Mindfulness-enhanced parenting programmes for improving the psychosocial outcomes of children (0 to 18 years) and their parents.

BACKGROUND: Emotional and behavioural difficulties (EBD) in children are common, characterised by externalising or internalising behaviours that can be highly stable over time. EBD are an important cause of functional disability in childhood, and predictive of poorer psychosocial, academic, and occupational functioning into adolescence and adulthood. The prevalence, stability, and long-term consequences of EBD highlight the importance of intervening in childhood when behavioural patterns are more easily modified. Multiple factors contribute to the aetiology of EBD in children, and parenting plays an important role. The relationship between parenting and EBD has been described as bidirectional, with parents and children shaping one another's behaviour. One consequence of bidirectionality is that parents with insufficient parenting skills may become involved in increasingly negative behaviours when dealing with non-compliance in children. This can have a cyclical effect, exacerbating child behavioural difficulties and further increasing parental distress. Behavioural or skills-based parenting training can be highly effective in addressing EBD in children. However, emotional dysregulation may intercept some parents' ability to implement parenting skills, and there is recognition that skills-based interventions may benefit from adjunct components that better target parental emotional responses. Mindful parenting interventions have demonstrated some efficacy in improving child outcomes via improvements in parental emotion regulation, and there is potential for mindfulness training to enhance the effectiveness of standard parent training programmes. OBJECTIVES: To assess the effectiveness of mindfulness-enhanced parent training programmes on the psychosocial functioning of children (aged 0 to 18 years) and their parents. SEARCH METHODS: We searched the following databases up to April 2023: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL Plus, PsycINFO, Sociological Abstracts, Social Sciences Citation Index, Conference Proceedings Citation Index - Social Science & Humanities, AMED, ERIC, ProQuest Dissertations & Theses, Cochrane Database of Systematic Reviews, Campbell Collaboration Library of Systematic Reviews, as well as the following trials registers: ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We also contacted organisations/experts in the field. SELECTION CRITERIA: We included randomised and quasi-randomised trials. Participants were parents or caregivers of children under the age of 18. The intervention was mindfulness-enhanced parent training programmes compared with a no-intervention, waitlist, or attentional control, or a parent training programme with no mindfulness component. The intervention must have combined mindfulness parent training with behavioural or skills-based parent training. We defined parent training programmes in terms of the delivery of a standardised and manualised intervention over a specified and limited period, on a one-to-one or group-basis, with a well-defined mindfulness component. The mindfulness component must have included mindfulness training (breath, visualisation, listening, or other sensory focus) and an explicit focus on present-focused attention and non-judgemental acceptance. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane procedures. MAIN RESULTS: Eleven studies met our inclusion criteria, including one ongoing study. The studies compared a mindfulness-enhanced parent training programme with a no-treatment, waitlist, or attentional control (2 studies); a parent training programme with no mindfulness component (5 studies); both a no-treatment, waitlist, or attentional control and a parent training programme with no mindfulness component (4 studies). We assessed all studies as being at an unclear or high risk of bias across multiple domains. We pooled child and parent outcome data from 2118 participants to produce effect estimates. No study explicitly reported on self-compassion, and no adverse effects were reported in any of the studies. Mindfulness-enhanced parent training programmes compared to a no-treatment, waitlist, or attentional control Very low certainty evidence suggests there may be a small to moderate postintervention improvement in child emotional and behavioural adjustment (standardised mean difference (SMD) -0.46, 95% confidence interval (CI) -0.96 to 0.03; P = 0.06, I2 = 62%; 3 studies, 270 participants); a small improvement in parenting skills (SMD 0.22, 95% CI 0.06 to 0.39; P = 0.008, I2 = 0%; 3 studies, 587 participants); and a moderate decrease in parental depression or anxiety (SMD -0.50, 95% CI -0.96 to -0.04; P = 0.03; 1 study, 75 participants). There may also be a moderate to large decrease in parenting stress (SMD -0.79, 95% CI -1.80 to 0.23; P = 0.13, I2 = 82%; 2 studies, 112 participants) and a small improvement in parent mindfulness (SMD 0.21, 95% CI -0.14 to 0.56; P = 0.24, I2 = 69%; 3 studies, 515 participants), but we were not able to exclude little to no effect for these outcomes. Mindfulness-enhanced parent training programmes compared to parent training with no mindfulness component Very low certainty evidence suggests there may be little to no difference postintervention in child emotional and behavioural adjustment (SMD -0.09, 95% CI -0.58 to 0.40; P = 0.71, I2 = 64%; 5 studies, 203 participants); parenting skills (SMD 0.13, 95% CI -0.16 to 0.42; P = 0.37, I2 = 16%; 3 studies, 319 participants); and parent mindfulness (SMD 0.11, 95% CI -0.19 to 0.41; P = 0.48, I2 = 44%; 4 studies, 412 participants). There may be a slight decrease in parental depression or anxiety (SMD -0.24, 95% CI -0.83 to 0.34; P = 0.41; 1 study, 45 participants; very low certainty evidence), though we cannot exclude little to no effect, and a moderate decrease in parenting stress (SMD -0.51, 95% CI -0.84 to -0.18; P = 0.002, I2 = 2%; 3 studies, 150 participants; low certainty evidence). AUTHORS' CONCLUSIONS: Mindfulness-enhanced parenting training may improve some parent and child outcomes, with no studies reporting adverse effects. Evidence for the added value of mindfulness training to skills-based parenting training programmes is suggestive at present, with moderate reductions in parenting stress. Given the very low to low certainty evidence reviewed here, these estimates will likely change as more high-quality studies are produced.

Decision-Making and Relationship Competence When Reporting Suspected Physical Abuse and Child Neglect: An Objective Structured Clinical Evaluation.

Mandatory reporting of suspected child abuse and neglect highlights the challenges between the ethical and legal obligations of social workers and the need to maintain the therapeutic relationship with the client. The ability to bridge this tension is paramount to ensure continued psychosocial treatment and the well-being of children. This paper discusses a study to determine the decision-making factors of social work students and practitioners when facing a suspicion of child abuse and neglect, how they justify their decision to report or not report to child protection services, and the current and future relationship repair strategies used with simulated clients during an objective structured clinical evaluation (OSCE). Nineteen BSW, MSW, and experienced practitioners (N = 19) underwent an OSCE with one of two child maltreatment vignettes, physical abuse or neglect. Fisher's exact test was used to examine participants' historical and current reporting behaviors. Independent samples T-tests, Cohen's D, and qualitative content analysis was used to examine participants' decision making and relationship repair strategies when faced with suspected child abuse and neglect. Results showed that six participants discussed the duty to report during the OSCE while 13 participants did not. Participants' who discussed and did not discuss the duty to report during the OSCE articulated clear reasons for their decision and identified relationship repair strategies in working with the client. A sub-group of participants who identified the child maltreatment but did not discuss the duty to report, provided more tentative and complex reasons for their inaction and next steps in working with the client. All participants demonstrated a degree of competence and critical reflection in the OSCE, with integration for future learning. These findings are discussed and implications for future practice are offered.

Decision-Making Factors in the Mandatory Reporting of Child Maltreatment.

The goal of this exploratory study was to investigate the factors that may impact a social worker's decision to report suspected child maltreatment. A volunteer sample of social workers (n = 439) from Ontario, Canada completed an online survey where they reviewed three hypothetical vignettes of potential child maltreatment (exposure to intimate partner violence, physical, emotional). Social workers responded to questions regarding their decision-making and the factors which would impact their reporting decision (legal requirements, ethnicity of caregivers, circumstances around disclosure, reporting history, consultation or supervision, field of practice). A series of multiple logistic regression analyses were performed for each version of the three vignettes. The study found that consultation or supervision were significant predictors in social worker's decision to report suspected child maltreatment. Peer consultation may assist with emotional regulation and provide an outside perspective to guide decision-making.

Professional competencies for promoting recovery in mental illness.

This study explored professional caregiving from the perspective of people diagnosed with schizophrenia to develop proposed professional competencies for promoting recovery. We conducted semi-structured qualitative interviews with 40 people diagnosed with schizophrenia to explore their experiences of caregiving. Interview segments related to professional caregiving were analyzed to derive categories and themes that described aspects of caregiving that clients believed contributed to their recovery. The proposed competencies derived from the interviews overlap with hypothesized competencies identified in the literature, but also suggest other areas of skill and attitude that relate to promoting recovery, including use of time, talk, and teamwork. The significance participants attach to time and talk suggests that services play an important role in recovery by creating the space for service users and service providers to engage in recovery-promoting practices.

Supporting front-line practitioners' professional development and job satisfaction in mental health and addiction.

Substantial organizational change in many health institutions has eliminated profession-based departments and replaced them with program management structures. This article aims to explore practitioners' perceptions of their professional work in a large urban centre for addiction and mental health that has undergone such change. Seventy-six practitioners from six professions participated in focus groups that were transcribed and analyzed. Practitioners' perceptions about their professional competence, performance, development, and job satisfaction were affected by three interrelated factors: available supervision from experts who validate practitioners' subjective work experiences and provide population-specific knowledge for effective interventions; teams that provide a home base and support through positive interpersonal relations, collaboration and informal feedback; and organizations and managers who provide assistance and training while expecting quality performance and productivity. Effective clinical and organizational leaders manage tensions between providing supportive environments and expecting accountability throughout the workplace.