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An intervention for parents with severe personality difficulties whose children have mental health problems: a feasibility RCT.
Health Technol Assess. 2020 03; 24(14):1-188.HT

Abstract

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.

Authors+Show Affiliations

CAMHS Research Unit, Centre for Parent and Child Support, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK.Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.The Centre for Psychiatry, Department of Medicine, Imperial College London, London, UK.The McPin Foundation, London, UK.CAMHS Research Unit, Centre for Parent and Child Support, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK.King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.Institute of Lifecourse Development, University of Greenwich, London, UK.Institute of Mental Health, University of Nottingham, Nottingham, UK.School of Psychology, University of Sussex, Brighton, UK.Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.CAMHS Research Unit, Centre for Parent and Child Support, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK.Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.PEDAL Research Centre, The Faculty of Education, University of Cambridge, Cambridge, UK.Department of Mental Health, Social Work and Integrative Medicine, School of Health and Education, Middlesex University, London, UK.

Pub Type(s)

Clinical Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32174297

Citation

Day, Crispin, et al. "An Intervention for Parents With Severe Personality Difficulties Whose Children Have Mental Health Problems: a Feasibility RCT." Health Technology Assessment (Winchester, England), vol. 24, no. 14, 2020, pp. 1-188.
Day C, Briskman J, Crawford MJ, et al. An intervention for parents with severe personality difficulties whose children have mental health problems: a feasibility RCT. Health Technol Assess. 2020;24(14):1-188.
Day, C., Briskman, J., Crawford, M. J., Foote, L., Harris, L., Boadu, J., McCrone, P., McMurran, M., Michelson, D., Moran, P., Mosse, L., Scott, S., Stahl, D., Ramchandani, P., & Weaver, T. (2020). An intervention for parents with severe personality difficulties whose children have mental health problems: a feasibility RCT. Health Technology Assessment (Winchester, England), 24(14), 1-188. https://doi.org/10.3310/hta24140
Day C, et al. An Intervention for Parents With Severe Personality Difficulties Whose Children Have Mental Health Problems: a Feasibility RCT. Health Technol Assess. 2020;24(14):1-188. PubMed PMID: 32174297.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An intervention for parents with severe personality difficulties whose children have mental health problems: a feasibility RCT. AU - Day,Crispin, AU - Briskman,Jackie, AU - Crawford,Mike J, AU - Foote,Lisa, AU - Harris,Lucy, AU - Boadu,Janet, AU - McCrone,Paul, AU - McMurran,Mary, AU - Michelson,Daniel, AU - Moran,Paul, AU - Mosse,Liberty, AU - Scott,Stephen, AU - Stahl,Daniel, AU - Ramchandani,Paul, AU - Weaver,Timothy, PY - 2020/3/17/entrez PY - 2020/3/17/pubmed PY - 2020/3/17/medline KW - CHILD BEHAVIOUR KW - CHILD EMOTIONAL PROBLEMS KW - PARENTING KW - PERSONALITY SP - 1 EP - 188 JF - Health technology assessment (Winchester, England) JO - Health Technol Assess VL - 24 IS - 14 N2 - 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. SN - 2046-4924 UR - https://www.unboundmedicine.com/medline/citation/32174297/An_intervention_for_parents_with_severe_personality_difficulties_whose_children_have_mental_health_problems:_a_feasibility_RCT_ L2 - https://doi.org/10.3310/hta24140 DB - PRIME DP - Unbound Medicine ER -