Evaluating the acceptability, feasibility, and short-term effects of a coach-supported, online parenting program (‘PiP-SP+’) to empower parents whose adolescents have suicidal thoughts and/or behaviours.

The intervention, ‘Partners in Parenting-Suicide Prevention’ (PiP-SP+), is a newly adapted version of the Partners in Parenting-Plus (PiP+) program (formerly known as Therapist-Assisted Online Parenting Strategies [TOPS] - refer to ACTRN12618000290291). The original PiP+ program is an online parenting program designed to equip parents with evidence-based parenting strategies to respond to anxiety or depression in their 12-18-year-old adolescent. PiP-SP+ has been adapted to empower parents to support their adolescent who have suicidal thoughts and/or behaviours. The PiP-SP+ intervention has two components: 1) a web-based program drawn from the Partners in Parenting intervention (refer to ACTRN12615000328572 and ACTRN12619001781134) which includes a parenting self-assessment with tailored feedback about the parent's current parenting practices and up to 13 web-based modules); and, 2) a coaching component (refer to ACTRN12618000290291) delivered via videoconference, henceforth referred to as ‘coaching sessions’. The web-based program includes 13 self-directed online modules covering topics related to parenting an adolescent who have suicidal thoughts and/or behaviours in the context of anxiety and/or depression: 1) understanding anxiety and depression, 2) parent-teen relationships, 3) talking about suicide and responding to suicide risk, 4) managing ongoing suicide risk, 5) understanding non-suicidal self-injury, 6) establishing family rules, 7) problem-solving, 8) minimising conflict, 9) breaking the anxiety cycle, 10) parental involvement and autonomy granting, 11) encouraging supportive relationship, 12) encouraging good habits, 13) relapse prevention. The coaching component involves parents attending up to 9 sessions, of which the first includes an orientation component before educational materials. The coaching will be held with a PiP-SP+ coach via videoconference. The aim of the orientation component is to discuss the program objectives and boundaries with the parent, build rapport, conduct an initial assessment of the parent and teen’s situation, and collaboratively decide the order of the remaining coaching session topics. PiP-SP+ coaches are provisional psychologists completing a PhD (Clinical Psychology) at Monash University or registered psychologists. All coaches will receive an intensive training program which will include online learning materials and live and/or recorded role-play exercises with feedback. Additionally, coaches will be provided with ongoing support and development through regular supervision with a registered clinical psychologist (frequency dependant on coach level of training, e.g. weekly for provisional psychologists, fortnightly for registered psychologists). Each session takes approximately 50-60 minutes. Parents will be encouraged to complete coaching sessions weekly. Coaching sessions are manualised to ensure standardised delivery of the intervention. Parents will receive the following as part of the PiP-SP+ intervention: 1) Parents first complete an online self-assessment of their parenting practices associated with risk of adolescent depression and anxiety disorders (the Parenting to Reduce Adolescent Depression and Anxiety Scale [PRADAS]). The PRADAS assesses parenting practices in relation to the recommendations in the evidence-based parenting guidelines "How to Prevent Depression and Clinical Anxiety in your Teenager: Strategies for Parents" (Parenting Strategies Program, 2013; henceforth the Guidelines), which form the basis of the original PiP+ program content. 2) Based on their responses to the PRADAS, parents receive an individually-tailored feedback report. The feedback highlights areas of parenting strength and/or confidence, and provides practical strategies for identified areas for further development. The feedback report is displayed to parents online (on their 'personal dashboard' as part of the PiP-SP+ program). Parents are also emailed a link to access a PDF copy of the Guidelines. 3) Parents will receive at least 5 core modules but are recommended up to 13 interactive online modules. All parents in the current trial will receive the following core modules, as these are considered the most important topics for parents of adolescents who have increased suicide risk: 1) understanding anxiety and depression, 2) parent-teen relationships), 3) talking about suicide and responding to suicide risk, 4) managing ongoing suicide risk, 5) relapse prevention. Additionally, all parents will be recommended the non-suicidal self-injury module, however selection of this module will remain optional. The remaining modules will be recommended based on each parent’s identified areas for further development (PRADAS scores), but remain optional. The modules provide practical strategies to support parents to make changes to their parenting to align more closely with the parenting recommendations in the Guidelines, and evidence-based content curated to support adolescents who have suicidal thoughts/behaviours and non-suicidal self-injury (NSSI). Parents can further tailor their program by selecting additional modules or de-selecting optional modules recommended to them. Therefore in addition to the 5 core modules, parents can select up to 8 other online modules to add to their personalised program. By default, modules will ‘unlock’ (i.e. become available for parents to complete) at a rate of one module per week, until all selected modules have been unlocked. Parents are notified by email and SMS (if they opt in to SMS notifications) when a new module unlocks. If they prefer, parents can choose to override the default unlock date, and unlock modules at an earlier date. After all initially-selected modules have been unlocked, all remaining modules, including those not initially selected, will become available for parents to complete if they wish. Parents can revisit any modules they have already completed at any time. The interactive modules can be accessed online, from any device with internet access (including smartphones). The modules include educational materials, illustrations, audio clips, videos, vignettes, interactive activities, goal-setting exercises, and an end-of-module quiz with immediate feedback to consolidate learning. Each module takes about 20-35 minutes to complete, depending on the topic and how parents engage with the module. Parents are invited to complete their first module immediately after they have completed their baseline survey and received their personalised feedback report. 4) Parents will receive coaching sessions with a PiP coach via video-conference. After completing each selected online module, parents will attend a coaching session associated with the completed module content. Parents will have a maximum of 14 weeks to complete a maximum of 9 coaching sessions and will be encouraged to attend weekly. The nine topics which include offer both coaching session and associated modules are: 1) understanding anxiety and depression, 2) parent-teen relationships), 3) talking about suicide and responding to suicide risk, 4) managing ongoing suicide risk, 5) relapse prevention, with the option of additional coaching sessions to include 6) understanding non-suicidal self-injury, 7) problem-solving, 8) minimising conflict, and 9) parental involvement and autonomy granting. In each session parents will be guided by their coach through a check-in, a review of the online-module content, completion of an activity, and a goal-setting exercise, with a view to work towards their selected goal between sessions. Post-session, parents will have access to a collaborative coach-parent document housed on Google Documents (accessible via a unique URL sent via email), akin to a guided reflection, learning record, and summary page. Additionally, the collaborative coach-parent document will include a personalised tool to help parents to respond to their teen’s risk of NSSI or suicide. Intervention adherence will be monitored through website analytics (module completion) and attendance records (coaching sessions). Note. Adolescents will not participate in coaching sessions or have access to the modules. The intervention period is anticipated to run for 4 months while the adolescent continues to receive standard external psychological care. Cardamone-Breen, M. C., Jorm, A. F., Lawrence, K. A., Mackinnon, A. J., & Yap, M. B. (2017). The Parenting to Reduce Adolescent Depression and Anxiety Scale: Assessing parental concordance with parenting guidelines for the prevention of adolescent depression and anxiety disorders. PeerJ, 5, e3825.