STUDY PROTOCOL Open Access

Parenting Resilient Kids (PaRK), an onlineparenting program to prevent anxiety anddepression problems in primary school-aged children: Study protocol for arandomised controlled trialLuwishennadige Madhawee N. Fernando1†, Wan Hua Sim1†, Anthony F. Jorm2, Ron Rapee3,Katherine A. Lawrence1 and Marie B. H. Yap1,2*

Abstract

Background: Preventive efforts targeting childhood anxiety and depression symptoms have the potential to alterthe developmental trajectory of depression and anxiety disorders across the lifespan. Substantial previous researchsuggests that modifiable parenting factors such as parental aversiveness and over-involvement are associated withchildhood anxiety, depressive and internalising symptoms, indicating that parents can play a critical role inprevention. The Parenting Resilient Kids study is a new evidence-based online parenting program designed toprevent anxiety and depression problems in primary school-aged children by reducing family-based risk factors andenhancing protective factors through increased positive interactions between parent and child.

Methods/design: The current study is a parallel group superiority randomised controlled trial with parent-childdyads randomised to the intervention or active-control group in a 1:1 ratio. The intervention group will receive theParenting Resilient Kids program consisting of a feedback report on parenting behaviours and up to 12 interactiveonline modules personalised based on responses to the parent survey. The active-control group will receive astandardised package of online educational materials about child development and wellbeing. The trial website isprogrammed to run a stratified random allocation sequence (based on parent gender) to determine groupmembership. We aim to recruit 340 parent-child dyads (170 dyads per group). We hypothesise that the interventiongroup will show greater improvement in parenting risk and protective factors from baseline to 3-month follow-up(primary outcome), which will in turn mediate changes in child depressive and anxiety symptoms from baseline to12 and 24 months (co-primary outcomes). We also hypothesise that the intervention group will show greaterbenefits from baseline to 3-, 12- and 24-month follow-up, with regard to: child depressive and anxiety symptoms(co-primary outcomes); and child and parent health-related quality of life, and overall family functioning (secondaryoutcomes).(Continued on next page)

* Correspondence: marie.yap@monash.edu†Equal contributors1Monash Institute of Cognitive and Clinical Neurosciences, MonashUniversity, Clayton, VIC, Australia2Melbourne School of Population and Global Health, University ofMelbourne, Melbourne, VIC, AustraliaFull list of author information is available at the end of the article

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Fernando et al. Trials (2018) 19:236 https://doi.org/10.1186/s13063-018-2605-8

(Continued from previous page)

Discussion: This randomised controlled trial will examine the efficacy of the Parenting Resilient Kids program as apreventive intervention for anxiety and depression symptoms in primary school-aged children, as well as changesin child and parent health-related quality of life. Findings from this study will examine design features that renderweb-based prevention programs effective and the extent to which parents can be engaged and motivated tochange through a minimally guided parenting program.

Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): Trial ID ACTRN12616000621415Registered on 13 May 2016. Updated on 3 March 2017.

Keywords: Prevention, Mental health, Universal, Internalising, Internet, Childhood

BackgroundDepression and anxiety disorders tend to start early inlife and give rise to a cascade of negative long-term con-sequences. A meta-analysis of the age of onset for anx-iety disorders shows that separation anxiety and specificphobia show an age of onset from 10 to 11 years indicat-ing that primary school years could be a significant riskphase for developing anxiety disorders [1]. Longitudinalstudies have found a significant association betweenearly-onset anxiety disorders and later risk of anxietyand depressive disorders in adulthood, nicotine, alcoholand illicit drug dependence, under-achievement in edu-cation, and early parenthood [2]. The recurrence of de-pressive disorders in adulthood following a childhoodepisode of major depressive disorder has been estimatedto be as high as 75% [3]. Therefore, preventive effortstargeting childhood anxiety and depression syptomshave the potential to alter the developmental trajectoryof anxiety and depressive disorders across the lifespan.Consideration of family and parenting factors in the

prevention of depression and anxiety has been recog-nised as a key research translation priority [4–6]. Yapand Jorm conducted a systematic review of the com-plex literature examining links between parental fac-tors and depression or anxiety problems in childrenaged 5–11 [5]. They identified a range of modifiableparental factors, such as warmth, aversiveness andover-involvement, which were associated with child-hood depressive symptoms, anxiety symptoms, and in-ternalizing problems. They also noted that someparenting factors, namely abuse, inter-parental conflictand over-involvement, have not been adequately in-corporated into existing prevention and interventionprograms. Therefore, there is a clearly identified needfor translation of the evidence regarding risk and pro-tective factors into specific, practical strategies thatparents can use to reduce the risk of depression andanxiety in their children.Parenting-focused preventative interventions have

been found to reduce externalising and internalisingproblems as well as increase positive attributes such asself-regulation and self-esteem [7]. Yap et al. conducted

a meta-analysis of randomised controlled trials (RCTs)of parenting interventions to prevent internalising prob-lems in children and reported small but significant ef-fects in reducing child internalising (including bothdepression and anxiety) problems in the longer term [8].However, Morawska and Sanders argue that the capacityfor preventative parenting interventions to produce val-ued outcomes is often compromised by poor parentalengagement [9]. While perceived practical barriers, suchas difficulties with accessibility (timing, frequency, loca-tion), have been shown to lead to poor engagement,using different delivery modalities and self-directed in-terventions has been shown to promote engagement [9].Web-based programs reduce geographical and time

constraints and can also be anonymous, potentially in-creasing engagement for individuals concerned aboutprivacy, confidentiality, and stigma. Furthermore, onlineprograms can be disseminated widely at low cost, mak-ing universal preventive efforts feasible. A meta-analysisof 12 web-based parenting programs showed statisticallysignificant medium effects across parent and child out-comes, suggesting that parenting interventions can bedelivered effectively using online platforms [10]. There isalso considerable support for effectiveness of web-basedprevention and intervention programs for child and ado-lescent anxiety and depression [11–13]. Given the ad-vantages of online delivery, and the success of onlineprograms to date, the development of web-based pre-ventive parenting interventions has been recommendedas an important strategy to increase participation in pre-ventive programs [14, 15].

Development of ‘Parenting Resilient Kids’The ‘Parenting Resilient Kids’ (PaRK) intervention ispart of the broader Parenting Strategies program(www.parentingstrategies.net), and modelled on twoother existing web-based parenting interventions[16, 17]. It was developed as a web-based preventiveparenting intervention for depression and anxiety inprimary school-aged children. The content of the pro-gram is derived from the Parenting Guidelines ‘Howto reduce your child’s risk of depression and clinical

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anxiety: strategies for parents of primary school-agedchildren’, which will be referred to as Guidelines here-after [18]. The Guidelines were developed based on asystematic review of parental factors associated withanxiety, depression, and internalising problems inchildren aged 5–11, which parents can potentiallymodify [5], as well as a Delphi expert consensus studyto translate the evidence into practical strategies. Arecent online survey evaluation of the Guidelines sup-ports their acceptability among both parents and pro-fessionals, and their dissemination as a universalresource for the prevention of childhood depressionand anxiety [19]. Parents who intend to put theGuidelines into practice may require further supportin identifying individual needs as well as in buildingskills in the domains identified in the Guidelines. Tofacilitate this process, an online parenting programwas developed which includes: (a) an online self-assessment parenting scale, which provides a persona-lised feedback report; and (b) an interactive parentingprogram comprising up to 12 modules. Table 1 showsthe Guidelines and the corresponding subsections ofthe parenting scale and module components.The Parenting Resilient Kids program was also devel-

oped to fulfill many of the principles of persuasive sys-tems design, a concept defined as “computerisedsoftware or information systems designed to reinforce,change or shape attitudes or behaviours [20]. A system-atic review by Kelders and colleagues suggests that ad-herence to web-based interventions can be improved byincorporating persuasive technology elements into thedesign [21]. For example, persuasive design features ofthe program include tailoring (of feedback and parentingprogram), personalisation (the parenting program offersparticipants their own personalised dashboard, diarypages etc.) and self-monitoring (of progress throughgoals and modules).The online parenting scale was developed to evalu-

ate a wide range of potentially modifiable parentingpractices against the 12 parenting domains covered inthe Parenting Guidelines. This scale is a criterion-referenced measure that is modelled on two otherpublished measures used in the existing ParentingStrategies interventions [22, 23]. Parents’ responses tothe items in the parenting scale are used to determinethe content of the individually tailored feedback re-port, which will be received by parents in the inter-vention group. To automate the personalisation of thefeedback content, a system of scoring the scale re-sponses was developed whereby algorithms were cre-ated for all possible combinations of responses oneach parenting domain on the scale. The algorithmslink each possible combination of scale responses tothe corresponding feedback messages that are

appropriate to the responses selected and the scoreobtained for the parenting domain. The resulting per-sonalised feedback report highlights individualstrengths and areas for improvement in the differentparenting domains. Where relevant, links are providedfor parents to seek additional information from exter-nal websites if they wish. The feedback messages aredesigned to be brief and provide an overview of theparenting modules to encourage parents seeking fur-ther information to refer to the modules. The contentof the scale and feedback messages were initiallydrafted by a doctoral student with postgraduate quali-fications in psychology (WHS) and evaluated by theresearch team (comprising WHS, MBHY, AFJ, KAL)to ensure their fidelity to the Guidelines.The web-based parenting program consists of 12

modules carefully selected to encompass the contentof the Guidelines. Table 1 outlines the module titlesand rationale for including each module. The modulesare presented in a conversational tone and are de-signed to be engaging, informative and interactive.Each module includes illustrations, tasks designed tohelp parents troubleshoot parenting challenges, vi-gnettes, interactive tasks that provide further practicefor skills learnt in the modules, goal-setting tasks andan end-of-module quiz with immediate feedback.Module content was initially drafted by a doctoralstudent with graduate qualifications in psychology(LMNF) and evaluated by the research team (com-prising LMNF, MBHY, AFJ, and KAL) to ensure theirfidelity to the Guidelines as well as to other relevantevidence and credible resources.Target end-users (parents of primary school-aged

children) were invited to co-design the program byparticipating in reference groups. Fourteen parents ofprimary school-aged children (5–11 years) were re-cruited via staff newsletters across Monash Universityand the University of Melbourne. Parents participatedin a 2-hour workshop in which they reviewed the textof the parenting scale and a mock feedback report,focusing on the acceptability of the language, and thelogic of the feedback messages. Parents also reviewedtwo modules for language, tone, degree of interactiv-ity and density of content. Parents who had agreed tobe contacted on an ad hoc basis following the work-shop, were consulted regarding the design and layoutof the registration website and online scales, the use-fulness of feedback messages generated from the par-enting scale, and as well as content and presentationof modules.

Aim and hypothesesThis RCT will compare the effects of providing par-ents with the Parenting Resilient Kids program

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Table 1 The Guidelines and the corresponding subsections of the parenting scale and module components

Guidelinessubheading

Correspondingsubsection of theparenting scale andfeedback report

Title of interactivemodule

Outline of content Rationale for inclusion

You can reduce yourchild’s risk ofdevelopingdepression andclinical anxiety

NA. Not included inparenting scale orfeedback report.

Not included in themodules

Psychoeducation about therole of parents in theprevention of depression andanxiety in primaryschool-aged children.

Endorsed by experts.

Establish andmaintain a goodrelationship with yourchild

Relationship with yourchild

Topic 1: Showaffection andacceptance

Helps parents show theirchildren physical affectionand acceptance throughwords and actions.

Sound evidence that parentalwarmth is associated withless internalizing symptoms.Emerging evidence thatparental warmth is associatedwith fewer depressionsymptoms.

Topic 4: Make time totalk

Helps parents develop asupportive relationship withtheir child by learningeffective ways to talk andlisten to their child.

Be involved andsupport increasingautonomy

Involvement in yourchild’s life

Topic 2: Be involved Helps parents stay involvedand interested in their child’slife.

Emerging evidence thatparent’s knowledgeregarding their child′sactivities, whereabouts andfriends (parental monitoring)is associated with less anxietyand depressive symptoms.

Topic 3: Encourageautonomy

Helps parents encourageincreasing age-appropriateautonomy in their child’s life.

Sound research evidence thatover-involvement and auton-omy granting are risk andprotective factors, respect-ively, for depression; en-dorsed by experts.

Encourage supportiverelationships

Child’s relationshipswith others

Topic 9: TopicEncourage supportiverelationships

Provides strategies forparents to support theirchild’s social skillsdevelopment.

Emerging evidence thatparental encouragement ofsociability is associated withless child anxiety; endorsedby experts.

Establish family rulesand consequences

Rules andconsequences foryour child

Topic 6: Establishfamily rules andconsequences

Highlights the importance ofconsistent and clearboundaries for child’sbehaviours, and providesspecific strategies to establishthese.

Emerging evidence of theassociation betweeninconsistent discipline andinternalizing symptoms;endorsed by experts.

Encourage goodhealth habits

Health habits Topic 5: Encouragehealthy habits

Provides strategies to helpparents encourage goodhealth habits in their child,including a healthy diet,physical activity, good sleephabits, and appropriatescreen time.

Endorsed by experts

Minimise conflict inthe home

Home environment Topic 10: Manageconflict in the home

Addresses the need foradaptive conflictmanagement betweenparents, and between parentand child, and providesspecific strategies to dothese.

Evidence that inter-parentalconflict and aversiveness(including parent-childconflict) are risk factors fordepression (sound evidence)and anxiety (emergingevidence); endorsed byexperts.

Help your child tomanage emotions

Managing emotions Topic 8: Help yourchild manageemotions

Helps parents understandand talk about their child’semotions as well as providesparents strategies to helpchildren manage strongemotions.

Emerging evidence thatparents modelling anxiety isassociated with anxietysymptoms in children.Endorsed by experts.

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(intervention) to a standardised package of educa-tional factsheets about child development andwellbeing.Specifically, we hypothesise that:

H1: The intervention group will show greaterimprovement than the control group in parenting riskand protective factors from baseline to 3-month follow-up (primary outcome), which will in turn mediatechanges in child depressive and anxiety symptoms frombaseline to 12 and 24 months (co-primary outcomes).H2: The intervention group will show greater benefitsthan the control group from baseline to 3-, 12- and 24-month follow-up, with regard to:H2a. Child depressive and anxiety symptoms (co-primary outcomes); andH2b. Child and parent health-related quality of life,and overall family functioning (secondary outcomes).

Methods/designTrial designA parallel group superiority RCT was designed withparent-child dyads randomised to the intervention oractive-control group in a 1:1 ratio. The trial can be

considered a ‘pilot’ to determine the efficacy of theParenting Resilient Kids program with the view todisseminate the program more widely in the future.All participants will be assessed at baseline, post-intervention (3 months after baseline), at 9-monthfollow-up (12 months after baseline) and 21-monthfollow-up (24 months after baseline). A dedicatedwebsite has been set up to take registrations, run theprogram, and collect and store data. The trial proto-col flow diagram is outlined in Fig. 1. Further detailsabout the protocol are reported in the SPIRIT figure(Fig. 2) and SPIRIT checklist (Additional file 1).

Ethical approval and trial registrationThis study has been approved by the Monash UniversityHuman Research Ethics Committee (MUHREC IDCF16/152–2016000063), the Department of Educationand Training (DET) Victoria, and Catholic EducationMelbourne. Approvals for research study promotionand recruitment have also been received from therelevant authorities and schools in other states ofAustralia. The study is registered on the AustralianNew Zealand Clinical Trials Registry (ANZCTR) -Trial ID: ACTRN12616000621415.

Table 1 The Guidelines and the corresponding subsections of the parenting scale and module components (Continued)

Guidelinessubheading

Correspondingsubsection of theparenting scale andfeedback report

Title of interactivemodule

Outline of content Rationale for inclusion

Help your child to setgoals and solveproblems

Setting goals anddealing withproblems

Topic 7: Help setgoals and solveproblems

Provides strategies forparents to help their childrendevelop goodproblem-solving skills.

Endorsed by experts.

Support your childwhen something isbothering them

Dealing with negativeemotions

Topic 11: Help yourchild manage anxiety

Provides strategies forparents to help their childrenmanage their everydayanxiety.

Emerging evidence thatparents modelling anxiety isassociated with anxietysymptoms in children.Endorsed by experts.

Help your child tomanage anxiety sothat it does notbecome a problem

Dealing with negativeemotions

Topic 11: Help yourchild manage anxiety

Provides strategies forparents to help their childrenmanage their everydayanxiety.

Emerging evidence thatparents modelling anxiety isassociated with anxietysymptoms in children.Endorsed by experts.

Encourageprofessional helpseeking when needed

Getting help whenneeded

Topic 12: Seek help Helps parents understandwhat depression and anxietyproblems can look like inprimary school- agedchildren and what they cando if their child is/becomesunwell.

Endorsed by experts;evidence that parents areimportant conduits tochildren seeking professionalhelp for mental healthproblems.

Do not blame yourself(not included in theGuidelines andparenting scale, butincluded in feedbackreport for all parents)

NA. No module onthis topic.

Aims to dispel guilt/self-blame in parents.

Endorsed by experts.

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ParticipantsSample sizeBased on a power analysis for a repeated-measures de-sign with a power of 0.80, small effect (Cohen’s d = 0.2),and alpha of 0.05 two-tailed, a sample size of 294parent-child dyads (147 dyads per group) is required.Allowing for an attrition of approximately 10–15%, weaim to recruit 340 parent-child dyads (170 dyads pergroup).

RecruitmentParents will be recruited using a combination ofmethods. The primary recruitment strategy will involvereaching parents through school networks. Primaryschools across Australia will be contacted by the

research team, to request for the promotional materialto be disseminated via any means of parent communica-tion approved by the school. In addition, online parent-ing forums, parenting associations and groups will beapproached to promote the study. Advertisements willalso be placed on community locations frequented byparents such as public libraries and community healthcentres. Parents will self-select by registering themselvesand one child for the study online.

Inclusion criteriaParent participants: Parents or guardians of at leastone child aged 8 to 11 years (inclusive), who residein Australia, are fluent in English, have regular ac-cess to the Internet and an email account are

Fig. 1 Trial protocol. Children’s Report of Parent Behaviour Inventory (CRPBI), Psychological Control Scale (PCS), RCADS (Revised Children’s Anxietyand Depression Scale), Child Health Utility (CHU-9D), Assessment of Quality of Life (AQoL-8D), General Functioning subscale of the McMasterFamily Assessment Device (GF)

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eligible for the study. Parents are able to participateeven if their child opts out. Child participants: chil-dren of participating parents/guardians, aged 8 to 11(inclusive), who reside in Australia, are fluent inEnglish, will be included in the study. The child’sparent or guardian must have provided consent fortheir child’s participation, and the child must provideinformed verbal assent to participate. Only one par-ent and one child per family are able to participatein the trial.There are no exclusion criteria in relation to the

child participant’s mental health status. While theGuidelines and the intervention are targeted at par-ents of children aged 5–11 years, the age range of thestudy sample is restricted to children aged 8–11 yearsin part due to the availability of psychometricallysound child-report measures that also have parent-informant reports; and in part, to limit the heterogen-eity of the sample given the vast developmental differ-ences between children aged 5 and children aged 11.

ProcedureA flowchart outlining the study procedures is shownin Fig. 1. Interested parents will be directed to thetrial website to review the Explanatory Statements(Parent and Child). Specifically, participants will beinformed of the following: (1) study inclusion and ex-clusion criteria; (2) the two arms of the trial andtheir chance of being assigned to one of the arms;(3) the potential risks and benefits of participation;(4) privacy and confidentiality arrangements; (5) thatthe check-in calls provide them with an opportunityto ask any questions related to the study procedures,but will not provide any therapeutic support; and (6)contact helplines should they require immediateprofessional help. Parents who would like to proceedto participate in the study with their child will beasked to submit their informed consent and contactdetails on the trial website. One of the project man-agers (LMNF or WHS) will first screen registrationsfor eligibility. Subsequently, a member of the research

Enrolment Allocation Post allocation Follow up

TIMEPOINT** T1-pre 0

8 to 12 weeks depending on personalised program

T2

Post intervention (3 months post-baseline)

T3

12 month follow up

T4

24 month follow up

ENROLMENT:

Eligibility screen X

Informed consent X

*Child verbal assent X

Child baseline assessment X

** Parent Baseline Assessment/

AllocationX

INTERVENTIONS:

PaRK intervention

Active control-Factsheets

ASSESSMENTS:

***Child assessment(CRPBI, PCS-YSR,,

RCADS, KIDSCREEN-27, CHU-9D)

X X X X

Parent assessment(Parenting Scale, CRPBI, PCS,GF,

AqoL-8D,RCADS, KIDSCREEN-27,

X X X X

Fig. 2 SPIRIT figure

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team will contact the child participant at a pre-arranged time to obtain verbal assent, and then guidehim or her through the online assessment over thephone as required. To assist child participants withliteracy issues, the website provides audio clips whichdictate the assessment instructions and items to par-ticipants when clicked.Following submission of the child baseline assessment,

an automated email will be sent to the parent containingthe link to their online baseline assessment. Upon com-pleting their baseline assessment, parents allocated tothe intervention group will receive their tailored feed-back report, a copy of the Guidelines, and the onlineparenting program comprising the recommended mod-ules (out of a possible 12). Parents allocated to the con-trol group will receive the first of their eight weeklyfactsheets.Parents in the intervention group will receive a 5-min,

weekly phone call from a researcher, starting 7 days aftercompleting their baseline assessment and receiving theirpersonalised feedback report, and every week thereafterfor at least 8 weeks. The total number of calls will matchthe total number of modules selected plus one, with thefirst call focusing on the feedback report and supportingparents’ familiarisation with their online modules. Re-search staff will be trained to make these calls followinga standard script and will not provide individual adviceor therapy. The aims of these calls are to enhance paren-tal engagement and ensure that parents progresssmoothly through their allocated program until comple-tion. Parents in the control group will receive a 5-min,weekly phone call from a researcher, starting 7 days aftercompleting their baseline scale, and every week there-after for 8 weeks to match the number of factsheetsreceived.At post-intervention (3-month) and each of the

follow-up assessments (12-month and 24-month), chil-dren and parents will complete the same set of measuresusing the same procedure as the baseline assessment.Participants can opt out at any stage of the study. Verbalassent will be obtained from the child prior to askingthem to complete each follow-up assessment.

Randomisation and blindingImmediately after parents submit their baseline assess-ment online, the trial website is programmed to run astratified random allocation sequence (based on parentgender) to allocate parent-child dyads to either the con-trol or intervention group.As such, allocation is concealed from both participants

and researchers prior to assignment and baseline assess-ment. The ‘people administering the treatment’ (for bothintervention and control groups) are also masked fromthe assignment as the intervention is delivered online by

an automated trial website. Child informants of the out-comes of interest are assumed to be blinded becausethey are not direct recipients of the intervention (i.e.parenting program).

InterventionsIntervention groupThe ‘Parenting Resilient Kids’ intervention comprises:

1. An individually-tailored feedback report that high-lights areas of strength in parenting (i.e., concordantwith the Guidelines) and areas for improvement(i.e., not concordant with the Guidelines),

2. An interactive online parenting intervention (up to12 modules) to support parents in making changesto the identified areas for improvement. Modulerecommendations are based on responses to thebaseline parenting scale.

Feedback reports will be available online immediatelyafter the baseline assessment is completed. Parents willalso be emailed a copy of their feedback report and theGuidelines. Five days later, parents will be emailed a linkto access their individually-tailored interactive parentingprogram. Parents can further tailor their parenting pro-gram by deselecting recommended modules and/orselecting additional modules. Parents then confirm theirselection and can commence their personalised program.The 12 modules comprising the intervention are derivedfrom topics covered in the Guidelines. Modules includeillustrations, vignettes, interactive activities, goal-settingexercises, and an end-of-module quiz with immediatefeedback to consolidate learning. Module topics and ra-tionale for inclusion are shown in Table 1.The website is programmed to unlock one module per

week from each parent’s program, until all modules intheir personalised program have been unlocked irre-spective of whether parent has completed precedingmodules. Each module will take 15–25 min to complete.Once parents have completed all the modules in theirpersonalised program, they have ongoing access to all 12modules for the duration of the RCT (up to 4 years).

Control groupParents in the control group are provided with a stan-dardised package of educational materials about childdevelopment and wellbeing via the trial website (seeTable 2). Parent participants receive an email each week,which provides a link to the corresponding webpagewith their information factsheet for that week, for8 weeks (to match the expected mean number of mod-ules received by the intervention group). This packageprovides general information to parents as opposed totailored, actionable strategies, and is designed to

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represent a selection of resources that are available toparents as part of the current health promotion ap-proach for child wellbeing. The materials are adaptedfrom credible existing resources provided on the RaisingChildren Network website (www.raisingchildren.net.au).

Outcome measuresThe following primary outcomes were measured:changes in parental concordance with the Guidelinesand changes in child anxiety and depressive symptoms.The secondary outcomes measured were child report ofparenting, parent report of general family functioning,and child and parent health-related quality of life.

Primary outcome measuresChange in parental concordance with the Guidelines‘How to reduce your child’s risk of depression and clin-ical anxiety: strategies for parents of primary school-aged children’ will be assessed by a parenting scale de-veloped for use in this study. The scale consists of 83questions, and is a criterion-referenced measure asses-sing parents’ current parenting practices (key parentingrisk and protective factors) against specific recommen-dations in the Guidelines.The 25-item Revised Children’s Anxiety and Depres-

sion Scale (RCADS) [24] will be administered to bothparents (parent-report form) and child (child-reportform) participants aged 8 to 11 inclusive. Change inchild anxiety symptoms, as measured by the 15-itemTotal Anxiety subscale score, and child depressive symp-toms, as measured by the 10-item Depression subscalescore, will be tracked.

Secondary outcome measuresChild’s report of parenting is assessed by the 10-itemAcceptance/Rejection subscale in the latest revision ofSchaefer’s Children’s Report of Parent Behaviour In-ventory (CRPBI-30, [25] and the 8-item PsychologicalControl Scale-Youth Self-Report (PCS-YSR) [26]. Eachof these scales assesses some aspects of parentingcovered in the parenting scale and will be used as acomplementary measure for assessing parenting, aswell as to form part of the validation of the newly de-veloped parenting scale. This measure is completedonly by child participants in Grades 5 and 6 (agedapproximately 10–11), to ensure that children are ableto provide valid reports on these measures. On theseparenting measures, child participants are asked to re-port on their participating parent only. Parent partici-pants will also complete the parent versions of theCRPBI and PCS-YSR.General family functioning will be measured by par-

ents’ reports on the 12-item General Functioning sub-scale of the McMaster Family Assessment Device [27].Parents’ health-related quality of life will be measured bythe 35-item Assessment of Quality of Life (AQoL-8D).The dimensions included in AQoL-8D are: independentliving, pain, senses, mental health, happiness, coping, re-lationships and self-worth [28].Child’s health-related quality of Life will be measured

by Child Health Utility 9D (CHU-9D) and KIDSCREEN-27. The 9-item CHU-9D [29] assesses children’s self-report functioning across nine domains (worry, sadness,pain, tiredness, annoyance, school, sleep, daily routineand activities). The KIDSCREEN-27 [30] developed forchildren 8–18 years old, and has both self-report and

Table 2 Factsheet topics and order of presentation

Order of presentation Topic Synopsis

Factsheet 1 Child development in thepre-teen years: an overview

Helps parents understand their child’s physical, emotionaland social changes in the pre-teen years.

Factsheet 2 Behavioural changes in thepre-teen years

Helps parents understand common behavioural concernsin the pre-teen years and learn ways to encourage goodbehaviour

Factsheet 3 Connecting andcommunicating

Helps parents understand the importance of stayingconnected with their child and provide ideas on ways toimprove communication with their child

Factsheet 4 Internet safety Provides parents with ideas on how to help their child usethe Internet safely and responsibly

Factsheet 5 Health and wellbeing in thepre-teen years

Helps parents understand the importance for their child tohave healthy lifestyle habits

Factsheet 6 Nutrition during the pre-teenyears

Provides parents with ideas on making healthy foodchoices for their child

Factsheet 7 School and education in thepre-teen years

Helps parent understand how they can support theirchild’s learning and education

Factsheet 8 Building a strong positiverelationship with the school

Provides parent with ideas on how to be involved in theirchild’s school and to build a positive relationship with theschool

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parent proxy versions. It contains 27 items in five do-mains: physical well-being (five items), psychologicalwell-being (seven items), autonomy and parents (sevenitems), peers and social support (four items), and schoolenvironment (four items). The CHU-9D will be com-pleted by the child participant.As part of program evaluation, parents in both groups

will also be asked six to eight questions relating to theprogram they have received at each of the follow-upassessments.

Protocols for adverse eventsChildren who express distress during any of the childassessment calls will be contacted by either one ofthe project managers (LMNF or WHS) or the chiefinvestigator (MBHY), all of whom are eitherprovisional or registered psychologists. They will as-sess the level of acute risk and refer parent and childto appropriate follow-up options as required. Parentsare provided contact details for the researchers andare encouraged to communicate any concerns abouttheir participation in the program. A T-score of 70 ormore on the Revised Children’s Anxiety and Depres-sion Scale (RCADS) is used in the current study fordetecting elevated child symptoms [24]. If both childand parent report elevated child symptoms, the pro-ject managers (LMNF and WHS) will follow-up withthe parent participants, to encourage them to discussthese concerns with their child, as well as to provideinformation about the services they may wish to useif required. Participants are free to withdraw from theresearch or request that their data be withdrawn atany time.

Training for fidelityResearch staff are trained to conduct the weekly check-in calls with parents using a standard script (i.e. standardlist of questions and prompts). At least one project man-ager (LMNF or WHS) will oversee the daily operation ofthe trial, and two research assistants will conduct thephone calls to parent and child participants. Extensiveefforts will be made to minimise non-response anddrop-out rates, including reminder calls, text messages,emails, participant reimbursement, and child birthdaycards.

ConfidentialityInformation obtained from the research will only be ac-cessible by the researchers, and all electronic files will bepassword protected. Reports arising from the researchwill only include group data, and individual participantswill not be identifiable in any way. As discussed in theadverse events protocol above, if both child and parentreported anxiety or depression scores on the RCADS are

elevated, only the participating parent will be informedvia email. However, no individual data will be providedto the parent. All data will be securely destroyed after aminimum of 5 years from when the final report of thestudy is published.

Statistical analysisThe primary analyses will be intention-to-treat analyses.To assess group differences in changes in primary andsecondary outcomes across time points, a series of mixedmodels repeated measures (MMRM) will be conducted.Little’s missing completely at random (MCAR) test will beused to analyse the extent and pattern of missing data.

DiscussionPrevious research suggests that parents can play a criticalrole in the prevention of anxiety and depressive disordersin their children. The Parenting Resilient Kids Programwas developed as a web-based parenting intervention forparents of children aged 5–11 and was designed to bepractical and parent-friendly, yet firmly rooted in researchevidence. This RCT will examine whether compared toproviding parents with a standardised package of educa-tional factsheets, the Parenting Resilient Kids programleads to changes in parenting factors that are important inpreventing child depression and anxiety in the short term(3 months after baseline), and child depressive and anxietysymptoms in the medium term (12 months post-intervention) and longer term (24 months post interven-tion). The RCT will also examine whether, compared tothe control group, parents who have received the Parent-ing Resilient Kids intervention would show significantchanges in children’s and parents’ health-related quality oflife. If the Parenting Resilient Kids intervention is found tobe effective, it can then be disseminated widely as a cost-effective preventative parenting program leading to bettermental health and quality of life outcomes for primaryschool-aged children. This carries the potential to alterthe developmental trajectory of anxiety and depressivedisorders across the lifespan. Findings from this study mayalso contribute to the knowledge base for designing effect-ive web-based prevention programs for parents and theextent to which parents can be engaged and motivated tochange through a minimally guided parenting program.

Trial statusThis trial is currently recruiting participants till end ofMarch 2018. A total of 1894 primary schools were con-tacted across Australia, of which 358 agreed to advertisethe study. To date, the study has recruited 321 parent-childdyads, which is 94% of the required sample. The first par-ticipant was enrolled on 8 March 2017.

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Additional file

Additional file 1: SPIRIT checklist. (DOCX 27 kb)

AbbreviationsANZCTR: Australian New Zealand Clinical Trials Registry; AQoL-8D: Assessment of Quality of Life; CRPBI-30: Children's Report of ParentBehaviour Inventory; DET: Department of Education and Training;MCAR: Missing completely at random; MMRM: Mixed Models RepeatedMeasures; PaRK: Parenting Resilient Kids; PCS-YSR: Psychological ControlScale-Youth Self-Report; RCADS: Revised Children’s Anxiety and DepressionScale; RCT: Randomised controlled trial

AcknowledgementsThe authors would like to acknowledge the team of research assistants whoassisted with data collection, and the parents in our reference group for theirinput into the development of the parenting scale and the web-based inter-vention. We also acknowledge beyondblue for their partnership in develop-ing and disseminating the guidelines.

FundingThis research project has been funded by a Monash University FacultyStrategic Grant (SGS16-0406) and Advancing Women’s Research SuccessGrant, and an Australian Rotary Health Research Grant. The webdevelopment of the intervention was funded by the National Health andMedical Research Council (NHMRC). Authors Fernando and Sim aresupported by an Australian Government Research Training ProgramScholarship. Author Yap received salary support from an NHMRC CareerDevelopment Fellowship (APP1061744). Author Jorm received salary supportfrom an NHMRC Senior Principal Research Fellowship (APP1059785). AuthorRapee received salary support from an Australian Research Council LaureateFellowship (FL150100096). The funding sources did not have any role in theconduct or publication of this study.

Availability of data and materialsData sharing is not applicable to this article as no datasets were generatedor analysed during the preparation of this manuscript.

Authors’ contributionsLMNF drafted the module and factsheet content that constitute the PaRKintervention, drafted and revised the manuscript based on input of allauthors and contributed to the implementation of the study. WHS draftedthe content of the parenting scale, scoring algorithms and feedback report,drafted and revised the manuscript and contributed to the implementationof the study. MBHY is the chief investigator, grant holder and led theimplementation of the study. AFJ, RR, KAL conceived and contributed torefinement of the PaRK intervention and study protocol and contributed tothe critical revision of the manuscript. All authors have approved the finalmanuscript.

Ethics approval and consent to participateThis study has been approved by the Monash University Human ResearchEthics Committee (MUHREC ID CF16/152–2016000063), the Department ofEducation and Training (DET) Victoria, and Catholic Education Melbourne.The study is registered on the Australian New Zealand Clinical Trials Registry(ANZCTR) - Trial ID: ACTRN12616000621415. Informed consent will beobtained from all participants in the trial.

Consent for publicationNot applicable.

Competing interestsThe authors declare that they have no competing interests.

Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims inpublished maps and institutional affiliations.

Author details1Monash Institute of Cognitive and Clinical Neurosciences, MonashUniversity, Clayton, VIC, Australia. 2Melbourne School of Population andGlobal Health, University of Melbourne, Melbourne, VIC, Australia. 3Centre forEmotional Health, Department of Psychology, Macquarie University, Sydney,NSW, Australia.

Received: 18 December 2017 Accepted: 14 March 2018

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