Randomised feasibility trial of the helping families programme-modified: an intensive parenting intervention for parents affected by severe personality difficulties.

BACKGROUND

Specialist parenting intervention could improve coexistent parenting and child mental health difficulties of parents affected by severe personality difficulties.

OBJECTIVE

Conduct a feasibility trial of Helping Families Programme-Modified (HFP-M), a specialist parenting intervention.

DESIGN

Pragmatic, mixed-methods trial, 1:1 random allocation, assessing feasibility, intervention acceptability and outcome estimates.

SETTINGS

Two National Health Service health trusts and local authority children's social care.

PARTICIPANTS

Parents: (i) primary caregiver, (ii) 18 to 65 years, (iii) severe personality difficulties, (iv) proficient English and (v) capacity for consent. Child: (i) 3 to 11 years, (ii) living with index parent and (iii) significant emotional/behavioural difficulties.

INTERVENTION

HFP-M: 16-session home-based intervention using parenting and therapeutic engagement strategies. Usual care: standard care augmented by single psychoeducational parenting session.

OUTCOMES

Primary feasibility outcome: participant retention rate.

SECONDARY OUTCOMES

(i) rates of recruitment, eligibility and data completion, and (ii) rates of intervention acceptance, completion and alliance (Working Alliance Inventory-Short Revised). Primary clinical outcome: child behaviour (Eyberg Child Behaviour Inventory).

SECONDARY OUTCOMES

child mental health (Concerns About My Child, Child Behaviour Checklist-Internalising Scale), parenting (Arnold-O'Leary Parenting Scale, Kansas Parental Satisfaction Scale) and parent mental health (Symptom-Checklist-27). Quantitative data were collected blind to allocation.

RESULTS

Findings broadly supported non-diagnostic selection criterion. Of 48 participants recruited, 32 completed post-intervention measures at mean 42 weeks later. Participant retention exceeded a priori rate (HFP-M=18; Usual care=14; 66.7%, 95% CI 51.6% to 79.6%). HFP-M was acceptable, with delivery longer than planned. Usual care had lower alliance rating. Child and parenting outcome effects detected across trial arms with potential HFP-M advantage (effect size range: 0.0 to 1.3).

CONCLUSION

HFP-M is an acceptable and potentially effective specialist parenting intervention. A definitive trial is feasible, subject to consideration of recruitment and retention methods, intervention efficiency and comparator condition. Caution is required in interpretation of results due to reduced sample size. No serious adverse events reported.

TRIAL REGISTRATION NUMBER

ISRCTN14573230.

Informations de copyright

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: CD is the lead developer of two parenting programmes used in this report: Helping Families Programme and Empowering Parents Empowering Communities. MJC has previously received research grant funding on behalf of Imperial College London from the National Institute for Health Research. LH is a co-developer of the Helping Families Programme. MM was an author of the Psychoeducation plus Problems Solving (PEPS) intervention for adults with personality disorder. PEPS helped to inform the modified HFP. PM reports personal fees from a talk given at Fourth Bergen International Conference on Forensic Psychiatry 2016, Outside of the submitted work. PM led the development of the SAPAS, the personality disorder screen used in this study.