Short-term outcomes of the Therapist-assisted Online Parenting Strategies intervention for parents of adolescents treated for anxiety and/or depression: A single-arm double-baseline trial

Abstract

Objective: This study aimed to evaluate whether the Therapist-assisted Online Parenting Strategies programme increased parenting behaviours known to be supportive of adolescents experiencing anxiety and/or depression. Secondary parenting outcomes of parental self-efficacy, parental accommodation, carer burden, parent–adolescent attachment, family functioning and parent distress were also examined, along with adolescent outcomes of anxiety and depression symptoms, suicidal ideation and sleep. Method: Seventy-one parents (94.4% females) and their adolescents (73.2% females) aged 12–18 years (Mean = 15.02, SD = 1.56) being treated for depression and/or anxiety in Australia were recruited into a single-arm double-baseline open-label trial. Parents received Therapist-assisted Online Parenting Strategies, which comprised up to nine web-based modules each supplemented with coaching sessions via videoconferencing. Outcomes were analysed using latent growth curve modelling to determine if changes to outcomes at post-intervention (4 month post-second baseline) exceeded changes between two baselines measured 1 month apart. Results: Sixty-five parents (91.6%) completed at least one module of the online parenting intervention and on average received nine coaching sessions (SD = 2). Parenting behaviours targeted by Therapist-assisted Online Parenting Strategies improved at post-intervention (Cohen’s d = 1.16, 95% confidence interval [0.78, 1.51]). Parent-reported parental self-efficacy and parent−adolescent attachment increased (Cohen’s d = 1.44 [1.05, 1.82] and 0.39 [0.05, 0.74], respectively), while impairments to family functioning and parent distress decreased (Cohen’s d = −0.51 [−0.86, −0.16] and −0.84 [−1.23, −0.44], respectively). Changes to adolescent anxiety, depression and sleep were not significant. Conclusion: The Therapist-assisted Online Parenting Strategies intervention improved self-reported parenting behaviours, parental self-efficacy, parent levels of distress, parent–adolescent attachment, and family functioning in parents with adolescents being treated for anxiety and/or depression. However, significant changes in adolescent mental health and sleep outcomes at post-intervention were not observed. The usefulness of a therapist-supported online parenting programme in addressing a service gap for parents seeking professional help is indicated. Trial Registration: Australian New Zealand Clinical Trials Registry Number (ACTRN) 12618000290291, prospectively registered on 26 February 2018; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368031

Adapting a coach-assisted web-based intervention for parents of adolescents who refuse school: qualitative study with users of the Partners in Parenting Plus programme

“…The majority of participants reported making changes to their parenting as a result of their PiP+ participation. Consistent with results of the quantitative programme evaluation, 36 parents described making changes concordant with parenting guidelines to prevent and respond to adolescent anxiety and depression, 22,45 sustaining changes long-term, with their adolescent being responsive to their efforts (albeit after 6-12 months of parent persistence with strategy implementation) in the form of observed emotional, behavioural and relational improvements. However, a subset of parents reported that they did not make changes to their parenting as a result of PiP+ participation.…”

“…However, good variance across factors that were anticipated to be relevant to parent experience of the programme was achieved using stratified purposive sampling methods ( Table 1 ) and, despite the specific sample characteristics required for this study, a good sample size was obtained ( N = 14). In addition, an inclusion criterion for participation in the PiP+ trial, 36 from which the current sample was drawn, was for the adolescent of the participating parent to be actively engaged with a mental health professional. As such, any parent-reported impacts of the PiP+ programme on adolescent functioning may have been affected by any individual treatment the adolescent had received.…”

“…A stratified purposive sampling strategy was used to incorporate heterogeneity in characteristics relevant to parents’ experience of the programme. 35 These characteristics were (a) severity of school attendance difficulties experienced during the original PiP+ trial (coded as mild/moderate versus moderate/severe; ascertained qualitatively by reviewing recorded PiP+ coaching sessions in consultation with G.M., a senior clinical psychologist with clinical and research expertise in school refusal); (b) parents’ improvement in their concordance of parenting practices with a set of evidence-based parenting guidelines (primary outcome of the original trial; 36 coded as showing improvement or no improvement in concordance scores); and (c) adolescent-report anxiety scores as measured at baseline using the Spence Children's Anxiety Scale 37 (scores coded as falling above or below the clinical threshold). 38 The cut-off points were as follows: Spence Children's Anxiety Scale, boys ≥33, girls ≥40; 34 Short Mood and Feelings Questionnaire, ≥12.…”

“…Flow chart of study procedure and data collection processes. Grey cells indicate research activities conducted in the first Partners in Parenting Plus (PiP+) trial 36. CALIS, Child Anxiety Life Interference Scale; SMS, short message service.…”

Tailoring cognitive behavioural therapy for insomnia across contexts, conditions, and individuals: What do we know, where do we go?

“…In adapting CBT‐I to school‐aged children and adolescents, sessions were typically group based with varying degrees of parental involvement, depending on developmental stages. Some researchers have used a combination of child and parent–child sessions in‐person (Byrne et al, 2020; Orchard et al, 2020; Schlarb et al, 2010, 2018) or digitally (Schlarb et al, 2020); some did not directly involve parents, and used motivational interviewing to identifying reasons for and barriers to change (Bei et al, 2013; Blake et al, 2017); some incorporated parents as outside‐session support to promote adherence (de Bruin et al, 2014; Paine & Gradisar, 2011); others focused on parents without directly working with their children and incorporated CBT‐I components into parenting intervention strategies (Khor et al, 2021).…”