Title: A feasibility trial of video feedback for parents with personality disorder
Funder: Department of Health and Social Care

Abstract: Background: Personality disorder is an intergenerational phenomenon with a strongly environmental aetiology. By the time they are 18 months old, children who have a parent with personality disorder are 6 times more likely to have problems managing their emotions and behaviour than other children. By the time they are 14 years old, 45% have experienced a major depressive episode. Evidence suggests that parental personality disorder is a stronger risk factor for developing long-term mental health and social problems than other parental mental health problems. Parents with a personality disorder have long-term severe difficulties in managing their emotions and their relationships with others. This can lead to problems with coping, self-neglect, inconsistent parenting and impulsive behaviour, all of which can have an adverse effect on the development and health of their children. Providing support with parenting at an early stage could help prevent development of difficulties in this vulnerable group of parents and children. However, no evidence on effective parenting interventions for people with personality disorder exists. The Video feedback Intervention for Positive Parenting (VIPP) uses video feedback to help parents understand and respond sensitively to children s behaviour - something that parents with personality disorder can find difficult. VIPP has been shown to be effective in improving a range of child and parent social, emotional and behavioural outcomes in other at-risk families. However, a feasibility trial is necessary to adapt the intervention to meet the specific needs of parents with personality disorder, and determine whether and how to conduct a definitive trial. Aims: To evaluate the feasibility and acceptability of delivering and testing a brief video-feedback intervention to reduce the risk of behavioural problems in the infants of parents with personality disorder. Plan of Investigation: In Phase 1 we will pilot the intervention in up to ten parents with personality disorder and use their feedback to modify it to increase its acceptability. In Phase 2 we will test the modified intervention in a feasibility randomised controlled trial. Twenty parents will be randomly assigned to receive video feedback in addition to their usual treatment, and twenty to receive usual treatment alone. We will establish objective indices of feasibility and acceptability: the proportions consenting, receiving the intervention, and completing the trial, and the acceptability and variance of the proposed outcome measures. Proposed outcome measures include child behaviour problems (primary), and parenting stress, competency, and sensitivity (secondary). We will gain feedback on the acceptability of the intervention and trial procedures through qualitative interviews with participants and the clinicians delivering the intervention. If the objective indices and qualitative feedback meet our pre-specified indicators of feasibility and acceptability, we will proceed to a definitive trial application to the NIHR HTA, using the feedback to further optimise our intervention and trial protocol. Potential benefits to patients and the NHS: National provision of perinatal psychological therapies falls well below the level recommended in NHS commissioning guidance, and the majority of perinatal mental-health services report limited provision for parents with personality disorder. The proposed trial will provide evidence on the feasibility of a brief video feedback intervention which has the potential to be widely used. The proposed trial will also provide evidence on the feasibility of a definitive randomised controlled trial, which would test the effectiveness of an intervention that has the potential to benefit parents with personality disorder and their children by: reducing parenting stress, improving parent-child relationships, improving child behaviour, and preventing the children developing serious mental health and social problems. Given that the intergenerational consequences of perinatal mental illness cost UK society &pound;8.1 billion per one-year birth cohort, this could potentially generate considerable savings for services.

Lay abstract: Parents with a personality disorder have long-term severe difficulties in managing their emotions and their relationships with others. This can lead to problematic parenting and child protection concerns, and places their children at elevated risk of long-term social and mental health difficulties. By the time they are 18 months old, children who have a parent with personality disorder are 6 times more likely to have problems managing their emotions and behaviour than other children. By age 14, 45% have experienced a major depressive episode. Offering additional parenting support while their children are still infants could prevent their children developing mental health problems, disrupting the intergenerational cycle of difficulties. However, there is no evidence on what interventions could be helpful for parents with personality disorder. Research with other vulnerable families has shown a brief six-session video-feedback intervention can improve parenting skills and child behaviour problems, by helping parents understand and respond sensitively to their child s behaviour. Engaging and maintaining individuals with personality disorder in treatment often requires adaptation of interventions to meet their specific needs. The present research will therefore establish whether parents with personality disorder consent to and complete this video feedback intervention, how they think it could be improved, and whether it is feasible to test it in a larger trial in the future. We will first pilot the intervention in up to 10 parents, then randomly assign 20 parents to receive video feedback in addition to their usual treatment, and 20 to receive usual treatment alone. We will interview the parents about their experiences of the intervention and the research, and use their feedback to decide how to adapt the intervention and whether to test it in a larger trial in the future. An advisory group of parents with personality disorder will oversee the research, providing guidance throughout.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MENTAL HEALTH