27/11/2018 Increasing early childhood resilience – a feasibility study in general practice Philip Wilson and Anette Graungaard Section and Research Unit for General Practice

Aims of the feasibility study Funded by TrygFonden We aim to establish the feasibility of a randomised trial of an online resource (the Robusthed Programme, RP) to enhance the ‘mentalisation skills’ of parents of young children and thus improve parenting skills and child development

Design of the proposed full-scale cluster randomised trial 27/11/2018 Design of the proposed full-scale cluster randomised trial The randomised trial will involve around 100 GPs and 1000 families Recruitment during GP pregnancy check-ups GPs will deliver structured pregnancy and child development checks which include: Parental mental health Parent-child interaction Child brain (neurological) development 3 assessments in pregnancy then at 5 weeks, 5 months and 1 and 2 years. ~50 GPs in the intervention arm will recommend use of RP to all pregnant women and partner plus when they think it will be useful to families ~50 GPs in the control arm will not be trained in RP Outcomes will be focussed on child development, particularly language, behaviour and cognitive functioning.

Components of the feasibility study 1 Develop and refine the RP intervention to meet the needs of families through pregnancy and early child-rearing With a group of 10 GPs: Develop structured pregnancy and child development assessments Refine a tool (CARO) to assess parent-child interaction Evaluate the quality of assessments using video recording Offer training in the best use of the RP Assess the extent to which the needs of families are matched to recommendations about using RP Get feedback about the study design

Components of the feasibility study 2 With 100 families: Establish patterns of use of the RP intervention Establish the acceptability of the study process and outcome measures to mothers Establish the acceptability to partners Get feedback about the study design

Potential add-on projects at feasibility stage Validation of the CARO tool for assessing parent-child interaction: assess the accuracy of GPs’ judgements about parent-child interaction GP readiness for new approach to child assessment – NPT framework Video recordings of consultations – how do GPs address issues about mental health and wellbeing in pregnancy consultations and child development assessments? Assessment of consultation patterns and their relationship with parent stress and parent-infant interaction Evaluating which RP tools work best for which families etc etc.

The RP trial feasibility study team Anette Graungaard, Kirsten Lykke, Gritt Overbeck, Ruth Ertmann, Jakob Kragstrup, Phil Wilson Mette Væver, Karsten Vrangbæk, Mette Gørtz, Volkert Siersma Lucy Thompson, Christine Puckering, Christopher Gillberg Thank you!