The Effect of Nonviolent Resistance in Parent Group Training in Child Psychiatric Care

Study Overview
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Brief Summary
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In a Flemish sample of parents of children with psychiatric problems, this study evaluates the effect of a parent group training based on nonviolent resistance on family functioning, parenting variables and mental states of the parents, pre- and post-training.

Detailed Description
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Nonviolent Resistance (NVR) is an intervention method for families and teams that are suffering from helplessness and hopelessness. By empowering individuals through specific focus points and techniques, they can re-establish their role as authority figures for the child. The child, exhibiting dangerous and/or coercive behavior, can feel reconnected and guided. Previous research has shown that parents score higher on General family functioning, Affective reactions and affective involvement, and Role definitions, but not Behavioral control, Problem solving and Communication. Positive effects were visible at a follow up moment, three months later. Parents reported significantly lower on anxiety for the aggression of their child, the self-efficiency about parental capacities and received social support. General parenting stress diminished significantly. A control group showed no such significant changes. Participants with specific problems and waiting to be admitted in the residential ward at the study location can receive pre-care, in the form of a parental group training based on NVR. In six two weekly sessions, combined with intermediate telephone support and home assignments, parents are involved in important parent-child-oriented aspects. This study will evaluate the effect of the training in a Flemish sample, focusing on family functioning, parenting variables and reflective functioning of the parents, pre- and post-training. T1 is at the time between invitation to participate and the first session; T2 is in the first week after the last session (T1 + 12 to 14 weeks); T3 is at three months after the last session; T4 is at six months after the last session. The following primary outcomes are expected after the parent group: More behavior and mental states pointing towards NVR More use of adequate emotion regulation Less behavioral problems in the child Secondary outcomes are expected, according to previous research measuring indirect effects of NVR treatment More adequate attunement to child More cohesion and structure in the family More adequate parenting behavior Less stress and burdening for parents The investigators also expect parents with a more secure attachment style to benefit more (T2) and longer (T3 and T4) from the training.

Official Title
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The Effect of Nonviolent Resistance in Parent Group Training in Child Psychiatric Care

Conditions
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Helplessness, Learned, Family Conflict, Mentalising, Parenting

Intervention / Treatment
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* Behavioral: Nonviolent Resistance


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Parents engage in the NVR training of the child psychiatric clinic at the study location for at least 5 out of 6 training sessions Exclusion Criteria: insufficient understanding of Dutch/Flemish language simultaneously following a different parent group treatment, external to the study location

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Behavioral: Nonviolent Resistance|Six two weekly sessions of two hours, based on nonviolent resistance Questionnaires pre and post intervention|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline mean scores in four domains of Nonviolent Resistance as measured with the Parental Anchoring Scale (Flemish version) | The Parental Anchoring Questionnaire (Flemish version = OAFS) measures Presence, Self-Control, Social Support, and Structure, on a 7-point scale. High scores mean more Nonviolent Resistance. | T1 baseline = 1 to 2 weeks before first session; T2 = T1 + 12 to 14 weeks; T3 = T2 + three months; T4 = T2 + six months | 
| Change from baseline mean scores in child behavior as measured with the Child Behavior Checklist (CBCL) | The CBCL is a general questionnaire measuring internalizing and externalizing behavior of the child as perceived by the parents, using a 3-point scale. High scores mean more problems. | T1 baseline = 1 to 2 weeks before first session; T2 = T1 + 12 to 14 weeks; T3 = T2 + three months; T4 = T2 + six months | 
| Change from baseline mean scores in emotion regulation as measured with the Emotion Regulation Questionnaire (ERQ) | The ERQ measures Reappraisal and Suppression as two distinct mechanisms to deal with emotional problems. Reappraisal is related more with healthy coping. A 7-point scale leads to scores pointing to high Reappraisal and high Suppression. | T1 baseline = 1 to 2 weeks before first session; T2 = T1 + 12 to 14 weeks; T3 = T2 + three months; T4 = T2 + six months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline mean scores in attunement to the child as measured with the Parental Reflective Functioning Scale (PRFQ) | The PRFQ measures reflective functioning or mentalizing, a process essential in developing a secure attachment and positive attunement to the child. There are three subscales with a 7-point scale: Pre-mentalizing (PM), Certainty about Mental States (CMS), and Interest and Curiosity in Mental States (IC). | T1 baseline = 1 to 2 weeks before first session; T2 = T1 + 12 to 14 weeks; T3 = T2 + three months; T4 = T2 + six months | 
| Change from baseline mean scores in family functioning as measured with the Questionnaire for Family Functioning (VGFO) | The VGFO measures Basic care, Education, Social contacts, Youth experiences (of parents), and the Partner relationship, each on a 5-point scale. | T1 baseline = 1 to 2 weeks before first session; T2 = T1 + 12 to 14 weeks; T3 = T2 + three months; T4 = T2 + six months | 
| Change from baseline mean scores in parental burden as measured with the Parental Burden Questionnaire (OBVL) | The OBVL measures possible sources of burden for parents in five scales: Parent-child relationship, Parenting competency, Depressed mood (of the parent), Role restriction, Health complaints, all on a 4-point scale. Higher scores mean more burden for the parents. | T1 baseline = 1 to 2 weeks before first session; T2 = T1 + 12 to 14 weeks; T3 = T2 + three months; T4 = T2 + six months | 
| Change from baseline mean scores in parental behavior as measured with the Short Scale for Parental Behavior (VSOG) | The VSOG measures five different types of parental behavior on a 5-point scale: Positive engagement, Setting/teaching rules, Material rewarding, Punishing, and Physical punishment. | T1 baseline = 1 to 2 weeks before first session; T2 = T1 + 12 to 14 weeks; T3 = T2 + three months; T4 = T2 + six months |