The Impact of Parent Training on the Child's Health Services

Pediatric health services utilization (pHSU) by children with mental health conditions
demonstrated dramatic increases between 2006 and 2011. These national trends reflecting large
increases in pHSU for mental health conditions were seen across multiple developmental
levels. Health services costs for children with mental health conditions are estimated to be
twice those for the average child. The Incredible Years® Parent Program (IY) has a strong
evidence-base supporting its effectiveness in reducing early onset conduct problems. The
overall objective of this stage 3 (T3) translational research proposal is to conduct a pilot
study of 45 pediatrician-referred parents who participate in IY and examine the impact of IY
on pHSU of their children. Pediatric HSU outcome measures include: all-cause ED visits;
in-patient hospitalizations and length of stay; authorizations for specialist referrals;
primary and acute care visits; and ED visits for mental health conditions. The investigator's
central hypothesis is that children ages 3 to 6 years with behavior concerns whose parents
are referred by their pediatricians for participation in IY will have decreased mean annual
all-cause pHSU and decreased ED visits for mental health conditions in the 12 months
following IY, compared to the 24 months prior to IY participation. This is important to
demonstrate because significant financial barriers exist to integrating effective family
focused prevention services like IY into pediatric primary care settings. Demonstration of
reduced pHSU is one way to address these translational barriers. Results of this pilot study
are expected to provide preliminary data on pre- and post-intervention effect sizes; these
data will be used to demonstrate the feasibility of collecting data using existing sources of
pHSU to design a more fully powered multi-site trial with a robust comparator group.

Inclusion Criteria:

- Children receiving primary care at CHLA AltaMed with parent-reported behavioral
concerns whose parents are referred by their pediatricians for participation in the
Incredible Years Parenting Program.

- Continuous enrollment in AltaMed Medicaid funded health services during the 24 months
prior to participation in IY and 12 months following participation in IY with lapses
in coverage of no more than 90 days in length.

- Parents are English or Spanish-speaking or willing to use interpretation if they speak
another language.

Exclusion Criteria:

- Private (commercial non-Medicaid) insurance coverage for greater than 90 days during
the 24 months prior to participation in IY and 12 months following participation in
IY.