Using telehealth technologies to engage and support parents of children with disabilities: An evaluation of a novel telehealth parenting programme

Abstract

In the absence of effective and appropriate supports, the many unique challenges faced by families of children with disability are likely to be exacerbated. Telehealth technologies offer a promising service-delivery model for disseminating parenting interventions in an accessible, timely and convenient manner with research indicating comparable outcomes between telehealth-based and conventional face-to-face programmes. Regardless of these encouraging findings, few empirically-validated parenting programmes are available in a telehealth delivery modality, with even fewer interventions specifically targeting, and/or including, adaptations to meet the specific needs of parents and caregivers of children with a disability.The primary aim of the current study is to develop and investigate the efficacy of a telehealth-based parenting intervention for parents of children with a disability. The acceptability of and parent satisfaction with the developed intervention will also be examined as a secondary outcome of the research. Chapter 1 of this dissertation provides a brief overview of the pertinent issues impacting upon the research field and provides a rationale for the current research.Chapter 2 is a systematic review of the literature in relation to online/telehealth parenting interventions for parents of children with an intellectual or developmental disability. The systematic review was undertaken between October 2013 and April 2014. Eight articles met inclusion criteria; reporting on five trials (three RCTs and two pre-post). All five studies used standardised parent-reported measures of child behaviour. The review provides preliminary evidence as to the efficacy of telehealth-based delivery of programmes in this population, however the small number of studies available and the restricted areas of disability investigated (TBI and FASD), indicates that this is currently a very limited field of research.Chapter 3 details a qualitative inquiry as to the telehealth-related consumer preferences of parents and carers of children (aged 0-17 years) with mixed disabilities. The survey investigated parents’ access to and use of the internet, degree of comfort with a range of online and telehealth-based technologies, the acceptability of online parenting training to this population and preferences in relation to potential delivery modalities and supports. Results were used to inform the development of a telehealth-based parenting intervention for this population.Chapter 4 provides the protocol of a randomised controlled trial (RCT) of a novel telehealth-based parenting programme for parents and carers of children (aged 2-12 years) with a disability. The theoretical basis, study hypotheses, methods and planned analyses for this protocol are described.Chapter 5 is a manuscript accepted for publication with Research in Developmental Disorders, and reports on the results of the RCT conducted. Ninety-eight parents were randomly assigned to either the telehealth intervention (Triple P Online-Disability) or a control condition (care as usual over 8 weeks). At post-intervention parents receiving the Triple P Online-Disability (TPOL-D) intervention demonstrated significant improvements in parenting self-efficacy and parenting styles when compared with the treatment-as-usual (TAU) control group, but not on child behavioural or emotional problems. At 3-month follow up intervention gains were either maintained and/or enhanced. A significant decrease in parent- reported child behavioural and emotional problems was also detected at this time.Chapter 6 briefly examines the acceptability of and parent satisfaction with TPOL-D. Using data from 46 completing intervention parents, research questions addressed: (1) intervention adherence; (2) overall satisfaction with TPOL-D; (3) therapist identification and alliance; (4) perceived helpfulness of the individual components of TPOL-D; (5) ‘useability’ of online modules; and (6) future consumer preference and advocacy issues. Given that no in-person contact occurs at any time in TPOL-D (including the delivery of remote access and technological support), questions of therapist identification and alliance (if any) were of particular interest. Overall, parents reported a high degree of satisfaction with TPOL-D on all outcomes of interest.Finally, Chapter 7 provides a general discussion of the research findings presented in this dissertation examining their contribution to the field, as well as the limitations of the research. Implications are discussed and suggestions made for future research. Results from this thesis suggest that the developed intervention (TPOL-D) is a promising intervention for parents and carers of children with disabilities.