The Incredible Years Parents and Babies Program: A Pilot Randomized Controlled Trial

Effects on Child Development and Parent-Child Interaction of the FACAM Intervention: A Randomized Controlled Study of an Interdisciplinary Intervention to Support Women in Vulnerable Positions through Pregnancy and Early Motherhood

Health inequality can have a profound impact on a child's life. Maternal mental health challenges can hinder bonding, leading to impaired functioning and poorer child outcomes. To provide extra support for vulnerable pregnant women, the FACAM intervention offers the services of a health nurse or family therapist from pregnancy until the child starts school. This study examined the effects of FACAM intervention on pregnant women in vulnerable positions and their children until the child turned two years old. We randomly assigned 331 pregnant women to either FACAM intervention or care as usual and assessed them at baseline and when the infant was 3-6, 12-13.5, and 24 months old. The primary outcome was maternal sensitivity measured by Coding Interactive Behavior (CIB). Secondary outcomes included the parent-child relationship, child social-emotional development, child developmental progress, parent-child interaction, and child development. Our findings indicate that care-as-usual children were significantly more involved than FACAM children when the child was 4-6 months old (b = -0.25, [-0.42; -0.08] d = -0.42). However, we suspect this result is due to a biased dropout. We did not find any significant differences in any other outcomes. Therefore, the study suggests that the FACAM intervention is not superior to care as usual regarding child development and parent-child interaction outcomes.

Does group-based parent support during the transition to parenthood affect child socio-emotional problems and health care utilization? A randomized controlled trial

As government-funded universal programs for new parents continue to expand, it is critical to investigate their short- and longer-term effects. The level of knowledge, especially on the effect of group-based interventions, is sparse. This study is the second report from a large trial of a widely implemented universal group-based parenting program in Denmark and includes outcomes on child socio-emotional problems and use of health services. A sample of 1701 unborn children from families representative within the area, were randomized to intervention or care as usual beginning November 2014. From these families, 1268 mothers and 999 partners (mean age 29.4 and 31.19, respectively; 6% migration background) filled in the Ages and Stages Questionnaire. Intention-to-treat-analyses showed fewer socio-emotional problems in the intervention group (between-group difference - 2.34, 95% CI [0.40, 4.30], d = - 0.13) as reported by mothers, but not partners, when children were 10 months old. This finding was transitory (no longer significant at 19 months). No effects were found on health care utilization. The previous report from this trial showed no effects on measures of parenting. In total, these findings serve the purpose of adjusting future expectations to the size and type of effect to be gained from a universal parent program in a resourceful setting. We conclude that even if the Family Startup Program (DK: Familieiværksætterne) 2 was liked, well implemented, and well attended by the parents, the positive effect on children's socio-emotional problems, was too modest to be the argument that can carry the weight of policy going forward. PUBLIC SIGNIFICANCE STATEMENT: This study examined the effects of the Family Startup Program (DK: Familieiværksætterne), a universal, group-based program to support parents during the transition to parenthood. Results showed a modest transitory preventive effect on children's socio-emotional problems and no effects on health care utilization. These findings adjust down previous expectations to the size and type of effects to be gained from universal group-based parent support in a well-resourced setting.

A meta-analytic review of the implementation characteristics in parenting interventions to promote early child development

This review summarizes the implementation characteristics of parenting interventions to promote early child development (ECD) outcomes from birth to 3 years. We included 134 articles representing 123 parenting trials (PROSPERO record CRD42022285998). Studies were conducted across high-income (62%) and low-and-middle-income (38%) countries. The most frequently used interventions were Reach Up and Learn, Nurse Family Partnership, and Head Start. Half of the interventions were delivered as home visits. The other half used mixed settings and modalities (27%), clinic visits (12%), and community-based group sessions (11%). Due to the lack of data, we were only able to test the moderating role of a few implementation characteristics in intervention impacts on parenting and cognitive outcomes (by country income level) in the meta-analysis. None of the implementation characteristics moderated intervention impacts on cognitive or parenting outcomes in low- and middle-income or high-income countries. There is a significant need in the field of parenting interventions for ECD to consistently collect and report data on key implementation characteristics. These data are needed to advance our understanding of how parenting interventions are implemented and how implementation factors impact outcomes to help inform the scale-up of effective interventions to improve child development.

Parenting and family self-sufficiency services contribute to impacts of Early Head Start for children and families

Introduction

There is evidence that two-generation early childhood programs, those that strive to support not only child development, but also optimal parenting and family wellbeing, help to foster resilience for young children and their families in the face of adversity.

Methods

Using data from a large experimental evaluation, the Early Head Start Research and Evaluation Project, this paper explores how parenting and family self-sufficiency services embedded in Early Head Start (EHS), a federally funded, nationally implemented two-generation early childhood program for low-income families lasting from pregnancy and until children are three, contribute to the impacts of the program for both the children and their families.

Results

Parenting support in any modality (home visiting, case management or parent education) contributed to program impacts on important child and family outcomes, but not parent employment. Somewhat surprisingly, family receipt of employment services did not lead to any of the impacts of the program, while education and job training services did. When EHS parents received education or job training services, it led to impacts not only on mother employment, but also on other important family and child outcomes.

Discussion

These findings validate and reinforce the two-generation approach of EHS, specifically supporting the focus on parenting and parent education and job training.

Effects of an Online Play-Based Parenting Program on Child Development and the Quality of Caregiver-Child Interaction: A Randomized Controlled Trial

Background

Studies assessing the effects of parenting programs have focused on interventions delivered through face-to-face modalities. There is a need for research to evaluate the effects of online parenting programs on child development, such as the BEM Program ('Play Teaches Change' in English), an online play-based parenting program that teaches caregivers on how to introduce playful interactions into their daily household chores.

Objective

To assess the effects of the BEM Program on child development and the quality of caregiver-child interaction.

Method

A two-arm randomized controlled trial was conducted in a socioeconomically disadvantaged district of São Paulo city in Brazil. 129 children aged 12-23 months and their caregiver were randomly assigned to receive either the BEM Program for 8 weeks (intervention, n = 66) or standard child care (control, n = 63). Data were collected at baseline and endline of the intervention through home visits and online interviews. An intention-to-treat analysis was conducted.

Results

The intervention showed positive effects on child development, by improving language development (Cohen's d = 0.20, 95%CI 0.08-0.47) and reduced intrusiveness (Cohen's d = 0.35, 95%CI 0.06-0.65) of caregiver-child interaction. No significant differences were observed in caregiver's repertoire and engagement in age-appropriate play activities with the child while doing the household chores, parenting sense of competence and perceived stress.

Conclusions

Despite the small size and low adherence to the program, such promising results advance evidences for fully remote parenting programs and their effects on child development.

Baby and us: Community-based, Feasibility Trial of a Psychosocial Intervention for New Parents and their Infants

Infancy is a critical period during which major developmental transformations occur. Early parenting is one of the strongest influences on infants’ immediate and longer-term outcomes. The transition to parenting can be demanding and stressful for mothers and fathers. This paper reports results from a feasibility study of the Empowering Parents Empowering Communities Baby and Us programme, an 8-week, universal, peer-led parenting programme for new parents living in socially disadvantaged communities. This study is a quasi-experimental, one arm, no control group study, assessing the feasibility and acceptability of Baby and Us. Programme participants (n = 158) completed standardised self-report measures of parent goal attainment, self-efficacy, knowledge about parenting, mental wellbeing, parental confidence, and programme acceptability. We found that recruiting parents from disadvantaged backgrounds was feasible (96% of programmes recruited sufficient parents to proceed, mean = 6.6 parents per programme); parent goals closely matched the aims of the programme; programme completion was high (74%), and self-report measurement completion rates were in line with other large scale community delivered parenting programmes; parents rated the programme as highly satisfactory; and they reported significant improvements in their mental wellbeing, confidence, parenting skills, self-efficacy, and goal attainment. These results provide important data to conduct a full-scale trial of Baby and Us.

Parent-child relationship outcomes of the Incredible Years Parents and Babies Program: A Pilot Randomized Controlled Trial

Background

A warm, sensitive, and responsive relationship to a caregiver is essential for healthy child development.

Objective

This paper examines the effects of the Incredible Years Parents and Babies (IYPB) program on the parent-child relationship at post-intervention when offered as a universal parenting intervention to parents with newborn infants.

Method

We conducted a pragmatic, two-arm, parallel pilot randomized controlled trial; 112 families with newborns were randomized to IYPB intervention (76) or usual care (36). The IYPB program is a group intervention with eight two-hour sessions. In addition to parent-reported questionnaires, we collected a six-minute-long video at post-intervention from 97 families to assess the parent-child relationship, which was then coded with the Coding Interactive Behavior system.

Results

There were no significant intervention effects on either the total score or any of the seven subscales at post-intervention when the children were around 5.5 months old. For parental sensitivity, results were significant at the 10% level, favoring the IYPB group. When examining the lowest-functioning mothers in moderator analyses, we also found no significant differences between the two groups.

Conclusion

In line with parent-report outcomes, we did not find any statistically significant differences between the IYPB program and usual care on parent-child relationship when offered as a universal intervention for a relatively well-functioning group of parents with infants in a setting with a high standard of usual care. However, there was a positive trend for the total score, parental sensitivity and reciprocity with effect sizes in the range of .41-.51. It is possible that a larger sample would have resulted in significant differences for these outcomes.

Trial registration

ClinicalTrials.gov NCT01931917 (registration date August 27, 2013)

A proportionate, universal parenting programme to enhance social-emotional well-being in infants and toddlers in England: the E-SEE Steps RCT

Background

Mental disorders have become a public health crisis. Early prevention is key. Parenting programmes are effective for children aged ≥ 3 years; however, there is a lack of evidence of their effectiveness for children aged ≤ 2 years.

Objectives

To establish if the model named Enhancing Social–Emotional Health and Well-being in the Early Years (E-SEE) Steps can (1) enhance child social emotional well-being and establish whether or not it is cost-effective at 20 months of age when compared with services as usual; and (2) be delivered as a proportionate universal model with fidelity.

Design

A pragmatic two-arm randomised controlled trial and economic appraisal, with an embedded process evaluation to examine the outcomes, implementation and cost-effectiveness of the intervention, and intervention uptake, compared with services as usual. The study had an external pilot phase (which was originally planned as an internal pilot).

Setting

The intervention was delivered in community settings by early years children’s services and/or public health staff in four sites.

Participants

A total of 341 parents of infants aged ≤ 8 weeks were randomised in a ratio of 5 : 1 (intervention, n = 285; control, n = 56). The target sample was 606 parents.

Intervention

Two Incredible Years® parenting programmes (i.e. infant and toddler) delivered in a proportionate universal model with three levels [one universal (book) and two targeted group-based parenting programmes].

Main outcome measures

Child social and emotional well-being (primary outcome) was assessed using the Ages and Stages Questionnaire: Social and Emotional, 2nd edition, at 2, 9 and 18 months after randomisation. Parent depression (secondary key outcome) was assessed using the Patient Health Questionnaire-9 items. Both questionnaires were eligibility screeners for targeted groups.

Results

The primary outcome analysis provided no evidence that the E-SEE Steps model was effective in enhancing child social and emotional well-being. The adjusted mean difference was 3.02 on the original Ages and Stages Questionnaire: Social and Emotional, 2nd edition, in favour of the control [95% confidence interval –0.03 to 6.08; p = 0.052; N = 321 (intervention, n = 268; control, n = 53)]. Analysis of the key secondary outcome (i.e. parent depression levels as assessed by the Patient Health Questionnaire-9 items) provided weak evidence on the Patient Health Questionnaire-9 items in favour of the intervention (adjusted mean difference –0.61, 95% confidence interval –1.34 to 0.12; p = 0.1). Other secondary outcomes did not differ between arms. The economic analysis showed that the E-SEE Steps model was associated with higher costs and was marginally more effective (0.031 quality-adjusted life-years gained from E-SEE Steps compared with SAU, 95% confidence interval –0.008 to 0.071) than services as usual, resulting in an incremental cost-effectiveness ratio of approximately £20,062 per quality-adjusted life-year compared with services as usual. Overall take-up of the targeted parenting programmes was low. Sites, although enthusiastic, identified barriers to delivering the intervention.

Limitations

The target sample size was not met and the study was not powered to explore the effectiveness of each level of intervention. Most parents in the sample were well educated and, therefore, the results are unlikely to be generalisable, particularly to those at greatest risk of poor social and emotional well-being.

Conclusions

The E-SEE Steps proportionate universal model did not enhance child social and emotional well-being, but generated non-significant improvements in parent health outcomes, resulting in considerable uncertainty around the cost-effectiveness of the intervention. The primary and key secondary outcome gave inconsistent signals. Although, with system changes, increased resources and adaptations to the intervention, the model could be implemented, evidence for positive outcomes from the E-SEE Steps model is poor.

Future work

The universal-level E-SEE Step data (i.e. the Incredible Years book) from the external pilot will be pooled with the main trial data for further exploration up to follow-up 1, which is the time point at which most change was seen.

Trial registration

This trial is registered as ISRCTN11079129.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 8. See the NIHR Journals Library website for further project information.

Introducing Parenting Support in Primary Care: Professionals’ Perspectives on the Implementation of a Positive Parenting Program

While positive parenting programs are an initiative aligned with the Family-Centered Care model and the Council of Europe’s Recommendation on Positive Parenting, implementation in healthcare centers remains a challenge. The aims of this study were to (1) investigate how the hybrid version (online course plus face-to-face activities) of the program “Gain Health & Wellbeing From 0 to 3” was implemented in Spain from professionals’ perspective, and (2) explore the perceived impact of this hybrid version of the program on the implementers’ professional development. We used a qualitative mixed-methods design that included focus groups and surveys. Fifty professionals from 17 centers completed the survey on professional development. Thirty-one of these also participated in the focus groups to address the first aim. The key themes identified from the focus group were professional training, parent recruitment, program features, organizational issues, parental responses, and program sustainability. Survey results related to positive professional impact fit nicely with subthemes concerning collaboration with parents, parental needs, center coordination, and future expectations. The perceived relevance of the parenting program and its positive impact on the implementers’ professional development were potential predictors for the adoption and sustainability of the program in the public health system.

Evidence base review of couple- and family-based psychosocial interventions to promote infant and early childhood mental health, 2010-2019

Infant and early childhood mental health (IECMH) has been defined as the capacity of infants and young children to regulate their emotions, form secure relationships, and explore their environments. For this special issue, we conducted a review of IECMH outcomes from evaluations of couple- and family-based psychosocial interventions not explicitly designed for trauma exposure published from 2010 through 2019, following Evidence Base Update criteria and the current convention of classifying general categories of intervention approaches rather than the former practice of evaluating specific brand-name packaged programs. Full-text review of 695 articles resulted in 39 articles eligible for categorization into intervention approaches, taking into consideration the theoretical orientation of the treatment, the population served, the intervention participants, the target outcomes, the treatment theory of change, and the degree to which the intervention was standardized across participants. Four intervention approaches were identified in this review as Probably Efficacious: Behavioral Interventions to Support Parents of Toddlers, Interventions to Support Adolescent Mothers, Tiered Interventions to Provide Support Based on Assessed Risk, and Home Visiting Interventions to Provide Individualized Support to Parents. Other intervention approaches were classified as Possibly Efficacious, Experimental, or did not have sufficient evidence in this time period to classify under these criteria. Further research could explore how to ensure that all families who need support can receive it, such as by increasing the reach of effective programs and by decreasing the number of families needing additional support.

What do parents think of using informational videos to support recruitment for parenting trials? A qualitative study

Background

Lower than expected recruitment and retention rates are common challenges in parenting trials—particularly for community-based trials targeting parents of young children that rely on face-to-face recruitment by frontline workers. Recruitment requires parental informed consent, yet information sheets have been criticized for being lengthy and complex, and particularly challenging for parents with low literacy. Recent innovations include ‘talking head’ information videos. This paper aims to explore parent perceptions of using a ‘talking head’ video to support informed consent, recruitment, and retention procedures in parenting trials.

Methods

We conducted semi-structured interviews with a sample of 24 mothers recruited after their final follow-ups in two different parenting trials in Denmark. Before consenting to participate in the trials, parents were invited to view a video of a member of the study team giving information about the study, and again before the interviews for the current study. The audio data was transcribed and thematic analysis was conducted.

Results

We identified three overarching themes: (1) general impression of the video, (2) thoughts on participation in research, and (3) recruitment and retention. Participants were generally positive in their appraisal of the two talking head informational videos. We found that participants felt that a mix of paper-based and video-based sources of information would enable them to make an informed choice about whether to participate in a research study. We also found that a professionally produced video featuring a key member of the study team produced a feeling of commitment to the study that could impact retention rates.

Conclusions

Informational videos are acceptable to parents; however, co-production or participant/patient involvement in the development of such videos is recommended. Informational videos may not increase recruitment but have the potential for improving retention. Key design recommendations are to ensure a ‘professional’ look to the video, to supplement videos with paper-based information, to keep the length to < 3 min, and for the ‘talking head’ part to feature a key member of the study team.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05826-0.

Group-based parent support during the transition to parenthood: Primary outcomes from a randomised controlled trial

RATIONALE

Theory suggests that when parents believe in their ability to positively influence their children, the children are at lower risk of poor developmental outcome. For this reason, parents' sense of competence is a common target in early parenting interventions.

OBJECTIVE

This study assessed effects on parents' sense of competence, parenting stress, and symptoms of depression from a widely implemented universal and group-based parenting program.

METHODS

In total, 1701 families were enrolled and randomised to one of two conditions a) participation in Family Start up Program (FSP), currently implemented at large scale in Denmark, or b) Care as Usual (CAU). FSP aims to empower new parents through knowledge and network. CAU is the public pre- and post-natal care available to families in both conditions. Recruitment was conducted between November 24, 2014, and February 1, 2017 at Aarhus University Hospital, from all incoming pregnant women within one of the larger Danish municipalities. In total, 4313 families were assessed for eligibility. Data were analysed as intention-to-treat and with n = 1255 (74%) mothers and n = 984 (60%) partners who responded at 10 months postpartum.

RESULTS

When randomised to the FSP, 92% of the mothers and 94% of the partners received the intervention attending an average of 8.4 [SD = 3∙4] and 7.9 [SD = 3∙3] group meetings, respectively. The program evaluation data indicated that parents were satisfied with the program. We found no mean differences between FSP and CAU in parental sense of competence, parental stress, or symptoms of depression at 10 months in mothers or partners.

CONCLUSION

The intervention did not influence parents' sense of competence even if the parents attended and liked the group meetings. This highlights the need for refinement of either the intervention approach or the expectation to its outcome. ClinicalTrials.gov ID: NCT02294968.

Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis

BACKGROUND

Parents are the primary caregivers of young children. Responsive parent-child relationships and parental support for learning during the earliest years of life are crucial for promoting early child development (ECD). We conducted a global systematic review and meta-analysis to evaluate the effectiveness of parenting interventions on ECD and parenting outcomes.

METHODS AND FINDINGS

We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for peer-reviewed, published articles from database inception until November 15, 2020. We included randomized controlled trials (RCTs) of parenting interventions delivered during the first 3 years of life that evaluated at least 1 ECD outcome. At least 2 reviewers independently screened, extracted data, and assessed study quality from eligible studies. ECD outcomes included cognitive, language, motor, and socioemotional development, behavior problems, and attachment. Parenting outcomes included parenting knowledge, parenting practices, parent-child interactions, and parental depressive symptoms. We calculated intervention effect sizes as the standardized mean difference (SMD) and estimated pooled effect sizes for each outcome separately using robust variance estimation meta-analytic approaches. We used random-effects meta-regression models to assess potential effect modification by country-income level, child age, intervention content, duration, delivery, setting, and study quality. This review was registered with PROSPERO (CRD42018092458 and CRD42018092461). Of the 11,920 articles identified, we included 111 articles representing 102 unique RCTs. Pooled effect sizes indicated positive benefits of parenting interventions on child cognitive development (SMD = 0.32, 95% CI [confidence interval]: 0.23, 0.40, P < 0.001), language development (SMD = 0.28, 95% CI: 0.18 to 0.37, P < 0.001), motor development (SMD = 0.24, 95% CI: 0.15 to 0.32, P < 0.001), socioemotional development (SMD = 0.19, 95% CI: 0.10 to 0.28, P < 0.001), and attachment (SMD = 0.29, 95% CI: 0.18 to 0.40, P < 0.001) and reductions in behavior problems (SMD = -0.13, 95% CI: -0.18 to -0.08, P < 0.001). Positive benefits were also found on parenting knowledge (SMD = 0.56, 95% CI: 0.33 to 0.79, P < 0.001), parenting practices (SMD = 0.33, 95% CI: 0.22 to 0.44, P < 0.001), and parent-child interactions (SMD = 0.39, 95% CI: 0.24 to 0.53, P < 0.001). However, there was no significant reduction in parental depressive symptoms (SMD = -0.07, 95% CI: -0.16 to 0.02, P = 0.08). Subgroup analyses revealed significantly greater effects on child cognitive, language, and motor development, and parenting practices in low- and middle-income countries compared to high-income countries; and significantly greater effects on child cognitive development, parenting knowledge, parenting practices, and parent-child interactions for programs that focused on responsive caregiving compared to those that did not. On the other hand, there was no clear evidence of effect modification by child age, intervention duration, delivery, setting, or study risk of bias. Study limitations include considerable unexplained heterogeneity, inadequate reporting of intervention content and implementation, and varying quality of evidence in terms of the conduct of trials and robustness of outcome measures used across studies.

CONCLUSIONS

Parenting interventions for children during the first 3 years of life are effective for improving ECD outcomes and enhancing parenting outcomes across low-, middle-, and high-income countries. Increasing implementation of effective and high-quality parenting interventions is needed globally and at scale in order to support parents and enable young children to achieve their full developmental potential.

One-year follow-up of The Incredible Years Parents and Babies Program: A pilot randomized controlled trial

Background

The foundation of a healthy life begins in pregnancy and early adversity can have detrimental long-term consequences for affected children.

Objective

This paper examines the effects of the Incredible Years Parents and Babies program (IYPB) at one-year follow-up when offered as a universal parenting intervention to parents with newborn infants.

Method

We conducted a pragmatic, two-arm, parallel pilot randomized controlled trial; 112 families with newborns were randomized to IYPB intervention (n = 76) or usual care (n = 36). The IYPB program is a group intervention with eight two-hour sessions. Follow-up outcomes collected a year after the intervention ended include parental stress, depression, well-being, reflective function, sense of competence, and child cognitive and socio-emotional development.

Results

There were no intervention effects on any of the primary or secondary parent-reported outcomes at one-year follow-up when the children were 18 months old. When examining the lowest-functioning mothers in moderator analyses, we found that mothers assigned to the IYPB group reported significantly lower scores for the interest and curiosity subscale of the parent reflective function scale than control mothers (β=-1,07 [-2.09,-0.06]).

Conclusion

We found no long-term effects of the IYPB when offered as a universal intervention for a relatively well-functioning group of parents with infants in a setting with a high standard of usual care. The intervention was developed for more vulnerable families in settings with a low level of universal care and the program may be effective for families in those circumstances.

"Putting Meat on the Bones": Understanding the Implementation of a Community-Based Early Intervention and Prevention Programme-Contextual, Person, and Programme Influences

The adoption and effective delivery of evidence-based interventions within "real-world" community-based, primary health care service settings are of crucial importance. In this paper, we explore the successes and challenges of implementing a new complex, group-based, early parenting intervention called the Parent and Infant (PIN) programme. This study involved a systematic analysis of the processes and factors that influence the implementation of the PIN programme; the analysis was guided and informed by the Implementation Outcome Framework and the Consolidated Framework for Implementation Research. A documentary review, alongside a series of one-to-one interviews and small group discussions with a range of stakeholders (n = 44), and 7 focus groups (n = 24) were used as data sources. Factors that promoted programme adoption, acceptability, and implementation feasibility included programme characteristics and stakeholder attitudes, as well as organisational and systems factors (e.g. leadership and collaboration). Key challenges to implementation success included engagement and adoption barriers. This research provides a useful and important example of real-world, theory-driven implementation research which helped to identify interrelated processes, factors, and contexts which shape and influence the implementation of early intervention and prevention programmes, removed for blind review.

Comparison of video and in-hospital consultations during early in-home care for premature infants and their families: A randomised trial

Introduction

Early in-home care is increasingly being used in Scandinavian countries for clinically stable premature infants. Due to challenges with travel and hospital resources, alternative ways to support parents during early in-home care are being considered. The aim of this study was to test whether the proportion of mothers exclusively breastfeeding, parental confidence and mother–infant interaction increased after early in-home care with premature infants, and to compare the outcomes of in-home care involving the use of video communication and a mobile application with those of in-home care involving in-hospital consultations.

Methods

This study was conducted in four neonatal wards offering premature infant in-home care in Denmark. Premature infants were randomised using 1:1 block randomisation. During early in-home care, families had planned consultations two to three times a week, during which they received support from nurses: the intervention group had video consultations, while the control group had in-hospital consultations.

Results

The proportion of exclusively breastfeeding mothers at discharge was 66.7% in the intervention group vs 66% in the control group and decreased to 49.4% vs 55%, respectively, 1 month after discharge. No significant improvements were found in the intervention group compared with the control group. In the intervention group, some video consultations were changed to telephone consultations due to problems with the video function, or to in-hospital consultations due to infants’ requirement for medical services. No significant differences in secondary outcomes were observed.

Discussion

The study showed similar breastfeeding proportions at discharge. No unfavourable effects of video consultation compared with in-hospital consultation were found, indicating that video consultation could be a viable option and an important supplement during early in-home care.

Trial registration

ClinicalTrials.gov ID: NCT02581800.

The Relevance of Infant Outcome Measures: A Pilot-RCT Comparing Baby Triple P Positive Parenting Program With Care as Usual

Problems in infant mental health such as the ability to experience, regulate, and express emotional states is expressed in behavioral problems like excessive crying, feeding, and sleeping problems. Parenting programs are popular but their effectiveness on infant mental health remains uncertain. Possibly, because recent studies have focused only on parental and parent–child measures while they miss to assess infant behavioral measures. The goal of this pilot study is to fill in this gap by assessing infantile behavioral measures. We investigated the acceptance and first indicators of efficacy of the universal group parenting training Baby Triple P (BTP) compared to a care as usual (CAU) control condition focusing on early behavioral problems. In all, 49 couples were randomly allocated to receive either eight BTP sessions before birth and per telephone after birth or to take part in CAU. Infant behavior was assessed with a diary and a structured diagnostic interview. Parental self-report measures of partnership quality and parental competence were assessed before birth, 10 weeks after birth and at 6-month follow-up. Since the parent training was conducted before the birth of the child, the child’s mental health could not be assessed before the parent training. Thus, for this variable no within measurement (pre–post) could be carried out and intention-to-treat analysis was not possible. However, a between group analysis comparing BTP against CAU took place to assess effectiveness of BTP on children’s mental health. Mothers and fathers rated the program as feasible and relevant. Results indicate significant group differences in crying behavior 6 months after birth to the benefit of the intervention group. No beneficial outcomes were found for feeding and sleeping problems in infants or partnership quality, parental sense of competence in parents. Due to an unrepresentative high level of education of the participating parents and the small sample size, these findings can be considered preliminary. Nevertheless, these results allow to further investigate the effectivity of BTP in large-scale clinical trials. Behavioral diaries or diagnostic interviews for early mental health problems should be routinely implemented in randomized controlled trials (RCTs) in order not to miss possible behavioral changes in infants.

Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02313493.

Parent and facilitator experiences of an intensive parent and infant programme delivered in routine community settings

AIM

The aims of this study were to (1) assess the initial experiences of parenthood amongst mainly disadvantaged mothers; (2) explore their views on the extent to which they felt they had benefitted (or not) from participating in a newly developed, intensive mother and baby support programme in the community; and (3) explore the perspectives of those who delivered the programme (i.e., facilitators), most of whom were Public Health Nurses (PHNs).

BACKGROUND

Positive parent-child interactions and appropriate levels of infant stimulation are essential to promoting a child's well-being and laying a foundation in the early years for positive developmental outcomes. It is important, therefore, to examine participants' experiences of community-based, family-focused, early prevention and intervention programmes.

METHODS

This study was undertaken as part of a larger evaluation of a newly developed parent and infant (PIN) programme which was delivered in two disadvantaged areas in Ireland. One-to-one interviews were conducted with both mothers (n = 22) and facilitators (n = 8) (including three PHNs) plus six focus groups with an additional sub-group of facilitators (n = 17).

FINDINGS

The collective findings suggest that mothers found the programme helpful in promoting a greater understanding of their infants' behaviour and needs, and in alleviating stress and concerns associated with motherhood. Mothers described feeling more knowledgeable about the importance of regular and appropriate infant interaction to encourage learning and development. Facilitators, specifically PHNs, also reported a greater awareness of the value of infant socioemotional development for their clinical practice and observed greater positive communication between mothers and infants.

CONCLUSION

These findings suggest that a community-based, intensive mother and baby programme can help to promote parental competence and enhance infant learning and development. Additional benefits in terms of early intervention and positive changes to public health nursing practice are also discussed.

Maternal confidence after birth in at-risk and not-at-risk mothers: internal and external validity of the Danish version of the Karitane Parenting Confidence Scale (KPCS)

BACKGROUND

Parenting confidence is a key factor in predicting a range of outcomes for both parents and children, such as parental depression, parental stress, and child health development. This study examines maternal confidence in at-risk and not-at-risk mothers and the psychometric properties of the Karitane Parenting Confidence Scale (KPCS).

RESULTS

The total sample consisted of 695 mothers (488 not-at-risk and 207 at-risk) from a community setting. Cronbach's alpha ranged from 0.72 to 0.79, and item-rest correlations ranged from 0.17 to 0.57. Total score improved significantly from 41.75 at two months to 42.41 at six months for the not-at-risk group and increased significantly from 39.51 at two months to 41.12 at six months for the at-risk group. The differences between the two risk groups were significant at both times.

CONCLUSION

The KPCS has acceptable internal consistency, but an overall ceiling effect, with many items characterized by low discrimination. Despite a significant difference in maternal confidence between at-risk and not-at-risk mothers at both two and six months, the total score did not predict risk status very well in this sample. A nine-item version may be equal to the original 15-item version.

Comparative use of the Ages and Stages Questionnaires in the USA and Scandinavia: a systematic review

AIM

The aim of this systematic review was to investigate screening practices with the Ages and Stages Questionnaires (ASQ) and the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) in the USA and Scandinavia and to identify practical lessons and research opportunities.

METHOD

The review was performed for ASQ- and ASQ:SE-related studies in children from birth to 5 years. From nine databases and 1689 references (published from 1988-2018), 127 articles were included and categorized using Covidence online software. The Critical Appraisal Skills Programme Checklists were used before data synthesis.

RESULTS

US studies primarily use the ASQ/ASQ:SE to detect delays in general and at-risk populations in medical settings, which increases early detection, clinician-referral, and intervention rates. Scandinavian studies commonly use the ASQ/ASQ:SE to monitor developmental-behavioural differences in intervention/exposure-based cohorts. Pre-visit screening yields completion/return rates of 83% to more than 90% and fosters same-day interpretation. When referrals are indicated, systemwide care coordination or colocation with a developmental-behavioural specialist is beneficial.

INTERPRETATION

Practical implementation lessons are reviewed. Research opportunities include investigating and measuring the ASQ/ASQ:SE's 'overall' sections. Danish, Norwegian, and Swedish translations are available but up-to-date norming and validation studies are needed throughout Scandinavia. Randomized controlled trials are needed to investigate outcomes in screened versus unscreened cohorts.

WHAT THIS PAPER ADDS

General and at-risk populations broadly benefited from periodic Ages and Stages Questionnaires (ASQ) and/or Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) screening. Pre-visit ASQ and/or ASQ:SE screenining implementation systems work best. The ASQ and ASQ:SE 'overall' sections are not quantifiable and under-researched.