Enhancing the quality of interactions between parents with psychosis and their young children: A feasibility randomised controlled trial of video feedback.

Background Psychotic disorders are severe, persistent mental health conditions characterised by distressing hallucinations and delusional beliefs; problems with concentration and motivation; emotional problems; and difficulties understanding mental states of others. Patients with psychosis have dependent children, and value their parenting role. However, the problems of psychosis can disrupt parent-child interactions, with patients not responding in a timely and appropriate way to child cues, leading to withdrawn or intrusive interaction. Children at familial high-risk of psychosis have increased odds of adverse health outcomes. Healthcare policy prioritises early help for vulnerable children, to reduce intergenerational transmission of poor mental health. Parent-child interaction is a key modifiable factor for promoting child emotional development. Video Interaction Guidance (VIG) is a brief, strengths-based video feedback intervention that uses videotaped interactions of the parent and child to enhance parental responsiveness to the child s cues. There is good evidence that video feedback improves parent-child interactions and child mental health in other high-risk groups. However, parents with psychosis require tailored interventions to meet their specific needs. There are currently no trials of any parent-infant intervention for parents with psychosis. Aim This feasibility study aims to establish the necessary key parameters for a definitive trial to determine the effects of an adapted brief video feedback intervention (VIG) on the quality of interactions between parents with psychosis and their young children and on patient and child outcomes. Methods In Phase 1, we will pilot VIG with six parents with psychosis and use their and PPI feedback to refine the intervention to increase its acceptability. In Phase 2, we will conduct a feasibility randomised controlled trial. Forty patients with a diagnosed psychotic disorder and caregiving responsibilities for a child aged 2-36 months will be recruited from NHS mental health teams. Participants will be randomised to receive VIG in addition to usual care or usual care alone. We will establish objective feasibility criteria for a definitive trial: the proportions consenting, receiving the intervention, and completing the assessments. We will examine the acceptability and variance of the proposed outcomes: parental responsiveness (primary), and parenting stress, parental mental health, and social and emotional wellbeing of infants/toddlers (secondary). We will gain feedback on the acceptability of the intervention and trial procedures through qualitative interviews with participants and the VIG therapists. If the objective criteria meet our pre-specified feasibility benchmarks, we will proceed to a definitive trial application to the NIHR EME programme, using the qualitative feedback to optimise our intervention and trial protocol. Potential benefits to patients and the NHS This research will provide evidence on the feasibility and acceptability of a tailored video feedback intervention for parents with psychosis. The findings will inform a future definitive randomised controlled trial to test the effects of an intervention that could benefit parents with psychosis and their young children by improving parent-child interactions, reducing parenting stress, and improving parent and child mental health. In the longer term, this research has potential to reduce the societal costs of intergenerational transmission of severe mental illness within families.