title: Online group course for parents with mental illness: development and pilot study.
abstract: BACKGROUND
  Children of parents with mental illness (COPMI) are at greater risk of developing mental disorders themselves. Since impaired parenting skills appear to be a crucial factor, we developed a facilitated 8-session preventative group course called KopOpOuders (Chin Up, Parents) delivered via the Internet to Dutch parents with psychiatric problems. The goal was to promote children's well-being by strengthening children's protective factors via their parents. To reach parents at an early stage of their parenting difficulties, the course is easily accessible online. The course is delivered in a secure chat room, and participation is anonymous.
  
  
  OBJECTIVE
  This paper reports on (1) the design and method of this online the group course and (2) the results of a pilot study that assessed parenting skills, parental sense of competence, child well-being, and course satisfaction.
  
  
  METHODS
  The pilot study had a pre/post design. Parenting skills were assessed using Laxness and Overreactivity subscales of the Parenting Scale (PS). Sense of parenting competence was measured with the Ouderlijke Opvattingen over Opvoeding (OOO) questionnaire, a Dutch scale assessing parental perceptions of parenting using the Feelings of Incompetence and Feelings of Competence subscales. Child well-being was assessed with the total problem score, Emotional Problems, and Hyperactivity subscales of the Strengths and Difficulties Questionnaire (SDQ). Paired samples t tests were performed, and Cohen's d was used to determine effect sizes. Intention-to-treat analyses and analyses of completers only were both performed. Course satisfaction was evaluated using custom-designed questionnaires.
  
  
  RESULTS
  The sample comprised 48 parents with mental illness. The response rate was 100% (48/48) at pretest and 58% (28/48) at posttest. Significant improvements were found on PS Laxness and Overreactivity subscales (P < .01) and on the OOO Feelings of Incompetence and Competence subscales (P < .01) in analysis of completers only as well as by intention-to-treat analysis. Effects were moderate on the PS (d = .52 and d = .48) and were large and moderate on the OOO (d = 0.61 and d = 0.46). At pretest, 75% and 64% of PS scores were in the clinical range, which declined to 43% and 39% at posttest. No significant changes were found for child well-being. Scores for approximately two thirds of children were not in the clinical range at both pretest and posttest. The mean course satisfaction score was 7.8 on a 10-point scale. Of all participants, 20% (10/48) followed all the sessions.
  
  
  CONCLUSIONS
  This online group course on parenting skills is innovative in the field of e-support and among interventions for mentally ill parents. The pilot results are promising, showing moderate to large effects for parenting skills and parental sense of competence. Test scores at baseline indicating parenting problems were largely in the clinical range, and baseline scores indicating problems among the children were in the nonclinical range, suggesting that parents were reached at an early stage. Course satisfaction was high. Future research should focus on cost effectiveness and course adherence.
authors.affiliation: Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands. rzanden@trimbos.nl
authors.forename: Rianne A P
authors.initials: RA
authors.lastname: van der Zanden
authors.forename: Paula A M
authors.initials: PA
authors.lastname: Speetjens
authors.forename: Karlijn S E
authors.initials: KS
authors.lastname: Arntz
authors.forename: Simone A
authors.initials: SA
authors.lastname: Onrust
mesh_terms: D000328:Adult; D002648:Child; D016241:Child of Impaired Parents / Q000523:psychology* / Q000706:statistics & numerical data; D003194:Computer-Assisted Instruction / Q000379:methods*; D005260:Female; D006126:Group Processes; D006266:Health Education / Q000379:methods*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D009426:Netherlands; D010287:Parent-Child Relations; D016487:Parenting / Q000523:psychology; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010549:Personal Satisfaction; D010865:Pilot Projects; D016730:Program Development; D015397:Program Evaluation