Mindful Parenting - A Single Case Experimental Design Study

A Single Case Experimental Design Study of an Online Mindful-parenting Intervention for Parents of Children Living With a Visible Difference

Some parents of children living with a visible difference can experience heightened stress due to the associated challenges of this. Parent's views of the child's visible difference and their responses to the child are important. Mindful parenting approaches have been found to reduce stress or distress for parents of children with disabilities, physical health problems and skin conditions.

This study will be completed with a small number of participants (around six to 12). Participants will be parents or carers of a child living with a visible difference aged four to 16 years, who are experiencing stress. Parents or carers will complete an online mindful parenting intervention (called Two Hearts) including video content, audio files and a workbook, over six weeks. Over the twelve-week study period participants will also provide the following information which will be compared over time:

• Complete four group support sessions during the intervention via videoconferencing
• Complete questionnaires at four timepoints
• Provide information about their use of the intervention materials and home practice weekly
• Answer two questions daily via text message about parenting stress levels We hope to learn about the initial effects of the mindful parenting programme for parents or carers of children living with a visible difference. We also hope to learn whether parents or carers find completing an online programme possible and practical. Finally, we hope to learn what parents' or carers' views are of the online programme and whether this type of intervention in online format would be helpful for other parents or carers.

Study Overview

• Status: Recruiting
• Conditions: Cleft Lip and Palate; Parenting; Neurofibromatoses; Skin Condition; Alopecia; Craniofacial; Limb Difference
• Intervention / Treatment: Behavioral: Mindful Parenting Programme

Detailed Description

Aims

• To investigate the feasibility, acceptability, and initial effects of an online mindful parenting intervention for parents of children living with a visible difference.
• To investigate whether the intervention reduces parenting stress.
• To investigate whether completion of the intervention results in increased levels of mindful parenting.
• To investigate whether completion of the mindful parenting intervention has an impact upon child wellbeing.
• To investigate the feasibility of an online mindful parenting intervention for parents of children living with a visible difference, including adherence to the intervention, attrition, and participant perceptions of the acceptability of the intervention.

Hypotheses

• Completion of the intervention will result in changes in idiographic measures of parental stress. Namely, an improvement in the positive target and a reduction in the negative target. These improvements will be maintained on follow up.
• Completion of the intervention will result in reductions of parental stress on standardised assessment measures. These improvements will be maintained on follow up.
• Completion of the intervention will result in an improvement in child wellbeing on standardised assessment measures. These improvements will be maintained on follow up.
• Completion of the intervention will increase levels of mindful parenting as measured using a standardised assessment measure. These improvements will be maintained on follow up.
• Increased levels of mindful parenting will be associated with improved outcomes on idiographic and standardised assessment measures.

Methodology Design This study will adopt an A-B-A2 single case experimental design . Phase A will consist of a two-week baseline period. Phase B will be the six-week intervention. Phase A2 will be a four-week follow up period and an exit interview. The main outcome variable will be general parenting stress and parenting stress associated with the child's visible difference, measured idiographically via daily text messages. Secondary outcome variables will comprise standardised assessment measures of mindful parenting, parenting stress and parent reported child wellbeing. Feasibility of the online intervention will be assessed through recording of practical issues such as access to online content, participant adherence to the intervention (including home practice) and participant retention. Acceptability of the intervention will be assessed via participant evaluations of the workbook, online content, home practice and intervention overall through weekly feedback and the exit interview.

Participants The aim will be to recruit between six and 12 participants. Single case series methodology usually comprises only a small number of participants as each participant acts as their own control and provide large amounts of data.

Screening interview All participants will complete a screening interview to assess suitability for the intervention. During the screening interview the participants will be asked about 1. The nature of their child's visible difference, 2. Their access to a tablet or computer to complete the intervention, 3. Whether the parent is currently accessing any psychological therapy, 4. Parental mental health and stress (current and over the past year) including the use of medications, 5. Parental experience of mindfulness or meditation. Information obtained from the screening interview will be used to assess eligibility for the study, based on the above criteria.

Measures Demographic data Demographic information will be gathered at the beginning of the study. Parents will be asked to report their age, gender, ethnicity, education background; as well as their child's age, gender and nature of the visible difference (i.e. skin condition, mark, injury etc.) and part of the child's body affected.

Daily Idiographic measures of parenting stress Two unique targets identified by each participant around parenting stress will be measured daily on a scale of 1-100.

Standardised assessment measures Participants will be asked to complete standardised questionnaire measures at four timepoints: on baseline, immediately prior to beginning the intervention, immediately on completion and at follow up (four weeks after intervention completion).

Intervention engagement, home practice and retention Adherence and attrition will be recorded. Weekly feedback will be collected from participants regarding levels of engagement with the intervention and mindfulness home practice.

Intervention evaluation The acceptability of the intervention will be assessed through the following. An evaluation questionnaire will be used to assess parents' experiences of the Two Hearts Mindful Parenting intervention based on those developed by Bogels and Restifo for their Mindful Parenting programme. Parents will also complete an exit interview. Exit interviews will be audio recorded, or notes will be taken in line with participant preference. Where interviews are recorded these will be transcribed verbatim within six weeks of completion and then deleted.

Procedure Participants will first be interviewed via telephone to assess suitability. If the participant is suitable for the intervention, they will be directed to the online consent forms. If the participant choses to participate, then the researcher will support the parent to identify two target idiographic measures of parenting stress. A secure online text messaging service will be used to collect these measures from parents daily from baseline. Participants will be asked to complete standardised assessment measures through the online platform Qualtrics at four timepoints (baseline, immediately prior to starting the intervention, immediately on completion of the intervention and at four week follow up). Participants will be asked to provide weekly feedback regarding their engagement with the intervention materials and home practice. Participants will be able to begin the online intervention when enough participants have been recruited and at least two weeks after they complete their baseline measures. On completion of the follow up period participants will be asked to complete an exit interview.

Recruitment strategy Charitable foundations such as Changing Faces, Cleft Lip and Palate Association (CLAPA), the Children's Burns Trust (CBT), Headlines Craniofacial Support, and Ichthyosis Support Group, based in the UK, will be invited to share our recruitment advert and a link to our study information sheet on their social media pages and websites. Snowball sampling will be enabled to allow wide distribution.

Intervention The Two Hearts mindful parenting is an online programme based on the Mindful Parenting programme developed by Bogels & Restifo and was developed by an expert panel (L-M. Emerson, S. Bögels, J. Paynter). The intervention has been piloted with parents from a community population. In this pilot study the intervention was found to be acceptable to parents. Intervention retention was 100%, however adherence to home practice was variable. Reductions in parenting stress and increased levels of mindfulness were reported for half of the participants. The Mindful Parenting intervention will be free for participants. Parents only will complete the intervention.

The Two Hearts programme comprises four self-directed online modules, which involve video and audio recorded content supported by a parent workbook (Introduction, Mindful Awareness in Parenting, Mindful Parenting in Action, Compassion in Parenting). The introductory module will consist of a brief PDF document alongside an audio file to support home practice. All three other modules consist of a series of two to four short videos to be accessed via an appropriate online platform, reading from the Parent Workbook and audio files to support mindfulness practices. Mindfulness practices include three-minute breathing space and mindful movement.

The intervention period will begin when enough participants have been recruited and around two-weeks after participants complete baseline measures. Intervention content is to be hosted on an online platform and parents will be able to access one module at a time over the six-week intervention period. Participants will be encouraged to engage in regular mindfulness home practice.

Participants will be supported to engage with the intervention via text message reminders twice a week during the six-week intervention period and once per week during the four-week follow up period. Four group support sessions (videoconferencing) will be scheduled at the start of the programme (introduction) after week two, week four and week six. These sessions will be organised with participants in small groups (or individually if necessary). Participants will be sent a link to the group support sessions via email. Sessions will be conducted via videoconferencing. No data will be collected during these sessions other than attendance data, and they will not be recorded. At the beginning of group support sessions issues of confidentiality (and it's limits) and group conduct will be discussed. Support sessions are intended to help participants overcome any barriers to engaging with the intervention materials or completing home practice. Attendance data will be linked with anonymised participant numbers on a secure database.

Data Analysis

Idiographic data:

Idiographic data will be organised in excel and observed in a graph and analysed visually to identify trends, variability and data patterns.

Idiographic data will be analysed with Tau-U via an online calculator. Tau-U examines data non-overlap between study phases (baseline, intervention, follow-up). Baseline scores will initially be analysed for trend and any significant trend will be corrected for. Weighted averages will be calculated.

Secondary outcome data:

Differences between phases (baseline, intervention, and follow up) on secondary outcome measures will be examined using Jacobson's reliable change index. The distribution of scores on these measures will be gathered from existing literature to generate reliable change criteria. Analyses will be completed employing the Leeds Reliable Change Indicator .

Evaluation data:

Quantitative intervention engagement data, evaluation form data and exit interview data will be tabulated. Descriptive analyses and frequencies will be reported. Thematic analysis will be used to identify themes from qualitative exit interview data.

• Study Type: Interventional
• Enrollment (Anticipated): 12
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Abigail Clifton, BSc; Phone Number: +44(0)2920870582; Email: cliftona3@cardiff.ac.uk
• Study Contact Backup: Name: Professor Thompson; Phone Number: +44(0)2920870582; Email: thompsona18@cardiff.ac.uk

Study Locations

• United Kingdom
  • Cardiff, United Kingdom
    • Recruiting
    • Cardiff University
    • Contact: Abigail Clifton, BSc; Phone Number: 029 20 870 582; Email: cliftona3@cardiff.ac.uk
    • Contact: Professor Thompson; Phone Number: 029 20 870 582; Email: thompsona18@cardiff.ac.uk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Parents aged over 16 years, of children aged between four (4)-16 years living with a visible difference
• All types and aetiologies of child visible differences including any scarring, condition, disability, or mark that affects a person's appearance, with confirmation via self-report
• Parent experiencing self-reported stress associated with the child's visible difference
• Able to communicate in verbal and written English
• Access to a computer/tablet with an active internet connection

Exclusion Criteria:

• Parent currently accessing psychological therapy for their own wellbeing, including parenting programmes
• Parent experiencing active thoughts of suicide or self-injury
• Parent experienced a psychotic episode or engaged in deliberate self-injury over the past year
• Parent commenced medications for mood in the last two months
• Parent previously accessed a mindful parenting intervention
• Child currently in an acute phase following a physical injury
• Only one parent or carer per household can take part

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Online Mindful Parenting Programme; Parents or carers will be invited to complete a six week online mindful parenting programme comprising online video, audio and written content plus four group support sessions via videoconferencing.	Behavioral: Mindful Parenting Programme; Online Mindful Parenting Programme with group support sessions; Other Names: Two Hearts

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 1
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 2
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 3
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 4
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 5
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 6
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 7
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 8
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 9
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 10
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 11
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 12
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 13
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 14
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 15
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 16
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 17
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 18
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 19
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 20
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 21
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 22
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 23
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 24
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 25
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 26
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 27
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 28
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 29
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 30
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 31
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 32
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 33
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 34
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 35
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 36
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 37
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 38
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 39
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 40
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 41
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 42
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 43
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 44
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 45
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 46
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 47
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 48
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 49
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 50
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 51
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 52
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 53
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 54
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 55
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 56
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 57
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 58
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 59
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 60
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 61
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 62
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 63
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 64
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 65
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 66
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 67
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 68
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 69
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 70
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 71
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 72
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 73
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 74
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 75
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 76
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 77
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 78
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 79
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 80
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 81
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 82
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 83
Parenting Stress (unique to each participant)	Parents will identify two targets for desired change around parenting stress related to the child's visible difference. It is intended that participants will identify one target area for improvement (positive target) and one for reduction (negative target). Questions will be rated on a scale of 0 (not at all) to 100 (extremely). Idiographic measures will be completed via text message. Text messages will be sent via a secure online provider (PageOne's Janet txt). Example targets include: be more present in interactions with my child and be grumpy or respond abruptly with my child less.	Day 84

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Parenting Stress Index 4th Edition Short Form	Measure of Parenting Stress with total stress reported on a scale of 36-180 and higher scores being indicative of higher levels of stress.	Baseline
Parenting Stress Index 4th Edition Short Form	Measure of Parenting Stress with total stress reported on a scale of 36-180 and higher scores being indicative of higher levels of stress.	Pre-intervention (week 2)
Parenting Stress Index 4th Edition Short Form	Measure of Parenting Stress with total stress reported on a scale of 36-180 and higher scores being indicative of higher levels of stress.	Post-intervention (week 8)
Parenting Stress Index 4th Edition Short Form	Measure of Parenting Stress with total stress reported on a scale of 36-180 and higher scores being indicative of higher levels of stress.	Follow up (week 12)
Interpersonal Mindfulness in Parenting scale	Measure of Mindful Parenting measured on a scale of 31-155 for total mindfulness with higher scores indicative of higher levels of mindful parenting.	Baseline
Interpersonal Mindfulness in Parenting scale	Measure of Mindful Parenting measured on a scale of 31-155 for total mindfulness with higher scores indicative of higher levels of mindful parenting.	Pre-intervention (week 2)
Interpersonal Mindfulness in Parenting scale	Measure of Mindful Parenting measured on a scale of 31-155 for total mindfulness with higher scores indicative of higher levels of mindful parenting.	Post-intervention (week 8)
Interpersonal Mindfulness in Parenting scale	Measure of Mindful Parenting measured on a scale of 31-155 for total mindfulness with higher scores indicative of higher levels of mindful parenting.	Follow up (week 12)
Strengths and Difficulties questionnaire (SDQ)	Parent reported child wellbeing measure with scores ranging from 0-40 with higher scores being indicative of higher levels of difficulty on all subscales other than the prosocial subscale.	Baseline
Strengths and Difficulties questionnaire (SDQ)	Parent reported child wellbeing measure with scores ranging from 0-40 with higher scores being indicative of higher levels of difficulty on all subscales other than the prosocial subscale.	Pre-intervention (week 2)
Strengths and Difficulties questionnaire (SDQ)	Parent reported child wellbeing measure with scores ranging from 0-40 with higher scores being indicative of higher levels of difficulty on all subscales other than the prosocial subscale.	Post-intervention (week 8)
Strengths and Difficulties questionnaire (SDQ)	Parent reported child wellbeing measure with scores ranging from 0-40 with higher scores being indicative of higher levels of difficulty on all subscales other than the prosocial subscale.	Follow up (week 12)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Participant evaluation of the Mindful Parenting Programme	An evaluation questionnaire will be used to assess parents' experiences of the Two Hearts Mindful Parenting intervention based on those developed by previous authors. Questions include: "Do you feel you've got something of lasting value of importance because of taking the training?", adherence to home practice "On average, how many times a week did you practice the meditation exercises during the course?", and perceived importance/ value of specific elements of the intervention "body scan".	Follow up (week 12)
Exit interview to gather feedback on participant experience of participation in the study	Questions will include: "What was your experience of the video content of the intervention?", "What was your experience of the support sessions?", "Are there any practices in you plan to take forwards beyond the end of the study?", "Have you noticed any changes in their self-compassion?", and "What changes, if any, have you noticed in the way you interact with your child?".	Follow up (week 12)
Levels of participant engagement with intervention materials and home practice exercises	Adherence and attrition will be recorded. Feedback will be collected from participants regarding levels of engagement with the intervention and mindfulness home practice. Participants will provide this information via text message giving the number of minutes spent on each reading intervention materials and engaging with home practice.	Week 3
Levels of participant engagement with intervention materials and home practice exercises	Adherence and attrition will be recorded. Feedback will be collected from participants regarding levels of engagement with the intervention and mindfulness home practice. Participants will provide this information via text message giving the number of minutes spent on each reading intervention materials and engaging with home practice.	Week 4
Levels of participant engagement with intervention materials and home practice exercises	Adherence and attrition will be recorded. Feedback will be collected from participants regarding levels of engagement with the intervention and mindfulness home practice. Participants will provide this information via text message giving the number of minutes spent on each reading intervention materials and engaging with home practice.	Week 5
Levels of participant engagement with intervention materials and home practice exercises	Adherence and attrition will be recorded. Feedback will be collected from participants regarding levels of engagement with the intervention and mindfulness home practice. Participants will provide this information via text message giving the number of minutes spent on each reading intervention materials and engaging with home practice.	Week 6
Levels of participant engagement with intervention materials and home practice exercises	Adherence and attrition will be recorded. Feedback will be collected from participants regarding levels of engagement with the intervention and mindfulness home practice. Participants will provide this information via text message giving the number of minutes spent on each reading intervention materials and engaging with home practice.	Week 7
Levels of participant engagement with intervention materials and home practice exercises	Adherence and attrition will be recorded. Feedback will be collected from participants regarding levels of engagement with the intervention and mindfulness home practice. Participants will provide this information via text message giving the number of minutes spent on each reading intervention materials and engaging with home practice.	Week 8

Collaborators and Investigators

• Sponsor: Cardiff University
• Collaborators: University of Canterbury
• Investigators: Principal Investigator: Professor Thompson, Cardiff University

Publications and helpful links

General Publications

• Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991 Feb;59(1):12-9. doi: 10.1037//0022-006x.59.1.12.
• Parker RI, Vannest KJ, Davis JL, Sauber SB. Combining nonoverlap and trend for single-case research: Tau-U. Behav Ther. 2011 Jun;42(2):284-99. doi: 10.1016/j.beth.2010.08.006. Epub 2011 Feb 3.
• Bögels, S., & Restifo, K. (2013). Mindful parenting: A guide for mental health practitioners. Springer Science & Business Media.
• Abidin, R. (2012). Parenting Stress Index-Fourth Edition (PSI-4). Lutz, FL: Psychological Assessment Resources.
• Dempsey L, Dowling M, Larkin P, Murphy K. Sensitive Interviewing in Qualitative Research. Res Nurs Health. 2016 Dec;39(6):480-490. doi: 10.1002/nur.21743. Epub 2016 Jul 19.
• Emerson, L. M., Aktar, E., de Bruin, E., Potharst, E., & Bögels, S. (2019). Mindful Parenting in Secondary Child Mental Health: Key Parenting Predictors of Treatment Effects. Mindfulness, 1-11.
• Heapy C, Norman P, Emerson LM, Murphy R, Bogels S, Thompson AR. Mindful parenting intervention for parents of children with skin conditions: a single group experimental cases series. Behav Cogn Psychother. 2022 Sep;50(5):462-480. doi: 10.1017/S1352465822000170. Epub 2022 Apr 25.
• Kabat-Zinn, J. (2013). Full Catastrophe Living, Revised Edition: How to Cope with Stress, Pain and Illness Using Mindfulness Meditation: Hachette uK.
• Morley, S., & Dowzer, C. (2014). The Leeds Reliable Change Indicator. University of Leeds.
• Sherwood, A. (2020). Mindful Parenting Brief Online Intervention: Exploring Program Feasibility and Initial Effects. Griffith University Gold Coast,
• Vannest, K. J., Parker, R. I., Gonen, O., & Adiguzel, T. (2016). Single Case Research: Web Based Calculators for Scr Analysis. Retrieved from http://www.singlecaseresearch.org/

Study record dates

Study Major Dates

• Study Start (Actual): January 3, 2023
• Primary Completion (Anticipated): March 28, 2023
• Study Completion (Anticipated): April 14, 2023

Study Registration Dates

• First Submitted: December 20, 2022
• First Submitted That Met QC Criteria: March 9, 2023
• First Posted (Actual): March 22, 2023

Study Record Updates

• Last Update Posted (Actual): March 22, 2023
• Last Update Submitted That Met QC Criteria: March 9, 2023
• Last Verified: January 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Neoplasms by Histologic Type; Neoplasms; Congenital Abnormalities; Genetic Diseases, Inborn; Neuromuscular Diseases; Stomatognathic Diseases; Mouth Diseases; Neurodegenerative Diseases; Neoplasms, Nerve Tissue; Peripheral Nervous System Diseases; Pathological Conditions, Anatomical; Nervous System Neoplasms; Heredodegenerative Disorders, Nervous System; Neoplastic Syndromes, Hereditary; Lip Diseases; Mouth Abnormalities; Stomatognathic System Abnormalities; Nerve Sheath Neoplasms; Neurocutaneous Syndromes; Peripheral Nervous System Neoplasms; Hypotrichosis; Hair Diseases; Cleft Lip; Skin Diseases; Neurofibromatoses; Neurofibromatosis 1; Neurofibroma; Alopecia
• Other Study ID Numbers: EC.22.08.09.6601R2

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