102 Chapter 5 Parental skills. Parental intervention skills, or parental fidelity is defined as “to execute parent-implemented techniques accurately and consistently” (Killmeyer, 2017). By measuring parental skills, investigators document that parents can indeed perform the intervention techniques as they were intended to be used. These skills will be rated by the parent scales of the JERI and consists of four items covering caregivers’ scaffolding, symbol highlighting, following in on child’s focus and caregivers’ affect. The scaffolding item assesses how well the parent supports the child’s activities and provides learning opportunities. Symbol highlighting focuses on how often the caregiver directs the child’s attention to symbols (language and/or symbolic gestures and acts). Following in on child’s focus captures if the parent is following the child’s interests and maintain focus with the child. Finally, caregivers’ affect measures the parent’s affect and how it influences the parentchild interaction (Adamson & Suma, 2020). Items fit the techniques taught by the BEAR intervention. Just as with the joint engagement items, parent scale items will be rated from a scale of 1 to 7. Parental skills will be rated based on the same videotaped dyadic interaction as the joint engagement measure, as collected at baseline, end of treatment and follow-up. Also, in order to capture the flow of interaction between parent and child, an interaction item (fluency and connectedness) will be scored. Parental satisfaction. Parental satisfaction with care in general is measured at follow-up through a survey created by our group. The full survey can be found in the supplementary materials (Appendix A). Topic items included initial concerns, searching for help, receiving a diagnosis, child and parent treatment and overall satisfaction with the healthcare process. To measure parental satisfaction specifically for the BEAR intervention specifically, the Rating Scale Satisfaction and Effect questionnaire (in Dutch: Beoordelingsschaal Tevredenheid en Effect [BESTE]; De Meyer et al., 2004) will be conducted. The BESTE consists of two versions: one for parents and one for healthcare practitioners, and both versions will be administered. Validity and reliability have been established (De Meyer et al., 2004. The BESTE will only be conducted end of treatment, and in the BEAR condition only. Descriptive statistics will be used to present percentages regarding satisfaction and effect, as mentioned by both parents and practitioners. Assessment of healthcare sources. Direct and indirect costs as a consequence of the child’s psychiatric condition, i.e. the medical costs and productivity losses in parents are measured using the ‘Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness’ (Tic-P questionnaire; Tan et al., 2012). Validity and reliability have been established (Tan et al., 2012). For every participant, the duration and type of each contact as well as the type of health care worker with whom the contact was in the last 3 months will be registered as to monitor use of healthcare sources in both groups as well as to calculate the costeffectiveness of arms. Productivity losses of parents associated with their child’s health problem or its treatment will be registered as well.
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