Structured Review of Parenting Programs in Primary Care to Prevent Adolescent Mental, Emotional, and Behavioral Disorder

Research has repeatedly shown that family and parent-based interventions are one of the most efficacious ways to prevent adolescent mental, emotional, and behavioral disorders (MEBs) by changing child and adolescent’s developmental context and mediating mechanisms such as parent-child communication and parental monitoring.  Family-based interventions have been more effective in reducing adolescent substance-abuse, internalizing, and externalizing disorders compared to school alone or child alone interventions.  Recent reviews have shown that these effects are not only observed at post-test, but through long term outcomes as well.  However, dissemination of many of these interventions has been slow or non-existent, limiting accessibility by families. One environment that could potentially support the delivery of parenting interventions is general medical care settings such as primary care, family medicine, or pediatrics, especially as the Affordable Care Act (ACA) has increased coverage for youth up to age 26 and for preventive services.  Further, the ACA instilled power into the United States Preventive Services Task Force (USPSTF) by ensuring that all “A” or “B” level recommendations for prevention focused screening and services in primary care would be covered by Medicare or private insurance.  This offers an excellent opportunity for increased dissemination of parenting interventions to improve youth and adolescent outcomes, yet many interventions have not been developed in or adapted for primary care, and are thus the body of literature to establish sufficient evidence for USPSTF recommendations is wanting.  To assess the state of the evidence, we are completing a structured review of trials published in PubMed and/or registered in the National Clinical Trials registry to assess which parenting interventions targeting child and adolescent MEBs have been developed for or scaled out to general medical care settings.  We found that a number of programs have shown promising effects, while others are currently being adapted and testing in primary care.  This presentation will discuss frameworks for scaling out evidence-based parent-based prevention programs into a new setting, such as primary care, core elements and mechanisms of intervention effects as identified during the review, and action steps to develop a policy informed research agenda for parenting interventions.