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Kedzior SGE, Barrett S, Muir C, Lynch R, Kaner E, Forman JR, Wolfe I, McGovern R. "They had clothes on their back and they had food in their stomach, but they didn't have me": The contribution of parental mental health problems, substance use, and domestic violence and abuse on young people and parents. CHILD ABUSE & NEGLECT 2024; 149:106609. [PMID: 38181566 DOI: 10.1016/j.chiabu.2023.106609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/03/2023] [Accepted: 12/14/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND The parental risk factors of mental health problems, substance use, and domestic violence and abuse each individually negatively impacts children's health and developmental outcomes. Few studies have considered the lived experience and support needs of parents and children in the real-world situation where these common risks cluster. OBJECTIVE This study explores parents' and young people's lived experiences of the clustering of parental mental health problems, parental substance use, and domestic violence and abuse. METHODS Semi-structured interviews were conducted with 18 mothers, 6 fathers, and 7 young people with experiences of these parental risk factors. Transcribed interviews were analysed using reflexive thematic analysis. RESULTS Four themes were developed, 1) cumulative adversity, 2) the impact of syndemic risk, 3) families navigating risk, and 4) family support. Parents and young people described family situations of stress wherein they experienced cumulative impact of multiple parental risk factors. Parents sought to navigate stressors and parent in positive ways under challenging conditions, often impeded by their own childhood trauma and diminished confidence. Parents and young people spoke of the need for, and benefits of having, support; both as a family and as individuals, to successfully address this trio of parental risks and the related impact. CONCLUSIONS This study highlights the high level of stress families experience and the efforts they go to mitigate risk. Services and interventions need to reflect the complexity of multiple needs and consider both the whole family and individuals when providing support.
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Affiliation(s)
- Sophie G E Kedzior
- Department of Women and Children's Health, King's College London, London, United Kingdom.
| | - Simon Barrett
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Cassey Muir
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rebecca Lynch
- Sociology, Philosophy, and Anthropology, University of Exeter, United Kingdom
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Julia R Forman
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Ingrid Wolfe
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Barrett S, Muir C, Burns S, Adjei N, Forman J, Hackett S, Hirve R, Kaner E, Lynch R, Taylor-Robinson D, Wolfe I, McGovern R. Interventions to Reduce Parental Substance Use, Domestic Violence and Mental Health Problems, and Their Impacts Upon Children's Well-Being: A Systematic Review of Reviews and Evidence Mapping. TRAUMA, VIOLENCE & ABUSE 2024; 25:393-412. [PMID: 36789663 PMCID: PMC10666514 DOI: 10.1177/15248380231153867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Children exposed to parental intimate partner violence and abuse, mental illness, and substance use experience a range of problems which may persist into adulthood. These risks often co-occur and interact with structural factors such as poverty. Despite increasing evidence, it remains unclear how best to improve outcomes for children and families experiencing these adversities and address the complex issues they face. AIMS AND METHODS Systematic review of systematic reviews. We searched international literature databases for systematic reviews, from inception to 2021, to provide an evidence overview of the range and effectiveness of interventions to support children and families where these parental risk factors had been identified. RESULTS Sixty-two systematic reviews were included. The majority (n = 59) focused on interventions designed to address single risk factors. Reviews mostly focused on parental mental health (n = 38) and included psychological interventions or parenting-training for mothers. Only two reviews assessed interventions to address all three risk factors in combination and assessed structural interventions. Evidence indicates that families affected by parental mental health problems may be best served by integrated interventions combining therapeutic interventions for parents with parent skills training. Upstream interventions such as income supplementation and welfare reform were demonstrated to reduce the impacts of family adversity. CONCLUSION Most intervention approaches focus on mitigating individual psychological harms and seek to address risk factors in isolation, which presents potentially significant gaps in intervention evidence. These interventions may not address the cumulative impacts of co-occurring risks, or social factors that may compound adversities.
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Lane C, Hogg E, Karwatowska LA, French L, Ranieri VF, Jesnick LGD, Roberts C, Scott S, Senior R, Skinner GC, Kennedy EMM. Personalised interventions for subgroups of children with conduct problems. Cochrane Database Syst Rev 2023; 4:CD012746. [PMID: 37115724 PMCID: PMC10144971 DOI: 10.1002/14651858.cd012746.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Conduct problems are a range of disruptive behaviours in childhood that are associated with long-term adverse outcomes in adolescence and adulthood, including antisocial behaviour, substance misuse, and poor academic achievement. Children with conduct problems can vary according to age of onset, comorbidities, and environmental factors, and it has been suggested that certain groups of children may have different treatment outcomes. Therefore, it is important to assess the extent to which personalised interventions for different groups of children with conduct problems may affect outcomes. To our knowledge, this is the first review to systematically identify and appraise the effectiveness of personalised interventions, adapted, or developed, for prespecified subgroups of children with conduct problems. OBJECTIVES To assess whether personalised interventions, adapted or developed for subgroups of children with conduct problems are effective in improving outcomes. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was 1 February 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs), in any setting, in children (aged two to 12 years) with conduct problems and within a prespecified subgroup, comparing a personalised intervention with a non-personalised intervention, waitlist control, or treatment as usual. Personalised interventions included adaptations to standard practice, such as parent-training programmes; other recommended interventions for children with conduct problems; or interventions developed specifically to target subgroups of children with conduct problems. We excluded non-personalised and non-psychological interventions (e.g. pharmacological or dietary intervention). Prespecified subgroups of children with conduct problems, however defined, were eligible for inclusion. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. child conduct problems or disruptive behaviour and 2. ADVERSE EVENTS Our secondary outcomes were 3. personalised treatment outcomes relevant to each subgroup, 4. parenting skills and knowledge, 5. family functioning, engagement and decreased dropout, and 6. educational outcomes. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We identified 13 RCTs (858 participants). Seven studies were conducted in the USA, five in Australia, and one in Germany. Eleven studies reported their source of funding, with five studies receiving grants from the National Institute of Mental Health. In total, 15 different funders supported the studies included in the review. We separated subgroups of children with conduct problems into three broad categories: children with co-occurring conditions (e.g. emotional difficulties), parent characteristics (e.g. conflict between parents), or familial/environmental circumstances (e.g. rural families). All studies delivered a personalised intervention that was adapted or developed for a prespecified subgroup of children with conduct problems. We rated all trials at unclear or high risk of bias in most domains. Below, we report the results of improvement in child conduct problems and disruptive behaviour, personalised treatment outcomes, and parenting skills and knowledge for our main comparison: personalised versus non-personalised interventions. Improvement in child conduct problems and disruptive behaviour Compared with a non-personalised intervention, a personalised intervention may result in a slight improvement in child conduct problems or disruptive behaviour measured using the Eyberg Child Behavior Inventory (ECBI) Problem subscale in the short term (mean difference (MD) -3.04, 95% confidence interval (CI) -6.06 to -0.02; 6 studies, 278 participants; P = 0.05), but may have little to no effect on improving child conduct problems or disruptive behaviour measured by the ECBI Intensity subscale (MD -6.25, 95% CI -16.66 to 4.15; 6 studies, 278 participants; P = 0.24), or the Externalising subscale of the Child Behaviour Checklist (CBCL) (MD -2.19, 95% CI -6.97 to 2.59; 3 studies, 189 participants, P = 0.37) in the short term. We graded the certainty of evidence as very low for all three outcomes, meaning any estimate of effect is very uncertain. Personalised treatment outcomes, relevant to each subgroup Although six studies reported personalised treatment outcomes, relevant to each subgroup, we were unable to pool the data due to differences between the measures used in the studies and the heterogeneity this would produce in analysis. The results for this outcome were inconclusive. Parenting skills and knowledge Although seven studies reported parenting skills and knowledge, we were unable to pool the data due to differences between the measures used in the studies and the heterogeneity this would produce in analysis. The results for this outcome were inconclusive. Adverse events None of the trials reported monitoring adverse events. Summary of results In summary, there is limited evidence that personalised intervention improves child conduct problems, personalised treatment outcomes, relevant to each subgroup, or parenting skills and knowledge compared with a non-personalised intervention. AUTHORS' CONCLUSIONS There is limited evidence for the effectiveness of personalised interventions for subgroups of children with conduct problems. The certainty of evidence for all outcomes was very low, meaning that we have very little confidence in the estimated effects and the true effects may be different to our findings, which will limit the relevance of our findings to clinical decisions. To overcome the limitations of the evidence, large-scale RCTs are needed to determine whether personalised interventions, adapted or developed, for subgroups of children with conduct problems are effective in improving outcomes. Consensus on the most appropriate measures to use in these studies is needed in order to facilitate cross-study comparisons. Persistent conduct problems predict a range of adverse long-term outcomes, so future research should investigate the medium- and long-term effects of personalised treatments. Studies are needed in low- and middle-income countries as well as studies recruiting children aged between nine and 12 years, as they were under-represented in the studies.
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Affiliation(s)
- Chloe Lane
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Elizabeth Hogg
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Lucy A Karwatowska
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Lorna French
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Veronica F Ranieri
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Leah G D Jesnick
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - Stephen Scott
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert Senior
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Guy Cm Skinner
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Eilis M M Kennedy
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Berry V, Mitchell SB, Blower S, Whittaker K, Wilkinson K, McGilloway S, Mason-Jones A, Carr RM, Bywater T. Barriers and facilitators in the delivery of a proportionate universal parenting program model (E-SEE Steps) in community family services. PLoS One 2022; 17:e0265946. [PMID: 35696375 PMCID: PMC9191704 DOI: 10.1371/journal.pone.0265946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background A proportionate universal (PU) approach to early years’ service provision has been advocated to improve children’s health and development and to reduce health inequality, by ensuring that services provide timely and high-quality parenting support commensurate with need. Process-oriented research is critical to examine the factors that contribute to, or hinder, the effective delivery/implementation of such a model in community-based family services. This study aimed to assess the delivery, acceptability and feasibility of a new PU parenting intervention model (called E-SEE Steps), using the Incredible Years® (IY) parent program, when delivered by trained health/family service staff in three “steps”—one universal step (the IY Babies Book), and two targeted steps (group-based IY Infant and Toddler programs). Methods An embedded mixed-methods process evaluation within a pragmatic parallel two-arm, assessor blinded, randomized controlled trial was conducted in community services in four local authorities in England. The process evaluation used qualitative data gathered via interviews and focus groups with intervention arm parents who were offered the targeted steps (n = 29), practitioners (n = 50), service managers (n = 7) and IY program mentors (n = 3). This was supplemented by quantitative data collected using group leader pre-training (n = 50) and post-delivery (n = 39) questionnaires, and research notes of service design decisions. Results The E-SEE Steps model was acceptable to most parents, particularly when it was accompanied by engagement strategies that supported attendance, such as providing childcare. Practitioners also highlighted the positive development opportunities provided by the IY training and supervision. However, participant views did not support the provision of the IY Babies book as a standalone universal component, and there were barriers to eligible parents—particularly those with low mood—taking up the targeted programs. Service providers struggled to align the PU model with their commissioned service contracts and with their staff capacity to engage appropriate parents, including tackling common barriers to attendance. Conclusions Despite general enthusiasm and support for delivering high-quality parenting programs in community services in the England, several barriers exist to successfully delivering IY in a proportionate universal model within current services/systems.
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Affiliation(s)
- Vashti Berry
- College of Medicine and Health, University of Exeter, Exeter, Devon, United Kingdom
- * E-mail:
| | - Siobhan B. Mitchell
- College of Medicine and Health, University of Exeter, Exeter, Devon, United Kingdom
| | - Sarah Blower
- Department of Health Sciences, University of York, York, North Yorkshire, United Kingdom
| | - Karen Whittaker
- School of Nursing, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Kath Wilkinson
- College of Medicine and Health, University of Exeter, Exeter, Devon, United Kingdom
| | - Sinead McGilloway
- Centre for Mental Health and Community Research, Department of Psychology and Social Sciences Institute, Maynooth University, Maynooth, Co Kildare, Republic of Ireland
| | - Amanda Mason-Jones
- Department of Health Sciences, University of York, York, North Yorkshire, United Kingdom
| | - Rachel Margaret Carr
- Department of Health Sciences, University of York, York, North Yorkshire, United Kingdom
| | - Tracey Bywater
- Department of Health Sciences, University of York, York, North Yorkshire, United Kingdom
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Bywater T, Berry V, Blower S, Bursnall M, Cox E, Mason-Jones A, McGilloway S, McKendrick K, Mitchell S, Pickett K, Richardson G, Solaiman K, Teare MD, Walker S, Whittaker K. A proportionate, universal parenting programme to enhance social-emotional well-being in infants and toddlers in England: the E-SEE Steps RCT. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/bcfv2964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Mental disorders have become a public health crisis. Early prevention is key. Parenting programmes are effective for children aged ≥ 3 years; however, there is a lack of evidence of their effectiveness for children aged ≤ 2 years.
Objectives
To establish if the model named Enhancing Social–Emotional Health and Well-being in the Early Years (E-SEE) Steps can (1) enhance child social emotional well-being and establish whether or not it is cost-effective at 20 months of age when compared with services as usual; and (2) be delivered as a proportionate universal model with fidelity.
Design
A pragmatic two-arm randomised controlled trial and economic appraisal, with an embedded process evaluation to examine the outcomes, implementation and cost-effectiveness of the intervention, and intervention uptake, compared with services as usual. The study had an external pilot phase (which was originally planned as an internal pilot).
Setting
The intervention was delivered in community settings by early years children’s services and/or public health staff in four sites.
Participants
A total of 341 parents of infants aged ≤ 8 weeks were randomised in a ratio of 5 : 1 (intervention, n = 285; control, n = 56). The target sample was 606 parents.
Intervention
Two Incredible Years® parenting programmes (i.e. infant and toddler) delivered in a proportionate universal model with three levels [one universal (book) and two targeted group-based parenting programmes].
Main outcome measures
Child social and emotional well-being (primary outcome) was assessed using the Ages and Stages Questionnaire: Social and Emotional, 2nd edition, at 2, 9 and 18 months after randomisation. Parent depression (secondary key outcome) was assessed using the Patient Health Questionnaire-9 items. Both questionnaires were eligibility screeners for targeted groups.
Results
The primary outcome analysis provided no evidence that the E-SEE Steps model was effective in enhancing child social and emotional well-being. The adjusted mean difference was 3.02 on the original Ages and Stages Questionnaire: Social and Emotional, 2nd edition, in favour of the control [95% confidence interval –0.03 to 6.08; p = 0.052; N = 321 (intervention, n = 268; control, n = 53)]. Analysis of the key secondary outcome (i.e. parent depression levels as assessed by the Patient Health Questionnaire-9 items) provided weak evidence on the Patient Health Questionnaire-9 items in favour of the intervention (adjusted mean difference –0.61, 95% confidence interval –1.34 to 0.12; p = 0.1). Other secondary outcomes did not differ between arms. The economic analysis showed that the E-SEE Steps model was associated with higher costs and was marginally more effective (0.031 quality-adjusted life-years gained from E-SEE Steps compared with SAU, 95% confidence interval –0.008 to 0.071) than services as usual, resulting in an incremental cost-effectiveness ratio of approximately £20,062 per quality-adjusted life-year compared with services as usual. Overall take-up of the targeted parenting programmes was low. Sites, although enthusiastic, identified barriers to delivering the intervention.
Limitations
The target sample size was not met and the study was not powered to explore the effectiveness of each level of intervention. Most parents in the sample were well educated and, therefore, the results are unlikely to be generalisable, particularly to those at greatest risk of poor social and emotional well-being.
Conclusions
The E-SEE Steps proportionate universal model did not enhance child social and emotional well-being, but generated non-significant improvements in parent health outcomes, resulting in considerable uncertainty around the cost-effectiveness of the intervention. The primary and key secondary outcome gave inconsistent signals. Although, with system changes, increased resources and adaptations to the intervention, the model could be implemented, evidence for positive outcomes from the E-SEE Steps model is poor.
Future work
The universal-level E-SEE Step data (i.e. the Incredible Years book) from the external pilot will be pooled with the main trial data for further exploration up to follow-up 1, which is the time point at which most change was seen.
Trial registration
This trial is registered as ISRCTN11079129.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tracey Bywater
- Department of Health Sciences, University of York, York, UK
| | - Vashti Berry
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sarah Blower
- Department of Health Sciences, University of York, York, UK
| | | | - Edward Cox
- Centre for Health Economics, University of York, York, UK
| | | | - Sinéad McGilloway
- Centre for Mental Health and Community Research, Maynooth University, Maynooth, Ireland
| | | | - Siobhan Mitchell
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Kate Pickett
- Department of Health Sciences, University of York, York, UK
| | | | | | - M Dawn Teare
- Sheffield Clinical Trials Research Unit, Sheffield, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Karen Whittaker
- School of Nursing, University of Central Lancashire, Preston, UK
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Bywater T, Berry V, Blower S, Bursnall M, Cox E, Mason-Jones A, McGilloway S, McKendrick K, Mitchell S, Pickett K, Richardson G, Solaiman K, Teare MD, Walker S, Whittaker K. A randomized controlled trial of a proportionate universal parenting program delivery model (E-SEE Steps) to enhance child social-emotional wellbeing. PLoS One 2022; 17:e0265200. [PMID: 35377882 PMCID: PMC8979462 DOI: 10.1371/journal.pone.0265200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/21/2021] [Indexed: 12/21/2022] Open
Abstract
Background Evidence for parenting programs to improve wellbeing in children under three is inconclusive. We investigated the fidelity, impact, and cost-effectiveness of two parenting programs delivered within a longitudinal proportionate delivery model (‘E-SEE Steps’). Methods Eligible parents with a child ≤ 8 weeks were recruited into a parallel two-arm, assessor blinded, randomized controlled, community-based, trial with embedded economic and process evaluations. Post-baseline randomization applied a 5:1 (intervention-to-control) ratio, stratified by primary (child social-emotional wellbeing (ASQ:SE-2)) and key secondary (maternal depression (PHQ-9)) outcome scores, sex, and site. All intervention parents received the Incredible Years® Baby Book (IY-B), and were offered the targeted Infant (IY-I)/Toddler (IY-T) program if eligible, based on ASQ:SE-2/PHQ-9 scores. Control families received usual services. Fidelity data were analysed descriptively. Primary analysis applied intention to treat. Effectiveness analysis fitted a marginal model to outcome scores. Cost-effectiveness analysis involved Incremental Cost-Effectiveness Ratios (ICERs). Results The target sample (N = 606) was not achieved; 341 mothers were randomized (285:56), 322 (94%) were retained to study end. Of those eligible for the IY-I (n = 101), and IY-T (n = 101) programs, 51 and 21 respectively, attended. Eight (of 14) groups met the 80% self-reported fidelity criteria. No significant differences between arms were found for adjusted mean difference scores; ASQ:SE-2 (3.02, 95% CI: -0.03, 6.08, p = 0.052), PHQ-9 (-0.61; 95% CI: -1.34, 0.12, p = 0.1). E-SEE Steps had higher costs, but improved mothers’ Health-related Quality of Life (0.031 Quality Adjusted Life Year (QALY) gain), ICER of £20,062 per QALY compared to control. Serious adverse events (n = 86) were unrelated to the intervention. Conclusions E-SEE Steps was not effective, but was borderline cost-effective. The model was delivered with varying fidelity, with lower-than-expected IY-T uptake. Changes to delivery systems and the individual programs may be needed prior to future evaluation. Trial registration International Standard Randomized Controlled Trial Number: ISRCTN11079129.
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Affiliation(s)
- Tracey Bywater
- Department of Health Sciences, University of York, York, North Yorkshire, United Kingdom
- * E-mail:
| | - Vashti Berry
- College of Medicine and Health, University of Exeter, Exeter, Devon, United Kingdom
| | - Sarah Blower
- Department of Health Sciences, University of York, York, North Yorkshire, United Kingdom
| | - Matthew Bursnall
- Sheffield Clinical Trials Research Unit, Sheffield, South Yorkshire, United Kingdom
| | - Edward Cox
- Centre for Health Economics, University of York, York, North Yorkshire, United Kingdom
| | - Amanda Mason-Jones
- Department of Health Sciences, University of York, York, North Yorkshire, United Kingdom
| | - Sinead McGilloway
- Centre for Mental Health and Community Research, Maynooth University, Maynooth, Co Kildare, Ireland
| | - Kirsty McKendrick
- Sheffield Clinical Trials Research Unit, Sheffield, South Yorkshire, United Kingdom
| | - Siobhan Mitchell
- College of Medicine and Health, University of Exeter, Exeter, Devon, United Kingdom
| | - Kate Pickett
- Department of Health Sciences, University of York, York, North Yorkshire, United Kingdom
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, North Yorkshire, United Kingdom
| | - Kiera Solaiman
- Sheffield Clinical Trials Research Unit, Sheffield, South Yorkshire, United Kingdom
| | - M. Dawn Teare
- Institute of Health and Society University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Simon Walker
- Centre for Health Economics, University of York, York, North Yorkshire, United Kingdom
| | - Karen Whittaker
- School of Nursing, University of Central Lancashire, Preston, Lancashire, United Kingdom
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Hawes DJ, Dadds MR. Practitioner Review: Parenting interventions for child conduct problems: reconceptualising resistance to change. J Child Psychol Psychiatry 2021; 62:1166-1174. [PMID: 33543502 DOI: 10.1111/jcpp.13378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
Parenting interventions based on social learning theory have received extensive empirical support in the treatment of child conduct problems; yet, they fail to produce lasting gains in as many as a third of cases. Perspectives on these poor outcomes have been informed by numerous lines of research, and practitioner recommendations for improving such outcomes have often emphasized processes related to clinical engagement. In this Practitioner Review, we examine recent theory and evidence pertaining to these processes, including emerging research into the therapeutic relationship across face-to-face and eHealth treatment modalities, and the clinical engagement of both mothers and fathers. The concept of resistance to change is examined in light of these developments, and it is argued that the process of overcoming such resistance can be characterized as one of reflective practice. A novel process model based on this perspective is presented, comprising practical clinical strategies that are designed to be initiated from the earliest contacts with a family and build on one another across treatment.
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Affiliation(s)
- David J Hawes
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Mark R Dadds
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
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Lawrence PJ, Parkinson M, Jasper B, Creswell C, Halligan SL. Supporting the parents of children and young people with anxiety and depressive disorders is an opportunity not to be missed: a scoping review. Lancet Psychiatry 2021; 8:909-918. [PMID: 34537101 DOI: 10.1016/s2215-0366(20)30315-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 10/20/2022]
Abstract
Guidance is scarce on whether and how to involve parents in treatment for anxiety and depressive disorders in children and young people. We did a scoping review of randomised controlled trials of psychological interventions for anxiety and depressive disorders in children and young people, in which parents were involved in treatment, to identify how parents and carers have been involved in such treatments, how this relates to both child and broader outcomes, and where research should focus. We identified 73 trials: 62 focused on anxiety and 11 on depressive disorders. How parents were involved in treatments varied greatly, with at least 13 different combinations of ways of involving parents in the anxiety trials and seven different combinations in the depression trials. Including parents in treatment did not impair children's and young people's outcomes, but the wide variability in how they were involved prevents clarity about why some trials favoured parent involvement and others did not. Studies must consider the long-term and wider benefits beyond children's and young people's mental health, such as enhanced engagement, family wellbeing, and economic gains.
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Affiliation(s)
- Peter J Lawrence
- School of Psychology, University of Southampton, Southampton, UK
| | - Monika Parkinson
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Bec Jasper
- Parents and Carers Together, Suffolk, UK
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.
| | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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McKay K, Kennedy E, Senior R, Scott S, Hill J, Doolan M, Woolgar M, Peeren S, Young B. Informing the personalisation of interventions for parents of children with conduct problems: a qualitative study. BMC Psychiatry 2020; 20:513. [PMID: 33081742 PMCID: PMC7576822 DOI: 10.1186/s12888-020-02917-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Parenting programmes aim to alleviate behavioural problems in children, including conduct disorder. This study was part of a multi-phase mixed-methods project seeking to extend the reach of parenting programmes for the treatment of conduct problems through developing an evidence base to inform a personalised approach. It explored the narratives of parents of children with behavioural and conduct problems about parenting programmes to identify how such programmes could be personalised in order to extend their reach to parents and children who do not currently benefit. METHODS Face-to-face semi-structured interviews with a purposive sample of 42 parents, who had different experiences of parenting programmes. Interviews were conversational and informed by a topic guide. Analysis of transcripts of audio-recorded interviews drew on inductive thematic approaches and was framed largely within a phenomenological perspective. RESULTS Parents' accounts demonstrated three themes: 1) a personalised approach needs to include the child; 2) a supportive school matters; and, 3) the programme needs to feel personal. Parents were more likely to have a positive experience at a parenting programme, and for their child to demonstrate positive behavioural changes, when they felt their concerns were validated within the group and they also felt supported by the child's teachers. Parents whose children had been assessed prior to undertaking the programme were also more likely to perceive the programme to be beneficial, compared to parents who felt their child's individual issues were never considered. CONCLUSIONS Our findings point to the potential for personalised approaches to extend the reach of parenting programmes to parents and children who do not currently benefit from such programmes. Important in personalising parenting programmes is assessing children before parents are referred, to directly work with children as well as parents, and to work collaboratively with parents and children to identify which families are most suited to group support or one-to-one support and how this may change depending on circumstances.
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Affiliation(s)
- Kathy McKay
- University of Liverpool, Liverpool, UK
- Tavistock and Portman NHS Foundation Trust, 120 Belsize Lane, London, NW3 5BA UK
| | - Eilis Kennedy
- Tavistock and Portman NHS Foundation Trust, 120 Belsize Lane, London, NW3 5BA UK
| | - Rob Senior
- Tavistock and Portman NHS Foundation Trust, 120 Belsize Lane, London, NW3 5BA UK
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Ljungström BM, Kenne Sarenmalm E, Axberg U. "Since his birth, I've always been old" the experience of being parents to children displaying disruptive behavior problems: a qualitative study. BMC Psychol 2020; 8:100. [PMID: 32962763 PMCID: PMC7510140 DOI: 10.1186/s40359-020-00465-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/04/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Being parents of children who display disruptive behavior problems (DBP) can pose several challenges. Interventions for children with DBP are primarily outpatient group parent training (PT) programs. The purpose of this study was to explore how parents of children with disruptive behavior problems, diagnosed with oppositional defiant disorder (ODD), describe the difficulties they face in their family and parenting situations. METHODS Nineteen parents of children aged 3 to 8 years who had searched for help and signed up for a parent training program provided by Child and Adolescent Mental Health Service participated in the study. Semi-structured diagnostic interviews and a modified background interview adapted for the purpose of the study were conducted before parents entered the program. All children included in the study met the DSM criteria for ODD. The interviews were audiotaped and transcribed. Thematic analysis was used to examine, identify, and report patterns of meaning in the data. The analysis was conducted inductively using a contextual approach. RESULTS Parents described their own vulnerability, how they were affected by the parent-child interaction, and the challenges they perceived in their parenting practices. The study contributes to an understanding of the complexity that parents of children with ODD perceive in everyday life. CONCLUSIONS The parents in the study highlight the need to address parents' own mental health problems, parental alliance, capacity for emotion regulation, perceived helplessness as parents, lack of parental strategies, sense of isolation, and absence of supportive social networks. All these factors could be important when tailoring interventions aimed to help and support parents of children who display DBP, and specifically ODD.
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Affiliation(s)
| | - Elisabeth Kenne Sarenmalm
- Research and Development Centre, Skaraborg Hospital, 541 85 Skövde, Sweden
- Institute of Health and Care Sciences and Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Box 400, 405 30 Gothenburg, Sweden
| | - Ulf Axberg
- Department of Psychology, University of Gothenburg, Box 500, 405 30 Gothenburg, Sweden
- Faculty of Social Studies, Department of Family Therapy and Systemic Practice, VID Specialized University, Diakonveien 12-18, 0370 Oslo, Norway
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Honoring the Contributions and Legacy of Thomas Dishion. Dev Psychopathol 2019; 31:1605-1608. [PMID: 31718733 DOI: 10.1017/s0954579419001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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