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
Authors: Neukel C. , Bermpohl F. , Kaess M. , Taubner S. , Boedeker K. , Williams K. , Dempfle A. , Herpertz S. C. ,   the UBICA-II consortium, Herpertz Sabine C. , Neukel Corinne , Bermpohl Felix , Kaess Michael , Brunner Romulad , Taubner Svenja , Volkert Jana , Georg Anna , Fleck Leonie , Fuchs Anna , von der Lühe Tabea , Mielke Emilia , Parzer Peter , Resch Franz , Roth Corinna , Seeger Fabian , Wenigmann Marc , Williams Katharina , Banzhaf Christian , Boedeker Katja , Brandl Eva , Dittrich Katja , Hindi-Attar Catherine , Kluczniok Dorothea , Plank Irene Sophia , Reuter Catherina , Ratayczak Judith , Schoofs Nikola , Winter Sybille , Bertsch Katja 
Published: October 2021

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