Randomised controlled trial to evaluate the effectiveness and cost-effectiveness of the Partners in Parenting Plus – Education (PiP-Ed+) program for parents of adolescents experiencing emotionally based school avoidance (EBSA).

Partners in Parenting Plus – Education (PiP-Ed+) is a clinician-supported, online parenting program for parents of early adolescents with emotionally based school avoidance (also known as ‘school refusal’). It was adapted from a clinician-supported online program which equips caregivers with evidence-based strategies to address adolescent anxiety and depression (ACTRN12618000290291). Feasibility and acceptability of PiP-Ed+ were previously evaluated in a feasibility and acceptability trial (ACTRN12622000977774), the findings of which informed refinements to the intervention and its implementation in the current randomised controlled trial (RCT). PiP-Ed+ comprises two concurrent components delivered over up to 14 weeks. Component 1: Self-guided online parenting program The online program is accessed via a dedicated PiP-Ed+ trial website, where parents login to access their program (via their personal ‘Dashboard’) and complete study-related assessments. Parents first complete an online self-assessment of parenting practices associated with adolescent anxiety and depression (the Parenting to Reduce Adolescent Depression and Anxiety Scale; PRADAS; Cardamone-Breen et al., 2017), which is used to generate individually-tailored parenting feedback. The feedback identifies areas of parenting strength and provides practical strategies for identified areas for further development. Immediately following their parenting self-assessment and feedback, parents select which modules to add to their personalised program. There are a total of 13 modules in the PiP-Ed+ program, six of which are considered core program content and are automatically selected for all parents: 1) Understanding anxiety and depression; 2) Connect (parent-adolescent relationship); 3) Breaking the anxiety cycle; 4) Understanding school refusal; 5) Working together to overcome school refusal; and 6) Maintaining the gains (relapse prevention). Module 7: Looking after yourself (parent self-care), will be recommended to all parents, however, parents can choose whether or not to select this module. The remaining six modules are optional and recommended to parents according to their PRADAS subscale scores. Parents are also able to select modules that are not recommended to them. These optional topics are: 8) Calm versus conflict (minimising conflict in the home); 9) Raising good kids into great adults (establishing family rules); 10) Nurture roots and inspire wings (parental involvement and autonomy granting); 11) Partners in problem solving; 12) Good friends = supportive relationships; and 13) Good habits for good mental health. The interactive modules can be accessed online, from any device with internet access (including smartphones). The modules include 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 20-30 minutes to complete, depending on the topic and how parents engage with the module. Modules automatically ‘unlock’ weekly, and parents receive an automated email (and SMS if they opt in to SMS notifications) when a new module unlocks. Parents can also manually unlock modules ahead of schedule and revisit previously completed modules. Component 2: PiP-Ed+ coaching sessions Concurrent to the online modules, parents will attend a maximum of 9 coaching sessions (approx. 50-60 mins, via Zoom) over 14 weeks, with their allocated PiP-Ed+ coach. Coaching session topics align with module content, for the following 8 topics: 1) Understanding anxiety and depression, 2) Connect (parent–adolescent relationship); 3) Breaking the anxiety cycle; 4) Understanding school refusal; 5) Working together to overcome school refusal; 6) Calm versus conflict (minimising conflict in the home); 7) Raising good kids into great adults (establishing family rules); and 8) Maintaining the gains (relapse prevention). An optional mid-program review session will also be offered, based on coach discretion (i.e. if the coach feels the review session is warranted) to review the parent’s progress and overall program goals, discuss any barriers to implementation or program participation, and where relevant, review and trouble-shoot the adolescent and/or parent’s access to professional mental health support, as well as the parent’s own self-care. Parents are required to complete the corresponding online module prior to their coaching session on the topic. Parents will be encouraged to attend their 9 coaching sessions weekly. Coaching sessions are manualised and involve structured activities, with the following core components of each session: session agenda; check-in; goal review; module review; session activity (related to module topic); goal-setting; confidence check-in; next steps. All PiP-Ed+ coaches are registered or provisional psychologists who receive standardised training prior to commencing coaching, and ongoing supervision throughout the trial to ensure fidelity to the manualised intervention. Co-parents may attend coaching sessions with the participating on request. Adolescents do not participate in coaching sessions. It is recommended that adolescents access standard psychological care externally to the intervention as clinically indicated. Adherence and engagement monitoring 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 module activities are completed. Goal completion will be defined as: the parent (or coach, in discussion with parent) indicates that the selected module goal was ‘attempted’. Coaching Fidelity All coaching sessions will be video and audio recorded via Zoom. A series of 9 fidelity checklists (aligning with each of the 9 coaching sessions, developed specifically for the PiP-Ed+ intervention), will be used as follows: 1) to support ongoing fidelity, coaches will complete the self-report fidelity checklist after each coaching session; 2) to assess fidelity for the trial, a trained independent observer will complete the observer fidelity checklist to rate 3 randomly selected session recordings per parent, one each from early (first or second session), middle (any session between ‘early’ and ‘late’) and late (second-last or final session) intervention. The observer will rate whether each component of the session was completed by the coach (yes = 1; no = 0; not applicable = not scored).