Parenting intervention for parents with psychosis in adult mental health services

Plain English summary of protocol

Background and study aims
Around 2 in 100 people in the UK experience psychosis and the majority of these are parents. The stress of parenting can worsen psychotic symptoms and parents with psychosis need help early. Their children tend to do less well in life and are more likely to develop mental health problems themselves. Several government and NHS bodies recognise the importance of good parenting in preventing poor mental health and breaking this cycle.
A self-directed parenting programme, called TripleP, could be useful for parents with psychosis. TripleP reduces parenting stress by improving parenting skills and child behaviour but we do not yet know how well it works for parents with psychosis. We offered it to ten parents in a small pilot study. Afterwards, parents reported feeling less stressed and more confident as parents. Their psychotic symptoms and their children’s behaviours improved.
Parents have told us that they do not want parenting support from family services, because these services do not understand the added burden that psychosis brings. Parents would rather receive this type of support from mental health staff, with whom they have an established relationship. Staff say they would be willing to help parents, but services do not routinely offer this type of intervention.
This study will compare TripleP to usual care within adult mental health services. People taking part will receive either TripleP in addition to their usual care or usual care alone. Which group people are in will be selected at random.
Parents offered TripleP can choose to access it online or via a workbook because both approaches work equally well and not all families have internet access.
The aim of the study is to find out if the researchers can recruit 75 parents with psychosis, whether they will complete TripleP, and whether they can be retained in the study.
The researchers will measure parenting stress, confidence, mental health and wellbeing alongside children’s behaviour at the start (baseline), after 16 weeks (end of programme) and after 39 weeks (follow-up), comparing the two groups at the end. They will also interview parents and staff to explore their experiences of taking part. The researchers want to find out what was easy or difficult, and if there were any benefits or otherwise. This information will help determine the best way of delivering TripleP to parents with psychosis and to design a full clinical trial to test TripleP further in the future.
The study was designed by researchers, clinicians and parents with lived experience of psychosis. Parents will continue to be involved throughout. They will contribute to all aspects of the study, from designing materials at the start, to producing reports at the end. This co-production will ensure the study is relevant to their needs.

Who can participate?
People aged 18 years or over who have experienced psychosis, are under the care of an adult mental health team, and who have a child aged 2 and 12 years old.

What does the study involve?
Following consent, participants will be asked to meet with a researcher to complete some questionnaires about parenting stress, parenting confidence and child behaviour as well as an interview about how they have been feeling. We will then allocate participants, by chance, into one of two groups. The first group will receive usual NHS care. The second group will receive usual NHS care and will also be given access to the Triple P parenting programme. Parents in the Triple P group will choose whether they want to access it online, or via a workbook. They will be given 15 weeks to work through the activities in the book or online programme. The activities focus on ‘positive parenting’ for example spending quality time with children; using good behaviour charts; planning activities to prevent problems and encouraging independence. The care coordinators of parents in this group will be asked to check in with parents to see how they are getting on with the programme.
After completing the programme, roughly 4 months into the study, a member of the research team will meet with participants for the follow-up assessment, which involves completing the questionnaires they helped the team with at the beginning of the study and taking part in another interview about how they are feeling. They may also be asked to take part, if they wish to, in a more in-depth interview with a member of the research team about their experiences of the programme. Another 3 months after this, participants will be asked to complete the same questionnaire and interview again.
Participants who were allocated to receive usual NHS care will be asked to complete the questionnaires and take part in an interview about how they are feeling 4 months and 7 months after starting the study. They will be offered a copy of the Triple P workbook after these last assessments.
The researchers will interview 12-15 care coordinators to explore their experiences of supporting parents to take part.

What are the possible benefits and risks of participating?
About two-thirds of the parents in the study will be allocated at random to the Triple P group. It is possible that accessing Triple P will improve how they manage their children their and benefit their mental health. However, this cannot be guaranteed. The information we get from this study will help us to better support parents with psychosis in the future.
The assessments involve parents talking about their children and how they are feeling, which they may find upsetting. Participants will have the opportunity to discuss any concerns they have with the researchers, and they are free to withdraw from the study at any point without giving a reason. If they decide they would like to withdraw from the research, this decision will not affect any care they may receive now or in the future.
 
Where is the trial run from?
Greater Manchester Mental Health NHS Foundation Trust (UK)

When is the trial starting and how long is it expected to run for?
January 2023 to September 2025

Who is funding the trial?
National Institute for Health Research (NIHR) (UK)

Who is the main contact?
Lynsey Gregg, lynsey.gregg@manchester.ac.uk

Contact information

Dr Lynsey Gregg
Public, Scientific, Principal investigator

Zochonis Building
The University of Manchester
Manchester
M13 9PL
United Kingdom

ORCID ID	0000-0001-5683-5574
Phone	+44 (0)161 275 8486
Email	lynsey.gregg@manchester.ac.uk

Study information

Eligibility

Locations

Countries of recruitment

• United Kingdom
• England

Study participating centres

Results and Publications

Study outputs

Editorial Notes

22/04/2024: The following changes have been made:
1. Date of ethics approval added.
2. Study website added.
3. Patient information sheet link added.
4. The recruitment start date was changed from 01/02/2024 to 16/04/2024.
05/01/2024: Study's existence confirmed by the HRA.