Understanding and breaking the intergenerational cycle of abuse in families enrolled in routine mental health services: study protocol for a randomized controlled trial and two non-interventional trials investigating mechanisms of change within the UBICA II consortium

Abstract

Background Parents’ mental illness (MI) and parental history of early life maltreatment (ELM) are known to be significant risk factors for poor parenting while poor parenting is a crucial mediator of the intergenerational continuity of child maltreatment. Hence, maltreatment prevention programs for families with an MI parent, which pay particular attention to experiences of ELM in the parent, are urgently needed. Parental mentalizing was previously found to mediate successful parenting. Interventions aimed at improving the parental mentalizing capacity reduced maltreatment risk in parents. The aim of the present study is to investigate the effectiveness of a mentalization-based parenting-counseling in acutely mentally ill parents currently treated at a psychiatric hospital. Methods Mentalization-based parenting-counseling (MB-PC) vs. enhanced standard clinical care (SCC+) will be administered in a cluster-randomized-controlled trial (RCT). Patients treated at psychiatric hospitals with children between 1.5 and 15 years will be included in the trial. MB-PC will be administered as a 12-h combined individual and group program enriched by social counseling (over a course of 5 weeks) as add-on to standard clinical care, while the control condition will be standard clinical care plus a 90-min psychoeducation workshop on positive parenting. Primary efficacy endpoint is self-reported parenting practices at follow-up. Embedded within the RCT will be two sub-studies investigating social cognition and dyadic synchrony as biobehavioral mechanisms of change. Discussion The main goal of the present study is to investigate ways to break the intergenerational continuity of maltreatment by assessing the benefits of a prevention program which aims at improving parenting in vulnerable mothers and fathers. MB-PC is a short, low-cost intervention which can be delivered by nurses and social workers and is applicable to MI patients with children with a broad range of diagnoses. If it is shown to be effective, it can be directly implemented into standard psychiatric hospital care thereby providing help to prevent child maltreatment. Trial registration German Clinical Trials Register DRKS00017398. Registered on 5 July 2019

Parental Mental Illness, Borderline Personality Disorder, and Parenting Behavior: The Moderating Role of Social Support

“…A program that combines the three elements recommended by Marston et al [ 100 ], incorporates video feedback, and thereby focuses on parental mentalization capabilities is the lighthouse parenting program [ 28 ] which is currently conducted and investigated in a study of our work group that aims to understand and break the intergenerational cycle of abuse (UBICA) in mentally ill parents [ 102 ]. The group program specifically focuses on social support via peer-to-peer exchange (informal social support) and further incorporates social counseling (formal social support).…”

“…The group program specifically focuses on social support via peer-to-peer exchange (informal social support) and further incorporates social counseling (formal social support). We test for superiority of this prevention program against pure psychoeducation and aim to identify potential mechanisms of change mediating the effects of the mentalization-based intervention on parenting behavior (for details see [ 102 ]).…”

An exploratory study on how attachment classifications manifest in group psychotherapy

“…This study analyzed treatment data from the BMBF-funded project "Understanding and Breaking the Intergenerational Cycle of Abuse" (UBICA-II). The project is devoted to providing help for parents currently in psychiatric treatment with a high risk of abusing their child (Neukel, et al, 2021).…”

“…This study analysed treatment data from the BMBFfunded project ‘Understanding and Breaking the Intergenerational Cycle of Abuse’ (UBICA-II). The project is devoted to providing help for parents currently in psychiatric treatment with a high risk of abusing their child (Neukel, et al ., 2021 ). UBICA-II comprises a multicentric randomized controlled trial on the efficacy of a mentalization- based parenting intervention, the Lighthouse Parenting Intervention (LPI, Byrne et al ., 2019 ).…”

Inanspruchnahme einer Spezialsprechstunde für psychisch kranke Eltern

“…Auch zur Prävention psychischer Belastungen der nachfolgenden Generation könnte ein derartiger Ausbau an Behandlungsangeboten neben weiteren Interventionen zur Reduktion der psychischen Belastung der Kinder wie z. B. das im Rahmen der laufenden UBICA (Understanding and breaking the intergenerational cycle of abuse) -Studie angebotene Mentalisierungsbasierte Programm für Eltern mit psychischen Erkrankungen [20], einen wertvollen Beitrag leisten. Daher wäre sowohl im ambulanten als auch im stationären Bereich ein Ausbau von auf die Peripartalzeit bzw.…”