Improving Outcomes for Military Families with Young Children: Effects of a Novel Dyadic Coaching-Based Parenting Intervention in Two Exploratory Case Studies

Figures & data

Table 1. Overview of treatment components, by session.

Session/s	Attendees	Focus
1	Parent/s	Orientation to program Psychoeducation about mindfulness, mindful parenting, and emotion regulation Introduce steps in helping child to regulate emotions using NODD skill (Notice, Observe, Describe, Defuse). Homework: Complete daily mindfulness activity
2	Parent/s	Review of homework activities Introduce and teach mindful and mentalisation-based play skills using SKIP acronym. SKIP stands for specific praise (e.g., ‘I love how gentle you’re being with the toys), kid-focused (i.e., reflecting back the child’s verbalisations and describing their behaviour), internal states (e.g., acknowledging, labelling and validating emotions), and present moment (e.g., letting the child lead the play, avoiding questions, commands and negative talk). Role-play SKIP skills and provide corrective feedback Homework: Daily 5-minute parent-child play sessions, aiming for at least four per week
3-4	Parent/s and child	Review of homework activities Orient parent/s and child to play session with in vivo coaching Code parent and child play for five minutes Provide parent brief feedback on skills and set goals for coaching Coach parent to use SKIP and NODD skills during play with child Repeat coding and coaching if two parents participating Homework: Daily 5-minute parent-child play sessions, aiming for at least four per week
5	Parent/s	Review of homework activities Psychoeducation about mentalising Show video clips of recorded parent-child play and/or alternative clips (e.g., cartoon excerpts) Encourage parent/s to wonder about the child’s internal experience, with an emphasis on curiosity about rather than knowing or ‘mind-reading’, with the goal of increasing parental mentalising Homework: Daily 5-minute parent-child play sessions, aiming for at least four per week – emphasis on parental curiosity about child’s internal states (I in SKIP skill) to further develop mentalising stance
6	Parent/s and child	As per sessions 3 and 4, with an additional mentalising focus during live coaching
7	Parent/s	Review of homework activities Psychoeducation about managing children’s challenging behaviour to improve the parent-child relationship and increase positive/desired behaviours Teach strategies to manage challenging behaviour (e.g., giving effective commands, use of positive attention, effective use of reward systems and time out) Homework: Daily 5-minute parent-child play sessions, aiming for at least four per week. Incorporate strategies to manage challenging behaviour
8	Parent/s	Review of homework activities Psychoeducation about emotion coaching Introduce and teach skills for supporting child’s emotion regulation during play (e.g., recognising triggers, labelling emotions, coaching use of emotion regulation skills such as breathing) Homework: Daily 5-minute parent-child mindful play sessions, aiming for at least four per week, to reinforce skill development in mindful parenting skills. Practice emotion coaching during interactions with child
9	Parent/s and child	As per sessions 3, 4 and 6, with an additional focus on emotion coaching.
10	Parent/s	Review of homework activities Psychoeducation about emotion coaching during conversations (e.g., talking about past events) Introduce and teach skills for supporting parents to talk about challenging situations that occurred in the past using ONCE skills (Open-ended questions, New information, Confirming and validating child’s responses and emotions, and Emotion labelling, explanation and resolution) Homework: Daily past event conversation (practising ONCE skill) with child and 5-minute parent-child play sessions, aiming for at least four per week
11	Parent/s and child	Review of homework activities Orient parent/s and child to emotion coaching conversation activity Coach parents to use emotion coaching skills during past event conversations with their child Code parent and child play for five minutes Provide parent brief feedback on skills and set goals for coaching Coach parent to use mindful play skills and emotion regulation strategies during play with child Repeat conversation task, coding and coaching if two parents participating Homework: Daily 5-minute parent-child play sessions, aiming for at least four per week
12	Parent/s and child	Review of homework activities Graduation session Review and rehearse skills learned throughout treatment Review progress/changes family has made Discuss ‘relapse prevention’ and how to plan for future stressors (e.g., upcoming deployments, relocations) Conduct final 5-minute parent and child play observation Provide certificates of completion and celebrate family’s success

Table 2. Assessment measures and timeline.

Measure	Baseline	Treatment (weekly)	Post-treatment	Follow-up
Parenting/parent-child relationship
Dyadic Parent Child Interaction Coding System (DPICS) - observation measure of parent-child interaction quality	X	X
Brief Parental Self-Efficacy Scale (BPSES)	X	X	X	X
Parent mental health and wellbeing
Depression, Anxiety and Stress Scale-21 (DASS-21)	X		X
Self-Compassion Scale-Short Form (SCS-SF)	X		X
Difficulties with Emotion Regulation Scale (DERS)	X		X
Parental Reflective Functioning Questionnaire	X		X
Five Facets of Mindfulness Questionnaire-Short Form (FFMQ-SF)	X		X
Parental Stress Scale	X		X
Child emotions and behaviour
Eyberg Child Behavior Inventory (ECBI)	X	X	X	X
Child Behavior Checklist (CBCL)	X		X
Qualitative data
Semi-structured interview	X		X	X

Figure 1. Graphic displays of each parents’ specific praises, behaviour descriptions, and reflections.

Figure 2. Graphic displays of each parents’ questions, commands, and critical statements.

Figure 3. Graphic display of each parent’s BPSES scores.

Table 3. Parental mental health and wellbeing measure scores at pre-intervention and post-intervention, with percentage change.

Measure	Noah’s mother			Noah’s father			Willow’s mother
	Pre	Post	% change	Pre	Post	% change	Pre	Post	% change
DASS-21
Depression	2	1	50%↓	3	2	33.33%↓	3	0	100%↓
Anxiety	2	0	100%↓	0	1	100%↑	8	2	75%↓
Stress	6	3	50%↓	7	6	14.29%↓	13	3	79.92%↓
SCS-SF	3.25	3.42	5.23%↑	2.75	2.75	–	2.42	3.67	51.65%↑
DERS	71	65	8.45%↓	90	72	20%↓	71	75	5.64%↑
PRFQ
Pre-mentalising	2	1.5	25%↓	2.83	1.67	40.99%↓	3	1.33	55.67%↓
Certainty of mental states	4.33	4.33	–	3.5	4.33	23.71%↑	5.17	4.33	16.25%↓
Interest and curiosity	5	5.17	3.4%↑	5.5	6	9.09%↑	6.17	5.17	16.21%↓
FFMQ-SF
Full scale	3.25	3.5	7.69%↑	2.71	3.08	13.65%↑	3.58	3.63	1.4%↑
Describing with words	12	16	33.33%↑	18	21	16.67%↑	21	21	–
Nonreactivity to inner experience	21	21	–	12	12	–	18	19	5.56%↑
Nonjudging	18	10	80%↓	11	17	54.55↑	16	17	6.25↑
Observing	12	11	8.33↓	10	10	–	17	16	5.88↓
Acting with awareness	15	17	13.33↑	14	12	14.29↓	14	16	14.29↑
Parental Stress Scale	48	43	10.42%↓	33	30	9.09%↓	42	26	38.1%↓

Figure 4. ECBI intensity and problem T-scores for Noah and Willow.

Table 4. Child Behavior Checklist (CBCL) T-scores pre- and post-treatment.

	Internalising		Externalising		Total
	Pre	Post	Pre	Post	Pre	Post
Noah	63	67	54	60	63	68
Willow	68	71	64	66	69	72