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

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.

Study Overview

• Status: Not yet recruiting
• Conditions: Parenting; Family Conflict; Helplessness, Learned; Mentalising
• Intervention / Treatment: Behavioral: Nonviolent Resistance

Detailed Description

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.

• Study Type: Observational
• Enrollment (Anticipated): 64

Contacts and Locations

• Study Contact: Name: Bart Colson, MA; Phone Number: 003224776072; Email: bart.colson@uzbrussel.be
• Study Contact Backup: Name: Edward Campforts, MD; Phone Number: 003224776072; Email: edward.campforts@uzbrussel.be

Study Locations

• Belgium
  • Brussel, Belgium
    • UZ Brussel
    • Contact: Bart Colson, MA; Phone Number: 00324776072; Email: bart.colson@uzbrussel.be
    • Contact: Edward Campforts, MD; Phone Number: 00324776072; Email: edward.campforts@uzbrussel.be

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

- parents of child on the waiting list or already admitted for help in the child psychiatric clinic at the study location, with specific parental stress related to helplessness

Description

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

Study Plan

How is the study designed?

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Universitair Ziekenhuis Brussel
• Investigators: Principal Investigator: Bart Colson, MA, Universitair Ziekenhuis Brussel

Publications and helpful links

General Publications

• Sherman, E. (2018). Group-Based Nonviolent Resistance Program: Development of a Short-Term Intervention and Preliminary Assessment of Its Feasibility and Acceptance. Tel Aviv University, Master Thesis
• Omer H, Lebowitz ER. Nonviolent Resistance: Helping Caregivers Reduce Problematic Behaviors in Children and Adolescents. J Marital Fam Ther. 2016 Oct;42(4):688-700. doi: 10.1111/jmft.12168. Epub 2016 Jun 13.
• Kiliçarslan, S. (2019). The Effect of the Non-violent Resistance Program for the Parents of Children with Violent Behaviors. Kastamonu Education, 27(2), 701-716. https://doi.org/10.24106/kefdergi.2691
• Kiliçarslani, S., Ördem, S., Taltekin, A. & Ardiç, R. (2019). The Effect of Non-Violent Resistance Program on Family Relationships and Parentship Perceptions of Parents. PAU Journal of Education, 45, 211-234. doi: 10.9779/PUJE.2018.230
• Schorr-Sapir I, Gershy N, Apter A, Omer H. Parent training in non-violent resistance for children with attention deficit hyperactivity disorder: a controlled outcome study. Eur Child Adolesc Psychiatry. 2022 Jun;31(6):929-938. doi: 10.1007/s00787-021-01723-8. Epub 2021 Feb 2.
• Van Holen F, Vanderfaeillie J, Omer H. Adaptation and Evaluation of a Nonviolent Resistance Intervention for Foster Parents: A Progress Report. J Marital Fam Ther. 2016 Apr;42(2):256-71. doi: 10.1111/jmft.12125. Epub 2015 Apr 24.

Study record dates

Study Major Dates

• Study Start (Anticipated): October 1, 2021
• Primary Completion (Anticipated): December 1, 2023
• Study Completion (Anticipated): March 1, 2024

Study Registration Dates

• First Submitted: August 31, 2021
• First Submitted That Met QC Criteria: October 7, 2021
• First Posted (Actual): October 20, 2021

Study Record Updates

• Last Update Posted (Actual): October 20, 2021
• Last Update Submitted That Met QC Criteria: October 7, 2021
• Last Verified: October 1, 2021

More Information

Terms related to this study

• Other Study ID Numbers: 2021 GV OUG

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No