Evaluating the acceptability of a self-guided online parenting program (‘PiP-Ed’) to support parents of adolescents who refuse school in the context of anxiety and/or depression

The intervention, ‘Partners in Parenting-Education’ (PiP-Ed), is a newly adapted version of the online Partners in Parenting (PiP) program (see previous trials: ACTRN12615000247572, ACTRN12615000328572, ACTRN12619001781134, ACTRN12621000854831). The original PiP program is designed to equip parents with evidence-based parenting strategies to reduce the risk or impact of anxiety or depression in their adolescent. The version of PiP evaluated in the current trial is a self-guided version of the coach-supported PiP-Ed program (see ACTRN12622000977774). PiP-Ed has been adapted to support parents of adolescents who refuse school in the context of depression or anxiety disorders. School refusal is defined as persistent difficulty attending school due to significant emotional distress associated with attendance. The web-based program includes 13 self-directed online modules covering topics related to parenting an adolescent who is refusing school due to anxiety and/or depression: 1) understanding anxiety and depression, 2) parent-teen relationships, 3) breaking the anxiety cycle, 4) understanding school refusal, 5) working together to respond to school refusal, 6) minimising conflict in the home, 7) establishing family rules, 8) parental involvement and autonomy granting, 9) encouraging supportive relationships, 10) encouraging good health habits, 11) problem-solving, 12) parenting through the pandemic, and 13) relapse prevention. Parents will receive the following as part of the PiP-Ed intervention: 1) Parents first complete an online self-assessment of their parenting practices associated with risk of adolescent depression and anxiety disorders (the Parenting to Reduce Adolescent Depression and Anxiety Scale [PRADAS]). The PRADAS assesses parenting practices in relation to the recommendations in the evidence-base parenting guidelines "How to Prevent Depression and Clinical Anxiety in your Teenager: Strategies for Parents" (Parenting Strategies Program, 2013; henceforth the Guidelines), which form the basis of the program content. 2) Based on their responses to the PRADAS, parents receive an individually-tailored feedback report. The feedback highlights areas of parenting strength and/or confidence, and provides practical strategies for identified areas for improvement. The feedback report is displayed to parents online (on their 'personal dashboard' as part of the PiP-Ed program). Parents are also emailed a link to access a PDF copy of the Guidelines. 3) Parents are then recommended up to 12 of the interactive online modules. All parents in the current trial will be recommended the following 6 modules regardless of PRADAS responses, as these are considered critical topics for parents of adolescents with school refusal (the “core” modules of the PiP-Ed program): 1) understanding anxiety and depression, 2) parent-teen relationships, 3) breaking the anxiety cycle, 4) understanding school refusal, 5) working together to respond to school refusal, and 6) relapse prevention. The remaining modules will be recommended based on identified areas for improvement (PRADAS scores), with the exception of the module 'Parenting through the pandemic' which will be optional for all parents. The modules provide practical strategies to support parents to make changes to their parenting in order to align more closely with the parenting recommendations in the Guidelines, and new school refusal-specific parenting recommendations developed in a Delphi Expert-Consensus Study. Parents can further tailor their program by selecting additional modules or de-selecting optional modules recommended to them. Parents can select between 1 and 13 modules to add to their personalised program. By default, modules will ‘unlock’ (i.e. become available for parents to complete) at a rate of one module per week, until all selected modules have been unlocked. Parents are notified by email and SMS (if they opt in to receive SMS notifications) when a new module unlocks. If they prefer, parents can choose to override the default unlock date, and unlock modules at an earlier date. After all initially-selected modules have been unlocked, all remaining modules, including those not initially selected, will become available for parents to complete if they wish. Parents can revisit any modules they have already completed at any time. The interactive modules can be accessed online, from any device with internet access (including smartphones). The modules include educational materials, illustrations, audio clips, videos, vignettes, interactive activities, goal-setting exercises, and an end-of-module quiz with immediate feedback to consolidate learning. Each module takes about 20-35 minutes to complete, depending on the topic and how parents engage with the module. Parents are invited to complete their first module immediately after they have completed their baseline survey and received their personalised feedback report. Please see secondary outcome 2 for details of how program completion will be calculated. Module completion will be monitored using website analytics. References: Cardamone-Breen, M. C., Jorm, A. F., Lawrence, K. A., Mackinnon, A. J., & Yap, M. B. (2017). The Parenting to Reduce Adolescent Depression and Anxiety Scale: Assessing parental concordance with parenting guidelines for the prevention of adolescent depression and anxiety disorders. PeerJ, 5, e3825. Parenting Strategies Program (2013). How to prevent depression and clinical anxiety in your teenager: Strategies for parents. Melbourne: beyondblue.