Reducing Preschool Behavior Problems in an Urban Mental Health Clinic: A Pragmatic, Non-Inferiority Trial.

OBJECTIVE: This pragmatic, randomized, non-inferiority trial compared the effectiveness and cost of group-based parent management training (PMT) versus mastery-based individual coaching PMT in a low-income, predominantly African American sample.

METHOD: Parents seeking treatment for their 2-5 year old children's behavior problems in an urban fee-for-service child mental health clinic were randomized to the Chicago Parent Program (CPP; n=81) or Parent-Child Interaction Therapy (PCIT; n=80). Consent followed clinic intake and diagnostic assessment and PMT was delivered by clinicians employed at the clinic. Primary outcome measures were externalizing child behavior problems, assessed at baseline and post-intervention follow-up, using the Child Behavior Checklist (CBCL) and average per participant treatment cost.

RESULTS: Data from 158 parents were analyzed. Most were mothers (75.9%), African American (70.3%), and economically disadvantaged (98.7% Medicaid insured). Among the children, 58.2% were boys, mean age (SD) was 3.6 years (1.03). Based on CBCL scores, behavior problems improved in both conditions (Cohen's d=0.57 for CPP and 0.50 for PCIT). CPP was not inferior to PCIT (90% CI -1.58, 4.22) at follow-up, even after controlling for differences in treatment length (90% CI -1.63, 4.87). Average per participant treatment cost was higher for PCIT (M=$2,151) than CPP (M=$1,413) (95% CI $-1,304, $-170).

CONCLUSIONS: Among parents of young children living in urban poverty, CPP is not inferior to PCIT for reducing child behavior problems. CPP requires less time to complete and costs a third less than PCIT.