Video feedback intervention to enhance parental reflective functioning in primary caregivers of inpatient psychiatric children: protocol for a randomized feasibility trial

Abstract

Background Children requiring hospitalization for psychiatric care have serious disorders, high use of psychotropic medication, and frequent readmissions. The development and implementation of therapies focused on incorporating primary caregivers or attachment figures is necessary for working with children with severe psychiatric disorders. Mentalization or parental reflective functioning (PRF) is the ability of parents to understand their children’s behaviors as an expression of internal emotional states and act accordingly to help them regulate their emotions; in this way mentalizing is a key component of sensitive parenting. Video-assisted therapies have proven to be effective in promoting change in parent–child relationships. The majority of studies have been carried out with mothers of pre-school children and in an outpatient setting. Video intervention therapy (VIT) is a flexible manualized therapy, which allows the intervention to be individualized to the context where it is applied, according to the needs and resources of the people who participate in it. The objective of the study is to evaluate the feasibility and acceptability of applying VIT to improve the PRF of the parents as primary carers of children hospitalized in a psychiatric service. Methods This is a pilot randomized, single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 2:1 allocation (with more people allocated to the intervention arm). The intervention consists of four modules; every module has both one video-recorded play session and one VIT session per week. People assigned to the control group will receive treatment as usual plus weekly play sessions. Feasibility and acceptability of the study will be quantitatively and qualitatively assessed. Evaluation of the caregivers will include assessments of PRF, wellbeing and personality structure; assessments of children will include parent-ratings and clinician-ratings of symptomatology and general functioning. After every video feedback (VF) session, PRF, the caregiver’s wellbeing and children’s general functioning will be reassessed. Discussion This study will contribute to the currently scarce evidence on how to provide family attachment-based interventions in a child inpatient psychiatric unit. It will also inform the design and implementation of a future randomized clinical trial. Trial registration ClinicalTrials.gov, NCT03374904 . Registered on 14 December 2017 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s13063-019-3310-y) contains supplementary material, which is available to authorized users.

Effect of the Attachment and Child Health Parent Training Program on Parent–Child Interaction Quality and Child Development

“…Parental RF enables parents to regulate their feelings and behaviors toward their child in the context of parent-child interactions (Fonagy et al, 2002;Leyton et al, 2019;Rostad & Whitaker, 2016). Four studies demonstrated the effect of parental RF-focused interventions on parent-child interaction in children <36 months.…”

The Primary Care-Video Intervention Therapy for Growth-Vulnerable Infants. A Case Study

“…We observe that the pediatrician guidance might potentially sustain parents in shifting the attention from personal preoccupation towards the observation of infant competencies and initiatives. In this way, PC-VIT could modify both parents' subjective experience of a delicate moment and their interactive behaviors, making them more aware of their reactions and giving more realistic views of their child [29]. An enhanced ability to recognize infant autonomy and competences during relevant milestones, such as the weaning process, might be transferred into more sensitive and attuned daily interactions.…”

“…Other approaches base the choice of each session theme upon the particular case [23][24][25][26][27][28].Video-feedback for supporting parenting can be used for simultaneous purposes: (i) To aid parents to better notice and identify children's cues; (ii) to recognize and perhaps change parental behaviors; (iii) to better hypothesize the motivational roots of the child's behaviors. Overall, parents' experience of observing themselves in the video aids achieving a more realistic perspective on their relationship with their child [29]. In particular, they become more aware of their own reactions and are supported in better hypothesizing the motivational roots behind the child's behaviors.…”

Video Intervention Therapy for Primary Caregivers in a Child Psychiatry Unit: A Randomized Feasibility Trial

“…The protocol describing the methods in detail was previously published (23), the trial was retrospectively registered on ClinicalTrials.gov NCT: 03374904. This feasibility trial is reported with the Consolidated Standards of Reporting Trials (CONSORT) guideline for pilot trials (24).…”