This pilot randomized controlled trial evaluates the feasibility, acceptability, and preliminary effects of two digital parenting interventions for parents experiencing difficulties with anger in parenting. The interventions are internet-delivered adaptations of evidence-based parenting programs, collectively called the Supporting Healthier Interactions in Families by Online Tools (SHIFT) parenting programs. The main questions the study aims to answer are:
1. Are the study procedures and design feasible for a full-scale RCT? 2. Are the SHIFT parenting programs feasible and acceptable? 3. How do therapists and parents experience the SHIFT parenting programs? 4. Is participation in one of the SHIFT parenting programs, relative to the other and relative to waitlist control, associated with improvements in parent-reported intervention outcomes? 5. Is participation in the SHIFT parenting programs, relative to each other and waitlist control, associated with improvement in weekly measures of target mechanisms?
Researchers will compare the two programs against each other and against a waitlist control. The first intervention (SHIFT) is a behavioral parent training (BPT) program with parenting strategies to manage child behavior problems. The second intervention (SHIFT+) includes the same BPT strategies with emotion regulation (ER) techniques from anger-management treatments.
Participants will:
* Be randomized to SHIFT, SHIFT+ or waitlist control. * Take part in one of the digital interventions and receive support in text messages and phone calls from a therapist at family support services in Swedish municipalities. Some participants will take part in the intervention after the waitlist period. * Respond to questionnaires and take part in interviews.
Parent of a child or adolescent aged 2-17 years.
Experiences recurring conflicts with the child and recurring anger, irritation, or frustration in parenting situations, and wants strategies to manage situations where conflicts and/or anger occur. Determined via sores above the mean on the Parent Anger Scale (PAS; 10-item Swedish version) based on previous Swedish social service population data, and confirmed in a telephone screening. Another parent in the same family can also participate in the study and program even if they do not experience difficulties with anger.
Residing in or near a participating municipality.
Can read Swedish and has access to a smartphone, tablet, or computer with internet.
Information indicating ongoing or recent violence toward the child perpetrated by parents or other adults in the home.
Parallel
Online Behavioral Parent Training Program
BehavioralA 6-week digital parent training program incorporating core components from established behavioral parent training programs. Delivered via a secure digital platform with one module per week, text-based therapist support from family support workers, and two brief check-in telephone calls. Strategies include: strengthening parent-child relationship (e.g., child-directed play), understanding how parents' behavior triggers and reinforces child behavior, selective attention and praise for positive behavior, preparations and effective commands, and natural consequences.
Online Behavioral Parent Training + Emotion Regulation Program
BehavioralA 6-week digital program that integrates the same parenting strategies as SHIFT with additional emotion regulation strategies from anger-management treatments. Matched to SHIFT in duration and therapist contact. Emotion regulation strategies include: early identification and interruption of anger escalation, emotional awareness and self-validation, cognitive reappraisal, effective communication, and managing vulnerability to anger.
Participant Recruitment: Number of participants recruited
The number of eligible participants recruited within 6 months, or the recruitment time if the target sample size is reached before 6 months. For each participant, this is assessed at baseline (i.e., if the participant is included).
Intervention Completion: Completion of at least 3 of 6 modules
The proportion of participants who complete at least three of the six online intervention modules. Module completion is assessed through the digital intervention platform from intervention start until intervention completion or dropout.
Change from baseline on the Multidimensional Assessment of Parenting Scale version 2
Parenting practices are assessed using 31 items from the Multidimensional Assessment of Parenting Scale Version 2 (MAPS v2), covering six subscales: Proactive Parenting (6 items), Supportiveness (3 items), Positive Reinforcement (4 items), Warmth (4 items), Hostility (7 items), and Lax Control (7 items). Items are rated on a 5-point Likert scale ranging from 1 (Never) to 5 (Always). The four positive parenting subscales are summed to form a Positive Parenting broadband score ranging from 17 to 85, with higher scores indicating more frequent use of positive parenting practices. Hostility and Lax Control are scored separately, with each subscale ranging from 7 to 35 and higher scores indicating more frequent use of the respective negative parenting practice. The Physical Control subscale of the MAPS v2 is not administered; therefore, a Negative Parenting broadband score is not calculated.
Change from baseline on the Patient Health Questionnaire (PHQ-9)
Parents' symptoms of depression measured using the Patient Health Questionnaire-9 (PHQ-9; 9 items). 4-point Likert scale (0-3), total score 0-27, higher scores = greater severity of depression.
Change from baseline on the Parental Flooding Scale
Parental flooding assessed using the Parental Flooding Scale (PFS; 15 items). Measures the extent to which parents experience their children's negative affect during conflicts as unexpected, overwhelming, and distressing. 5-point Likert scale (1-5), total score 15-75, higher scores = greater difficulties.
Change from screening assessment on the Parent Anger Scale - subscale Experienced Anger
Parent-reported anger in parenthood measured using the Experienced Anger subscale of the Parent Anger Scale (PAS; 10-item Swedish version). Captures experienced anger toward children including physiological arousal, brooding, and rumination. 7-point Likert scale (0-6), total score 0-60, higher scores = more frequent anger.
Change from baseline on the Strengths and Difficulties Questionnaire
Child mental health assessed using the parent-rated 25-item Strengths and Difficulties Questionnaire (SDQ). Items rated on a scale of 0-2, total score 0-50, higher scores = greater difficulties.
Parents experiences of negative effects of the interventions
Potential negative effects will be assessed post-intervention by asking parents who report that the intervention made their problems worse (based on an item included in the Client Satisfaction Questionnaire \[CSQ\]) to what extent this negatively affected them or their family. This is assessed using a single item rated on a 5-point Likert scale ranging from 0 (Not at all) to 4 (Extremely). In addition, each week during the intervention, parents respond to an open-ended question asking whether the program has caused discomfort, felt burdensome, or had any other negative impact on them or their family during the past week.
Weekly change during intervention in parental emotion regulation - reappraisal
Emotion regulation strategies assessed weekly using the Reappraisal subscale (6 items) of the Revised Parental Emotion Regulation Inventory (R-PERI). 7-point scale (1-7), total score 6-42, higher = better emotion regulation.
Weekly change during intervention in parenting practices (4 item inspired by the MAPS v2)
Weekly parenting practices assessed using 4 items inspired by the MAPS v2. Positive parenting: 2 items (reflecting Warmth and Positive Reinforcement), score 2-10, higher = more positive. Negative parenting: 2 items (reflecting Lax Control and Hostility), score 2-10, higher = more negative.
Weekly change during intervention in child disruptive behavior
Weekly child disruptive behavior assessed using 2 items inspired by the ODD subscale. 4-point scale (0-3), higher = more severe disruptive behavior.
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Karolinska Institutet
Lead sponsor
Forte: Swedish research council for health, working life and welfare
Collaborator
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