Does A Parent Peer Support Program Help Parents of Children Who Need Mental Health Services Support Their Child's Care? – The Family VOICE Study [Internet]

Excerpt

Background: Family navigators (FNs), lay workers who utilize their lived experience of raising a child with special mental health needs, provide emotional and resource/referral support to other parents. Prior work suggests that parents who have a child with mental illness appear to value peer support services, but there is limited evidence about these types of interventions from large, rigorous trials. In this study, we assessed the impact of a FN program developed to increase child behavioral therapy service utilization on parent and child outcomes.

Objectives: The Family Value of Information, Community Support, and Experience (VOICE) study is an open-label, randomized controlled trial of FN services versus usual care for Medicaid-insured youth approved for antipsychotic medication treatment. The primary outcomes are parent-reported (1) empowerment, (2) social support, and (3) satisfaction with child mental health treatment, and the secondary outcomes are (1) parent report of child global behavioral functioning, (2) child utilization of behavioral therapy services, and (3) antipsychotic medication dose changes over the course of 90 days.

Methods: We randomized parents of Medicaid-insured youth <16 years old approved for antipsychotic medication treatment through a prior authorization program to FN services versus usual care. We provided FN services through flexible, telephone-only contact spanning 90 days.

Services included resource/referral information and support, and parents could also request assistance for any household family priorities (eg, assistance with housing). A research assistant, blinded to the study intervention, measured parent and child outcomes at baseline and at 90 days. We measured therapy service claims during the 90 days of prestudy enrollment (pre) and poststudy enrollment (post).

Results: The study enrolled 350 parents and 70% completed the 90-day follow-up. We assessed the primary outcome for 245 participants (128 FN, 117 treatment as usual). There were no significant differences between the 2 groups in terms of changes in the 3 coprimary outcomes: (1) Family Empowerment Scale (FN pre mean, 3.75; SD, 0.52, post mean, 3.81; SD, 0.55; treatment as usual (TAU) pre mean, 3.86; SD, 0.51, post mean, 4.02; SD, 0.51; P = .15); (2) Social Support Scale (FN pre mean, 2.58; SD, 1.10, post mean, 2.48; SD, 1.10; TAU pre mean, 2.46; SD, 1.07, post mean, 2.45; SD, 1.06; P = .53); or (3) Youth Services Treatment Satisfaction Survey scores (FN pre mean, 3.75; SD, 0.64, post mean, 3.81; SD, 0.61; TAU pre mean, 3.90; SD, 0.63, post mean, 3.95; SD, 0.60; P = .80) from baseline to 90 days. We observed no significant differences between groups in terms of the secondary outcomes psychosocial services utilization (Wald χ² [1, n = 696] = 1.60; P = .21) or improvement in child behavioral functioning on the Brief Problem Monitor Scale (FN pre mean, 69.51; SD, 5.69, post mean, 67.63; SD, 6.03; TAU pre mean, 69.19; SD, 5.62, post mean, 66.73; SD, 6.83; P = .33) during the intervention. Of those who remained on the same antipsychotic medication (FN 110 out of 175; TAU 119 out of 173), 23.6% of youth whose parents received FN services had an increase in antipsychotic medication dose at 90 days compared with 41.2% of youth whose parents received usual care, marking a statistically significant difference between the groups (χ² [1, n = 229] = 7.99; P = .005).

Conclusions: Short-term FN services did not result in greater improvement in therapy service utilization or parent empowerment, social support, or satisfaction with child mental health services compared with usual care. Youth whose parents received FN services were less likely to have an antipsychotic dose increase compared with those who received usual care.

Limitations: FN services did not provide any direct intervention for the child and we completed no long-term (beyond 90 days) follow-up assessments. As this study failed to detect benefits of short-term, phone-delivered family navigation, future work in this area may consider offering an intervention with more intensive and/or longer peer support services.