The Signposts Program for Parents of Children with a head injury

The Signposts for Building Better Behaviour program ('Signposts') is a manualised parenting intervention, initially developed to assist parents in managing difficult behaviour seen in children with an Intellectual Disability. The original program consists of 8 modules: 1. Introduction 2. Module 1 – Measuring your child's behaviour 3. Module 2 – Systematic use of daily interactions 4. Module 3 – Replacing difficult behaviour with useful behaviour 5. Module 4 – Planning for better behaviour 6. Module 5 – Developing more skills in your child 7. Your family as a team 8. Dealing with stress in the family Parents are also provided with a DVD, with videos demonstrating the parenting skills described in each module, and a workbook, with homework exercises designed to help parents practice the skills learned. In general, the program teaches parents to describe and measure unwanted behaviour, analyse its antecedents and consequences, and build on the child's skills in order to promote better behaviour. For example, homework exercises may involve describing their child's strengths, developing house rules, or recording their use of time-outs. More recently, research suggests efficacy when used with the parents of children with an Acquired Brain Injury, with the introduction of a 9th module "Dealing with a head injury in the family", where challenging behaviours are a reasonably common and persisting long-term sequelae of the injury. The current study is investigating the feasibility of delivering the program with online clinician support, via videoconferencing. We hope that delivery through this medium may improve program access for families, where barriers such as living in rural areas or working full time would have prevented them from participating in the face-to-face format that is usually offered through rehabilitation services. Parents will be offered to participate in either the intervention group or the wait-list control group on an alternating basis, based on the child's date of injury. Parents participating in the intervention program will be provided with hard copies of the 'Signposts' program, as well as an internet enabled iPad, loaded with the app "GoToMeeting", a videoconferencing program. Consistent with previous research investigating this program with telephone supported delivery, modules 1, 2, 7, 8, and 9 are initially provided, with subsequent modules mailed to parents on a fortnightly basis as needed. Parents will read through the program materials in their own time, complete the homework exercises, and record their own child's behaviour, It is estimated that reading the module will take an average of 30 minutes, and practicing the skills taught should be built into the regular family routine, with approximately 5 minutes per day dedicated to recording parenting skill practice or their child's behaviour into the workbook. Parents will then engage in fortnightly videoconference meetings with the 'Signposts' clinician, who is a trainee psychologist and has completed the 'Signposts' professional training workshop at the Parenting Research Centre, where the 'Signposts' program was originally developed. Clinical supervision will be provided by a registered Clinical Psychologist, who has also completed the 'Signposts' training. The purpose of these videoconference meetings is to review homework, troubleshoot any difficulties, and provide positive reinforcement for parents' efforts. It is expected that the time required for these sessions should be approximately 25 minutes, but will vary substantially depending on the parent's needs. Five videoconference sessions will be conducted, and it is expected that the program takes a minimum of 10 weeks to complete. Program adherence will be measured by whether parents successfully complete all modules of the program, and whether parents have sufficiently completed homework exercises at the time of the videoconference (as recorded by the 'Signposts' clinician during review of homework). Homework completion will be deemed sufficient if parents have at least attempted majority of the exercises and practiced the skills taught to an extent that facilitates discussion during the videoconference meeting.