Evaluating the effect of 'Partners in Parenting-Peer-to-Parent' (PiP-P2P) program for parents of adolescents with anxiety and depression on parenting skills and adolescent anxiety and depression symptoms

The intervention, ‘Partners in Parenting-Peer-to-Parent (PiP-P2P)’, is a newly adapted version of a therapist-coach assisted online parenting program, Partners in Parenting Plus (PiP+; formerly known as the Therapist-assisted Online Parenting Strategies [TOPS] program; refer to ACTRN12618000290291). The original PiP+ program is an online parenting program designed to equip parents (refers to any adult in a regular caregiving role) with evidence-based parenting strategies to respond to anxiety or depression in their 12-18-year-old adolescent. Adaptations of PiP+ have since been developed to address specific areas of concern, including school refusal (Partners in Parenting Plus-Education [PiP-Ed+], refer to ACTRN12622000977774) and suicide prevention (Partners in Parenting Plus-Suicide Prevention [PiP-SP+], refer to ACTRN12623000266662). In PiP-P2P, the coaching support that is provided by trained clinicians in PiP+ is instead provided by family/carer peer coaches, who are family/carer peer support workers with lived experience (FCWLE) of caring for an adolescent with mental health difficulties. This 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 10 web-based modules); and, 2) a coaching component (refer to ACTRN12618000290291) delivered via videoconference, henceforth referred to as ‘PiP-P2P coaching sessions’. The web-based program includes 10 self-directed online modules covering topics related to parenting an adolescent with anxiety and/or depression: 1) understanding anxiety and depression, 2) parent-teen relationships, 3) minimising conflict in the home, 4) parental involvement and autonomy granting, 5) problem-solving, 6) breaking the anxiety cycle, 7) establishing family rules, 8) encouraging good habits, 9) encouraging supportive relationships, and 10) relapse prevention. The coaching component involves parents attending a maximum of 10 PiP-P2P coaching sessions with a PiP-P2P coach via online videoconference. Prior to their first session, parents will receive a phone call from a member of the coaching team. The purpose of the phone call will be to introduce the coach and the program to the parent, and confirm the first coaching session. Parents will be encouraged to complete their PiP-P2P coaching sessions weekly, and will have a maximum of 14 weeks to complete up to 10 coaching sessions. The PiP-P2P coaching sessions will expand on the content of the modules, and peer coaches will draw on their own lived experience to support the parent to apply the content to their own circumstances. Discussions around goal setting and enabling goal attainment are also a focus of these sessions. PiP-P2P coaching sessions are manualised to ensure standardised delivery of the intervention. Each session takes approximately 50-minutes. PiP-P2P coaches will all be family/carer peer workers with lived experience (FCWLE), who have experience working as a family peer worker at a headspace centre or equivalent setting in Australia. headspace is Australia’s National Youth Mental Health Foundation, providing early intervention mental health services to 12-25 year olds and their families. Coaches will receive standardised training and regular supervision to deliver the manualised PiP-P2P coaching sessions. Note: Adolescents will not participate in PiP-P2P coaching sessions. It will be recommended that the adolescent receives standard psychological care externally to the intervention as required. Non-participant co-parents of the participating parent will be permitted to join PiP-P2P coaching sessions if requested. Parents will receive the following as part of the PiP-P2P 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-base 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 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 improvement. The feedback report is displayed to parents online (via their 'personal dashboard' as part of the PiP website). 3) Parents are recommended up to 10 interactive online modules. All parents in the current trial will be required to select the following modules, regardless of PRADAS responses, as these are considered critical foundational topics for the program: 1) understanding anxiety and depression, and 2) relapse prevention. Similarly, the parent-teen relationships module will always be recommended, regardless of PRADAS responses. The remaining modules will be recommended based on identified areas for improvement (scores on corresponding PRADAS subscales). The modules provide practical strategies to support parents to make changes to their parenting, in order to align more closely with the parenting recommendations in the Guidelines. Parents can further tailor their program by selecting additional modules or de-selecting optional modules recommended to them. In addition to the 2 mandatory modules, parents can select between 1 to 8 additional modules to comprise 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 automatically 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 approximately 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) In parallel, parents will attend a maximum of 10 one-on-one PiP-P2P coaching sessions with a PiP-P2P coach via online videoconference. Parents will have a maximum of 14 weeks to complete the 10 PiP-P2P coaching sessions and be encouraged to attend weekly. In each session parents will be guided by their coach through a check-in, a review of the module content, completion of an activity, and a goal-setting exercise, with a view to work towards their selected module goal between PiP-P2P coaching sessions. Intervention adherence will be monitored through website analytics (e.g., module completion) and attendance records (coaching sessions). Intervention engagement will be explored through: 1) percentage of selected modules completed; and 2) percentage of selected module goals completed. Modules are considered completed if 80% of pre-specified mandatory activities are completed. Goal completion will be defined as: a user (the parent, or coach, if applicable) indicates that the selected module goal was ‘attempted’. Intervention outcomes will be assessed through parent and adolescent online surveys completed at two timepoints: baseline and at post-intervention (120 days/4 months after the parent baseline assessment); and a post-intervention interview with a subgroup of n~15 parents. Reference: 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.