Video feedback parent‐infant intervention for mothers experiencing enduring difficulties in managing emotions and relationships: A randomised controlled feasibility trial

Abstract

Objectives: Parents experiencing mental health difficulties consistent with "personality disorder", often related to a history of complex trauma, may face increased challenges in parent-child relationships and child socioemotional development. There are no published randomised controlled trials (RCTs) evaluating perinatal parent-child interventions for this population. We evaluated the feasibility and acceptability of undertaking an RCT of the video feedback intervention for positive parenting adapted for perinatal mental health (VIPP-PMH). Design: Feasibility study incorporating a pilot RCT.Methods: Mothers with enduring difficulties in managing emotions and relationships, consistent with a "personality disorder", and their 6-to 36-month old infants were randomly allocated to receive six sessions of VIPP-PMH (n = 20) or usual care alone (n = 14). Results: 76% of eligible mothers consented to participate.Intervention uptake and completion rates were 95% (≥1 VIPP-PMH session) and 70% (6 sessions), respectively.

Mother and clinician experiences of a trial of a video feedback parent–infant intervention for mothers experiencing difficulties consistent with ‘personality disorder’: A qualitative interview study

“…Many developed an increased confidence in their parenting abilities. These findings triangulate well with quantitative data from the trial showing a medium-sized increase in parenting self-efficacy from pre-to post-intervention in the intervention condition (d RM, pooled = 0.45) and a pre-post increase in the percentage of mothers in the intervention condition rated as sensitive in blinded observer ratings of parent-child interaction (from 35% to 53%; Barnicot et al, 2022). Whilst some mothers did experience challenges during the intervention such as struggling to find the time and headspace to engage with it, and grappling with their negative self-perception and fears of being judged, the clinicians were largely able to work with mothers to overcome these difficulties.…”

“…Eleven mothers did not take part in feedback interviews; one explicitly declined, and the remainder did not respond to researcher contact attempts. Characteristics of interviewed and non-interviewed mothers (see Table 2) were broadly similar to the full RCT sample (Barnicot et al, 2022). The most commonly recorded primary diagnoses were depressive disorders, whilst just over a third had a recorded primary diagnosis of emotionally unstable (borderline) personality disorder on their medical records.…”

“…If the child was aged between 6 and 10 months at intervention initiation, modified developmentally appropriate filming tasks were used and intervention content around sensitive discipline was omitted (VIPP Training and Research Centre, 2015). The intervention was adapted for parents experiencing 'personality disorder' by adding material on managing self-critical feelings and anxieties about being judged (Barnicot et al, 2022). Clinicians delivering the intervention attended a 5-day accredited training in the adapted VIPP-SD programme and received accredited supervision prior to each delivered session.…”

“…However, these have not yet been tested in a randomised controlled trial (RCT). We have recently completed a feasibility RCT of the video feedback intervention for positive parenting (VIPP, Juffer et al, 2015), adapted for parents experiencing difficulties consistent with perinatal ‘personality disorder’ (VIPP‐PMH), and their 6‐ to 36‐month‐old children (Barnicot et al, 2022). This is, to our knowledge, the first published RCT of a perinatal parent–infant intervention in this population.…”

“…This is, to our knowledge, the first published RCT of a perinatal parent–infant intervention in this population. Uptake and completion rates indicated high levels of intervention feasibility and acceptability, whilst outcome data showed potential positive effects on parental sensitivity in parent–child interaction (Barnicot et al, 2022). Understanding parents' and clinicians' experiences of the trial and intervention is vital for informing further improvements in acceptability and feasibility.…”