The OPTIMA trial: evaluating the clinical and cost-effectiveness of the STEPS parenting app

What is the rationale for OPTIMA?

Many children referred to mental health services struggle with their behaviour, which can be difficult for parents. As an effective way to help parents manage behaviour problems, National Institute for Health and Care Excellence (NICE) recommend parenting support interventions for children referred for behavioural and attention problems. Parenting support interventions provide education, practical and psychological support. However, these are costly, time-consuming, and there is limited flexibility regarding access. Parenting support is also usually delivered face-to-face and after a full clinical assessment has been made, meaning long waiting times could make the problems faced by children and families worse.

Digital parenting interventions could provide an effective solution by reducing access barriers, offering a tailored provision and providing cost savings for services and families. OPTIMA tests whether a new mobile phone app called STEPS can help families of children who show challenging behaviour during the difficult waiting period after families first seek help. STEPS does not replace clinical support but gives parents access to additional help while they are waiting for a full clinical assessment.

What is STEPS?

STEPS is an unguided intervention, inspired by the New Forest Parenting Programme. It is a mobile phone app that provides psychoeducation and practical tools to help parents of children aged 5-11 years. This form of support is very flexible, can be delivered at low cost, and can be easily accessed at the point when families are accepted onto the children’s services’ waiting list.

Parents can move through the eight modules (steps) at their own pace and in their own time. It takes about 20 minutes to complete each module. Each user selects a ‘buddy’, a parent played by an actor. Each buddy delivers the same content, but the choice hopefully ensures that the user can find a buddy who is relatable to them.

The app includes downloadable resources and space to record audio or written note style reflections. Most of the content is delivered via short videos and audio clips; none of which is more than 3 minutes long.

In collaboration with our parent panel, we developed a short animation about the STEPS app which can be watched here:

What is the aim of OPTIMA?

The main component of OPTIMA was a fully remote randomised controlled trial. Parents were randomly allocated to two groups; half received STEPS for 3 months and half did not. Parents remained in the trial for around 12 months to measure any effects of the app. The primary objective is to evaluate whether STEPS can reduce the severity of children’s oppositional and defiant behaviour as rated by parents, compared to waiting as usual.

In OPTIMA, we will also test:

• Whether STEPS can help to reduce other child behaviours such as hyperactivity/impulsivity and emotional problems.
• Whether the app can help to reduce parental strain and improve parent-child closeness.
• How long any of these effects last; and
• Whether the app is a cost-effective intervention for services to provide.

Where are we now?

Follow-up to the OPTIMA RCT was completed in August 2024. The data are currently being analysed by the team statisticians. Please visit our website where we will promote the findings: https://optimastudy.co.uk/.