Parent Supports Intervention Project

Stress Clinical Trial

Official title:

Parent Supports Intervention Project for Parents of Adults With Developmental Disabilities

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01981070
• Other study ID #: 095/2013
• Status: Completed
• Phase: N/A
• First received: October 24, 2013
• Last updated: June 6, 2016
• Start date: October 2013
• Est. completion date: July 2015

Study information

• Verified date: June 2016
• Source: Centre for Addiction and Mental Health
• Contact: n/a
• Is FDA regulated: No
• Health authority: Canada: Ethics Review Committee
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to evaluate the impact of two community based interventions for parents of adults with intellectual or developmental disabilities (IDD) who are requesting services.

The two interventions will include:

1. Support and Information Intervention - provides parents with support and information about services for their sons and daughters

2. Mindfulness Intervention - empowers parents through teaching them mindfulness skills

We hypothesize that:

1. Parents in both types of interventions will report benefits (reductions in psychological distress) maintained at follow-up.

2. Parents in mindfulness intervention group will report improvements in mindful parenting, self compassion, positive gain, empowerment, and reduced burden. Parents in support and information intervention group will report improvements in empowerment, positive gain, and reduced burden.

3. Parents in mindfulness intervention group will show greater improvements by 3 months follow-up than parents in the support and information group.

Description:

Parents report many positive dimensions of raising a child with IDD, yet at the same time, being a parent to an individual with IDD is associated with increased stress and poorer psychological wellbeing. Through the MAPS (see www.mapsresearch.ca) program, we have been studying the experience of parents of adults with IDD to better understand what contributes to their difficulties, and factors associated with their wellbeing. This research, combined with our recent systematic review on the experience of parents needing services, highlights the need for psychological supports to empower parents and to enhance their ability to care for their children. With the appropriate psychological supports, parents may be able to support their sons/daughters for longer. It is crucial that we invest in researching interventions and promising practices that may enhance the capacity of parents. However, limited research has considered what types of support make a difference in parental well-being.

Parent empowerment, mindfulness and psychological acceptance are key psychological variables related to positive parent outcomes, including the ability to more effectively care for others. Parent empowerment refers to active attempts to change situations through the application of knowledge and skill. Empowerment is possible when parents feel more familiar with services, and more able to advocate and plan for their child. Person directed planning, orientation to services, practical tips and planning are all helpful for empowerment. Psychological acceptance is a process that involves embracing current difficulties without actively attempting to directly change them, thus facilitating positive action in line with an individual's or family's values. Such acceptance can be particularly helpful for parents when stressful events cannot be immediately resolved or addressed.

Mindfulness is related to psychological acceptance, and is defined as the awareness that emerges through paying attention, on purpose, in the present moment, nonjudgementally to the unfolding of experience moment by moment. These latter processes may help parents preserve their emotional energy and reduce those thoughts, attitudes and judgments that can interfere with addressing their needs and the needs of their child. In this way, we expect that increasing psychological acceptance and mindfulness will facilitate parental and family empowerment. Mindfulness is an innovative support that shows particular promise because it may serve to strengthen parent capacity to care in times of stress, may fundamentally alter how parents spend time with their children, and it may help to make parents more effective advocates for their children. There is an emerging evidence base demonstrating the benefits of mindfulness and acceptance based interventions for a host of medical and psychological issues. Recent attention has been paid to teaching mindfulness to caregivers to help them with caregiving. Studies have included caregivers of patients with cancer, adults with dementia, youth with behavioural difficulties, and most recently, children with IDD.

Preliminary research from the UK and the US has demonstrated the benefits that mindfulness based interventions have on parent ability to care for their young children and youth with IDD. Singh and colleagues published case series teaching parents of children with IDD the philosophy and practice of mindfulness. These papers demonstrated that with 12 training sessions, parents reported decreases in child behaviour problems and increased parenting satisfaction. Blackledge and Hayes applied Acceptance and Commitment Therapy to a group of 20 parents of youth with autism and demonstrated significant improvement in general distress, depression, and maternal acceptance immediately following the therapy as well as 3 months later.

Most recently, Dykens and colleagues demonstrated improved mood and reductions in in a cohort of 287 parents of children with IDD participating in Mindfulness Based Stress Reduction in Tennessee, compared to parents participating in a Positive Psychology Support Program. Neece and colleagues reported similar improvements in a group of 100 parents with preschool age children with IDD in California. Most impressive in both studies was the high attendance rate of parents, attributed in part to onsite childcare. A similar group, using a modification of Mindfulness Based Cognitive Therapy (MBCT), developed by team member Zindel Segal and colleagues is currently being evaluated in Wales by team member Richard Hastings and colleagues.

We will evaluate the impact of two community based interventions for parents of adults with IDD who are requesting services. The first intervention is considered current best practice (active control), which will offer parents support and information about services to enhance parent empowerment ("support and information for parents"). This will be compared to an intervention that will target both parent empowerment and psychological acceptance/mindfulness by blending parent support with mindfulness training ("mindfulness intervention for parents"). The idea of adding a psychological intervention to a more practical intervention has been explored in mindfulness research previously and also in the parent training literature more generally. We will compare this intervention to an "active control" so that we can determine the unique contribution of the mindfulness component of the intervention.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 50
• Est. completion date: July 2015
• Est. primary completion date: July 2015
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Both
• Age group: N/A and older

Eligibility

Inclusion Criteria:

• Parent applied to Disability Services Ontario (DSO) Toronto Region for services for their adult child

• Adult child determined eligible for services but not yet completed the standardized assessment of need

• Child age 17.5 and up and living at home

• Parent proficient in English

Exclusion Criteria:

• Parent has not applied for DSO Toronto Region for services for their adult child

• Adult child determined ineligible for services

• Child age under 17.5 or not living at home

• Parent not proficient in English

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Developmental Disabilities
• Stress

Intervention

Behavioral:
• Mindfulness Intervention for Parents
See Study Arms
• Support and Information for Parents
See Study Arms

Locations

Country	Name	City	State
Canada	CAMH	Toronto	Ontario

Sponsors (2)

Lead Sponsor	Collaborator
Centre for Addiction and Mental Health	Ontario Ministry of Community and Social Services

Country where clinical trial is conducted

Canada, 

References & Publications (22)

Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006 Mar;13(1):27-45. — View Citation

Blackledge, J.T., & Hayes, S.C.. Using acceptance and commitment training in the support of parents of children diagnosed with autism. Child and Behaviour Therapy, 28, 1-18, 2006.

Bohlmeijer E, ten Klooster PM, Fledderus M, Veehof M, Baer R. Psychometric properties of the five facet mindfulness questionnaire in depressed adults and development of a short form. Assessment. 2011 Sep;18(3):308-20. doi: 10.1177/1073191111408231. Epub 2011 May 17. — View Citation

Carlson LE, Ursuliak Z, Goodey E, Angen M, Speca M. The effects of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients: 6-month follow-up. Support Care Cancer. 2001 Mar;9(2):112-23. — View Citation

Duncan LG, Coatsworth JD, Greenberg MT. A model of mindful parenting: implications for parent-child relationships and prevention research. Clin Child Fam Psychol Rev. 2009 Sep;12(3):255-70. doi: 10.1007/s10567-009-0046-3. Review. — View Citation

Dykens, E. (2012, July). Mindfulness-Based Stress Reduction: Overall Findings from the Parent-Stress Intervention Project (PSIP). Paper presented at 2012 IASSID World Congress, Halifax, Nova Scotia.

Epstein-Lubow, G., McBee, L., Darling, E., Armey, M., & Miller, M.. A pilot investigation of mindfulness-based stress reduction for caregivers of frail elderly. Mindfulness,2(2),95-102, 2011.

Ferraioli, S. J., & Harris, S. L.. Comparative effects of mindfulness and skills-based parent training programs for parents of children with autism: feasibility and preliminary outcome data. Mindfulness, 1-13, 2013.

Gutierrez, L. M.. Beyond coping: An empowerment perspective on stressful life events. Journal of Sociology & Social Welfare, 21: 201-219, 1994.

Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006 Jan;44(1):1-25. — View Citation

Jones L, Hastings RP, Totsika V, Keane L, Rhule N. Child behavior problems and parental well-being in families of children with autism: the mediating role of mindfulness and acceptance. Am J Intellect Dev Disabil. 2014 Mar;119(2):171-85. doi: 10.1352/1944-7558-119.2.171. — View Citation

Kabat-Zinn, J.. Mindfulness-Based Interventions in Context: Past, Present, and Future. Clinical Psychology: Science and Practice, 10(2): 144-156, 2003.

Koren, P., Dechillo, N., & Friesen, B.. Measuring empowerment in families whose children have emotional disabilities: A brief questionnaire. Rehabilitation Psychology, 37(4): 305-321, 1992.

Lawton MP, Moss M, Hoffman C, Perkinson M. Two transitions in daughters' caregiving careers. Gerontologist. 2000 Aug;40(4):437-48. — View Citation

Lovibond, S. H., & Lovibond, P. F.. Manual for the Depression Anxiety Stress Scales. Sydney: Psychology Foundation, 1995.

Lunsky, Y., Tint, A., Robinson, S., Vickar, M., Ouelette-Kuntz, H.. System-wide information about family caregivers of adults with intellectual/developmental disabilities - a scoping review of the literature. Journal of Policy and Practice in Intellectual Disabilities. Submitted.

Neece, C.. Mindfulness-Based Stress Reduction for Parents of Children with Developmental Delays: A Pilot Study. Paper presented at 2012 IASSID World Congress, Halifax, Nova Scotia. 2012, July.

Pit-ten Cate, I.. Positive gain in mothers of children with physical disabilities. Unpublished Doctoral Dissertation, University of Southampton, UK, 2003.

Raes F, Pommier E, Neff KD, Van Gucht D. Construction and factorial validation of a short form of the Self-Compassion Scale. Clin Psychol Psychother. 2011 May-Jun;18(3):250-5. doi: 10.1002/cpp.702. Epub 2010 Jun 8. — View Citation

Singh NN, Lancioni GE, Winton AS, Singh J, Curtis WJ, Wahler RG, McAleavey KM. Mindful parenting decreases aggression and increases social behavior in children with developmental disabilities. Behav Modif. 2007 Nov;31(6):749-71. — View Citation

Singh, N. N., Lancioni, G. E., Winton, A. S. W., Fisher, B. C., Wahler, R. G., McAleavey, K., Singh, J. & Sabaawi, M.. Mindful parenting decreases aggression, noncompliance, and self-injury in children with autism. Journal of Emotional and Behavioral Disorders, 14: 169-177, 2006.

Weiss, J., & Lunsky, Y.. The brief family distress scale: A measure of crisis in caregivers of individuals with autism spectrum disorders. Journal of Child and Family Studies, 20(4): 521-528, 2011.

* Note: There are 22 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Depression Stress Anxiety Scale	The Depression, Anxiety and Stress Scale (DASS; Lovibond & Lovibond, 1995) is a 21-item scale assessing the severity of a range of symptoms across depression, anxiety, and stress. Parents will be asked to rate each item (statement) on a 4-point Likert scale, with 0 being "did not apply to me at all" and 3 being "applied to me very much, or most of the time." Only two subscales, 7-items each, will be used: depression and stress. The DASS generates a total score for each of the two subscales.	21 weeks following Randomization	No
Secondary	Family Empowerment Scale	The Family Empowerment Scale (FES; Koren et al., 1992) is a 34-item measure that assesses feelings of empowerment. The FES is comprised of 3 subscales: Family, Service System and Community/Political and responses are given on a 5-point Likert scale, with 1 being "never" and 5 being "very often." Only two subscales, 12 items each, will be used: Family and Service System.	21 weeks following Randomization	No
Secondary	Five Facet Mindfulness Questionnaire-Short Form	The Five Facet Mindfulness Questionnaire- Short Form (FFMQ-SF; Bohlmeijer, et al, 2011) measures day-to-day mindfulness through 24 items on a 5-point Likert scale, with 1 being "never or very rarely true" and 5 being "very often or always true." It is commonly used in mindfulness research studies.	21 weeks following Randomization	No
Secondary	Bangor Mindful Parenting Scale	The Bangor Mindful Parenting Scale (BMPS; Jones, et al., in press) is a 15-item measure that assesses mindfulness explicitly in the parenting role and was developed for parents of children with developmental disabilities in the UK. Responses are given on a 4-point Likert scale, with 0 being "never true" and 3 being "always true."	21 weeks following Randomization	No
Secondary	Self-Compassion Scale-Short Form	The Self-Compassion Scale-Short Form (SCS-SF, Raes, et al., 2011) is a 12-item questionnaire that measures participant levels of self-compassion. Caregivers will be asked to rate each statement on a 5-point Likert scale, with 1 being "almost never" and 5 being "almost always."	21 weeks following Randomization	No
Secondary	Positive Gains Scale	The Positive Gains Scale (PGS; Pit-ten Cate, 2003) is 7-item measure that assesses caregivers' perceptions of positive contributions their child has made to their lives. The measure utilizes a 5-point Likert scale, ranging from 1 being "strongly agree" to 5 being "strongly disagree."	21 weeks following Randomization	No
Secondary	Burden Scale	The Caregiver Burden scale measures subjective feelings of caregiver burden using the 9-item burden subscale of the Revised Caregiver Appraisal Scale (Lawton, Kleban, Moss, Rovine & Glicksman, 2000). Items measure caregiver's perception of the negative impacts caregiving has had on his or her health, well-being, social life and personal relationships. The items utilize a 5-point Likert scale ranging from 5 being "agree a lot" to 1 being "disagree a lot." Total scores range from 9 to 45, with higher scores indicating higher levels of perceived burden.	21 weeks following Randomization	No
Secondary	Brief Family Distress Scale	The Brief Family Distress Scale (BFDS; Weiss & Lunsky, 2011) measures family distress. Parents will be asked to select one of ten statements that best represents where their families are in terms of crisis. Each of the 10 statements corresponds to a number, with 0 being "no stress" and 10 being "crisis." This measure will only be given at baseline to match families on distress.	21 weeks following Randomization	No

External Links

•   Centre for Addiction and Mental Health (CAMH)