A randomized controlled trial and economic evaluation of the Parents Under Pressure Program for parents in substance abuse treatment

Background There is growing interest in the provision of parenting support to substance misusing parents. Methods This pragmatic, multi-center randomized controlled trial compared an intensive one-to-one parenting program (Parents under Pressure, PuP) with Treatment as Usual (TAU) in the UK. Parents were engaged in community-based substance misuse services and were primary caregivers of children less than 2.5 years of age. The primary outcome was child abuse potential, and secondary outcomes included measures of parental emotional regulation assessed at baseline, 6 and 12-months. A prospective economic evaluation was also conducted. Results Of 127 eligible parents, 115 met the inclusion criteria, and subsequently parents were randomly assigned to receive PuP (n = 48) or TAU (n = 52). Child abuse potential was significantly improved in those receiving the PuP program while those in TAU showed a deterioration across time in both intent-to-treat (p < 0.03) and per-protocol analyses (p < 0.01). There was also significant reliable change (recovery/improvement) in 30.6% of the PuP group compared with 10.3% of the TAU group (p < 0.02), and deterioration in 3% compared with 18% (p < 0.02). The probability that the program is cost-effective was approximately 51.8% if decision-makers are willing to pay £1000 for a unit improvement in the primary outcome, increasing to 98.0% at a £20,000 cost-effectiveness threshold for this measure. Conclusions Up to one-third of substance dependent parents of children under 3-years of age can be supported to improve their parenting, using a modular, one-to-one parenting program. Further research is needed

The negative compatibility effect: A case for self-inhibition

In masked priming, a briefly presented prime stimulus is followed by a mask, which in turn is followed by the task-relevant target. Under certain conditions, negative compatibility effects (NCNCEs) occur, with impaired performance on compatible trials (where prime and target indicate the same response) relative to incompatible trials (where they indicate opposite responses). However, the exact boundary conditions of NCEs, and hence the functional significance of this effect, are still under discussion. In particular, it has been argued that the NCE might be a stimulus-specific phenomenon of little general interest. This paper presents new findings indicating that the NCE can be obtained under a wider variety of conditions, suggesting that it reflects more general processes in motor control. In addition, evidence is provided suggesting that prime identification levels in forced choice tasks – usually employed to estimate prime visibility in masked prime tasks – are affected by prior experience with the prime (Exp. 1) as well as by direct motor priming (Exp. 2 & 3)

Mums4mums -- structured telephone peer-support for women experiencing postnatal depression : a pilot RCT to test its clinical effectiveness

Background Postnatal Depression (PND) is experienced by around 13% of women, who suffer a range of disabling symptoms that can have a negative effect on the mother and infant relationship, with significant consequences in terms of the child’s later mental health. Research has shown that providing support to mothers experiencing PND can help reduce their depressive symptoms and improve their coping strategies. This study aimed to evaluate the impact of telephone peer-support for women experiencing PND. Methods/Design A pilot RCT was conducted in which women who screened positive for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS>=10) were randomised to receive telephone-based support from peers who had recovered from PND, or standard care. Primary outcome measures included depressive symptomatology measured post-intervention and at six-months using the EPDS, and parent-infant interaction using the CARE-Index. Secondary outcome measures included anxiety and depression, dyadic adjustment, parenting stress, and self-efficacy. Maternal perceptions of the telephone peer-support were being assessed using semi-structured interviews. Quantitative and qualitative data was also collected from the peer-supporters to assess the impact on them of delivering the intervention. Results Participants: twenty-eight participants were recruited to the study, and there was a fifty-percent dropout rate (intervention group n=6, control group n=8). While there were no differences in EPDS scores between the two groups at post-intervention, the intervention group continued to improve at six-month follow-up, whereas the control group showed signs of relapse. The intervention had no impact on mother-infant interaction. In-depth interview data show that women valued the support that was provided. Peer-Supporters: nineteen peer-supporters were recruited, of whom five left before supporting a participant, and eight left after supporting only one participant. The quantitative results showed a significant non-clinical increase in anxiety at post intervention. The qualitative results indicated that the peer-supporters found the majority of calls challenging, and that delivering the intervention had had a deleterious impact on some peer-supporters. Conclusion While these findings suggest a positive impact of telephone-based peer-support, further research into ways of improving mother-infant interaction are urgently required. Research is also required into providing effective support for the peer supporters

An evaluation of the parents under pressure programme: a study protocol for an RCT into its clinical and cost effectiveness

Background: Many babies in the UK are born to drug-dependent parents, and dependence on psychoactive drugs during the postnatal period is associated with high rates of child maltreatment, with around a quarter of these children being subject to a child protection plan. Parents who are dependent on psychoactive drugs are at risk of a wide range of parenting problems, and studies have found reduced sensitivity and responsiveness to both the infant's physical and emotional needs. The poor outcomes that are associated with such drug dependency appear to be linked to the multiple difficulties experienced by such parents.An increase in understanding about the crucial importance of early relationships for infant well-being has led to a focus on the development and delivery of services that are aimed at supporting parenting and parent-infant interactions. The Parents under Pressure (PuP) programme is aimed at supporting parents who are dependent on psychoactive drugs or alcohol by providing them with methods of managing their emotional regulation, and of supporting their new baby's development. An evaluation of the PuP programme in Australia with parents on methadone maintenance of children aged 3 to 8 years found significant reductions in child abuse potential, rigid parenting attitudes and child behaviour problems.Methods/design: The study comprises a multicentre randomised controlled trial using a mixed-methods approach to data collection and analysis in order to identify which families are most able to benefit from this intervention.The study is being conducted in six family centres across the UK, and targets primary caregivers of children less than 2.5 years of age who are substance dependent. Consenting participants are randomly allocated to either the 20-week PuP programme or to standard care.The primary outcome is child abuse potential, and secondary outcomes include substance use, parental mental health and emotional regulation, parenting stress, and infant/toddler socio-emotional adjustment scale.Discussion: This is one the first UK studies to examine the effectiveness of a programme targeting the parenting of substance-dependent parents of infants and toddlers, in terms of its effectiveness in improving the parent-infant relationship and reducing the potential for child abuse.Trial registration: International Standard Randomised Controlled Trial Number Register: ISRCTN47282925

Mums 4 Mums : structured telephone peer-support for women experiencing postnatal depression. Pilot and exploratory RCT of its clinical and cost effectiveness.

BACKGROUND: Postnatal depression (PND) can be experienced by 13% of women who give birth, and such women often exhibit disabling symptoms, which can have a negative effect on the mother and infant relationship, with significant consequences in terms of the child's later capacity for affect regulation. Research has shown that providing support to mothers experiencing PND can help reduce their depressive symptoms and improve their coping strategies. The Mums4Mums study aims to evaluate the impact of telephone peer-support for women experiencing PND. METHODS/DESIGN: The study design adopts the MRC framework for the development and evaluation of complex interventions. Health visitors in Warwickshire and Coventry Primary Care Trusts are screening potential participants at the 8-week postnatal check using either the Edinburgh Postnatal Depression Scale (EPDS > = 10) or the three Whooley questions recommended by NICE (http://guidance.nice.org.uk/CG45). The Mums4Mums telephone support intervention is being delivered by trained peer-supporters over a period of four months. The primary outcome is depressive symptomatology as measured by the Edinburgh Postnatal Depression Scale. Secondary outcomes include mother-child interaction, dyadic adjustment, parenting sense of competence scale, and self-efficacy. Maternal perceptions of the telephone peer-support are being assessed using semi-structured interviews following the completion of the intervention. DISCUSSION: The proposed study will develop current innovative work in peer-led support interventions and telecare by applying existing expertise to a new domain (i.e. PND), testing the feasibility of a peer-led telephone intervention for mothers living with PND, and developing the relationship between the lay and clinical communities. The intervention will potentially benefit a significant number of patients and support a future application for a larger study to undertake a full evaluation of the clinical and cost effectiveness of telephone based peer-support for PND. TRIAL REGISTRATION: ISRCTN: ISRCTN91450073. The study has received a major funding grant from National Institute for Health Research (NIHR) (UK) - Research for Patient Benefit (RfPB) programme (ref: PB-PG-0407-13232)