Child Adult Relationship Enhancement in Pediatric Primary Care Parenting Group to Reduce Child Behavior Problems

Child behavioral concerns are common among families served by The Children's Hospital of
Philadelphia (CHOP) urban primary care centers. To address this, we developed Child Adult
Relationship Enhancement Model in Primary Care Parenting Program (PriCARE), a scaled down
version of Parent Child Interaction Therapy designed for urban primary care clinics. The
objectives of this study are to 1) evaluate the efficacy of the modified PriCARE to decrease
child behavior problems and improve parenting capacity and skills and 2) understand parents'
perceptions of the efficacy of PriCARE and strategies for improving its implementation and
dissemination. We will perform a randomized controlled trial (RCT) of the effectiveness of
the modified PriCARE on decreasing child behavior problems and improving positive parenting
among 2- to 6-year-old children with behavior problems and their parents at CHOP's urban
Primary Care Centers. We intend to randomize 120 child-parent pairs (240 subjects) to receive
PriCARE immediately plus usual treatment (intervention group) and 60 child-parent pairs (120
subjects) to receive PriCARE at a later time plus usual treatment (control group) for a total
of 180 child-parent pairs (360 subjects). All child-parent pairs randomized to the control
group will be placed on a waitlist and offered PriCARE after completion of data collection.
Child behavior and parenting style will be measured at baseline (time 1), at 6-19 weeks (time
2), and at 14-27 weeks (time 3).

Inclusion Criteria:

1. Parent is 18 years or older

2. Parent is English speaking

3. Child is 2-6 years old

4. Parent reports that child has a behavior problem

5. Child attends CHOP Urban Primary Care Center 6) Parental/guardian permission is
provided (informed consent)

Exclusion Criteria:

1. Child has a cognitive age less than 2 years old as determined by the referring
clinician

2. Child is already receiving behavioral health therapy or medication (other than
medication for ADHD)