Therapeutic Alliance and Group Cohesion Across Telehealth Delivery of Mentalizing-focused Parenting Groups.

This study assessed changes in therapeutic alliance and group cohesion among parents/primary caregivers enrolled in Connecting and Reflecting Experience (CARE), a short-term, group-based, mentalizing-focused parenting program designed to support a diverse community facing socioeconomic and health disparities. Caregivers (N = 44) experiencing parenting stress or parent-child relational challenges were recruited from their children's outpatient psychiatry clinic to participate in one of nine 12-session telehealth CARE groups. Caregivers completed the Working Alliance Inventory-Short Revised and the Therapeutic Factors Inventory Cohesiveness subscale after CARE Sessions 1 and 12. Ratings of group cohesion and therapeutic bond with facilitators increased significantly across treatment. Findings indicate that caregivers from underserved families with high levels of parenting stress experienced an increase in group cohesion and therapeutic alliance throughout a telehealth adaptation of CARE.

Safe haven in adolescence: Improving parental reflective functioning and youth attachment and mental health with the Connecting and Reflecting Experience.

Attachment security provides a well-documented protective developmental function for children exposed to individual- and community-level trauma, yet the effectiveness of prevention and intervention efforts targeting attachment during adolescence has been relatively underexplored. The Connecting and Reflecting Experience (CARE) program is a transdiagnostic, bi-generational, group-based, mentalizing-focused parenting intervention developed to dismantle the intergenerational transmission of trauma and support secure attachment relationships across the developmental spectrum within an under-resourced community. This exploratory study evaluated outcomes among caregiver-adolescent dyads (N = 32) in the CARE condition of a nonrandomized clinical trial at an outpatient mental health clinic within a diverse, urban U.S. community with disproportionate trauma exposure exacerbated by COVID-19. Caregivers predominantly identified as Black/African/African American (47%), Hispanic/Latina (38%), and/or White (19%). At pre- and post-intervention, caregivers completed questionnaires regarding parental mentalizing and their adolescents' psychosocial functioning. Adolescents completed scales regarding attachment and psychosocial functioning. Results showed a significant decrease in caregivers' prementalizing on the Parental Reflective Functioning Questionnaire, improvement in adolescent psychosocial functioning on the Youth Outcomes Questionnaire, and an increase in adolescents' reports of attachment security on the Security Scale. These preliminary findings suggest that mentalizing-focused parenting interventions may be effective in fostering improved attachment security and psychosocial functioning during adolescence.

La seguridad de la afectividad provee una bien documentada función protectora del desarrollo para niños expuestos al trauma individual y comunitario; aun así, la efectividad de los esfuerzos de prevención e intervención enfocados en la afectividad en la adolescencia ha sido relativamente poco explorada. El programa Conexión y Reflexión de la Experiencia (CARE) es una intervención de crianza transdiagnóstica, bigeneracional, con base en el grupo, enfocada en la mentalización, desarrollada para desarmar la transmisión intergeneracional de trauma y apoyar las relaciones de afectividad segura a lo largo del espectro del desarrollo dentro de una comunidad menos equipada con recursos. Este estudio exploratorio evaluó resultados entre díadas cuidador-adolescente (N = 32) bajo la condición CARE de un ensayo clínico no al azar en una clínica de salud mental ambulatoria dentro de una comunidad diversa y urbana en Estados Unidos, expuesta al trauma desproporcionadamente, lo cual fue exacerbado por COVID-19. A los cuidadores predominantemente se les identificó como negros/africanos/afroamericanos (47%), hispanos/latinas (38%), y/o blancos (19%). Antes y después de la intervención, los cuidadores completaron cuestionarios acerca de mentalización del progenitor y el funcionamiento sicosocial de sus adolescentes. Los adolescentes completaron escalas sobre la afectividad y el funcionamiento sicosocial. Los resultados mostraron una significativa disminución de la pre-mentalización en el Cuestionario del Funcionamiento con Reflexión del Progenitor, mejoras en el funcionamiento sicosocial de los adolescentes en el Cuestionario de Resultados de la Juventud, y un aumento en los reportes de los adolescentes sobre la seguridad de la afectividad en la Escala de Seguridad. Estos preliminares resultados sugieren que las intervenciones de crianza enfocadas en la mentalización pudieran ser efectivas para fomentar la mejorada seguridad de la afectividad y el funcionamiento sicosocial durante la adolescencia.

La sécurité de l'attachement offre une fonction protectrice au développement qui est bien prouvée pour les enfants exposés à un trauma individuel et communautaire. Cependant l'efficacité de la prévention et des efforts d'intervention ciblant l'attachement durant l'adolescence a été relativement peu exploré. Le programme de Connecting and Reflecting Experience (CARE, soit Expérience de Lien et de Réflexion) est une intervention de parentage transdiagnostique, bi-générationnel, basée sur un groupe, et ciblé sur la mentalisation développé afin de démonter la transmission intergénérationnelle du trauma et de soutenir des relations d'attachement sécure au travers du spectre développemental au soin d'une communauté manquant de moyens. Cette étude exploratoire a évalué les résultats chez des dyades personne prenant soin de l'adolescent-adolescent (N = 32) dans la condition CARE d'un essai clinique non-randomisé dans une clinique de santé mentale en consultation externe au soin d'une communauté américaine urbaine et diverse avec une exposition au trauma disproportionnée exacerbée par le COVID-19. Les personnes prenant soin des adolescents se sont en grande partie identifiés comme étant Noirs/Africains/Noir Américains (47%), Hispaniques/Latina (38%), et/ou Blanches (19%). Avant et après l'intervention les personnes prenant soin des adolescents ont rempli des questionnaires concernant la mentalisation parentale et le fonctionnement psychosocial de leurs adolescents. Les adolescents ont rempli des échelles concernant l'attachement et le fonctionnement psychosocial. Les résultats montrent une baisse importante de la pré-mentalisation des personnes prenant soin des adolescents concernant le Questionnaire de Fonctionnement de Réflexion Parental, une amélioration du fonctionnement psychosocial de l'adolescent au travers du Questionnaire des Résultats de Jeunesse (Youth Outcomes Questionnaire en anglais) et une augmentation dans les rapports de sécurité d'attachement faits par les adolescents au travers de l'échelle Security Scale. Ces résultats préliminaires suggèrent que les interventions de parentage focalisées sur la mentalisation peuvent être efficaces pour favoriser une sécurité de l'attachement améliorée et le fonctionnement psychosocial durant l'adolescence.

Connection During COVID-19: Pilot Study of a Telehealth Group Parenting Intervention.

OBJECTIVE: The COVID-19 pandemic has resulted in considerable stress for families, placing parents at risk for heightened psychological distress, while prompting widespread changes in mental health service delivery. This study evaluated treatment engagement, acceptability, and psychiatric distress among participants in the telehealth adaptation of the Connecting and Reflecting Experience (CARE) program after the onset of COVID-19. METHODS: CARE is a transdiagnostic, bigenerational, mentalizing-focused group parenting intervention based out of an outpatient child mental health clinic in an underserved urban community. Individuals participating in CARE during the clinic's transition to telehealth services were recruited for participation in this pre-post design pilot study. Participants (N=12) completed self-report surveys before and after their first telehealth group session and at their 20-week follow-up. Quantitative and qualitative measures were used to evaluate psychiatric symptoms, treatment engagement, and preliminary acceptability of the adaptation. RESULTS: Self-reported mood and anxiety symptoms decreased significantly after 20 weeks of telehealth therapy. Participants reported high levels of therapeutic alliance and group cohesion in the telehealth format. Results also showed minimal participant-reported privacy concerns and a trend toward increased treatment engagement. CONCLUSIONS: These findings have implications regarding the acceptability of teletherapy interventions for caregivers of children during this period of heightened vulnerability and limited access to social support and health services. They also are relevant to establishing the preliminary acceptability of mentalizing-focused parenting inventions delivered via telehealth.

The Connecting and Reflecting Experience (CARE): theoretical foundation and development of mentalizing-focused parenting groups.

In underserved communities with limited resources and disproportionately high morbidity and mortality rates, attachment-based, short-term, group interventions that are effective yet simple to disseminate can have a profound public health impact. This paper describes the implementation of a mentalizing-focused group parenting intervention. The Connecting and Reflecting Experience (CARE) serves primary caregivers of children from birth to 18 years within a diverse and impoverished community setting. Families living in communities facing health disparities are at heightened risk for intergenerational cycles of trauma which give rise to myriad public health crises at high societal cost. CARE's mission is to facilitate the intergenerational transmission of secure attachment which can profoundly reduce rates of psychiatric illness for future generations. The theoretical and empirical bases for the intervention and the evidence base for existing mentalizing-focused parenting interventions are reviewed. The program's structure and treatment goals are presented in the context of clinical case material.