scholarly journals Randomised feasibility trial of the helping families programme-modified: an intensive parenting intervention for parents affected by severe personality difficulties

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033637 ◽  
Author(s):  
Crispin Day ◽  
Jackie Briskman ◽  
Mike J Crawford ◽  
Lisa Foote ◽  
Lucy Harris ◽  
...  
Keyword(s):  
Mental Health ◽  
Usual Care ◽  
Child Mental Health ◽  
Parenting Intervention ◽  
Child Behaviour ◽  
Feasibility Trial ◽  
Random Allocation ◽  
Secondary Outcomes ◽  
Participant Retention ◽  
Capacity For Consent

BackgroundSpecialist parenting intervention could improve coexistent parenting and child mental health difficulties of parents affected by severe personality difficulties.ObjectiveConduct a feasibility trial of Helping Families Programme-Modified (HFP-M), a specialist parenting intervention.DesignPragmatic, mixed-methods trial, 1:1 random allocation, assessing feasibility, intervention acceptability and outcome estimates.SettingsTwo National Health Service health trusts and local authority children’s social care.ParticipantsParents: (i) primary caregiver, (ii) 18 to 65 years, (iii) severe personality difficulties, (iv) proficient English and (v) capacity for consent. Child: (i) 3 to 11 years, (ii) living with index parent and (iii) significant emotional/behavioural difficulties.InterventionHFP-M: 16-session home-based intervention using parenting and therapeutic engagement strategies. Usual care: standard care augmented by single psychoeducational parenting session.OutcomesPrimary feasibility outcome: participant retention rate. Secondary outcomes: (i) rates of recruitment, eligibility and data completion, and (ii) rates of intervention acceptance, completion and alliance (Working Alliance Inventory-Short Revised). Primary clinical outcome: child behaviour (Eyberg Child Behaviour Inventory). Secondary outcomes: child mental health (Concerns About My Child, Child Behaviour Checklist-Internalising Scale), parenting (Arnold-O’Leary Parenting Scale, Kansas Parental Satisfaction Scale) and parent mental health (Symptom-Checklist-27). Quantitative data were collected blind to allocation.ResultsFindings broadly supported non-diagnostic selection criterion. Of 48 participants recruited, 32 completed post-intervention measures at mean 42 weeks later. Participant retention exceeded a priori rate (HFP-M=18; Usual care=14; 66.7%, 95% CI 51.6% to 79.6%). HFP-M was acceptable, with delivery longer than planned. Usual care had lower alliance rating. Child and parenting outcome effects detected across trial arms with potential HFP-M advantage (effect size range: 0.0 to 1.3).ConclusionHFP-M is an acceptable and potentially effective specialist parenting intervention. A definitive trial is feasible, subject to consideration of recruitment and retention methods, intervention efficiency and comparator condition. Caution is required in interpretation of results due to reduced sample size. No serious adverse events reported.Trial registration numberISRCTN14573230

scholarly journals An intervention for parents with severe personality difficulties whose children have mental health problems: a feasibility RCT

2020 ◽  
Vol 24 (14) ◽  
pp. 1-188
Author(s):  
Crispin Day ◽  
Jackie Briskman ◽  
Mike J Crawford ◽  
Lisa Foote ◽  
Lucy Harris ◽  
...  
Keyword(s):  
Mental Health ◽  
Usual Care ◽  
Mental Health Problems ◽  
Parenting Intervention ◽  
Health Problems ◽  
Feasibility Trial ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Quality Adjusted Life

Background The children of parents with severe personality difficulties have greater risk of significant mental health problems. Existing care is poorly co-ordinated, with limited effectiveness. A specialised parenting intervention may improve child and parenting outcomes, reduce family morbidity and lower the service costs. Objectives To develop a specialised parenting intervention for parents affected by severe personality difficulties who have children with mental health problems and to conduct a feasibility trial. Design A pragmatic, mixed-methods design to develop and pilot a specialised parenting intervention, Helping Families Programme-Modified, and to conduct a randomised feasibility trial with process evaluation. Initial cost-effectiveness was assessed using UK NHS/Personal Social Services and societal perspectives, generating quality-adjusted life-years. Researchers collecting quantitative data were masked to participant allocation. Setting Two NHS mental health trusts and concomitant children’s social care services. Participants Parents who met the following criteria: (1) the primary caregiver of the index child, (2) aged 18–65 years, (3) have severe personality difficulties, (4) proficient in English and (5) capable of providing informed consent. Index children who met the following criteria: (1) aged 3–11 years, (2) living with index parent and (3) have significant emotional/behavioural difficulties. Exclusion criteria were (1) having coexisting psychosis, (2) participating in another parenting intervention, (3) receiving inpatient care, (4) having insufficient language/cognitive abilities, (5) having child developmental disorder, (6) care proceedings and (7) index child not residing with index parent. Intervention The Helping Families Programme-Modified – a 16-session intervention using structured, goal-orientated strategies and collaborative therapeutic methods to improve parenting, and child and parent functioning. Usual care – standard care augmented by a single psychoeducational session. Main outcome measures Trial feasibility – rates of recruitment, eligibility, allocation, retention, data completion and experience. Intervention acceptability – rates of acceptance, completion, alliance (Working Alliance Inventory-Short Revised) and experience. Outcomes – child (assessed via Concerns About My Child, Eyberg Child Behaviour Inventory, Child Behaviour Checklist-Internalising Scale), parenting (assessed via the Arnold-O’Leary Parenting Scale, Kansas Parental Satisfaction Scale), parent (assessed via the Symptom Checklist-27), and health economics (assessed via the Client Service Receipt Inventory, EuroQol-5 Dimensions). Results The findings broadly supported trial feasibility using non-diagnostic screening criteria. Parents were mainly referred from one site (75.0%). Site and participant factors delayed recruitment. An estimate of eligible parents was not obtained. Of the 86 parents referred, 60 (69.7%) completed screening and 48 of these (80.0%) were recruited. Participants experienced significant disadvantage and multiple morbidity. The Helping Families Programme-Modified uptake (87.5%) was higher than usual-care uptake (62.5%). Trial retention (66.7%, 95% confidence interval 51.6% to 79.6%) exceeded the a priori rate. Process findings highlighted the impact of random allocation and the negative effects on retention. The Helping Families Programme-Modified was acceptable, with duration of delivery longer than planned, whereas the usual-care condition was less acceptable. At initial follow-up, effects on child and parenting outcomes were detected across both arms, with a potential outcome advantage for the Helping Families Programme-Modified (effect size range 0.0–1.3). For parental quality-adjusted life-years, the Helping Families Programme-Modified dominated usual care, and child quality-adjusted life-years resulted in higher costs and more quality-adjusted life-years. At second follow-up, the Helping Families Programme-Modified was associated with higher costs and more quality-adjusted life-years than usual care. For child quality-adjusted life-years, when controlled for baseline EuroQol-5 Dimensions, three-level version, usual care dominated the Helping Families Programme-Modified. No serious adverse events were reported. Conclusion The Helping Families Programme-Modified is an acceptable specialised parenting intervention. Trial methods using non-diagnostic criteria were largely supported. For future work, a definitive efficacy trial should consider site selection, recruitment methods, intervention efficiency and revised comparator condition. Trial registration Current Controlled Trials ISRCTN14573230. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 14. See the NIHR Journals Library website for further project information.

scholarly journals Protocol of a feasibility trial for an online group parenting intervention with an integrated mental health component for parent refugees and asylum-seekers in the United Kingdom: (LTP + EMDR G-TEP)

2021 ◽  
Vol 9 ◽  
pp. 205031212110678
Author(s):  
Safa Kemal Kaptan ◽  
Filippo Varese ◽  
Betul Yilmaz ◽  
Panoraia Andriopoulou ◽  
Nusrat Husain
Keyword(s):  
Mental Health ◽  
Asylum Seeker ◽  
Asylum Seekers ◽  
Parenting Intervention ◽  
Feasibility Trial ◽  
Control Group ◽  
Parental Mental Health ◽  
Post Intervention ◽  
Poor Growth ◽  
Refugees And Asylum Seekers

Objectives: Conflicts expose families to a range of factors that could have a negative impact upon parental mental health which in turn leads to poor growth and development of children. Early support can improve parental mental health and parenting behaviours but currently, there is a lack of evidence on parenting interventions for forcibly displaced populations. This study aims to deliver an online parenting intervention with a mental health component for refugee and asylum-seeker parents to evaluate its feasibility and acceptability. Methods: This is a single-arm trial without a control group. The trial aims to recruit 14 refugee and asylum-seeker parents into an Online Learning Through Play and Eye Movement Desensitization and Reprocessing Group Traumatic Episode Protocol (LTP + EMDR G-TEP). The intervention will be delivered by trained research team members using online platforms. Results: The participants’ sense of parenting competence, symptoms of traumatic stress, anxiety and depression will be measured at baseline and post-intervention. Semi-structured interviews at post-intervention will also be conducted. Discussion: This study will assess the feasibility and inform the design of a future randomized controlled trial which aims to evaluate the effectiveness of LTP + EMDR G-TEP intervention for parent refugees and asylum-seekers with young children.

scholarly journals Improved Child Mental Health Following Brief Relationship Enhancement and Co-Parenting Interventions During the Transition to Parenthood

2020 ◽  
Vol 17 (3) ◽  
pp. 766
Author(s):  
Lianne M. Tomfohr-Madsen ◽  
Gerald F. Giesbrecht ◽  
Joshua W. Madsen ◽  
Anna MacKinnon ◽  
Yunying Le ◽  
...  
Keyword(s):  
Mental Health ◽  
Relationship Satisfaction ◽  
Child Mental Health ◽  
Internalizing Symptoms ◽  
Transition To Parenthood ◽  
Externalizing Symptoms ◽  
Parenting Intervention ◽  
Negative Emotionality ◽  
Emotional And Behavioral Problems ◽  
Parenting Interventions

The transition to parenthood has been identified as a significant relationship stressor. Many couples report declines in relationship satisfaction and difficulty with individual stress and co-parenting—problems that have been associated with both child temperament as well as emotional and behavioral problems. Several parenting and relationship interventions have been developed to buffer against these difficulties. In the current study, we report secondary analyses of a randomized controlled trial of brief (6-h) interventions that focused on improving either relationship satisfaction or co-parenting, delivered during pregnancy and the early postpartum period. In this trial, 90 opposite-sex couples (180 participants), who were pregnant with their first child, and were assessed as being at high risk for declines in relationship satisfaction, were randomized to receive either (1) a relationship intervention, (2) a co-parenting intervention, or (3) an information control. At 12 months postpartum, couples who received either the relationship or co-parenting intervention rated their infants as having lower negative emotionality and as having fewer externalizing symptoms compared to the information-only control. Lower externalizing symptoms at 12 months were, in turn, associated with reduced externalizing symptoms at 24 months postpartum. Whereas, lower ratings of child negative emotionality at 12 months were associated with reduced internalizing symptoms at 24 months postpartum. These results indicate that brief relationship or co-parenting interventions delivered during the transition to parenthood have secondary benefits for child mental health.

Acceptability and Preliminary Outcomes of a Parenting Intervention for Syrian Refugees

2020 ◽  
Vol 31 (1) ◽  
pp. 14-25
Author(s):  
Amanda L. Sim ◽  
Lucy Bowes ◽  
Sandra Maignant ◽  
Sara Magber ◽  
Frances Gardner
Keyword(s):  
Mental Health ◽  
Child Maltreatment ◽  
Child Mental Health ◽  
Mental Health Problems ◽  
Parenting Intervention ◽  
Nongovernmental Organization ◽  
Syrian Refugees ◽  
Paired Sample ◽  
Before And After ◽  
Humanitarian Setting

Purpose: Forced displacement may increase the risk of child maltreatment and mental health problems among children and caregivers. This study assessed the acceptability and preliminary outcomes of a parenting intervention to prevent child maltreatment and improve parental and child mental health among Syrian refugees in Lebanon. Method: 292 parents and 88 children participated in a structured assessment before and after a group-based parenting intervention implemented by an international nongovernmental organization serving refugee and vulnerable Lebanese communities. Results: Paired sample t tests showed significant reductions in harsh punishment and rejecting parenting behavior and significant improvements in measures of parental and child mental health from pre- to postintervention. On average, parents completed 7.7 of 10 sessions. Discussion: Preliminary results suggest that the parenting intervention was acceptable to refugee parents and may show promise in reducing child maltreatment and improving parental and child mental health in a humanitarian setting.

scholarly journals Managing Cancer And Living Meaningfully (CALM): randomised feasibility trial in patients with advanced cancer

2016 ◽  
Vol 9 (2) ◽  
pp. 209-218 ◽  
Author(s):  
Chris Lo ◽  
Sarah Hales ◽  
Aubrey Chiu ◽  
Tania Panday ◽  
Carmine Malfitano ◽  
...  
Keyword(s):  
Usual Care ◽  
Advanced Cancer ◽  
Experiential Avoidance ◽  
Controlled Trial ◽  
Well Being ◽  
Attachment Anxiety ◽  
Feasibility Trial ◽  
Trial Methodology ◽  
Phase 3 ◽  
Secondary Outcomes

BackgroundManaging Cancer And Living Meaningfully (CALM) is a brief individual psychotherapy for patients with advanced cancer. In an intervention-only phase 2a trial, CALM showed promising results, leading to the present 2b pilot, which introduces procedures for randomisation and improved rigour in preparation for a phase 3 randomised controlled trial (RCT).AimsTo test trial methodology and assess feasibility of a confirmatory RCT.DesignA parallel-arm RCT (intervention vs usual care) with 3 and 6-month follow-ups. Assessment of feasibility included rates of consent, randomisation, attrition, intervention non-compliance and usual care contamination. Primary outcome: depressive symptoms (Patient Health Questionnaire-9; PHQ-9). Secondary outcomes: major depressive disorder (MDD), generalised anxiety, death anxiety, spiritual well-being, attachment anxiety and avoidance, self-esteem, experiential avoidance, quality of life and post-traumatic growth. Bayesian conjugate analysis was used in this low-powered setting.Setting/participants60 adult patients with advanced cancer from the Princess Margaret Cancer Centre.ResultsRate of consent was 32%, randomisation 78%, attrition 25%, non-compliance 37% and contamination 17%. There was support for potential treatment effects on: PHQ-9, OR=1.48, 95% Credible Interval (CRI.95) (0.65, 3.38); MDD, OR=1.56, CRI.95 (0.50, 4.84); attachment anxiety, OR=1.72, CRI.95 (0.73, 4.03); and attachment avoidance, OR=1.58, CRI.95 (0.67, 3.71). There was no support for effects on the seven remaining secondary outcomes.ConclusionsA phase 3 CALM RCT is feasible and should aim to detect effect sizes of d=0.40, with greater attention to issues of compliance and contamination.Trial registration numberNCT02353546.

The Building Regulation in Dual-Generations Program (BRIDGE): A Mixed-Methods Feasibility Pilot of a Parenting Program for Depressed Mothers of Preschoolers, Matched with Dialectical Behavior Therapy Skills

2020 ◽  
Author(s):  
Leslie E Roos ◽  
Lauren Kaminski ◽  
Shaelyn Stienwandt ◽  
Sandra Hunter ◽  
Ryan Jeffrey Giuliano ◽  
...  
Keyword(s):  
Mental Health ◽  
Mixed Methods ◽  
Maternal Depression ◽  
Behavior Therapy ◽  
Dialectical Behavior Therapy ◽  
Child Mental Health ◽  
Feasibility Trial ◽  
Clinically Significant ◽  
Bridge Building ◽  
Preschool Aged Children

Early exposure to maternal depression is a key risk factor for child mental illness (MI), but there are limited programs that interrupt intergenerational transmission. The BRIDGE “Building Regulation in Dual GEnerations” Program treats maternal MI using Dialectical Behavior Therapy Skills with a paired curriculum that promotes non-reactive and emotionally validating parenting designed to improve child mental health and ultimately prevent MI.This pilot feasibility trial (n=28 dyads) included mothers and their preschool-aged children. The 20-week program was completed in a group-based format using mixed methods questionnaires and interviews. Results indicate high feasibility and acceptability (86% retention). Consistent improvements were seen across program targets and outcomes including maternal depression (d = 1.02) and child mental health (d = 1.08), with clinically significant symptom reductions for 85% of clients. Mothers with higher adversity exhibited greater reductions in parenting stress. Qualitative results highlighted efficacy in promoting positive parent-child relationships, rewarding parenting experiences, competence, and child development. Evidence suggests high feasibility and accessibility for BRIDGE in addressing intergenerational mental health needs. There was strong satisfaction with the program material and efficacy across key outcomes. BRIDGE holds promise for offering a transdiagnostic approach to preventing child MI in families of at-risk preschool aged children.

scholarly journals Crisis-planning interventions for people with psychotic illness or bipolar disorder: systematic review and meta-analyses

BJPsych Open ◽  
2019 ◽  
Vol 5 (4) ◽  
Author(s):  
Emma Molyneaux ◽  
Amelia Turner ◽  
Bridget Candy ◽  
Sabine Landau ◽  
Sonia Johnson ◽  
...  
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Usual Care ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Crisis Planning ◽  
Psychotic Illness ◽  
Health Crisis ◽  
Psychiatric Admissions ◽  
Secondary Outcomes

Background Mental health services lack a strong evidence base on the most effective interventions to reduce compulsory admissions. However, some research suggests a positive impact of crisis-planning interventions in which patients are involved in planning for their future care during a mental health crisis. Aims This review aimed to synthesise randomised controlled trial (RCT) evidence on the effectiveness of crisis-planning interventions (for example advance statements and joint crisis plans) in reducing rates of compulsory hospital admissions for people with psychotic illness or bipolar disorder, compared with usual care (PROSPERO registration number: CRD42018084808). Method Six online databases were searched in October 2018. The primary outcome was compulsory psychiatric admissions and secondary outcomes included other psychiatric admissions, therapeutic alliance, perceived coercion and cost-effectiveness. Bias was assessed using the Cochrane collaboration tool. Results The search identified 1428 studies and 5 RCTs were eligible. One study had high risk of bias because of incomplete primary outcome data. Random-effects meta-analysis showed a 25% reduction in compulsory admissions for those receiving crisis-planning interventions compared with usual care (risk ratio 0.75, 95% CI 0.61–0.93, P = 0.008; from five studies). There was no statistical evidence that the intervention reduced the risk of voluntary or combined voluntary and compulsory psychiatric admissions. Few studies assessed other secondary outcomes. Conclusions Our meta-analysis suggests that crisis-planning interventions substantially reduce the risk of compulsory admissions among individuals with psychotic illness or bipolar disorder. Despite common components, interventions varied in their content and intensity across the trials. The optimal models and implementation of these interventions require further investigation. Declaration of interest E.M., S.L., S.J. and B.L.-E. received funding from the National Institute for Health Research during the conduct of the study.

Sign in / Sign up

Export Citation Format

Share Document