Need and demand for parenting programmes in general practice

Parenting, child development and primary care-'Crescer em Grande!' intervention (CeG!) based on the Touchpoints approach: a cluster-randomised controlled trial protocol

INTRODUCTION

Despite support for parenting being already recognised as a priority, there remains a paucity of evidence on how to facilitate its adoption in regular visits of maternal and child health primary care (PC). We describe the protocol for a study to assess the effect of an innovative universal Touchpoints-based intervention-'Crescer em Grande!' (CeG!) - when supporting the process of transition to parenthood and early infancy, at multiple PC units.

METHODS AND ANALYSIS

A cluster-randomised trial will be conducted in 12 PC units (clusters) from the Lisbon metropolitan area, Portugal. Participants will be a minimum of three family physicians and one nurse/unit, as well as 216 expecting parents and future babies until 18 months who are using the PC services. Sites will be randomised to either the CeG! or usual care. The CeG! will consist of: (1) the integration of the Touchpoints approach in PC maternal and well-child visits, with the support of 28 leaflets for parents to file in a folder; plus (2) training for PC providers on how to perform the CeG! into existing practice. Parents will be required to fill in questionnaires at point throughout their child's 18-month, mostly online. The primary outcome will be the self-perception of parental competence (Parenting Sense of Competence Scale). Other outcomes include: family functioning, couple dynamics, mental health, well-being/quality of life, psychological experience of pregnancy, attachment, child development. Acceptability, satisfaction and feasibility of CeG! will also be obtained from providers' and parents' perspectives. Costs associated with delivering the CeG! will be calculated. Study analyses will be under the principle of intention-to-treat.

ETHICS AND DISSEMINATION

Approval was obtained from the Ethics Committee of the Regional Health Administration. The results will be shared with participants and disseminated via peer-reviewed published papers, presentations at scientific and professional conferences.

TRIAL REGISTRATION NUMBER

ISRCTN90692907.

Necessidades nos apoios à parentalidade: perceções e práticas dos profissionais de saúde

Várias perspetivas teóricas e recomendações internacionais salientam a importância de desenvolver serviços e medidas promotoras de uma parentalidade positiva na comunidade onde vivem as famílias. Conhecendo a realidade portuguesa, verificamos que há uma carência de respostas específicas que promovam as competências parentais, melhorem as relações pais-filhos, o conhecimento, a reflexão, as atitudes, comportamentos e níveis de confiança no papel parental.  O presente trabalho tem como propósito apresentar o conceito de parentalidade positiva como um elemento essencial no desenvolvimento de ações psicoeducativas no âmbito dos cuidados de saúde primários e na adoção de práticas profissionais centradas no suporte à parentalidade. 

Group Work Intervention for the Parents of Children with Mental Health Issues Admitted in the Tertiary Care Center

OBJECTIVES

The objective of this study was to develop a structured curriculum for a group-based parenting program for parents/caregivers of children or adolescents treated in the inpatient child and adolescent mental health unit of a national health institute.

METHODS

Data from group session reports of 3 years of conducting group-based parenting programs in the same setting were analyzed and prominent themes of discussions were shortlisted before finally arriving at a six-session group parenting program module.

RESULTS

A six-session intervention module was designed by psychiatric social workers experienced in group work. The content followed combination of various theoretical approaches and methodologies ultimately aiming in improving the overall knowledge and understanding of parents or caregivers on various child and adolescent mental health issues, and enhancing their skills and competence in dealing with various emotional and behavioral problems in children.

CONCLUSION

Group-based parenting programs are found to be effective in improving the over psychosocial health of parents and the emotional and behavioral problems of children and adolescents as a result of better parenting. Development and standardization of culture appropriate group intervention curriculums would help in the development of this cost effective method as a medium of change.

The effectiveness of the Incredible Years™ Parents and Babies Program as a universal prevention intervention for parents of infants in Denmark: study protocol for a pilot randomized controlled trial

BACKGROUND

Infancy is an important period in a child's life, with rapid growth and development. Early experiences shape the developing brain, and adverse experiences can have both an immediate and lifelong impact on health and wellbeing. Parenting interventions offered to parents of newborns can support parents in providing sensitive and responsive care, and reinforce healthy development for their infants. This study aims to evaluate the impact of the Incredible Years™ Parents and Babies Program in a universal setting for parents with infants.

METHODS/DESIGN

This is a pragmatic, two-arm, parallel, pilot, randomized controlled trial (RCT) where 128 families with newborn infants up to four-months-old are recruited in two municipalities in Denmark. Families are randomized to the Incredible Years Parents and Babies Program or usual care with a 2:1 allocation ratio. The primary outcome is parenting confidence measured after 20 weeks by the Karitane Parenting Confidence Scale and Parental Stress Scale. Secondary outcomes include measures of parent health, reflective functioning, relationship with the infant, and infant development. Interviewers and data analysts are blind to allocation status.

DISCUSSION

This is the first RCT of the Incredible Years Parents and Babies Program, and one of the first rigorous evaluations of a universally offered preventive intervention for parents with infants. The trial will provide important information on the effectiveness of a relatively brief, universally offered parenting intervention for parents of infants, and will also provide information on infant measures, parent recruitment and participation, and implementation of the program, which could inform future trials.

TRIAL REGISTRATION

This trial was registered with Clinicaltrials.gov (identifier: NCT01931917) on 27 August 2013.

'Living with Teenagers': feasibility study of a peer-led parenting intervention for socially disadvantaged families with adolescent children

OBJECTIVE

To develop and test the feasibility of a peer-led parenting intervention for parents of adolescent children.

DESIGN

Formative evaluation using a mixed-method cohort design.

SETTING

Socially deprived community sites in London, UK.

PARTICIPANTS

Parents seeking help with managing behavioural difficulties of an index adolescent child (aged 11-17 years).

INTERVENTION

A structured, group-based intervention ('Living with Teenagers') delivered by trained peer facilitators.

MAIN OUTCOME MEASURES

We assessed feasibility in terms of uptake and completion rates (% parents completing ≥5 sessions); social validity (assessed by service satisfaction measure and participant interviews); and potential for impact (assessed by parent-reported measures of adolescent behaviour and mental health, parenting satisfaction, expressed emotion, and disciplinary practices).

RESULTS

Participants (n=41) were predominately (79%) from minority ethnic backgrounds and nearly half were lone parents. Most had not previously accessed a structured parenting programme. The completion rate was 71%. Significant changes (p<0.05) were observed in reduced parental concern about adolescent problems, increased parenting satisfaction and less negative expressed emotion. There were non-significant changes in disciplinary practices and adolescent mental health. Participants were highly satisfied with their service experience and endorsed the acceptability of the intervention's content, materials and peer-led format, while suggesting an expanded number of sessions and more skills practice and demonstrations.

CONCLUSIONS

Peer-led parenting groups are feasible and potentially effective for supporting parents of adolescents living in socially disadvantaged communities. These findings warrant more rigorous testing under controlled conditions.

Support-seeking behavior among Japanese mothers at high-risk of mental health problems: a community-based study at a city health center

AIM

The aim of this small-scale study is to explore support-seeking behavior among mothers at high-risk of mental health problems on community basis in Japan.

METHODS

A survey using one month home visit data was conducted among mothers who registered their pregnancy at Shirakawa City Health Center, Fukushima, from April to September 2010. Probable postpartum depression at one month postpartum was assessed using the Japanese version of the Edinburgh Postnatal Depression Scale and the mother's bonding to her child at one month postpartum was measured by the Bonding Questionnaire.

RESULTS

A total of 118 out of 217 registered mothers were available for analysis. The proportion of probable depression among first time and experienced mothers was 12% and 3%, and that of low bonding was 43% and 13%, respectively. Factors that showed significant associations with probable depression and/or low-bonding among first-time mothers were financial difficulty, obstetrical problems, unhappy feeling towards pregnancy, younger maternal age, later gestational week at registration; associated factors among experienced mothers were financial difficulty and obstetrical problems. At the time of pregnancy, 35 (90%) of first-time mothers and 22 (31%) of experienced mothers expressed the intention to attend antenatal classes. None of the risk factors for probable depression or low-bonding were associated with the mother's intention to attend antenatal classes in this study.

CONCLUSION

Pregnancy history, obstetrical problems, sociodemographic information and maternal feeling toward pregnancy should be carefully screened in antenatal phase, and those at risk of postpartum mental health problems should be screened and actively invited to antenatal classes.

Evaluation of the national roll-out of parenting programmes across England: the parenting early intervention programme (PEIP)

BACKGROUND

Evidence based parenting programmes can improve parenting skills and the behaviour of children exhibiting, or at risk of developing, antisocial behaviour. In order to develop a public policy for delivering these programmes it is necessary not only to demonstrate their efficacy through rigorous trials but also to determine that they can be rolled out on a large scale. The aim of the present study was to evaluate the UK government funded national implementation of its Parenting Early Intervention Programme, a national roll-out of parenting programmes for parents of children 8-13 years in all 152 local authorities (LAs) across England. Building upon our study of the Pathfinder (2006-08) implemented in 18 LAs. To the best of our knowledge this is the first comparative study of a national roll-out of parenting programmes and the first study of parents of children 8-13 years.

METHODS

The UK government funded English LAs to implement one or more of five evidence based programmes (later increased to eight): Triple P, Incredible Years, Strengthening Families Strengthening Communities, Families and Schools Together (FAST), and the Strengthening Families Programme (10-14). Parents completed measures of parenting style (laxness and over-reactivity), and mental well-being, and also child behaviour at three time points: pre- and post-course and again one year later.

RESULTS

6143 parents from 43 LAs were included in the study of whom 3325 provided post-test data and 1035 parents provided data at one-year follow up. There were significant improvements for each programme, with effect sizes (Cohen's d) for the combined sample of 0.72 parenting laxness, 0.85 parenting over-reactivity, 0.79 parent mental well-being, and 0.45 for child conduct problems. These improvements were largely maintained one year later. All four programmes for which we had sufficient data for comparison were effective. There were generally larger effects on both parent and child measures for Triple P, but not all between programme comparisons were significant. Results for the targeted group of parents of children 8-13 years were very similar.

CONCLUSIONS

Evidence-based parenting programmes can be rolled out effectively in community settings on a national scale. This study also demonstrates the impact of research on shaping government policy.

A comparison of the effectiveness of three parenting programmes in improving parenting skills, parent mental-well being and children's behaviour when implemented on a large scale in community settings in 18 English local authorities: the parenting early intervention pathfinder (PEIP)

BACKGROUND

There is growing evidence that parenting programmes can improve parenting skills and thereby the behaviour of children exhibiting or at risk of developing antisocial behaviour. Given the high prevalence of childhood behaviour problems the task is to develop large scale application of effective programmes. The aim of this study was to evaluate the UK government funded implementation of the Parenting Early Intervention Pathfinder (PEIP). This involved the large scale rolling out of three programmes to parents of children 8-13 years in 18 local authorities (LAs) over a 2 year period.

METHODS

The UK government's Department for Education allocated each programme (Incredible Years, Triple P and Strengthening Families Strengthening Communities) to six LAs which then developed systems to intervene using parenting groups. Implementation fidelity was supported by the training of group facilitators by staff of the appropriate parenting programme supplemented by supervision. Parents completed measures of parenting style, efficacy, satisfaction, and mental well-being, and also child behaviour.

RESULTS

A total of 1121 parents completed pre- and post-course measures. There were significant improvements on all measures for each programme; effect sizes (Cohen's d) ranged across the programmes from 0.57 to 0.93 for parenting style; 0.33 to 0.77 for parenting satisfaction and self-efficacy; and from 0.49 to 0.88 for parental mental well-being. Effectiveness varied between programmes: Strengthening Families Strengthening Communities was significantly less effective than both the other two programmes in improving parental efficacy, satisfaction and mental well-being. Improvements in child behaviour were found for all programmes: effect sizes for reduction in conduct problems ranged from -0.44 to -0.71 across programmes, with Strengthening Families Strengthening Communities again having significantly lower reductions than Incredible Years.

CONCLUSIONS

Evidence-based parenting programmes can be implemented successfully on a large scale in community settings despite the lack of concentrated and sustained support available during a controlled trial.

Short-term operational evaluation of a group-parenting program for Japanese mothers with poor psychological status: adopting a Canadian program into the Asian public service setting

Although parenting practices differ across various sociocultural settings, scientific research on parenting intervention in Asia is scarce. We adopted a Canadian multilanguage group-based parenting program (Nobody's Perfect) into the Japanese public health service setting and evaluated its impact. Our program was feasible as a public service; was well-accepted among the participants with low psychological status, many of whom were first-time mothers; and had a potential positive impact on the mood of mothers and the self-evaluation of their abilities in society. Our results may facilitate and provide direction for similar research in Asia.

Repetitive behaviours in typically developing 2-year-olds

BACKGROUND

Repetitive behaviours are an essential part of the diagnosis of autism but are also commonly seen in typically developing children. The current study investigated the frequency and factor structure of repetitive behaviours in a large community sample of 2-year-olds.

METHODS

A new measure, the Repetitive Behaviour Questionnaire (RBQ-2) was completed by 679 parents.

RESULTS

The RBQ-2 had good psychometric properties. A four-factor model provided the best fit for the data, accounting for 51% of the variance, and suggested 4 sub-scales: unusual sensory interests, repetitive motor movements, rigidity/adherence to routine and preoccupations with restricted patterns of interest. These sub-scales closely resembled repetitive behaviour subtypes within the ICD-10 criteria for autism. Repetitive behaviours of every type were frequently reported. Higher scores were found for all children, and especially boys, on the subscale relating to preoccupations with restricted patterns of interests.

CONCLUSION

The results support the proposal that repetitive behaviours represent a continuum of functioning that extends to the typically developing child population.

Promoting the social and emotional health of children: where to now?

In advanced industrial societies such as the UK, the burden of disease is shifting from physical to mental health problems--emotional and behavioural problems currently being the major cause of disability in children. Evidence concerning the role of parents in promoting children's social and emotional health, in conjunction with the benefits of supporting parents in this role, has focused attention on the need for greater clarity concerning the role of both parents and governments in supporting and protecting children's social and emotional health. This paper examines the evidence base concerning children's social and emotional development and suggests some steps that may be necessary to ensure the future promotion of children's social and emotional health.

Impact of a general practice based group parenting programme: quantitative and qualitative results from a controlled trial at 12 months

AIMS

To test the effectiveness at one year of the Webster Stratton Parents and Children Series group parenting programme in a population sample of parents.

METHODS

In a multicentre block randomised controlled trial, parents of children aged 2-8 years in 116 families who scored in the upper 50% on a validated behaviour inventory, took part in Webster-Stratton's 10 week parenting programme led by trained and supervised health visitors. The following outcome measures were used: Eyberg Child Behaviour Inventory, Goodman Strengths and Difficulties Questionnaire, General Health Questionnaire, Parenting Stress Index, Rosenberg Self Esteem Scale.

RESULTS

The intervention significantly reduced child behaviour problems and improved mental health at immediate and 6 month follow ups. One year differences between control and intervention groups were not significant. Qualitative results suggest that these findings might be attributable in part to either Hawthorne effects or contamination of control group. At interview parents described ways in which the programme had improved their mental health. They reported gains in confidence and feeling less stressed. Some also reported beneficial changes in their own and their children's behaviour and improved relationships with their children. Some spoke of a need for further sessions to support the behaviour changes they had managed to make, and some the desire for attendance by both parents.

CONCLUSIONS

Parenting programmes have the potential to promote mental health and reduce social inequalities, but further work is needed to improve long term effectiveness.

Improving mental health through parenting programmes: block randomised controlled trial

AIMS

To assess the effectiveness of a parenting programme, delivered by health visitors in primary care, in improving the mental health of children and their parents among a representative general practice population.

METHODS

Parents of children aged 2-8 years who scored in the upper 50% on a behaviour inventory were randomised to the Webster-Stratton 10 week parenting programme delivered by trained health visitors, or no intervention. Main outcome measures were the Eyberg Child Behaviour Inventory and the Goodman Strengths and Difficulties Questionnaire to measure child behaviour, and the General Health Questionnaire, Abidin's Parenting Stress Index, and Rosenberg's Self Esteem Scale to measure parents' mental health. These outcomes were measured before and immediately after the intervention, and at six months follow up.

RESULTS

The intervention was more effective at improving some aspects of the children's mental health, notably conduct problems, than the no intervention control condition. The Goodman conduct problem score was reduced at immediate and six month follow up, and the Eyberg Child Behaviour Inventory was reduced at six months. The intervention also had a short term impact on social dysfunction among parents. These benefits were seen among families with children scoring in the clinical range for behaviour problems and also among children scoring in the non-clinical (normal) range.

CONCLUSION

This intervention could make a useful contribution to the prevention of child behaviour problems and to mental health promotion in primary care.