van der Zanden Rianne A P, Speetjens Paula A M, Arntz Karlijn S E, Onrust Simone A
Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.
J Med Internet Res. 2010 Dec 19;12(5):e50. doi: 10.2196/jmir.1394.
Children of parents with mental illness (COPMI) are at greater risk of developing mental disorders themselves. Since impaired parenting skills appear to be a crucial factor, we developed a facilitated 8-session preventative group course called KopOpOuders (Chin Up, Parents) delivered via the Internet to Dutch parents with psychiatric problems. The goal was to promote children's well-being by strengthening children's protective factors via their parents. To reach parents at an early stage of their parenting difficulties, the course is easily accessible online. The course is delivered in a secure chat room, and participation is anonymous.
This paper reports on (1) the design and method of this online the group course and (2) the results of a pilot study that assessed parenting skills, parental sense of competence, child well-being, and course satisfaction.
The pilot study had a pre/post design. Parenting skills were assessed using Laxness and Overreactivity subscales of the Parenting Scale (PS). Sense of parenting competence was measured with the Ouderlijke Opvattingen over Opvoeding (OOO) questionnaire, a Dutch scale assessing parental perceptions of parenting using the Feelings of Incompetence and Feelings of Competence subscales. Child well-being was assessed with the total problem score, Emotional Problems, and Hyperactivity subscales of the Strengths and Difficulties Questionnaire (SDQ). Paired samples t tests were performed, and Cohen's d was used to determine effect sizes. Intention-to-treat analyses and analyses of completers only were both performed. Course satisfaction was evaluated using custom-designed questionnaires.
The sample comprised 48 parents with mental illness. The response rate was 100% (48/48) at pretest and 58% (28/48) at posttest. Significant improvements were found on PS Laxness and Overreactivity subscales (P < .01) and on the OOO Feelings of Incompetence and Competence subscales (P < .01) in analysis of completers only as well as by intention-to-treat analysis. Effects were moderate on the PS (d = .52 and d = .48) and were large and moderate on the OOO (d = 0.61 and d = 0.46). At pretest, 75% and 64% of PS scores were in the clinical range, which declined to 43% and 39% at posttest. No significant changes were found for child well-being. Scores for approximately two thirds of children were not in the clinical range at both pretest and posttest. The mean course satisfaction score was 7.8 on a 10-point scale. Of all participants, 20% (10/48) followed all the sessions.
This online group course on parenting skills is innovative in the field of e-support and among interventions for mentally ill parents. The pilot results are promising, showing moderate to large effects for parenting skills and parental sense of competence. Test scores at baseline indicating parenting problems were largely in the clinical range, and baseline scores indicating problems among the children were in the nonclinical range, suggesting that parents were reached at an early stage. Course satisfaction was high. Future research should focus on cost effectiveness and course adherence.
父母患有精神疾病的儿童（COPMI）自身患精神障碍的风险更高。由于养育技能受损似乎是一个关键因素，我们开发了一个名为KopOpOuders（振作起来，父母）的8节促进式预防性团体课程，通过互联网提供给有精神问题的荷兰父母。目标是通过增强父母的儿童保护因素来促进儿童的幸福。为了在养育困难的早期阶段接触到父母，该课程在网上很容易获取。课程在一个安全的聊天室进行，参与是匿名的。
本文报告（1）这个在线团体课程的设计和方法，以及（2）一项试点研究的结果，该研究评估了养育技能、父母的能力感、儿童幸福和课程满意度。
试点研究采用前后测设计。使用养育量表（PS）的宽松和过度反应子量表评估养育技能。使用荷兰语的“Ouderlijke Opvattingen over Opvoeding”（OOO）问卷测量养育能力感，该问卷使用无能感和能力感子量表评估父母对养育的看法。使用优势与困难问卷（SDQ）的总问题得分、情绪问题和多动子量表评估儿童幸福。进行配对样本t检验，并使用科恩d值来确定效应大小。同时进行意向性分析和仅对完成者的分析。使用定制问卷评估课程满意度。
样本包括48名患有精神疾病的父母。前测时的回复率为100%（48/48），后测时为58%（28/48）。仅在完成者分析以及意向性分析中，PS宽松和过度反应子量表（P <.01）以及OOO无能感和能力感子量表（P <.01）有显著改善。PS的效应为中等（d =.52和d =.48），OOO的效应为大等和中等（d = 0.61和d = 0.46）。前测时，75%和64%的PS得分在临床范围内，后测时降至43%和39%。儿童幸福方面未发现显著变化。大约三分之二儿童的得分在前测和后测时均不在临床范围内。课程满意度平均得分为7.8（满分10分）。在所有参与者中，20%（10/48）参加了所有课程。
这个关于养育技能的在线团体课程在电子支持领域和针对患有精神疾病父母的干预措施中具有创新性。试点结果很有希望，显示出对养育技能和父母能力感有中等至较大的效果。基线时表明养育问题的测试得分大多在临床范围内，而基线时表明儿童问题的得分在非临床范围内，这表明在早期阶段就接触到了父母。课程满意度较高。未来的研究应关注成本效益和课程依从性。
