  • Infants with major sensory impairment (e.g., deafness blindness) or several problems that impair mobility (e.g., cerebral palsy)
  • Significant cognitive delay in the primary caregiver (i.e., estimated IQ score < 70 on the vocabulary subtest of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) for those speaking English or an average standard score < 4 on the vocabulary subtest of the Escala de Inteligencia Wechsler Para Adultos - Third Edition (EIWA-III) for those speaking Spanish)
  • Families involved with child protection services, which is expected to be low based on our pilot trials

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • South Miami Children's Clinic

    Miami, Florida, 33143

  • Nicklaus Children's Hospital

    Miami, Florida, 33155

Other trials in United States

About this study

The PANTHERS (Parents And iNfants Together in Home-based Early Remote Services) Projects is a study funded by the National Institute of Child Health and Human Development to evaluate the efficacy and maintenance of a remote home-based preventive intervention, the Infant Behavior Program (IBP), to decrease behavior problems in infants from high-risk families. All families will participate in five remote evaluations in their home, and families will also receive 6 remote treatment sessions of either the IBP or the EPPC. All participant procedures will be conducted remotely.

Read the detailed description

Research Design: The proposed study will evaluate the efficacy and maintenance of a remote home-based preventive intervention, the Infant Behavior Program (IBP), to decrease behavior problems in infants from high-risk families. Specifically, the investigators propose to conduct a randomized controlled trial to demonstrate its efficacy and maintenance in reducing behavior problems and increasing infant regulation relative to an enhanced pediatric primary care (EPPC) active control condition. Assessments will occur at pre (week 0)- and post (week 8)-intervention assessments (approximately 2 months apart), as well as at 4-month (week 24) , 8 -month (week 40), and 12-month (week 56) follow-up assessments.

Procedures: Families will be primarily recruited from pediatric primary care centers and will be randomized to receive six sessions of either IBP or EPPC in their home. Families also will participate in five remote home-based assessments.

Risks and Benefits: Families may experience risk from a breach in confidentiality as participants reveal sensitive information and there are risks in breach of confidentiality due to videoconferencing methods, in particular if study staff become aware of abuse or neglect situations. Families may experience discomfort when answering personal questions. Benefits to families could include providing families with information that can assist in caring for their child, and instilling new parenting strategies that are designed to outlast treatment.

Knowledge: This study will provide information about the efficacy of a remote home-based preventive intervention to improve infant behavior and regulation.

Being tested
Infant Behavior Program (IBP), Enhanced Pediatric Primary Care (EPPC)
Medical subject headings
Mental Disorders

What participants receive

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

  • Infant Behavior Program (IBP)Behavioural

    Infant Behavior Program (IBP) is a home-based adaptation of the Child-Directed Interaction (CDI) phase of Parent-Child Interaction Therapy (PCIT), an evidence-based intervention for early externalizing problems. Consistent with recommendations we maintained core features of CDI and addressed the unique developmental needs of infants. All IBP sessions will completed remotely.

  • Enhanced Pediatric Primary Care (EPPC)Other

    Families in EPPC will receive six one-hour home visits where they will receive information about normative developmental and health expectations for their infant. Specifically, therapists will provide education on six topics: (1) cognitive and emotional development; (2) language and social development; (3) safety; (4) feeding and nutrition; (5) sleep; and (6) fitness and activity. All EPPC sessions will completed remotely.

Study groups in NCT04594902
Study groupRoleWhat they receive
Infant Behavior Program (IBP)ExperimentalInfant Behavior Program (IBP) is a home-based adaptation of the Child-Directed Interaction (CDI) phase of Parent-Child Interaction Therapy (PCIT), an evidence-based intervention for early externalizing problems. Consistent with recommendations we maintained core features of CDI and addressed the unique developmental needs of infants. All IBP sessions will completed remotely.
Receives: Behavioral: Infant Behavior Program (IBP)
Enhanced Pediatric Primary Care (EPPC)Active comparatorFamilies in EPPC will receive six one-hour home visits where they will receive information about normative developmental and health expectations for their infant. Specifically, therapists will provide education on six topics: (1) cognitive and emotional development; (2) language and social development; (3) safety; (4) feeding and nutrition; (5) sleep; and (6) fitness and activity. All EPPC sessions will completed remotely.
Receives: Other: Enhanced Pediatric Primary Care (EPPC)

What is being measured

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

  1. Infant-Toddler Social and Emotional Assessment (ITSEA)

    The ITSEA is a 166-item parent-report measure of the frequency of specific behaviors (e.g., temper tantrums) in 12- to 36-month-olds. Participants will score their child behavior on a scale of 0-2 (0 Not true/Rarely, 2 Somewhat True/Sometimes and 3 Very True/Often). The higher the score, the higher the child is on behavior problems. The Externalizing scale will be an indicator of infant behavior. The higher the score the higher child's behavior problems.

    Measured: Change from week 0 to weeks 8, 24, 40, and 56

Secondary outcomes (26)
  1. Wechsler Abbreviated Scale of Intelligence Second Edition (WASI-II)

    The WASI will be used at screening to ensure ability to learn the skills. The vocabulary and matrix reasoning subtests will be administered, and primary caregivers will be required to receive an estimated IQ score ≥ 70 on the two-subtest version of the WASI-II. The higher the score the higher IQ.

    Measured: Screen

  2. Brief Infant-Toddler Social Emotional Assessment (BITSEA)

    The BITSEA will be used at screening as inclusion criteria. The 31-item Problem scale will be used to screen infants for the inclusion criterion (≥ 75th percentile) because it has high sensitivity and specificity in detecting current and predicting subsequent elevated externalizing problems. The higher the score the higher the child's behavior problem.

    Measured: Screen

  3. Ages and Stages Questionnaire-Third Edition (ASQ-III)

    Assess for developmental delay in children ages three months to five years. It is a 30-item parent-rating scale used to assess for developmental delay in children ages three months to five years. The ASQ-III has high test-retest reliability, interrater reliability, and concurrent validity134 and will be used as a baseline measure of the infant's developmental functioning. We will administer every scale- communication, gross motor, fine motor, problem solving, personal-social. Families respond to various milestones prompts on a scale of Yes, Sometimes, Not Yet. The higher the score the the higher the outcome.

    Measured: Week 0

  4. 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 and coded for during a 5-min caregiver-led play and 5-min clean up situation which will be adapted to meet the infant's developmental level (e.g., toy bucket in close proximity to infant). The higher the score the higher the parenting behavior and child compliance.

    Measured: Change from weeks 0 to week 8, 24, 40, and 56

  5. Early Childhood Behavior Questionnaire-Very Short Form (ECBQ)

    The ECBQ is a 36-item parent questionnaire of temperament. The effortful control scale will be used as the behavioral indicator of infant regulation. Participants will respond to various child behavior prompts using the 1-7 scale: 1- never, 2-very rarely, 3- less than half the time, 4- about half the time, 5- more than half the time, 6- almost always, 7- always. The higher the score the higher the outcome.

    Measured: Change from weeks 0 to week 8, 24, 40, and 56

  6. Laboratory Temperament Assessment Battery (Lab-TAB)

    The Lab-TAB is a standardized observation to assess early regulation. We will include an episode to elicit mild frustration that will involve the infant playing with a desired toy for 30 seconds, and then the parent will remove the toy from the infant and place the toy in a clear box that the child cannot open for 1 minute (repeated twice). Episodes will be videotaped and coded for infant emotional reactivity (latency to distress in seconds), lability (range from 0 = unstable to 4 = stable), and regulation (range from 0 = dysregulated to 4 = well-regulated). The higher the child distress the higher the outcome.

    Measured: Change from weeks 0 to week 8, 24, 40, and 56

  7. Short-form version of the MacArthur Communicative Development Inventories

    The MacArthur Short-form is an 89-word checklist for infant vocabulary comprehension and production and completed by the primary caregiver. Participants indicate which of a prespecified list of words the child can already understand and/or produce. The full scale will be administered, and the higher the score the higher the child's vocabulary.

    Measured: Change from weeks 0 to week 8, 24, 40, and 56

  8. Brief Infant Sleep Questionnaire (BISQ)

    10-item questionnaires used to measure infant and toddler sleep problems. There are no scales in this questionnaire.

    Measured: Change from weeks 0 to week 8, 24, 40, and 56

  9. Screen Media Use Questionnaire A

    The Screen Media Use Questionnaire A is a 6 item questionnaire to obtain information on family usage of screen devices. There are no scales in this questionnaire.

    Measured: Week 0

  10. Screen Media Use Questionnaire B

    The Screen Media Use Questionnaire B is a 21 item questionnaire to obtain information on family usage of screen devices. There are no scales in this questionnaire.

    Measured: Repeated at weeks 8, 24, 40, and 56.

  11. Screen Media Use Interview

    The Screen Media Use Interview was development by our team to obtain information of caregiver and infant use of screens (e.g., amount of time on screens, type of screen use). There are no scaled in this questionnaire.

    Measured: Repeated at weeks 0, 8, 24, 40, and 56.

  12. Parenting Scale

    The Parenting Scale is a 30-item self-report of parenting practices. Participants report their parenting strategies by answering prompts on 7-point likert scales. 1 indicates a high probability of using an effective discipline strategy and 7 indicates a high probability of ineffective discipline The Overreactivity scale will be used as an indicator of negative parenting practices. The higher the score the higher the outcome.

    Measured: Change from weeks 0 to week 8, 24, 40, and 56

  13. Parental Sensitivity/Responsivity: Global codes from the Early Parenting Coding System (EPCS)

    Global codes from the Early Parenting Coding System (EPCS), will be used to rate parental sensitivity/responsivity during the five-minute play. This is an observational tool with no scales.

    Measured: Change from weeks 0 to week 8, 24, 40, and 56

  14. Positive and Negative Affective Schedule (PANAS)

    The Positive and Negative Affective Schedule (PANAS) is a 20-item self-report measure (10 positive and 10 negative affective descriptors) with strong psychometric properties.The negative affect scale measures emotional experiences common to depression and anxiety and will be used as an indicator of parental distress. Participants respond with a 1-5 scale: 1- very slightly or not at all, 2- a little, 3- moderately, 4- quite a bit, 5- extremely. The higher the score the higher the outcome.

    Measured: Change from weeks 0 to week 8, 24, 40, and 56

  15. The Parenting Stress Index, Fourth Edition Short Form (PSI-SF)

    The PSI-SF parental distress scale will be used as an indicator of parental distress. The PSI-SF is a 36-item self-report questionnaire of parenting stress with three subscales (PD, PCDI, and DC) and a Total Stress scale. Families rate the responses with a likert-like scale: SA- Strongly Agree, A- Agree, NS- Not Sure, D- Disagree, SD- Strongly Disagree. The higher the score the higher the outcome.

    Measured: Change from weeks 0 to week 8, 24, 40, and 56

  16. Abbreviated Multidimensional Acculturation Scale (AMAS)

    The AMAS will be used to assess acculturation. It is a 42-item scale with 4-point self-report, Likert-type response options ranging from 1(strongly disagree) to 4 (strongly agree) for the cultural identity subscales and from 1 (not at all) to 4 (extremely well/like a native) for the language and cultural competence subscale. High scores relate to higher the acculturation..

    Measured: Week 0

  17. Multidimensional Acculturative Stress Inventory (MASI)

    The MASI will be used to assess acculturative stress. Families rate their responses to prompts across four scales (Spanish Competency Pressures, English Competency Pressures, Pressure to Acculturate and Pressure Against Acculturation) on a 0-5 likert scale (0- Not Applicable, 1- Not at all stressful, 2- A little stressful, 3- Somewhat stressful, 4- Very stressful, 5- Extremely stressful). All the scales will be administered, and the higher the score the higher the outcome.

    Measured: Week 0

  18. Adult Executive Functioning Inventory (ADEXI)

    The ADEXI requires that the informant rate the extent to which each item is true about them on a 5-point Likert scale (1: Definitely not true, 5: Definitely true). The questions are related to the frequency with which the informant experiences difficulty related to working memory and inhibition in everyday life. The higher the score the higher the outcome.

    Measured: Week 0

  19. NIH Cognitive Toolbox List Sorting Working Memory Test

    The List Sorting Working Memory Test assesses ability to store information until the amount of information to be stored exceeds one's capacity to hold that information. This is an observational task.

    Measured: Week 0

  20. Services for Children and Adolescents-Parent Interview (SCAPI)

    The SCAPI is a structured parent interview providing information on the type, number, duration, and intensity of physical and mental health services provided for the child and will be used to control for group differences in additional services families received in between each assessment, if applicable. The interview asks if the child has received any of the following services: Speech/Language Therapy, Physical Therapy, Occupational Therapy, Sensory Integration Therapy, Individual Child Counseling for Behavioral or Emotional Problems, Parent Training, Family Therapy, Play Therapy, Group Counseling. There are no scaled responses.

    Measured: Change from weeks 0 to week 8, 24, 40, and 56

  21. Technological Ease and Computer-based Habits Inventory (TECHI)

    The TECHI assesses caregiver and child technology use and literacy as a potential moderator of treatment response. Participants rate their comfort level with technology on a Strongly Disagree- Strongly Agree 0-5 likert scale. The higher the score the higher the comfort level with technology. The entire inventory will be administered.

    Measured: Week 0

  22. Therapy Attitude Inventory (TAI)

    The TAI is used document satisfaction with the intervention. The higher the score the higher the therapy satisfaction.

    Measured: Week 8

  23. IBP Quiz

    The IBP quiz will be administered to the IBP group only. The quiz was developed to asses parent's understanding of the information received during their participation in the program. The higher the score the higher the understanding.

    Measured: Week 8

  24. EPPC Quiz

    The EPPC quiz will be administered to the EPPC group only. The quiz was developed to asses parent's understanding of the information received during their participation in the program. The higher the score the higher the understanding.

    Measured: Week 8

  25. Center for Epidemiologic Studies Depression Scale (CES-D)

    The Center for Epidemiologic Studies Depression Scale (CES-D) is a 20-item self-report measure of depressive symptoms with strong psychometric support. The CES-D total score will be used as an indicator of parental distress. Participants respond to predetermined statements on a Likert-like scale. The higher the score the higher the depression symptoms.

    Measured: Change from weeks 0 to week 8, 24, 40, and 56

  26. COPING WITH TODDLERS' NEGATIVE EMOTION SCALE (CTNES)

    The Coping with Toddlers' Negative Emotions Scale (CTNES)161 is a measure of parent response to child negative emotions with support for use with infants.162 Consistent with previous work,163 we will combine items on the problem-focused, emotion-focused, and expressive-encouragement subscales as an indicator of parental responsivity. The higher the score the higher the outcome.

    Measured: Change from weeks 0 to week 8, 24, 40, and 56

Timeline

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

  1. First posted20 Oct 2020
  2. Study start8 Mar 2021
  3. Primary completion7 Sep 2026 (estimated)
  4. Study completion7 Sep 2026 (estimated)

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
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized control trial in which participants are randomly assigned to either receive the Infant Behavior Program (IBP) or the Enhanced Pediatric Primary Care (EPPC).
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
288 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04594902
Sponsor's protocol ID
#108696
Other IDs
1R01HD102201-01
Acronym
PANTHERS
Status last verified
Dec 2025
First submitted
29 Sep 2020
Last updated
2 Dec 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: We will use a controlled access approach, using a robust system to review requests and provide secure access to de-identified data

Publications

  • Bagner DM, Coxe S, Hungerford GM, Garcia D, Barroso NE, Hernandez J, Rosa-Olivares J. Behavioral Parent Training in Infancy: A Window of Opportunity for High-Risk Families. J Abnorm Child Psychol. 2016 Jul;44(5):901-12. doi: 10.1007/s10802-015-0089-5.

    PubMed 26446726
  • Heymann P, Heflin BH, Baralt M, Bagner DM. Infant-directed language following a brief behavioral parenting intervention: The importance of language quality. Infant Behav Dev. 2020 Feb;58:101419. doi: 10.1016/j.infbeh.2019.101419. Epub 2020 Jan 9.

    PubMed 31927404
  • Garcia D, Rodriquez GM, Hill RM, Lorenzo NE, Bagner DM. Infant Language Production and Parenting Skills: A Randomized Controlled Trial. Behav Ther. 2019 May;50(3):544-557. doi: 10.1016/j.beth.2018.09.003. Epub 2018 Sep 11.

    PubMed 31030872
  • Morningstar M, Garcia D, Dirks MA, Bagner DM. Changes in parental prosody mediate effect of parent-training intervention on infant language production. J Consult Clin Psychol. 2019 Mar;87(3):313-318. doi: 10.1037/ccp0000375. Epub 2018 Dec 27.

    PubMed 30589352
  • Blizzard AM, Barroso NE, Ramos FG, Graziano PA, Bagner DM. Behavioral Parent Training in Infancy: What About the Parent-Infant Relationship? J Clin Child Adolesc Psychol. 2018;47(sup1):S341-S353. doi: 10.1080/15374416.2017.1310045. Epub 2017 Apr 17.

    PubMed 28414546
  • Ramos G, Blizzard AM, Barroso NE, Bagner DM. Parent Training and Skill Acquisition and Utilization Among Spanish- and English-Speaking Latino Families. J Child Fam Stud. 2018 Jan;27(1):268-279. doi: 10.1007/s10826-017-0881-7. Epub 2017 Oct 17.

    PubMed 29456439
  • Bagner DM, Garcia D, Hill R. Direct and Indirect Effects of Behavioral Parent Training on Infant Language Production. Behav Ther. 2016 Mar;47(2):184-97. doi: 10.1016/j.beth.2015.11.001. Epub 2015 Nov 14.

    PubMed 26956651
  • Bagner DM, Rodriguez GM, Blake CA, Rosa-Olivares J. Home-Based Preventive Parenting Intervention for at-Risk Infants and Their Families: An Open Trial. Cogn Behav Pract. 2013 Aug 1;20(3):334-348. doi: 10.1016/j.cbpra.2012.08.001.

    PubMed 25414568

Questions about this trial

What is this clinical trial studying?

A study testing Infant Behavior Program (IBP) and Enhanced Pediatric Primary Care (EPPC) in people with Early Childhood Development and Behavior Problems, run by Florida International University at 2 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 3 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: under way, not looking for participants, as of the sponsor's last update on 2 Dec 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 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?

This study is still under way. Results are not available in the source record yet.

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?

Infant-Toddler Social and Emotional Assessment (ITSEA) (time frame: Change from week 0 to weeks 8, 24, 40, and 56). 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 NCT04594902, which also lists 8 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 2 Dec 2025.

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