Videoconferencing acceptance and commitment therapy for parents of children with special health care needs: A...

Parents of children with special health care needs endure substantial psychological distress, a challenge frequently encountered in nursing practice. While nurses are ideally positioned to identify and support these families, they require access to effective, scalable interventions that can be integrated into care pathways. This study investigated a task-shifting model, testing whether a brief, videoconferencing-delivered Focused Acceptance and Commitment Therapy programme is effective when delivered by trained paraprofessionals.

To determine the efficacy of a paraprofessional-led, videoconferencing-delivered Focused Acceptance and Commitment Therapy plus standard parenting advice versus standard parenting advice alone for reducing parenting stress and improving mental health outcomes among parents of children with special health care needs.

Assessor-blinded, multicentre randomised controlled trial with repeated measures.

The trial was conducted at six non-governmental organisation centres in Hong Kong. Eligible parents were randomised 1:1 to (i) Focused Acceptance and Commitment Therapy plus standard parenting advice or (ii) standard parenting advice alone. Standard parenting advice (usual care for both groups) comprised six weekly e-learning modules on positive parenting plus a videoconferencing review session at week 6. The intervention group additionally received 4-6 weekly, 45-60-minute individual Focused Acceptance and Commitment Therapy sessions delivered by trained paraprofessionals via videoconferencing. The primary outcome was parenting stress (Parental Stress Scale). Secondary outcomes were depressive symptoms, anxiety symptoms, and psychological flexibility. Outcomes were assessed at baseline (T0), postintervention (6 weeks post-baseline; T1), and 6 months postintervention (30 weeks post-baseline; T2). Analyses followed the intention-to-treat principle.

Among 254 parents (mean [SD] age, 39.0 [6.7] years; child age, 6.0 [2.3] years; 92.9% mothers), at T2, Focused Acceptance and Commitment Therapy plus standard parenting advice reduced parenting stress more than standard parenting advice alone (adjusted means difference, [aMD]; -4.88; 95% CI, -7.15 to -2.62; Cohen d, -0.30; 95% CI, -0.57 to -0.03). Depressive symptoms (aMD, -4.35; 95% CI, -5.43 to -3.27; Cohen d, -0.64; 95% CI, -0.91 to -0.37) and anxiety symptoms (aMD, -4.89; 95% CI, -6.00 to -3.78; Cohen d, -0.87; 95% CI, -1.14 to -0.59) decreased, while psychological flexibility improved (aMD, 3.61, 95% CI, 2.36 to 4.85; Cohen d, 0.67; 95% CI, 0.39 to 0.94).

A brief, paraprofessional-led Focused Acceptance and Commitment Therapy programme delivered via videoconferencing is effective and scalable for reducing parenting stress and improving caregiver mental health. These findings support a task-shifting model where nurses coordinate paraprofessional-delivered support to integrate evidence-based care into routine paediatric and community pathways.

ClinicalTrials.gov Identifier: NCT06262646 (Registration date: February 01, 2024; Start of recruitment: February 02, 2024).