The Effect of Online Parent Training With and Without Coaching Support on the Well-Being of Families of Children With Neurodisabilities: A Randomized Controlled Trial.

Families of children with neurodisabilities often face significant child behavioral challenges that can affect overall family functioning and well-being. This randomized controlled trial (RCT) used family resilience theory as the investigative framework to examine the impact of an online parenting program designed to address child behavioral challenges. Parents of children with a range of neurodisabilities were randomized into three groups: a self-directed online parenting program, the same program with coaching support, and a control group. Family well-being was measured using the SCORE-15 at baseline, 5, and 10 months. The primary analysis included a per-protocol sample comprising self-directed participants who completed ≥ 8 of 12 modules, coached participants who completed ≥ 8 modules and ≥ 8 coaching sessions, and all control-group participants. Linear mixed models (LMMs) were used to analyze the repeated measures data, followed by standard linear regression models to assess the average intervention effect at each time point. Clinically significant changes were calculated via the reliable change index (RCI). Of the 454 families randomized, 422 participants had at least one available SCORE-15 assessment (self-directed: n = 140; coached: n = 139; control: n = 143). Descriptively, mean SCORE-15 scores remained relatively stable in both intervention groups but increased over time in the control group (lower scores indicate better family functioning). Broader results from the full-sample analysis are reported separately (publication forthcoming). The present analyses focus on the 248 participants who met the per-protocol adherence criteria (self-directed: n = 36; coached: n = 60; control: n = 152). Families that reported higher baseline family well-being were associated with greater adherence to the intervention. Participants in both intervention groups demonstrated significant improvements in family well-being relative to the control group. The coached version of the intervention demonstrated a more robust and persistent impact relative to the self-directed version, particularly with respect to communication-related subscales. Across both versions of the intervention 10%-28% of participants experienced reliable clinical change. The findings from our analysis suggest that both versions of the parenting program led to notable enhancements in aspects of family well-being, with the coached group exhibiting particularly remarkable improvements. Our study highlights that parenting interventions can contribute to the well-being of the entire family system, extending beyond individual child and parent outcomes typically addressed by these programs.