Video feedback intervention to enhance parental reflective functioning in primary caregivers of inpatient psychiatric children: protocol for a randomized feasibility trial

Fanny Leyton, Marcia Olhaberry, Rubén Alvarado, Graciela Rojas, Luis Alberto Dueñas, George Downing, Howard Steele, Fanny Leyton, Marcia Olhaberry, Rubén Alvarado, Graciela Rojas, Luis Alberto Dueñas, George Downing, Howard Steele

Abstract

Background: Children requiring hospitalization for psychiatric care have serious disorders, high use of psychotropic medication, and frequent readmissions. The development and implementation of therapies focused on incorporating primary caregivers or attachment figures is necessary for working with children with severe psychiatric disorders. Mentalization or parental reflective functioning (PRF) is the ability of parents to understand their children's behaviors as an expression of internal emotional states and act accordingly to help them regulate their emotions; in this way mentalizing is a key component of sensitive parenting. Video-assisted therapies have proven to be effective in promoting change in parent-child relationships. The majority of studies have been carried out with mothers of pre-school children and in an outpatient setting. Video intervention therapy (VIT) is a flexible manualized therapy, which allows the intervention to be individualized to the context where it is applied, according to the needs and resources of the people who participate in it. The objective of the study is to evaluate the feasibility and acceptability of applying VIT to improve the PRF of the parents as primary carers of children hospitalized in a psychiatric service.

Methods: This is a pilot randomized, single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 2:1 allocation (with more people allocated to the intervention arm). The intervention consists of four modules; every module has both one video-recorded play session and one VIT session per week. People assigned to the control group will receive treatment as usual plus weekly play sessions. Feasibility and acceptability of the study will be quantitatively and qualitatively assessed. Evaluation of the caregivers will include assessments of PRF, wellbeing and personality structure; assessments of children will include parent-ratings and clinician-ratings of symptomatology and general functioning. After every video feedback (VF) session, PRF, the caregiver's wellbeing and children's general functioning will be reassessed.

Discussion: This study will contribute to the currently scarce evidence on how to provide family attachment-based interventions in a child inpatient psychiatric unit. It will also inform the design and implementation of a future randomized clinical trial.

Trial registration: ClinicalTrials.gov, NCT03374904 . Registered on 14 December 2017 (retrospectively registered).

Keywords: Inpatient psychiatric children; Parental reflective functioning; Video feedback intervention; Video intervention therapy.

Conflict of interest statement

Authors’ information

FL is the principal investigator of this study. She is a psychiatrist and is Assistant Professor of the Faculty of Medicine of Universidad de Valparaíso and a researcher of the Millennium Nucleus Psychological Intervention and Change in Depression (MIDAP). This research is part of her dissertation to obtain her doctorate in psychotherapy from Pontificia Universidad Católica and Universidad de Chile.

Ethics approval and consent to participate

Full ethical approval was obtained from the local Ethics Committee (Comité Ético Científico del Servicio de Salud Valparaíso-San Antonio, ORD 1502, 8 August 2017). The study will be conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki (1996) and the principles of Good Clinical Practice (such as data storage and administrative functions).

Written informed consent will be obtained from participants in the study (adults and children). Participants will be free to withdraw from the study at any time without giving a reason and without their care being affected. All the information collected during this trial will be confidential.

Interviews that are transcribed will be anonymized at the point of transcription. Any third party involved with transcribing of interviews will sign a confidentiality agreement and will be fully instructed in how to anonymize transcripts.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of study phases and instrument application. TAU, treatment as usual; FMSS, Five Minutes Speech Sample; OPD-SQ, Operationalized Psychodynamic Diagnosis - Structured Questionnaire; GHQ, General Health Questionnaire; SDQ, Strengths and Difficulties Questionnaire; CGAS, Children Global Assessment Scale; VF, video feedback
Fig. 2
Fig. 2
Schedule of enrollment, interventions and assessments. VIT, Video Intervention Therapy; TAU, treatment as usual; FMSS, Five Minutes Speech Sample; OPD-SQ, Operationalized Psychodynamic Diagnosis - Structured Questionnaire; GHQ, General Health Questionnaire; SDQ, Strengths and Difficulties Questionnaire; CGAS, Children Global Assessment Scale; VF, video feedback. *VIT participants only

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