The initial five years of a child's life mark a critical developmental phase and a period
of high sensitivity to environmental stressors, including the impact of parental mental
illness (MI) and parenting stress. Research has consistently linked parental MI with a
broad range of child-related issues, including irritability, sleep disturbances, and
socio-emotional developmental impairments. These adverse outcomes are often attributed to
environmental factors, including parental modeling of maladaptive emotion coping
strategies such as avoidance and aggression and harsh parenting practices characterized
by reactive discipline and conflictual interactions. Notably, when parental MI is
accompanied by additional stressors such as domestic conflict or financial strains, the
long-term risks for children are exacerbated. Further, the chronicity of parental MI has
critical implications for children. When stressors and parental MI are persistent, the
risk of adverse developmental outcomes for children increases, putting children at
heightened risk for stress and development of their own psychopathology. This highlights
the critical need for interventions that address parental MI and the broader spectrum of
parenting stress and its multifaceted impacts on children.
Despite the need for parents to improve their stress and mental health symptoms, the
majority of parents do not access evidence-based treatments. Previous research has
documented many barriers preventing parents from accessing care. These barriers include
service backlogs, long waitlists, high costs of individual therapy, lack of information
of where to access interventions, and overwhelming childcare demands. Additionally,
although evidence-based treatments exist, most interventions do not comprehensively
address the mental health of both parents and children. This gap in services is
significant, given meta-analytic evidence indicating that dual-generation programs, which
simultaneously target parent MI and child well-being, yield impacts that are 50% larger
in promoting positive child outcomes compared to programs focused solely on addressing
parental MI. There is a clear need to provide accessible and scalable solutions that
promote positive mental health and developmental outcomes in at-risk children. Digital
mental health interventions offer a potential avenue for addressing family needs and
barriers to care that are an accessible and low-cost option, and research shows great
promise for treating adult depression using these methods. Additional emerging research
highlights the efficacy of app-based programs in improving parental MI and parent-child
interactions. However, very limited existing app-based or mHealth programs address both
parental mental health and parenting skills, which indirectly targets child well-being.
In response to this need, the investigators conducted qualitative research (i.e., focus
groups and individual interviews with parents with lived experience) and consulted with a
parent advisory board to co-develop a program that simultaneously addressed parental MI
and parenting. Results suggested that parents wanted accessible, online services grounded
in expert research. Alongside patient-partners and community providers the investigators
then developed the BEAM (Building Emotional Awareness and Mental Health) app-based
program. The BEAM program is aligned with best practices in mHealth programs including
patient-driven priorities, rapid-cycle iterations to facilitate continual improvements,
and a commitment to evidenced-based care. Key elements of the original BEAM program
include: (1) expert-led educational videos using transdiagnostic therapy and
emotion-focused parenting strategies; (2) brief group sessions to consolidate therapeutic
content and build social support; (3) a community forum to enhance social connection; and
(4) symptom monitoring to track progress. In case of a mental health or parenting-related
crisis, clinical coaches also consult via phone. BEAM builds on evidence from the
investigative team's knowledge synthesis work suggesting that mHealth therapeutics can
address parent MI and while appealing to parents.
The BEAM intervention has consistently demonstrated promising outcomes across various
trials to date. The investigative team's latest phase II RCT with mothers of toddlers
found that the BEAM program outperformed a services-as-usual (SAU) control condition.
Significant improvements in parental MI symptoms including anxiety, anger, and alcohol
use were observed. Additionally, BEAM was effective in reducing harsh parenting practices
and negative parent-child interactions, with substantial improvements observed for
families living in poverty. This trial also showed noteworthy participant engagement with
retention rates (84%), comparable to in-person therapy sessions. This phase of research
built on and replicated the success of earlier trials with both an open pilot and pilot
RCT demonstrating BEAM's efficacy in reducing MI symptoms such as depression, anxiety,
anger, sleep issues, and substance use. Qualitative feedback from the initial trials
emphasized the positive impact of the BEAM program on mental health and parenting,
leading to enhanced quality of life and improved family relationships. Participants also
highlighted the value of the social support gained through the online community.
To further address family mental health needs, this trial will test the readiness of the
BEAM program for scalability. The current study involves a hybrid
effectiveness-implementation trial design to build on previous work. The investigators
will use both effectiveness and implementation metrics including short-term follow ups of
primary outcomes alongside longer-term follow-ups of mental health and
socio-developmental outcomes with linked administrative data. This hybrid design follows
the "type 2" model, in which effectiveness and implementation are co-primary aims and can
be tracked simultaneously as the trial progresses. This approach is consistent with the
investigative team's rapid-cycle program development to date in which BEAM has been
tested and adapted in response to patient and provider feedback through each iteration.
This implementation trial aims to maximize BEAM's accessibility, equitability, and
effectiveness for future nation-wide implementation. For the current implementation
trial, the investigators conducted a full App rebuild to create BEAM Version 2.0 based on
participant and Parent Advisory Board feedback. BEAM 2.0 updates include improvements to
psychoeducational video content (e.g. high-quality video production, animations, closed
captioning), the mobile application user experience (e.g. push notifications, direct
messaging, integrated video player that adjusts video quality based on available
bandwidth, easy-to-navigate platform), and functionality across mobile device operating
systems (iOS, Android). The weekly psychoeducational videos, short symptom tracking
surveys, and social support community forum are now housed seamlessly within the BEAM
app. Other aspects of the program include individual check ins with trained peer coaches,
group drop-in sessions, and a connection to a systems navigator, whose role will be to
support participants in accessing community resources.