Exploring Staff Implementation of a Self-directed Parenting Intervention for Parents with Mental Health Difficulties

Parents with mental health difficulties face significant barriers in accessing evidence-based parenting interventions. Self-directed approaches may be a destigmatising, accessible alternative. Evidence has suggested that Triple P Positive Parenting Programme's self-directed format is as effective as more time- and cost-intensive delivery methods. The aim of the current study was to establish whether staff were able to use this intervention with parents with mental health difficulties and to explore staff experiences of implementation. Triple P self-help workbooks were provided to practitioners across three teams. Data were collected regarding workbook uptake and use. Interviews with staff exploring their experiences of implementation were analysed using thematic analysis. Overall, 41 participants were recruited, of which 12 (29.27%) also consented to interviews. Overall, six practitioners (14.63%) reported that they utilised the workbook. Uptake and utilisation were varied, but practitioners who used the workbook reported positive outcomes. Interviews revealed themes regarding practitioner concerns, views of the intervention and implementation issues. Self-directed Triple remains a promising intervention but its feasibility is dependent on addressing barriers to implementation and facilitating a family-focused approach to meet the needs of these parents and their children.

Brief materials and programmes for children and families who have experienced conflict and displacement

This presentation will provide an overview of a set of materials and programmes designed for families who are living through or have escaped conflict and displacement. Delivery formats include i) brief leaflets giving parenting advice for caregivers; ii) a more extensive booklet and format for a Conversation Group, and iii) a programme designed to address post-traumatic stress in children, Teaching Recovery Techniques (TRT), to which a caregiver and parenting skills module was added, to form TRT+Parenting. Each intervention has been tested or trialled with families living in challenged contexts. The leaflet was distributed to 3000 families via bakeries in conflict zones in Syria. The Conversation Group was trialled for feasibility in Palestine. TRT+Parenting was piloted with Syrian families living on the Turkey-Syria border, and then trialled with 120 families in Lebanon, with teachers and social care workers trained as facilitators. In Syria, 59.5% of 3000 parents returned questionnaires and reported satisfaction with the leaflet despite the study being conducted in a conflict zone and in the context of humanitarian intervention. The Conversation Group proved feasible and acceptable, and caregivers in Palestine gave positive feedback. Children and caregivers showed significant improvements across measures of trauma and mental health, with higher levels of improvement seen in the TRT+Parenting group compared to TRT alone or waitlist. Caregivers who took part in the Plus Parenting component also reported improvement in their own mental health. The results demonstrated valuable improvements across all interventions, and indicate that brief programs can and should be widely used as components of preventive strategies.

Parents' Perceptions and Experiences of Parenting Programmes: A Systematic Review and Metasynthesis of the Qualitative Literature

Supporting parents to meet the challenges of their caregiving role is identified as a public health concern and a priority in policies internationally. Quantitative research has established the efficacy of parenting programmes but less is understood about the key aspects that make interventions meaningful and helpful to families. We aimed to explore parents' experiences and perceptions of parenting programmes in order to highlight the parent voice and identify key factors that parents perceive to be meaningful and improve our understanding of the acceptability and perceived benefits of parenting programmes. Six key electronic databases were searched systematically for qualitative research and eligibility for inclusion was established. A thematic synthesis was undertaken. Twenty-six studies were included, spanning 17 years of parenting research and involving 822 parents. Three main themes and nine subthemes were identified: (1) a family's journey (prior to the parenting programme, outcomes (including changes in the parent, child and wider family) and post-intervention), (2) aspects perceived to be important or valuable (group leader or facilitator, programme content and delivery and value of the group) and (3) challenges or difficulties (barriers to engagement or attendance, programme content and suggestions for improvement). Reported outcomes of parenting programmes included changes in the parent alongside changes in the child and family more widely. Key recommendations to improve provision of accessible, clinically and cost-effective interventions for parents include ensuring high-quality training and supervision of facilitators, balancing flexibility and fidelity to ensure tailored content to meet individual needs, a sensitivity to parental adversity, the need for wider familial support and the availability of ongoing support following the end of a parenting programme.

'I felt a little bubbly in my tummy': eliciting pre-schoolers' accounts of their health visit using a computer-assisted interview method

BACKGROUND

In the health care services, children's rights to participate in all matters that concern them are considered important. However, in practice this can be challenging with young children. In My Shoes (IMS) is a computer-assisted interview tool developed to help children talk about their experiences. The aim of the study was to evaluate the IMS' ability to elicit pre-schoolers' subjective experiences and accurate accounts of a routine health visit as well as the children's engagement in the interview process.

METHODS

Interviews were conducted with 23 children aged 4-5 years, 2-4 weeks after their health visit. The interviews were transcribed verbatim and analysed using a method inspired by Content Analysis to evaluate IMS's ability to elicit accounts about subjective experiences. Accurate accounts were assessed by comparing the transcribed interviews with the filmed visits at the child health centre. The children's engagement was defined by the completion and length of the interviews, and the children's interaction with the software.

RESULTS

All children gave accounts about their subjective experiences, such as their emotional state during the visit, available toys or rewards they received. All children related to the correct event, they all named at least one person who was present and 87% correctly named at least one examination procedure. The majority of children (91%) completed the interview, which lasted 17-39 min (M = 24), and 96% interacted with the IMS software.

CONCLUSIONS

IMS was feasible to help children describe their health care experiences, in both detail and depth. The children interacted with the software and maintained their interest for an extended period of time.

Establishing the feasibility of assessing the mental health of children displaced by the Syrian conflict

BACKGROUND

In the humanitarian crisis context of conflict zones, collecting data is essential for identifying and addressing the mental health needs of refugee children to avoid mass suffering. This study tested the feasibility of recruiting refugees caring for children and using established and brief parent-report questionnaires in a challenging context to collect mental health data on refugee children displaced by Syria's conflict.

METHODS

Caregivers of 4-10-year olds attending primary schools run by non-governmental organisation (NGO) Generation Freedom in and near refugee camps on the Syrian-Turkish border were invited to complete the Pediatric Emotional Distress Scale (PEDS) and Strengths and Difficulties Questionnaire (SDQ).

RESULTS

It was possible to reach 144 adult refugees caring for children with research participation information and use informed consent procedures. A total of 106 caregivers completed the questionnaires yielding a good return rate (74%). Eighty-two (77.4%) caregivers had complete data on the PEDS and 61 (57.5%) on the SDQ. Almost half (49%) of the children met the clinical cut-off for being anxious/withdrawn and 62% for being fearful rated using the PEDS and 45% for SDQ rated emotional symptoms. More than a third had clinical levels of behavioural problems on both scales.

CONCLUSIONS

It proved feasible to collect child mental health data in challenging conditions in the context of the Syrian crisis with support from a local NGO providing humanitarian assistance. The PEDS performed better than the SDQ in this context. High levels of emotional distress and behavioural problems in children reiterate the urgent need for evidence-based psychosocial support.

Developing web-based Triple P 'Positive Parenting Programme' for families of children with asthma

BACKGROUND

We examined the feasibility of self-directed Triple P 'Positive Parenting Programme' for optimizing parents' management of childhood asthma and behaviour.

METHODS

Eligible families were invited to access asthma-specific web-based Triple P as part of a preliminary randomized controlled study.

RESULTS

Initial study information and introductory website pages received considerable interest but intervention uptake was poor with high rates of attrition.

CONCLUSIONS

Although parents of children with asthma show willingness to access web-based parenting support, further work is necessary to develop engaging websites and determine barriers to uptake, and adherence to online parenting interventions with this population.

Assessing expressed emotion: comparing Camberwell Family Interview and Five-minute Speech Sample ratings for mothers of children with behaviour problems

Little is known of the concordance between ratings of expressed emotion (EE) derived from the Camberwell Family Interview (CFI) and Five-minute Speech Sample (FMSS) for parents of children with behaviour problems. Concordance between CFI and FMSS ratings of EE was assessed prior to intervention and compared to parent-rated behaviour after intervention, at follow-up, 12 months later. Female primary caretakers of 75 children (3-10 years) showing behavioural difficulties were interviewed using FMSS and CFI. Interviews were coded independently by criterion-standard raters. Using CFI, 57 families were classified high EE, and 18 low EE. Using FMSS, 65 families were classified high EE and 10 low EE. 55/75 pairs of ratings (73%) were the same (high, n = 51: low, n = 4) and 20 mothers (27%) were allocated different EE status (Kappa = 0.14, n.s.). The FMSS ratings at initial interview appeared more closely related to behaviour rating at follow-up than CFI. Further investigation is required to establish comparability of CFI and FMSS results for carers of children.

Can computers help in assessing children's postoperative pain? Initial validation of a computer-assisted interview

BACKGROUND AND OBJECTIVE

Computers offer the potential for the assessment of children who have difficulties in communication and cannot describe pain using conventional approaches. Such approaches must be reliable and valid. As a preliminary step towards this goal, the validity and reliability of a computer-assisted pain assessment for children (MacInterview) was assessed using children with no known disabilities who had undergone surgery.

METHODS

MacInterview uses body outlines and a range of different pain representations with scaling for size and intensity, and associated emotion. Following piloting with non-clinic children, the experience of acute postoperative pain was assessed for 30 children undergoing adenotonsillectomy or tonsillectomy the day following surgery using the MacInterview and three existing standardized assessment measures. Each child self-reported their current experience of postoperative pain on two occasions 30 min apart, and retrospectively on pain the previous evening in the immediate postoperative period.

RESULTS

Analyses indicated good performance of MacInterview, showing positive correlations between 0.65 and 0.88 with standardized pain-intensity measures, and test-retest reliability was 0.9. Face validity was high, and children enjoyed the procedure.

CONCLUSIONS

The procedure shows promise and is likely to merit further development for children showing difficulties in communication.

An experimental investigation of thought suppression and anxiety in children

OBJECTIVES

This study aimed to explore the effects of thought suppression in children--in particular, whether trying to suppress a thought leads to an immediate and/or delayed increase in its occurrence. The influence of anxiety on children's performance in the experimental paradigm was also examined.

DESIGN

Participants were allocated to conditions in a between-groups experimental design devised on the basis of thought suppression methodologies reported in the adult literature.

METHODS

One-hundred and twelve participants were recruited from local primary schools and randomly allocated to four experimental conditions. Children in all conditions monitored the occurrence of a target thought (either neutral or anxiety-provoking) by tapping their hand on a table each time the thought came to mind during two consecutive experimental periods. During the first period, half the children were asked not to think about the target thought, while the remaining half were asked to think about anything. During the second period, all children were instructed to think about anything.

RESULTS

No evidence was found for either an immediate or a delayed increase in frequency of target thoughts as a consequence of suppression attempts. State and trait anxiety were, however, found to influence children's performance during these experimental tasks and were associated with increased intrusions under certain conditions.

CONCLUSIONS

The results of this study suggest that the experimental thought suppression paradigm is workable with 7-11-year-old children. The methodological, theoretical and clinical implications of these findings are discussed.

The prediction of parasuicide repetition in a high-risk group

OBJECTIVES

This study explores whether the specificity of risk assessment for parasuicide repetition can be improved by measurement of two psychological variables (over-generality of autobiographical memory and future fluency for positive events) in the immediate aftermath of the index parasuicide.

DESIGN

In a longitudinal study, parasuicide patients deemed to be at high risk of repetition on the basis of sociodemographic factors (Kreitman & Foster, 1991) were followed-up over a 12-month period.

METHOD

As soon as practicable after taking a deliberate drug overdose, patients completed the Autobiographical Memory Test, the Personal Future Test and the Beck Hopelessness Scale. The relative power of each of these measures, together with the number of sociodemographic risk factors, in predicting parasuicide repetition was investigated using a forward step-wise logistic regression analysis.

RESULTS

The most potent short-term predictor of parasuicide repetition was found to be scores on the Beck Hopelessness Scale, whereas in the longer term the number of previous para-suicides was the major predictor.

CONCLUSION

For the heterogeneous parasuicide population as a whole, psychological variables are unlikely to improve upon the Beck Hopelessness Scale, sociodemographic risk factors and clinical interview in the prediction of parasuicide repetition.

Are eating and psychosocial characteristics in early teenage years useful predictors of eating characteristics in early adulthood? A 7-year longitudinal study

OBJECTIVES

This longitudinal research aimed to determine the utility of psychosocial and eating characteristics in early teenage years in predicting eating attitudes and behaviors in early adulthood.

METHOD

Self-esteem, perfectionism, family function, and eating attitudes were measured at 12 years and eating attitudes and behavior were assessed at 19 years. Sixty-three women (71.6%) remained in the study over the 7 years.

RESULTS

Bulimic attitudes in early teenage years were related to subsequent bulimic features, while restrictive attitudes were more closely related to later purging behaviors. Self-esteem and perfectionism were only weakly linked with subsequent eating. However, different perceived family characteristics at the first stage were associated with specific aspects of eating in early adulthood.

CONCLUSIONS

There is consistency of eating characteristics across time, but psychosocial characteristics have a more limited predictive power. Future longitudinal studies should begin earlier in childhood if psychosocial factors are to be useful predictors of eating psychopathology in adulthood.

Psychological disturbance and child sexual abuse: a follow-up study

OBJECTIVE

The aim of this prospective study was to identify risk factors for the development of psychological disturbance in sexually abused children, enabling recognition of the need for appropriate psychological intervention and provision.

METHOD

A city-wide study of children aged 16 or under was carried out, with all cases of CSA requiring investigation within 12 months included. Data were collected on 144 children from police, social services, and pediatricians. Follow-up was by questionnaire and interview with involved professionals at 4 weeks, 9 months, and 2 years post investigation.

RESULTS

Initially, two-thirds of children showed emotional or behavioral indicators of disturbance, commonly sleep disturbance, temper tantrums, and depression. Over time, there was a substantial increase, with anxiety and depression, suicide attempts, substance abuse, lack of interaction with peers and sexualized behavior showing increases over the study's duration. Age, gender, abuse, and perpetrator characteristics did not show strong effects initially. Children involved in criminal proceedings were at particular risk. No improvement was evident over time.

CONCLUSIONS

In the absence of clear risk factors other than initial disturbance, process models involving cognitive factors may be helpful in explaining disturbance, and the need for early identification of disturbance and intervention is highlighted.

The effect of a child's disability on mother's mental health

The prevalence of maternal depression was investigated in the mothers of 96 children: 30 premature infants at risk for the development of cerebral palsy; 35 premature infants considered not to be at risk for the development of cerebral palsy; and 31 healthy fullterm infants. There were equally high levels of depression in all three groups of mothers, regardless of birth status, prediction of disability, or presence of actual disability, throughout the first year of the children's lives. Depressed mothers were, however, found to have significantly more psychosocial stress. An early physiotherapy intervention had no effect on the prevalence of depression in mothers whose children were at risk for the development of cerebral palsy.

Who knows best? Family interaction and eating disorders

Links have been established between eating disorders and abnormal patterns of interaction between members of the sufferer's family. Faced with often contradictory information, the clinician needs to know which member of the family will give the most valid description of that family's interaction. This study demonstrated the value of the Family Assessment Device (FAD) as a measure of 'pathology' in the families of anorectic and bulimic women. Using the ability to predict the eating disorder as an index of concurrent validity, the sufferers themselves had the most realistic perceptions of their families' interactional styles.

Eating disorders and family interaction

The McMaster Model of Family Functioning was used to compare women with eating disorders with a normal comparison group. The anorexia nervosa and bulimia nervosa groups showed similar perceived family pathologies but bulimics with no history of anorexia showed a pattern of family interaction that was more severely 'unhealthy' than that of the other clinical groups. The McMaster Model could be a useful tool in clinical assessment and in planning therapy in this particular area.