Psychoeducational Parenting Intervention Research Articles

A Pilot Randomized Controlled Trial of Families Addressing Cancer Together for Parents With Cancer: Feasibility, Acceptability, and Preliminary Effects

ABSTRACTObjectiveTo evaluate the feasibility, acceptability, and preliminary efficacy of Families Addressing Cancer Together (FACT), a web‐based, individually tailored, psychoeducational intervention for parents with cancer to improve illness‐related communication with their minor children.MethodsParents with stage I‐IV solid tumors who had children ages 3–17 were randomized to 6 weeks of FACT versus waitlist control. Feasibility was assessed by rates of recruitment and retention. Acceptability (primary outcome) was defined a priori as ≥ 75% of FACT participants rating FACT ≥ 12 (on an 18‐point study‐specific scale), and semi‐structured interviews provided additional qualitative acceptability information. Generalized estimating equation methods were used to assess preliminary efficacy for communication self‐efficacy, depression, and anxiety; Fisher's exact tests explored differences in individual communication beliefs and behaviors.ResultsForty‐eight approached patients enrolled (recruitment rate: 73%), 85% were retained through the post‐intervention assessment, and 78% rated FACT as acceptable. In the FACT group compared to control, the modeled improvement in CSES scores from baseline to post‐intervention was 9.5 versus 0 points (p = 0.004). FACT participants were more likely to have told their children that they have cancer (83.3% vs. 52.2%, p = 0.03) and felt more prepared to answer their children's questions about cancer (p = 0.02). Groups did not differ in depression or anxiety.ConclusionsFACT was feasible, acceptable, and demonstrated potential to improve parents' communication self‐efficacy, beliefs, and behaviors. A large scale randomized controlled trial of FACT is needed to confirm these benefits and evaluate longer‐term effects on psychological outcomes for parents with cancer and their children.

Pilot Trial of a Peer-to-Peer Psychoeducational Intervention for Parents of Black Children Awaiting a Developmental Evaluation.

This study examined the short-term impact on child, family, and parent outcomes of a peer-to-peer psychoeducational intervention, Parents Taking Action (PTA) for Black families of children awaiting developmental-behavioral pediatric evaluations. We targeted parents and other primary caregivers of Black children aged 8 years or younger awaiting a developmental or autism evaluation at an academic tertiary care hospital. Using a single-arm design, we recruited participants directly from the appointment waitlist and used flyers in local pediatric and subspecialty clinics. Eligible participants received a version of PTA adapted for Black children in two 6-week modules delivered synchronously online. In addition to initial baseline demographic data, we collected 4 standardized measures of parent stress and depression, family outcomes (e.g., advocacy), and child behavior at preintervention, midintervention, and postintervention. We calculated effect sizes and used linear mixed models to examine changes over time. Fifteen participants completed PTA, the majority of whom were Black mothers with annual household incomes <$50,000. All children were Black and mostly boys, with an average age of 4.6 years. Parent depression, the family outcome total score, and 3 family outcomes (understanding child's strengths, needs, and abilities; knowing rights and advocating for child; and helping child develop and learn) significantly improved pre-post intervention, with medium to large effect sizes. Furthermore, the family outcome total score and "knowing rights and advocating for child" outcome significantly increased by midintervention ( d = 0.62-0.80). Peer-delivered interventions can result in positive outcomes for families awaiting diagnostic evaluations. Further research is needed to confirm findings.

Parents’ mental health literacy, preferred school counsellor roles, and intention to follow up referrals

AbstractMany mental illnesses have onset during adolescence, and if untreated may have long-term negative outcomes. Parents and school counsellors can assist adolescents by monitoring for mental illness and facilitating appropriate support. The present study investigated parents’ mental health literacy (MHL), preferred views of school counsellor roles, and intention to follow up referrals. Eighty-seven Australian parents of current secondary school students were recruited to an online cross-sectional survey via convenience sampling. Results showed that, on average, parents had good MHL, moderately endorsed school counsellor roles, and were committed to following up referrals. Higher MHL, but not preferred school counsellor roles, predicted intention to follow up referrals to general practitioners and specialised mental health services. Findings support targeted psychoeducational intervention for parents regarding MHL and the role of the school counsellor and directions for future research are discussed.

Family Minds: A randomized controlled trial of a group intervention to improve foster parents' reflective functioning.

Family Minds is a brief group psychoeducational parenting intervention designed to increase the reflective functioning (RF) and mentalization skills of foster parents. RF is important for foster parents who have to build relationships with children whose adverse experiences increase their risk for psychosocial challenges. A randomized controlled trial (RCT) for Family Minds was conducted in Texas with 89 foster parents. The main aims of this study were to examine whether the intervention could significantly increase the RF/mentalization skills of the foster parents and decrease their parenting stress. After 6 weeks, compared with the control group, intervention foster parents improved their RF via a lowering of pre-mentalizing and also significantly decreased parenting stress related to parent-child dysfunctional interactions. Other measures of RF and parenting stress showed no significant differences between groups. Foster child behavior was not significantly different between groups, although data at 6 months showed a possible lowering of internalizing symptoms for children of intervention parents. This RCT provides some encouraging evidence that Family Minds may increase RF in foster parents, improve parental sensitivity and their ability to emotionally regulate, decrease parenting stress related to challenging interactions with their foster children, and possibly decrease children's internalizing behavior.

Upping my game as a parent: Attributed gains in participating in a cancer parenting program for child-rearing parents with advanced cancer.

The objective of this study was to describe in the words of child-rearing parents with incurable cancer, what they had gained or thought about as a result of participating in a five-session, scripted, telephone-delivered psycho-educational parenting intervention, the Enhancing Connections Program in Palliative Care. A total of 26 parents completed the program. Parents' responses were audio-recorded and transcribed verbatim and verified for accuracy. The analysis proceeded through four steps: unitizing, coding into categories, defining categories, and formation of a core construct that explained parents' attributed gains. Trustworthiness of study results was protected by coding to consensus, formal peer debriefing, and maintaining an audit trail. Although 50% reached or exceeded clinical cutoff scores on anxiety and 42% reached or exceeded clinical cutoff scores on depressed mood, parents extensively elaborated what they gained. Results revealed six categories of competencies they attributed to their participation in the program: (1) being ready for a conversation about my cancer, (2) bringing things out in the open, (3) listening better to my child, (4) getting my child to open up, (5) not getting in my child's way, and (6) changing my parenting. Despite an extensive symptom burden, parents with incurable cancer attributed major gains from a brief, fully scripted, cancer parenting communication intervention. A manualized telephone-delivered educational counseling program for symptomatic parents with incurable cancer has the potential to augment competencies for parents as they assist their children manage the cancer experience.

Psycho-Educational Intervention for Parents Having Children with Attention Deficit Hyperactivity Disorder

Background: Attention-deficit/hyperactivity disorder (ADHD) is the most common psychiatric disorder of childhood that can profoundly affect the academic achievement, well-being, and social interactions of children. Therefore, this study aimed to evaluate the effect of applying a psycho educational intervention for Parents Having Children with Attention Deficit Hyperactivity Disorder. A quasi-experimental research design [pretest -posttest] was conducted at the Psychiatric out patient’s clinic at El Ahrar Hospital at Zagazig City. The instruments used for data collection were parents socio-demographic and clinical data sheet, parents’ knowledge about ADHD, parental caregivers positive and negative attitudes toward ADHD child, in addition to parent caregiver practices toward their ADHD children. Forty eight subjects were participated in this study and were chosen according to the inclusion criteria. Results: revealed that there was a statistical significant improvement of knowledge, practice, attitudes of the parents before and after psycho-educational program. Conclusion: the implementation of psycho-educational intervention for the parents of children with ADHD was effective in improving their knowledge, practice, and attitudes towards ADHD. Recommendation: Conduct more developed programs in the study settings for more improvements. Nurses should exert more effort to support the parents of children with ADHD, and they need training to be able to do this.

Feasibility trial of a psychoeducational intervention for parents with personality difficulties: The Helping Families Programme.

The Helping Families Programme is a psychoeducational parenting intervention that aims to improve outcomes and engagement for parents affected by clinically significant personality difficulties. This is achieved by working collaboratively with parents to explore ways in which their emotional and relational difficulties impact on parenting and child functioning, and to identify meaningful and realistic goals for change. The intervention is delivered via one-to-one sessions at weekly intervals over a period of 16 weeks. This protocol describes a two-arm parallel RCT in which consenting parents are randomly allocated in a 1:1 ratio to either the Helping Families Programme plus the usual services that the parent may be receiving from their mental health and/or social care providers, or to standard care (usual services plus a brief parenting advice session). The primary clinical outcome will be child behaviour. Secondary clinical outcomes will be child and parental mental health, parenting satisfaction, parenting behaviour and therapeutic alliance. Health economic measures will be collected on quality of life and service use. Outcome measures will be collected at the initial assessment stage, after the intervention is completed and at 6-month follow-up by research staff blind to group allocation. Trial feasibility will be assessed using rates of trial participation at the three time points and intervention uptake, attendance and retention. A parallel process evaluation will use qualitative interviews to ascertain key-workers’ and parent participants' experiences of intervention delivery and trial participation. The results of this feasibility study will determine the appropriateness of proceeding to a full-scale trial.

Mechanisms of change: Testing how preventative interventions impact psychological and physiological stress functioning in mothers in neglectful families.

The present study applies a multilevel approach to an examination of the effect of two randomized preventive interventions with mothers in neglectful families who are also contending with elevated levels of impoverishment and ecological risk. Specifically, we examined how participation in either child-parent psychotherapy (CPP) or psychoeducational parenting intervention (PPI) was associated with reductions in maternal psychological parenting stress and in turn physiological stress system functioning when compared to mothers involved in standard community services as well as a demographic comparison group of nonmaltreating mothers. The resulting group sizes in the current investigation were 44 for CPP, 34 for PPI, 27 for community services, and 52 for nonmaltreating mothers. Mothers and their 13-month-old infants were randomly assigned to intervention group at baseline. Mothers completed assessments on stress within the parenting role at baseline and postintervention. Basal cortisol was sampled at postintervention and 1-year follow-up. Latent difference score analyses examined change in these constructs over time. Results suggested that mothers within the CPP intervention experienced significant declines in child-related parenting stress, while mothers in the PPI intervention reported declines in parent-related parenting stress. In turn, significant decreases in stress within the CPP mothers were further associated with adaptive basal cortisol functioning at 1-year postintervention. The results highlight the value of delineating how participation in preventive interventions aimed at ameliorating child maltreatment in neglectful families within the context of poverty may operate through improvements in psychological and physiological stress functioning. Findings are discussed with respect to the importance of multilevel assessments of intervention process and outcome.

Preventive interventions and sustained attachment security in maltreated children

Thirteen-month-old maltreated infants (n = 137) and their mothers were randomly assigned to one of three conditions: child-parent psychotherapy (CPP), psychoeducational parenting intervention (PPI), or community standard (CS). A fourth group of nonmaltreated infants (n = 52) and their mothers served as a nonmaltreated comparison (NC) group. A prior investigation found that the CPP and the PPI groups demonstrated substantial increases in secure attachment at postintervention, whereas this change was not found in the CS and the NC groups. The current investigation involved the analysis of data obtained at a follow-up assessment that occurred 12 months after the completion of treatment. At follow-up, children in the CPP group had higher rates of secure and lower rates of disorganized attachment than did children in the PPI or the CS group. Rates of disorganized attachment did not differ between the CPP and the NC groups. Intention to treat analyses also showed higher rates of secure attachment at follow-up in the CPP group relative to the PPI and the CS groups. However, groups did not differ on disorganized attachment. Both primary and intention to treat analyses demonstrated that maternal-reported child behavior problems did not differ among the four groups at the follow-up assessment. This is the first investigation to demonstrate sustained attachment security in maltreated children 12 months after the completion of an attachment theory informed intervention. The findings also suggest that, although effective in the short term, parenting interventions alone may not be effective in maintaining secure attachment in children over time.

Preventing Posttraumatic Stress Following Pediatric Injury: A Randomized Controlled Trial of a Web-Based Psycho-Educational Intervention for Parents

The study objective is to evaluate the feasibility and efficacy of a web-based intervention for parents (AfterTheInjury.org [ATI]) in promoting emotional recovery following pediatric injury. 100 children with injuries requiring medical attention and their parents were randomly assigned to the intervention or usual care. Efficacy outcomes included parent knowledge and child and parent posttraumatic stress symptoms (PTSS). All parents in the intervention group completed the intervention (directed use of ATI) in the hospital. 56% reported using ATI online post-discharge, and 100% of these parents found it helpful. Parent knowledge increased immediately post-intervention, but there was no significant intervention impact on parent knowledge or PTSS at a 6-week follow-up. Relationships between knowledge and PTSS were identified. Brief web-based interventions introduced during child hospitalization are a feasible strategy to reach many parents following pediatric injury. Preventing psychological symptoms may require more than parental education alone.

1436 – Group psychoeducational intervention for parents of individuals with schizophrenia and parents of individuals with aytism: a comparative study

Families of individuals with schizophrenia and autism experience similar stressors in their everyday life. Research shows that working with families of people with schizophrenia is effective in reducing family burden and distress levels, through structured psychoeducational interventions. These interventions are delivered in individual family or group family design. However, psychoeducational interventions have not been widely implemented in standard clinical practice, while there is limited research on the effectiveness of psychoeducation in parents of children with autism. Psychoeducational interventions are organized around two primary objectives: a) provision of information about the nature and treatment of the disorder and b) teaching family members problem-solving, communication skills and behavior management techniques. The aim of this study was to compare and contrast the efficacy of group psychoeducational intervention in reducing family burden and in improving communication and problem solving skills, when applied to two groups of parents of individuals with schizophrenia and of children with autism. Eight parents of individuals with schizophrenia and six parents of children with autism participated in two group psychoeducational programs. Twenty three group sessions were conducted for each group. Pre and post treatment measures included qualitative assessment of knowledge about the nature of the disorder of their offspring and social stigma, as well as psychometric measurement of family burden, family rituals, family communication and general family functioning. Quantitative and qualitative data on the effectiveness of each group psychoeducational intervention, as well comparative data between the two groups will be discussed.

The effects of child maltreatment and polymorphisms of the serotonin transporter and dopamine D4 receptor genes on infant attachment and intervention efficacy

This investigation examined the extent to which polymorphisms of the serotonin transporter linked promoter region (5-HTTLPR) and the dopamine receptor D4 (DRD4) genes differentially influenced the development of attachment security and disorganization in maltreated and nonmaltreated infants at age 13 months, and the extent to which the efficacy of preventive interventions to promote attachment security were influenced by genetic variation. The sample consisted of 106 infants from maltreating families, participating in a randomized control trial evaluating the efficacy of two interventions, child-parent psychotherapy and psychoeducational parenting intervention, and 47 infants from nonmaltreating families. DNA samples were genotyped for polymorphisms of 5-HTTLPR, DRD4 exon III variable number tandem repeat, and DRD4-521. Attachment organization at age 1 and at age 2 was assessed with the Strange Situation for all participants, prior to and following the completion of the interventions. High rates of disorganized attachment were observed in the maltreatment compared to the nonmaltreatment group, and both interventions resulted in increased rates of attachment security at age 2. Genetic variation did not influence improvement in attachment organization among maltreated infants. Among maltreated infants, genetic variation had minimal effect on attachment organization. In contrast, among nonmaltreated infants, 5-HTTLPR and DRD4 polymorphisms influenced attachment security and disorganization at age 2 and the stability of attachment disorganization over time.

P03-346 - A group psychoeducational intervention for parents of individuals with schizophrenia

IntroductionFamilies of individuals with schizophrenia experience disempowerment and helplessness because of unique stressors in their everyday life, mainly derived from the positive and negative symptoms of the illness (Bauml, et al., 2006). Another line of research provides evidence that working with families of people with schizophrenia is effective in reducing family burden and distress levels, through structured psychoeducational interventions (Falloon, 2003; Bauml, et al., 2006).Objectives, aimsDespite evidence of their efficacy, psychoeducational interventions have not been widely implemented in standard clinical practice. The goal of this ongoing research project is to investigate the efficacy of a group psychoeducational intervention for parents of individuals with schizophrenia in reducing family burden and in improving their communication and problem solving skills, as well as their general family functioning.MethodsThe theoretical foundations of family psychoeducation is mainly derived from behavioral family therapy. Four couples (all parents of one or two individuals with schizophrenia) participated in this psychoeducational intervention program. Twenty three group sessions were conducted, organized around three primary goals: a) provision of information about the nature and the treatment of schizophrenia b) management of social and self-stigmatization and c) teaching family members problem-solving and communication skills (Solomon, 2000).Results and conclusionsPre and post treatment measures, as well as direct measures during treatment, were used to quantitatively assess family burden, family rituals, knowledge about the nature of the disorder, coping with stigma, communication and problem solving skills and general family functioning. Findings will be discussed.

Development of the first multidisciplinary psycho-educational intervention for parents and children with food allergy

Development of the first multidisciplinary psycho-educational intervention for parents and children with food allergy

Fostering secure attachment in infants in maltreating families through preventive interventions

The malleability of insecure and disorganized attachment among infants from maltreating families was investigated through a randomized preventive intervention trial. Findings from research on the effects of maltreatment on infant attachment were incorporated into the design and evaluation of the intervention. One-year-old infants from maltreating families (N = 137) and their mothers were randomly assigned to one of three intervention conditions: (a) infant-parent psychotherapy (IPP), (b) psychoeducational parenting intervention (PPI), and (c) community standard (CS) controls. A fourth group of infants from nonmaltreating families (N = 52) and their mothers served as an additional low-income normative comparison (NC) group. At baseline, mothers in the maltreatment group, relative to the nonmaltreatment group mothers, reported greater abuse and neglect in their own childhoods, more insecure relationships with their own mothers, more maladaptive parenting attitudes, more parenting stress, and lower family support, and they were observed to evince lower maternal sensitivity. Infants in the maltreatment groups had significantly higher rates of disorganized attachment than infants in the NC group. At postintervention follow-up at age 26 months, children in the IPP and PPI groups demonstrated substantial increases in secure attachment, whereas increases in secure attachment were not found for the CS and NC groups. Moreover, disorganized attachment continued to predominate in the CS group. These results were maintained when intent to treat analyses were conducted. The findings are discussed in terms of the utility of translating basic research into the design and evaluation of clinical trials, as well as the importance of preventive interventions for altering attachment organization and promoting an adaptive developmental course for infants in maltreating families.