ABSTRACT Child and adolescent behavioral health problems are related to the leading causes of youth morbidity and mortality and are costly to society. Parent-focused interventions effectively prevent behavioral health problems such as depression and conduct disorders and can provide an economic benefit to society. Unfortunately, parenting programs are not widely available, not accessible, nor well-attended. Pediatric primary care is a non- stigmatizing setting with nearly universal reach and, therefore, an ideal access point to increase access. However, primary care clinicians (PCCs) often have insufficient training in behavioral health topics and typical referral practices are often inadequate. There are also logistical barriers to attending in-person parenting programs, like the need for childcare and a large time-commitment. There is a need to develop effective referral practices in conjunction with increasing the accessibility of parenting programs. Our long-term goal is to prevent significant behavioral health problems through widespread access to effective and accessible parenting programs through primary care referrals. Previously, we successfully developed and pilot tested a brief training for PCCs that we call Support & Guide (S&G). S&G training provides a communication strategy for engaging parents in a conversation about parenting and for making referrals. We also successfully pilot tested a brief, online parenting intervention based on GenerationPMTO, called Empowered Generations (eGen); eGen is a six-session parent training program provided by therapists via video chat online to parents with a child between the ages of 3-8 years. S&G training and eGen were both found to be feasible and acceptable, and both demonstrated promise of effectiveness. Significantly, all clinical aspects of the study have been conducted in real-world settings and systems and are highly pragmatic. In the proposed R01, we will build on the knowledge gained through the R34 to conduct fully powered randomized trials. The secondary objective of this study is to test the effectiveness of brief PCC S&G training. The primary objective of this project is to test the effectiveness and cost-benefit of eGen. The study design includes two parallel randomized controlled trials (RCT). In the S&G RCT, we will randomize PCCs (aim 1); in the eGen RCT we will randomize parents (aim 2). These two trials are linked by the fact that the parents referred by PCCs in aim 1 are the same parents who are invited to participate in the aim 2 eGen trial. In addition, we will examine the cost benefit of eGen (aim 3) when implemented with community therapists and with a real-world, primary-care-referred sample of parents. This research is significant because it simultaneously addresses the need to develop effective referral practices in conjunction with increasing the accessibility of parenting programs. The innovative design in this study captures the entire patient flow from initial enga...