Program for Caregivers Involved With Mental Health Services

Early Phase 1

Completed

Brief Summary: The purpose of this two-year pilot study is to adapt a 12-week attachment-based parenting intervention for implementation with female adult caregivers who have or are at risk for long-term interpersonal conflict with family members, children, or significant others and are caring for a child between the ages of birth and 7 years.

Detailed Description: The purpose of this two-year pilot study is to adapt a 12-week attachment-based parenting intervention (Parenting from the Inside Out or PIO) originally developed for substance abusing mothers (as part of an ongoing NIDA-funded treatment development study; R01 DA17294) for implementation with female adult caregivers who have or are at risk for long-term interpersonal conflict with family members, children, or significant others and are caring for a child between the ages of birth and 7 years. The PIO intervention involves 12-24 weekly 1 hour individual therapy sessions with Masters level therapists who are trained and supervised by Dr. Suchman (the Principal Investigator) in the PIO approach.

Recruitment & Eligibility

Inclusion Criteria

receive psychiatric services through the adult or young adult treatment team at the West Haven Mental Health Clinic
have a child receiving psychiatric services through the child treatment team at the West Haven Mental Health Clinic
express interest in receiving a parent intervention at the West Haven Mental Health Clinic

Exclusion Criteria

severe mental health problems (e.g., suicidal, homicidal, psychosis, thought disorder)
severely cognitively impaired
have psychiatric or substance-related symptoms requiring inpatient hospitalization or ambulatory detoxification
are not fluent in English
child has a serious illness or significant developmental delay (e.g., cognitive, language, or motor)

Arm && Interventions

Group	Intervention	Description
Mentalization based therapy	Mentalization based therapy	Women who are the primary caregivers of a child between the ages of 0-7 years and are involved with mental health services for themselves or a child.

Primary Outcome Measures

Name	Time	Method
Maternal reflective functioning	Change at week 24 from baseline	PDI: Rated on a -1 to +9 scale where a score of 3 indicates simple awareness of mental states, 5 indicates rudimentary recognition of how mental states influence behavior, and above 5 indicates advance rPRFQ-1: Rated on a 7-point scale. 3 subscales: PMM (Pre-mentalizing Mode) with high scores indicating reliance on pre-reflective modes of thinking about child's behavior, NRO (Not Recognizing Opacity) with high scores indicating less recognition of the opaque nature of the child's mental states, and IC (Interest and Curiosity) with high scores indicating more interest and curiosity about the child's underlying mental states.

Secondary Outcome Measures

Name	Time	Method
Coding Interactive Behavior	Change at week 24 from baseline	The caregiver-child dyad will be given age-appropriate toys and instructed to interact freely and session is videotaped and coded using CIB. Composite scores are scored on a 1 - 5 scale. Composite maternal scales include Sensitivity, Intrusiveness, Limit Setting, and Negative Emotion. Composite Child Scales include Child Involvement, Withdrawal and Compliance. Composite Dyadic Scales include Reciprocity and Dyadic Negative States.
Maternal global psychiatric distress	Change at week 24 from baseline	The composite Global Severity Index (GSI) from the Brief Symptom Inventory measures current overall symptomatology across multiple domains (e.g., depression, anxiety, interpersonal sensitivity, somatic complaints, paranoid ideation) and has demonstrated good reliability and validity. T scores above 60 on the GSI indicate risk for a clinical disorder.
Maternal parenting stress	Change at week 24 from baseline	The PSI yields five scores: Parent Dysfunction, Parent-Child Difficulty, Difficult Child, Defensive Responding, and Total Stress which are standardized to percentile rankings. We will be testing for reduction in each stress domain to below the 85th percentile.
Maternal depression	Change at week 24 from baseline	Scores range from 0 to 63. We will be testing for significant reduction in total depression.

Locations (1): West Haven Mental Health Clinic
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West Haven, Connecticut, United States