The FACAM study: protocol for a randomized controlled study of an early interdisciplinary intervention to support women in vulnerable positions through pregnancy and the first 5 years of motherhood

BACKGROUND

Inequality in health can have profound short- and long-term effects on a child's life. Infants develop in a responsive environment, and the relationship between mother and infant begins to develop during pregnancy. The mother's ability to bond with the fetus and newborn child may be challenged by mental health issues which can cause impaired functioning and poorer health outcomes. Families with complex problems need interdisciplinary interventions starting in early pregnancy to be prepared for motherhood and to ensure healthy child development. This study aims to examine the effects of an early and coordinated intervention (the Family Clinic and Municipality (FACAM) intervention) offered to vulnerable pregnant women during pregnancy and the child's first year of life on the mother-child relationship, maternal social functioning, mental health, reflective functioning, well-being, parental stress, and the development and well-being of the child.

METHODS

The study is a prospective randomized controlled trial where we will randomize 320 pregnant women enrolled to receive antenatal care at the family clinic at Odense University Hospital, to either FACAM intervention or usual care. The FACAM intervention consists of extra support by a health nurse or family therapist during pregnancy and until the child starts school. The intervention is most intensive in the first 12 months and also includes attachment-based support provided either individually or in groups. The participants are assessed at baseline, and when the infant is 3 and 12 months old. The primary outcome is maternal sensitivity measured by the Coding Interactive Behavior (CIB) instrument. Secondary outcomes include prenatal parental reflective functioning, mental well-being, depressive symptoms, breastfeeding duration, maternal satisfaction, child development, parent competence, parental stress, and activities with the child.

DISCUSSION

The trial is expected to contribute knowledge about the effect of early coordinated support in antenatal and postnatal care for vulnerable pregnant women and their families.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03659721 . Registered on September 6, 2018.

An educator-administered measure of language development in young children

An increasing number of infants and toddlers in many countries are enrolled in early childhood education (ECE) programs, and educators thus play a central role in stimulating language development in these young children. A valid, brief educator-completed measure of language development in young children has important uses both for the identification and monitoring of language development and for the guidance and evaluation of intentional instruction and targeted interventions for children who need it. We present such a measure here for Danish, the CDI: Educator (CDI-Edu) version, which is based on well-developed and validated parent report measures, adapted for the early childhood education setting. It requires approximately 10 min per child on the part of the educator. It includes a 70-item vocabulary checklist, as well as questions concerning the child's use of decontextualized language with respect to objects and actions distant from the here and now. The test has been standardized on a total of 5097 children aged 18-34 months. Test-retest and internal consistency measures demonstrate reliability. Validation is established through correlations with age, maternal education, the Danish One-Word Picture Vocabulary Test, and the Social Emotional Assessment Measure.