(PS10-B33) Technology-enhanced Behavioral Parent Training: The Relationship Between Technology Use and Treatment Efficiency

Behavior disorders (BDs) are common and, without treatment, can have long-term impacts on child and family health. Behavior Parent Training (BPT) is the standard of care intervention for early-onset BDs; yet, engagement is challenging, especially for low-income families. Given the growing uptake of smartphone devices and recent efforts to use digital health to reduce the healthcare system burden exacerbated by COVID-19, mobile apps have garnered increasing attention as an avenue to improve treatment effectiveness among families facing structural socioeconomic barriers. Indeed, between-group analyses have shown that a technology-enhanced version of one BPT program (Technology-Enhanced Helping the Noncompliant Child; TE-HNC) significantly improves the efficiency of service delivery (i.e., fewer weeks to and associated costs with treatment completion) relative to traditional BPT (HNC), while achieving clinically significant gains in parenting skills and child behavior. Consistent with ABCT’s theme, “Emergency & Disaster Preparedness and Response,” this study extends existing research by exploring the patterns of parent use of specific technology components in TE-HNC, the perceptions that may shape their use, and their differential effect on the efficiency of service delivery (ESD).  

Data were collected from families who were randomized to and completed TE-HNC, yielding a sample of 34 parents (97.1% female, M_age=31.6) of 3- to 8-year old children (41.2% female, M_age=4.9) with clinically significant externalizing symptoms (determined by the Eyberg Child Behavior Inventory) from low-income households (100-250% of the federal poverty limit). TE-HNC included the standard HNC program and format, as well as access to a mobile app with three core components: a video series modeling concepts and skills, surveys capturing daily skill use and attitudes, and weekly videorecording submissions of skills practice at home. At the conclusion of treatment, parents completed the Consumer Satisfaction Scale, a 42-item measure that assesses the perceptions of each technology-enhanced component. Additionally, the frequency of component use was captured via the mobile app and contextualized by opportunities for use. Finally, the efficiency of service delivery was operationalized as the number of sessions required for parents to sufficiently master new skills and achieve associated improvements in child behavior, as determined by HNC criteria. 
The frequency of videorecording home practice averaged 62.8% (SD=33.2), followed by completion of the daily survey (35.1%; SD=23.8) and watching a skills video (26.0%; SD=23.4). Linear regression analyses were conducted to predict ESD from use of the core components in TE-HNC. These variables statistically significantly predicted ESD (P< 0.01); however, only use of the videorecording component added significantly to the predictive model (P< 0.01). Additional analyses will assess the perceptions of the components that may contribute to variability in use during and after treatment. Findings will have implications for the design and development of technology-enhanced treatments, as well as further understanding of facilitators of and barriers to engagement in underserved communities.