Online Parenting Support With VIPP-SD in Chile

The Ainsworth et al. sensitivity scale will be used to measure maternal sensitivity in a 10-minute free play session. Trained observers code the caregiver's behavior using two rating scales: Sensitivity vs. Insensitivity and Cooperation vs. Intrusiveness, on a scale ranging from 1 to 9, with high values indicating greater sensitivity and cooperation. The procedure will be applied twice, first in the pre-test at home and again in the post-test in the laboratory.

Parental limit-setting will be observed in a don't touch task. The task is video-taped and parental limit- setting is coded for positive discipline, using an adapted version of the revised Erickson 7-point rating scale for supportive presence, physical interference, rated on a 5-point scale, and Laxness, rated on a 5-point scale.

The Parental Burnout Assessment (PBA) is a 23-item questionnaire measuring the four dimensions of parental burnout: exhaustion - physical and emotional tiredness, contrast - the perceived discrepancy between the ideal caregiver they would like to be and the one they are currently, a comparison that produces guilt, feelings of being fed up - feeling tired of the parental role, and emotional distancing - putting an affective distance between themselves and their children). The Likert scale response options are: "never" (0), "a few times a year or less" (1), "once a month or less" (2), "a few times a month" (3), "once a week" (4), "a few times a week" (5), "every day" (6). High scores imply high levels of parental burnout.

Based on written and audio-recorded feedback of sessions, fidelity will be coded in terms of the delivery of key components of the treatment, as well as global adherence to the manual. Note that fidelity is promoted by regular intervision and supervision sessions. We will randomly select 10% of audio recordings for two assessors trained in the intervention to rate the adherence to the VIPP-SD manual using a 5-point scale (1 = Did not follow the manual at all, 2 = Adapted most of the material, did not follow the manual closely, 3 = Sometimes adapted the material, followed manual somewhat, 4 = Adapted only minor elements, followed the manual quite closely, and 5 = Followed the manual very closely and delivered the session as specified). A score of 3 will be set as the acceptable fidelity threshold, as to receive this score most core components of the intervention are present in the feedback.

Hair samples will be collected by a trained research assistant. As hair grows approximately 1 cm per month (4 cm at least per sample), every 1 cm segment of hair represents the past month. To collect hair samples, a strain of hair at the base of the vertex posterior of the scalp is selected and cut right at the scalp. Hair samples will be put into foil and stored at a dark location at room-temperature until sent to the lab for analysis.

Child conduct problems will be measured using the parent-reported Child Behavior Checklist (CBCL) at the pre- and posttest. The CBCL is a 100-item questionnaire that asks parents to rate how true the behavior is of their child over the last two months on a three-point scale (0 = not true, 1 = somewhat true, or 2 = very true or often true). The measure gives a total score, and scores for externalizing and internalizing behavior problems. The externalizing score is made up of scores for attention problems and aggressive behaviors. We will use the aggresive behaviors subscale to evaluate child conduct problems. This measure will additionally be used in the economic evaluation.

The Strange Situation Procedure (SSP), considered the "gold standard measure" for the assessment of infant attachment pattern in a laboratory procedure, will be used at the post-test. The SSP consists of a series of eight episodes in which the child is exposed to stressful situations such as the entry of a stranger into the room and brief separation from the caregiver, alternating with meetings with the caregiver. The procedure is conducted in a one-way laboratory room set up as a living room with toys and requires recording for later coding. For the attachment outcome, the coding will be based on the continuous scale of security, secure v/s insecure dichotomic classifications, and the D-scale.

Health and social care service use in experimental and control groups will be measured using the Child and Adolescent Service Use Schedule (CA-SUS). Parents report their own and their child's use of accommodation, hospital, community health and social services, and prescribed medication. This measure will be used for economic evaluation.

Quality of life will be measured with the 36-Item Short Form Health Survey questionnaire (SF-36). The SF-36 is a self-report questionnaire assessing health-related quality of life across eight physical and mental health domains. This measure will be used for economic evaluation.

Description: Two subscales of the Brief Symptom Inventory (BSI) will be used to assess depression and anxiety symptoms of both parents. Each subscale has 6 items, which are answered on a 5-point Likert scale according to the frequency of symptomatology within the last seven days, where (0) is Not at all and (4) is Very much.

The child's temperament will be assessed through the Infant Behavior Questionnaire - Revised - Very Short Form (IBQ-R-VSF) scale in the Spanish version, translated and validated in our country by Farkas & Vallotton, reaching good reliability. The IBQ-R-VSF is a 34-item parent-report questionnaire, which asks about the frequency of occurrence of specific child behaviors during the last week, on a 7-point Likert scale. Scores are obtained on three dimensions: surgency, effortful control and negative affect, where higher scores indicate greater intensity of the dimension.

The Pittsburgh Sleep Quality Index (PSQI) will be used to assess parental sleep quality, an important covariate in the burnout literature. The PSQI is a 19-item self-report questionnaire that includes different dimensions of sleep such as sleep disturbances, use of sleep medication, sleep duration and subjective sleep quality. It provides cut-off scores that distinguish between good and poor sleepers.