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  • 1. ______________________________________________________________________________________[Type text]MARCH 2013This publication was made possible through the support of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)through the U.S. Agency for International Development under contract number GHH-I-00-07-00059-00, AIDS Support andTechnical Assistance Resources (AIDSTAR-One) Project, Sector I, Task Order 1.A REVIEW OF PUBLISHED LITERATUREON SUPPORTING AND STRENGTHENINGCHILD-CAREGIVER RELATIONSHIPS(PARENTING)
  • 2. -DRAFT-
  • 3. -DRAFT-The authors views expressed in this publication do not necessarily reflect the views of the U.S. Agency forInternational Development or the United States Government.A REVIEW OF PUBLISHEDLITERATURE ONSUPPORTING ANDSTRENGTHENING CHILD-CAREGIVER RELATIONSHIPS(PARENTING)
  • 4. -DRAFT-AIDS Support and Technical Assistance Resources ProjectAIDS Support and Technical Assistance Resources, Sector I, Task Order 1 (AIDSTAR-One) is funded by theU.S. Agency for International Development under contract no. GHH-I-00–07–00059–00, funded January 31,2008. AIDSTAR-One is implemented by John Snow, Inc., in collaboration with Broad Reach Healthcare,Encompass, LLC, International Center for Research on Women, MAP International, Mothers 2 Mothers,Social and Scientific Systems, Inc., University of Alabama at Birmingham, the White Ribbon Alliance for SafeMotherhood, and World Education. The project provides technical assistance services to the Office ofHIV/AIDS and USG country teams in knowledge management, technical leadership, program sustainability,strategic planning, and program implementation support.Recommended CitationRichter, Linda M. and Sara Naicker. 2013. A Review of Published Literature on Supporting and Strengthening Child-Caregiver Relationships (Parenting). Arlington, VA: USAID’s AIDS Support and Technical Assistance Resources,AIDSTAR-One, Task Order 1.AcknowledgmentsThank you to the reviewers who provided excellent feedback and insight on the first draft of this document:Kate Iorpenda, Senior Advisor: Children and Impact Mitigation, International HIV/AIDS Alliance; JoanLombardi, Senior Fellow, Bernard van Leer Foundation; Nancy Geyelin Margie, Research Fellow, Office ofPlanning, Research and Evaluation, Administration for Children and Families, U. S. Department of Healthand Human Services; and Nurper Ülküer, former Advisor and Global Chief of Early Childhood Programs,UNICEF.Additional thank you to Gretchen Bachman, Senior Technical Advisor, PEPFAR Orphans and VulnerableChildren Technical Working Group Co-Chair, Office of HIV/AIDS, USAID; Janet Shriberg, M&ETechnical Advisor, Orphans and Vulnerable Children, Office of HIV/AIDS, USAID; and Marcy Levy,Orphans and Vulnerable Children Advisor, AIDSTAR-One.AIDSTAR-OneJohn Snow, Inc.1616 Fort Myer Drive, 16th FloorArlington, VA 22209 USAPhone: 703-528-7474Fax: 703-528-7480E-mail: info@aidstar-one.comInternet:
  • 5. -DRAFT-iiiCONTENTSExecutive Summary............................................................................................................................................vTechnical Note.................................................................................................................................................viiiGlossary...............................................................................................................................................................ixIntroduction...................................................................................................................................................... 11Families and HIV.............................................................................................................................................. 11Parenting and HIV ........................................................................................................................................... 13Supporting Parenting, Strengthening Caregiving....................................................................................... 15Theoretical Orientations in Parent Support ............................................................................................. 17Characteristics of Parent Support Interventions ..................................................................................... 19Effectiveness of Parenting Support .............................................................................................................. 21Preparation for parenthood..................................................................................................................................22Promoting children’s growth, development, learning, language, and education......................................24Child behavior management ................................................................................................................................26Family relations and child protection..................................................................................................................27Parental well-being..................................................................................................................................................28Adaptation and Implementation................................................................................................................... 29Structural Enablers for Parenting................................................................................................................. 32Conclusions ...................................................................................................................................................... 36References......................................................................................................................................................... 38Appendix 1: Methods of the Review........................................................................................................... 44Literature Search............................................................................................................................................. 44Appendix 2: The Quality of the Evidence for Parenting Support......................................................... 51Appendix 3: Summaries of Overviews and Systematic Reviews (2000-12) ....................................... 54Appendix 4: Brief Descriptions of Parent Support Programs .............................................................102Appendix 5: List Of References Included In The Literature Review.................................................147
  • 6. -DRAFT-iv
  • 7. -DRAFT-vEXECUTIVE SUMMARYThe remit for this literature review was to undertake a review of published literature from 2000 to2012 and to summarize empirically based recommendations for supporting and strengthening child-caregiver relationships in the context of HIV and poverty. The review covers children generally, andtakes a strengths-based approach that builds on the resources and capacities of children, caregivers,families, and communities. The review is not limited by geographical scope, but draws on what areconsidered universal features of children’s development and their relationships with caregivers,though specific variables may be influenced by cultural and local context. The review took intoaccount the broad body of research on supporting and strengthening child-caregiver relationships orparenting in order to extract general principles to guide discussions on the implementation ofparenting programs in contexts affected by HIV and poverty.Key findings include the following:• Families comprise the key response to children affected by HIV and poverty and are a criticalplatform for sustainable interventions to support and protect affected children.• Globally, funders, policy makers, and program implementers have accepted that familystrengthening is a core component of sustainable and effective responses to protect childrenaffected by AIDS and poverty. While economic assistance is recognized as a key aspect of a familystrengthening approach, less is known about effective methods for supporting parenting andcaregiving.• Although very few studies on strengthening parenting have been conducted in settings in whichchildren and families are affected by AIDS and poverty, there are solid grounds for optimismbased on positive results from parenting support programs in high-income countries and expertisegained over nearly 100 years of interventions to support parenting.• Many of the existing evidence-based programs are culture-bound and labor-intensive, and wouldbe difficult and costly to reproduce in low- and middle-income countries. However, it is notknown what degree of fidelity to such programs is required to achieve beneficial effects. Theresearch available attests to the wide flexibility of programs within a set of known parametersassociated with greater effectiveness.• There is good reason to assume that the theoretical bases for parenting programs―attachmenttheory, language acquisition, and social learning, among others―are universal mechanisms despitethe fact that they manifest differently under various sociocultural conditions. In addition, the goalsof parenting programs in high-income countries―to improve parental facilitation of children’shealth and development, to reduce parental stress, to improve family well-being, and to managedifficult child behavior―resonate with the known needs of caregivers and children affected byAIDS and poverty, although these also vary according to context.• Efforts to strengthen parenting are justified by the known impacts of HIV and poverty onchildren and families. Parents and other caregivers are under stress, children are in danger of beingneglected and critical aspects of their human potential lost, and parent-child and familyrelationships may suffer as a result of adversities arising from poverty and isolation.
  • 8. -DRAFT-vi• The studies reviewed together provide good evidence for the value of ongoing parenthoodsupport programs, especially those for young mothers and other caregivers facing particularchallenges that put them at high risk for parenting problems. In the context of HIV and poverty inlow- and middle-income countries, these at-risk groups are likely to include parents and othercaregivers living with HIV, destitute families in high-HIV prevalence areas, aged caregivers,caregivers or children living with a disability, and socially isolated caregivers with little socialsupport.• Promoting early child development is an enormously promising area, with indications thatparenting programs aimed at improving children’s development have not received the attentionthey merit. There is very good reason to expect that programs to promote early language andliteracy development are feasible, that they could be used to promote positive relationshipsbetween parents and children, and that they will benefit children’s language and cognitivedevelopment as well as their transition to school. This potential can be greatly enhanced if effortsto promote children’s learning are embedded within broader child health partnerships, as occurs inmany large-scale programs in high-income countries.• The effectiveness of parent programs aimed at improving parent-child relationships and betterchild behavior management are very well supported by evidence from high-income countries.Caregivers of children affected by HIV and poverty report concerns about children’s behaviorresulting from bereavement, dislocation, disadvantage, and stigmatization. Behavioral problemsrange from those related to anxiety and depression to acting out, rebelliousness, and aggression.There is a great deal of promise for the design of programs to assist parents and other caregivers,situated within broader efforts to address structural constraints such as poverty, stigma anddiscrimination, need for child care, and assistance with schooling. Programs to enhance parentalsensitivity, to support responsive parenting, and to facilitate parental knowledge and skills arebacked by evidence of effectiveness, and may be especially suited for families in which children areborn to parents living with HIV. Such families face a number of challenges, including managementof parental HIV, infant diagnosis and treatment, challenges to infant growth and development,and specialized infant care if required.• Evidence from programs to prevent abuse suggests that children and families identified as casesrequire professional services and intensive intervention. However, efforts to promote greater childand home safety and to eliminate harsh punishment through mass media approaches and trainingin verbal and behavioral limit setting have been successful. Both safety and child disciplineprograms are relevant for families living under conditions of high-HIV prevalence and poverty.• Many lessons have been learned with respect to implementation issues, including parameters ofprograms that enhance feasibility, acceptability to parents, and effectiveness. These parametersinclude understanding what parents need and want from a support program; setting clear goals;making local adaptations; using structured messages and attractive and easy-to-read supplementalmaterials; employing peer trainers, practice, and feedback; involvement of men; inclusion ofchildren where appropriate; ensuring good links and networks with other services; providingmaterial aid when needed; and assistance to families to enrol and continue to participate in parentsupport programs.• Social support in the form of encouraging family and peer assistance, and befriending programshas emerged as a key component of successful parent support interventions. This may be included
  • 9. -DRAFT-viiin a variety of delivery methods for parenting support, including outreach, home visiting, andenrollment in group activities.• Mass media approaches present many possibilities for sharing knowledge about children’sdevelopment and knowledge, social norms about discipline, household and child safety, theimportance of talking and reading to children, and so on. These can be implemented through awide variety of mechanisms, including child-to-child approaches, talks in communities and healthcenters, print, radio, and television. In areas where parent strengthening approaches are beingintroduced, mass media should be used to prepare for such programs and to reinforce theirmessages in the broader community. This is the approach taken in Level 1 in the Triple PParenting Program.• Parent support programs need to be situated within a broader context of improved structuralenablers for parenting. Depending on context, such enablers include protection from humanrights violations, protection from stigma and discrimination, economic relief, child care, andassistance with children’s education. The difficulties parents experience as a result of structuralfactors such as poverty and stigmatization should not be assumed to be addressed by person-centerd parenting programs. Experience in several countries indicates that parenting programs areless effective and parents feel alienated and are likely to drop out if parenting interventions do notadequately acknowledge and address the socioeconomic and other challenges experienced byparents.• As parent programs are developed and implemented to support families and children affected byHIV and poverty, every effort must be made to accumulate experience and an evidence base onwhich to make decisions to improve effectiveness and to support expansion. Across the evidencereviewed for this paper, the quality of studies declines as they are applied to more marginalfamilies―poorer families, migrants and immigrants, non-Western cultural groups, and familiesliving in low- and middle-income countries. This variability is a major impediment to greaterinvestment in parenting support programs and a significant barrier to iterative programmaticlearning and more effective interventions.
  • 10. -DRAFT-viiiTECHNICAL NOTEFive appendices are attached to this report: Appendix 1 outlines the methods used; Appendix 2 givesa brief outline of the quality of the available evidence; Appendix 3 contains short summaries ofqualitative reviews, overviews, and systematic reviews; Appendix 4 provides short descriptions ofidentifiable parent support programs and where they have been implemented; and Appendix 5provides the complete list of papers sourced for the literature review. Papers included in the report’sreference list refer to materials relevant to the line of argument developed in the report. These arelisted in full only if they do not appear in Appendix 5.While every effort has been made to achieve a comprehensive review of interventions to strengthencaregiving and parenting with potential for application in low- and middle-income countries affectedby poverty and HIV and AIDS, it is very likely that we have missed papers because of the limitationsof both electronic and manual search procedures.
  • 11. -DRAFT-ixGLOSSARYFor ease of understanding, the following terms are highlighted and defined according to the way theyare used in the report.Caregiving Caregiving is used interchangeably with parenting, though parenting is thepreferred term for long-term care of a child.Family strengthening Programs and interventions to support the family and caregivingsystem, including parenting.Parenting The generic category of caregiving a child in a stable, intimate, andcaring relationship―not restricted to biological parents.Parent education Information and education about children, child development, orother aspects of parenting.Parent support A broad range of programs and intervention to support one or moreaspects of parenting.Parent training Formal training programs based on a curriculum and usually deliveredthrough group sessions.Parenting interventions As with parent support―a broad range of programs and interventionto support one or more aspects of parenting.
  • 12. -DRAFT-11INTRODUCTIONIn addition to extensive literature on child development, much of which discusses some aspect ofparenting or caregiving (Biglan et al. 2012), the literature search for this project identified more than660 relevant peer-reviewed papers on the topic of parenting support—of more than 2,400 potentialpublications listed in PsycINFO alone (Lucas 2011). This includes more than 83 systematic reviewsand overviews published since 2000.…more than 600 relevant peer-reviewed papers on 83 synthetic and systematic reviews onparent support…We conducted the literature search in accordance with the best practice review methodology(Cochrane Collaboration 2006), focusing on children and parenting and/or caregiving in general. Inaddition, we used probe search procedures to identify recent reviews of interventions on particulartopics. We summarized the findings on interventions to support and strengthen caregiving and, fromthe review and additional papers, extracted general principles and lessons learned to support andstrengthen child-caregiver relationships and parenting in contexts in which children and families areaffected by HIV and AIDS in low- and middle-income countries.Apart from producing a short, readable, and useful report, the most significant challenge was to linkthis very large body of knowledge on the value of parent support interventions targeting low-resourcesettings with what we know and has been documented about the challenges facing caregivers andfamilies of children affected by HIV and AIDS (Richter et al. 2009; Franco et al. 2009). The list ofreferences assembled (see Appendix 4) indicate that almost all the available research has beenconducted in the United States, the United Kingdom, Canada, and Australia, with a few paperscoming from a handful of other high-income countries like Finland, the Netherlands, and Japan).Within these studies, there is very little reference to cultural diversity or minorities, an issuecommented on in several of the systematic reviews. The findings from individual studies, meta-analyses, and other research syntheses are limited in their generalizability to ethnic minorities, even inhigh-income countries. There are very few studies set in low- and middle-income countries. Weidentified papers, most of them descriptive studies, and limited to specific aspects of parenting orfamily life, set in Brazil, the Canary Islands, Chile, Haiti, Iran, Jamaica, Jordan, Lebanon, Pakistan,Puerto Rico, South Korea, Tanzania, Turkey, Uganda, and others. We have tried to make it clearwhich of the principles extracted and recommendations made are based on direct empirical evidenceand which are based on interpretations of potential value and feasibility.FAMILIES AND HIVVery large numbers of children are directly and indirectly affected by the HIV and AIDS epidemicand by the contexts of poverty, inequality, and social instability in which the disease has flourished.Globally, in 2011, children made up 13.2 percent of all new infections, and, some 3.4 million childrenwere living with HIV (UNAIDS 2012b; 2012a). In the same year, 230,000 children died as a result ofAIDS-related causes (UNAIDS 2012a), and in 2009, 16.6 million children were estimated to have lostone or both of their parents to AIDS (UNAIDS 2010). Both HIV-infected and HIV-exposed but
  • 13. -DRAFT-12uninfected children suffer additional mortality and morbidity (Filt 2009; Isanaka, Duggan, and Fawzi2009).Most children (> 80 percent) who have lost a parent to AIDS have a surviving parent, most oftentheir mothers (Richter 2008), and almost all double orphans live with extended family (Richter et al.2009). But the families and communities of both orphaned and non-orphaned children are challengedby AIDS. In high-burden countries in southern Africa, as many as two-thirds of families areestimated to be affected by an AIDS-related death, caring for an AIDS-sick person, or sharing ahousehold with someone living with HIV (Belsey 2005). In low and concentrated epidemics, thechildren of people in marginalized groups who are affected by HIV and AIDS are often stigmatizedand excluded from services (Franco et al. 2009).The rapid expansion of treatment is bringing benefits. Parental mortality―that is, the death of amother, a father, or both―is decreasing (UNAIDS 2010). Sub-Saharan Africa had 1 million fewerAIDS-related deaths in the period from 2001 to 2009. The President’s Emergency Plan for AIDSRelief (PEPFAR); the Global Fund to Fight AIDS, Tuberculosis and Malaria; other local andinternational donors; and governments have provided resources to mitigate the impact of HIV andAIDS on children, but the reach and scale of these efforts are minimal. It is estimated that only 11percent of households caring for orphaned and vulnerable children receive any form of supportexternal to the family (UNICEF 2011).Families were the first to respond to children affected by AIDS, both in the United States and insouthern Africa (Frierson, Lippmann, and Johnson 1987; Beer, Rose, and Tout 1988), and they havecontinued to be the vanguard of care and support for affected children. The same pattern of responsehas been seen in China, India, Eastern Europe, and other sites of concentrated AIDS epidemics(Bharat 1999; Franco et al. 2009; Li et al. 2008). When parents become ill or die, their spouses,siblings, parents, other family members, and neighbors help with or take on the care of affectedchildren―as kith and kin have always done during times of calamity and misfortune (Rutayuga 1992).… families continue to be the vanguard of care and support for affected children …Family and kin are usually the most appropriate source of support for vulnerable people and, in thepoorest communities, where there is little or nothing in the way of services provided by governmentor civil society organizations, they are often the only form of support (Iliffe 1986). This general trendof mutuality by necessity does not romanticize families nor gloss over family schisms that can adverselyaffect children, including when such schisms are occasioned by HIV and AIDS and are exacerbatedby stigma and shame, competition for inheritance, and the like (Bahre 2007).Families are an inherent aspect of human social organization; nevertheless, under social andindividual stress, they may not be able to meet children’s needs and can become dysfunctional andpotentially damaging (Goode 1963). But the idea of “family breakdown” at a societal level ismisguided (Mathambo and Gibbs, 2009). Families dissolve and re-form as part of the life and deathcycle of change. Even during war, calamitous natural disasters, and genocide, family groups continueto form as the central pillar of social organization for human beings, and the critical foundation forensuring the current and future well-being of children. Residential group care with paid staff is not asubstitute for the family, as is now recognized by scientists who study children as well as byinternational agreements and conventions (McCreery 2003). Residential group care must, in all cases,be temporary, until suitable family arrangements can be made. This is especially important for youngchildren.
  • 14. -DRAFT-13PARENTING AND HIVParenting is a functional term for the processes of promoting and supporting the development andsocialization of a child. Under most circumstances, children will be parented by their mother and/ortheir father. However, parenting functions can be independent of biological relationship; thus, for arange of reasons, children are also parented by grandparents, siblings, other family, foster parents,and so on.In addition to their parents, children in many non-Western cultures are parented by several people,with all of whom they have intimate and secure relationships. This is true in southern Africa, wherefamilies regard the siblings of a mother or father as “big mother” or “little father” to a child,depending on birth order (Chirwa 2002; Verhoef 2005). For this reason, the more general termcaregiving is sometimes used, to include also “parenting” of children by people other than biologicalparents.For the earliest period after birth, the vast majority of children will be cared for by their biologicalmother, especially while the baby is being breastfed. However, infants and young children developstrong emotional attachments to all the people with whom they have regular loving contact, includingtheir father, if he is present, siblings, and other people living in the household (Levitt and Cici-Gokaltun 2011). In turn, these caregivers develop parenting motivations and emotions, which areexpressed in their desire to care for and protect the child with affection (Papousek and Papousek1987). This “intuitive parenting” is evoked when adults take responsibility for the well-being of achild toward whom they are emotionally well-disposed (Dozier and Lindhiem 2006). These positiveparental motivations are associated with supportive caregiving (Dix 1991).The circle of people who constitute “the family” for the child may comprise both biologically relatedand non-related people, depending on culture and social and individual circumstances (Demo, Allen,and Fine 2000). In the first three years of life, this group of people together forms the mostimportant determinant of the child’s experiences of the world and, for most people, their familyremains a fundamental influence on their behavior, values, and achievements for all of their lives. InBronfenbrenner’s (1986) biopsychosocial ecological model (see Figure 1), the child is at the center ofparents and family. The household, in turn, is nested among kin and neighborhood. The familyinterfaces with a variety of services and other institutions, such as schools and clinics, thatcharacterize the social and economic context, and all, together, are situated within a broad culturaland political environment.… for most people, their family remains a fundamental influence on their behavior, values,and achievements for all of their lives.Parents and close family members comprise the proximal environment for young children. Thechild’s world is the family―materially, socially, and psychologically―and parents and family alsomediate the impact of the broader environment on the young child. Factors such as the quality of theneighborhood, the state of water and sanitation, and ethnic conflict impact the child through theprotective capacity and actions of parents and families. For example, if parents keep a child awayfrom dangerous waste or practice hand washing and water boiling, the same environment impactsthat child differently compared to one whose parents do not.
  • 15. -DRAFT-14Figure 1. Schematic representation of Bronfenbrenner’s (1986)biopsychosocial ecological modelEmpirical studies on the impact of HIV and AIDS on children and families are well documented(Foster and Williamson 2000) and indicate both stress and coping (Caldwell et al. 1993; Hosegood etal. 2007). HIV and AIDS potentially drains the capacities of families by reducing income anddestabilizing livelihoods and family structure, creating anxiety and grief among adults and children,and increasing dependency and stigmatization, which tear at family and community connectedness(Richter 2009). The epidemic has its worst impacts in contexts characterized by poverty, socialinstability, discrimination, and exclusion, making it harder for those affected and their families tocontinue to function in customary and supportive ways (Drimie and Casale 2009). Social exclusionand impoverishment make it harder for caregivers to continue to draw on the emotional and materialsupport of extended families and neighbors, increasing their isolation and further eroding theircoping capacity (Bravo et al. 2010).Affected families and children face a range of stresses associated with disclosure and stigmatization,chronic illness, grief and bereavement, residential instability, potential abuse and maltreatment, andchanges of residence and caregivers. The rate of depression among HIV-positive people is high(Bhatia et al. 2011), and a recent report indicates higher-than-expected rates of alcohol use amongHIV-positive women (Desmond et al. 2011). Because emotional, human, and financial resources arestretched or depleted, the stresses associated with HIV and AIDS make it more difficult to cope withthe challenges confronting all families. Finally, AIDS-associated disability often adds another layer toalready-difficult conditions (Rohleder et al. 2009). The combinations of these HIV-specific and HIV-related factors, together with individual and family-level risk and resilience affect parenting, caregiver-child relationships, and family functioning, with secondary effects on children (Murphy et al. 2010;Tomkins and Wyatt 2008).Despite the known adverse impacts of HIV and AIDS on families, parenting, and child-caregiverrelationships, there is a near-complete absence of research on interventions that are effective andTHECHILDImmediate environment- Parents, family, and communitySocial and economic context- Quality of the environment and access toservicesCultural context- Socioeconomic class, race, and othercontextualizing social and politicalcharacteristics
  • 16. -DRAFT-15have the potential to be scaled up in both high-prevalence and concentrated epidemic settings. Familyreunification and support, mainstays of disaster work (Blake and Stevenson 2009; Vernberg 1999),have not been systematically applied in the HIV and AIDS context and, despite the call for family-centered approaches for children affected by HIV and AIDS, little has been done to expand servicesbeyond small-scale programs (Richter 2010). Efforts to support child-caregiver relationshipsdeveloped in the United States, for example, by Rotheram-Borus et al. (1997), are sometimes seen tolack feasibility for wide-scale application in resource-poor environments.It is for these reasons that this review was commissioned―to consider how parental support can beimplemented in the context of HIV and AIDS by reviewing what is already known from descriptiveand experimental studies conducted in high-income, and where it exists, low- and middle-incomecountries.SUPPORTING PARENTING,STRENGTHENING CAREGIVINGMore is published on what adversely affects parenting than on how to support and strengthencaregiver-child relationships. For example, socioeconomic stress is a significant determinant ofparenting (Yoshikawa, Aber, and Beardslee 2012), as is parental mental health, especially depression,which is now known to be prevalent among both mothers and fathers of young children (Paulsonand Bazemore 2010)More is published on what adversely affects parenting than on how to support andstrengthen caregiver-child relationships.One reason for this bias in our knowledge is that parenting is an embedded process. It is invisible andthe requirements for good parenting are tacit. They only become clear when parenting is disturbed insome way. Parenting becomes conspicuous when it seems unnatural, as in the case of newreproductive technologies; when it is deemed inappropriate or risky, as occurs with teen parenting orparenting in poverty; when the parenting bond is broken by separation or death; when parents facechallenges as a result of substance abuse or mental health problems; when parenting is made moredifficult by disability experienced by the parent or the child; and when parenting is abusive orneglectful. We know that all of these factors damage parenting and, as a result, children’s health,development, well-being, achievement, and adjustment are put at risk.It is difficult to define parent support because it encompasses so many aspects of social and familysupport, including being financially secure; enjoying social inclusion and acceptance; having thecapacity to live with one’s children; and access to services to safeguard children’s health and givethem opportunities to learn, which provide families with a safety net when they are in trouble. Formany parents, it also means commitment, sharing, and assistance from a partner and a wider familynetwork.In most high-income countries, parent support corresponds to a considerable degree with parenttraining programs. Parent training, in turn, includes a wide variety of approaches largely directed towardone or more of three general goals:
  • 17. -DRAFT-161. To enable parents to better promote and facilitate their child’s health, development, andachievement. This is particularly salient when the knowledge and skill to parent effectively isnot fully formed or when parents lack confidence (e.g., as in first-time parenting, teen parenting,or foster parenting) or when parenting is compromised by specific challenges (e.g., disabilityexperienced by the parent or the child, poor mental or physical health, poverty, immigration,parental imprisonment, substance use, interpersonal violence, or parental death or desertion).2. To help adults to parent children with less stress, fewer problems, more satisfaction withparenting and family life, and to foster or preserve parental mental health and the couplerelationship and, in general, improve family well-being.3. To help parents to manage difficult child behavior. Difficult behavior refers to aggressionand oppositional behavior, tantrums, poor peer relationships, non-compliance to parentalinstructions, and the like.Of course, many parent training programs go beyond these general goals and are highly specific toparticular challenges, such as preventing (Barlow et al. 2007) or treating (Barlow et al. 2006) childabuse and neglect, assisting parents of children with chronic illnesses (Barlow and Ellard 2004),improving children’s linguistic preparedness for school (Boyce et al. 2010), and promoting fathers’engagement with children (Cowan et al. 2009).It is clear that each of these general goals of parenting programs arise in a specific historical, cultural,and social context that is, to a greater or lesser degree, specific to high-income Western countries, andmay be more or less applicable in non-Western contexts. For example, parenting is not a solo activityin many traditional societies. Child care is frequently shared because of cultural beliefs that childrenbelong to families and clans rather than to one or two individual parents. This results in what hasbeen called ”socially distributed nurturance” (Weisner 1997). It may also be shared by necessitywithin families and kin because of work and livelihood commitments in the absence orunaffordability of child care (Heyman 2006). As a consequence, information (or misinformation) andskill (or lack of it) may be shared within a caregiving network of related women. To some degree thiscan help to mitigate lack of preparation and confidence for parenting, help to compensate for someforms of compromised parenting, and lessen the strain on the couple and family relationships. But itis also possible that such shared parenting may serve to sustain harmful practices, such as beatingsand humiliation meted out to children, and their group endorsement may make them more resistantto change by an informed parent.Further, the nature of what is regarded as “difficult” behavior by children differs across cultures. Thestructure of traditional societies and families is hierarchical, and children have a particular place andspecified role in the hierarchy. Children acquire “social responsibility” within an interdependentsociety that entails respect for elders, compliance, and obedience (Super et al. 2011). Respect andobedience by children significantly reduces caregiver-child conflict, as seen also in the United States.Higher levels of respect and obedience have been found among children in Latino andAfrican-American as compared to European American families and child compliance. (Dixon, Graber, andBrooks-Gunn 2008). Cultural differences modify the interpretation and context of what is seen to be“difficult” behavior by Western cultures.This does not mean that research conducted in the West is not relevant to societies in the South thatare heavily impacted by HIV and AIDS. Many low- and middle-income countries are urbanizingrapidly and traditional structures and practices are breaking down, exposing families to many of the
  • 18. -DRAFT-17parenting stresses long experienced in the West. Moreover, HIV and AIDS are themselves changingfamilies and the requirements of childcare and parenting, as indicated earlier. The challenges ofpoverty, substance abuse, disability, death and more affect families in many of the same ways nomatter where they occur. And there is some evidence that conduct disorders and negative peerrelations that manifest in early childhood have common pathways to poor adolescent and adultadjustment (Simonoff et al. 2004).A great deal of research has been conducted on parenting support in high-income countries, some ofit of very good quality. This research has resulted in robust evidence that has been brought togetherin synthetic reviews, overviews, and meta-analyses. There is much to learn from these studies that canguide the development of programs to support parenting in low- and middle-income countries inways that benefit children affected by HIV and AIDS. In turn, though, as such programs aredeveloped, they themselves will have to be subjected to rigorous evaluation, as well as comparisonswith alternative interventions to benefit children. Such research is essential in resource-constrainedsettings, where policy makers have to reach decisions about which children’s services to support toachieve a given outcome at a specified cost. Such decisions always entail social value as much associal-scientific judgments (Stevens, Roberts, and Shiell 2010).A great deal of research has been conducted on parenting support in high-income countries,some of it of very good quality. This research has resulted in robust evidence that has beenbrought together in synthetic reviews, overviews and meta-analyses. There is much to learnfrom these studies that can guide the development of programs to support parenting in low-and middle-income countries in ways that benefit children affected by HIV and AIDS.THEORETICAL ORIENTATIONS INPARENT SUPPORTRegardless of their particular theoretical origins, most parenting support programs operate within atransactional model of parent-child relations (Sameroff 2009). That is, they assume that parentalbeliefs and actions affect children; reciprocally, children’s beliefs and actions affect parents. Thesetransactional processes are capable of producing virtuous and vicious cycles of interaction thatbecome embedded with short- and long-term positive or negative outcomes for children, parents,and the family.Parenting support programs aim to change parental beliefs and actions with the goal of changingchild behavior which, in turn, is likely to lead to changes in parental well-being, including improvedcouple and family relationships. Improvements in parental well-being and the quality of caregiver-child and couple relationships and family life are likely to nurture better communication, moreparental attention for positive child behaviors, and increases in child adaptive behaviors. Betterparent-child relationships are also more conducive to teaching and learning, as well as parentalguidance about risk behaviors and negative peer influences.Parenting support programs aim to change parental beliefs and actions with the goal ofchanging child behavior which, in turn, is likely to lead to changes in parental well-beingincluding the couple and family relationships.
  • 19. -DRAFT-18Parent support programs are loosely grounded in four distinct theoretical orientations. They areloosely grounded in the sense that parent support programs are theoretically informed, but by andlarge, empirically and practically determined by the particular purposes of the program. Manyprograms incorporate elements of all four theoretical approaches in multidimensional interventions:1. Adlerian psychology assumes that human beings aspire to develop and achieve through theirinterconnectedness with others. By this view, parents can help children to achieve theirpsychological and behavioral goals through the use of logical and natural consequences to childbehavior, mutual respect, and encouragement (Adler 1935). Popkin (1993) added aspects ofcommunication theory to the basic approach of developing “empathy training” for parents. Thatis, parents are helped to understand their child’s behavior in terms of the child’s purposesand to guide the child to achieve their adaptive goals. The most widely implemented parenttraining program based on Adlerian psychology is Systematic Training for Effective Parenting(STEP) (Dinkmeyer and Dinkmeyer 1979).2. Attachment theory based on the work of Bowlby (1969) and others stresses the importance ofsecure attachments to consistent, sensitive, and responsive caregivers in the first twoyears of life. Parent support programs that promote secure attachment focus on making parentsaware of their young children’s communicative signals and appropriate caregiver responses tothem. Attachment programs have successfully incorporated individual videotaped feedback intoparenting support. Examples of such approaches are the Circles of Support (Marvin et al. 2002)and the Steps to Effective and Enjoyable Parenting (STEEP) (Erickson and Egeland 2004)programs.3. Social learning theory, based on the work of Bandura (1977), postulates that children learn insocial contexts, from observing the behavior of others, particularly parents. Programs basedon this approach help parents to understand the effect of their behavior on children and how tochange their own behavior, also by using group and video feedback. Well-known programsbased on these principles include Project Teens and Adults Learning to Communicate (TALC)(Rotheram-Borus et al. 2001) and Video-feedback Intervention to Promote Positive Parenting(VIPP) (Lawrence et al. 2012).4. Cognitive behavioral therapies, based on the work of Beck (1979), aim to change the wayparents interpret and respond to children’s behavior. For example, parents commonlyassume that difficult children have motives to “test the limits,” “wind them up,” or “get themback.” These interpretations arouse emotions in parents which lead to behaviors that frequentlyescalate rather than resolve interactional difficulties. Cognitive approaches help parents toidentify distorted thinking and adopt rational interpretations of a child’s behavior. Examples ofprograms that incorporate cognitive behavioral principles are the Incredible Years ParentingProgramme (Webster-Stratton 1992) and the Protecting Families Programs (PFP) (Boyd,Diamond, and Bourjolly 2006).A number of commentators on parent support interventions have drawn attention to the programs’lack of attention to context (Nelson, Laurendeau, and Chamberland 2001), systemic thinking, andstructural interventions. Many programs include mothers only, rather than mothers and fathers, andvery few take into account other potentially influential members of the family, such as grandparents,older siblings, and aunts and uncles—with the unintended consequence that these members feelexcluded and may undermine positive changes (Mockford and Barlow 2004). There is also generally
  • 20. -DRAFT-19very little attention given to cultural factors or parenting styles (Sanders and Woolley 2005), the widersystems of which families are a part, or poverty, discrimination, and other social and structural causesof inadequate parenting and/or poor child outcomes (Lucas 2011; Nelson, Laurendeau, andChamberland 2001).CHARACTERISTICS OF PARENTSUPPORT INTERVENTIONSParenting interventions in their current form originated in the 1920s. There are several different typesof parent interventions—for example, mass media, family-school-community coalitions, groupprograms, home visiting, and intensive parent-child guidance and therapy. Some programs, such asTriple P, include many or all of these types of intervention. The proliferation and diversity ofparenting interventions are illustrated by the fact that in 2010, 140 different parent programs wereregistered in one database in the United Kingdom (Lucas 2011). Short descriptions of programsincluded in the review, illustrating different types of approaches, are provided in Appendix 3.Interventions may directly target parental behavior (e.g., trying to change parents’ thoughts andactions, teaching parents how to encourage a child’s schoolwork), or they may be indirect, helpingparents by giving them social support, assisting them with employment, or in other ways reducingstresses that interfere with effective parenting or are associated with punitive childrearing (Sweet andAppelbaum 2004).Almost all parenting interventions have been developed, implemented, and evaluated in urbansettings in the United States, the United Kingdom, Australia, and Canada (McNaughton 2004). It isestimated that about half of all programs are conducted in community settings and the other half aredivided equally between facilities such as clinics and day centers. Many parent interventions areconducted by professional nurses, psychologists, and/or social workers, some by trained non-professionals and peers (Thomas et al. 1999; Bunting 2004; Sweet and Appelbaum 2004), and a smallproportion are self-help programs with varying degrees of facilitator or therapist support (O’Brienand Daley 2011; Sorge, Moore, and Topiak 2009).Many programs target low-income parents, on the basis of the threats to parenting due tosocioeconomic stresses. About half include parents considered to be at risk of poor parenting, childabuse, or neglect (Thomas et al. 1999; Bunting 2004). The majority are directed at parents of childrenyounger than five years of age, and tend to focus on behavior problems. Fewer than half of allprograms include fathers.Parenting interventions have a wide range of objectives, but social support is reported byboth parent participants and professionals to be highly valued.Parenting interventions have a wide range of objectives, but social support is reported by both parentparticipants and professionals to be highly valued (Thomas et al. 1999). Social support takes the formof access to goods and services (Ayón 2011), information, and guidance (Mbenkenga et al. 2011), andan opportunity to make friends, share troubles, and counter social isolation (Letourneau, Stewart, andBarnfather 2004; Smith-Fawzi et al. 2012). Social support provided by partners, families, peers, andprofessionals have positive effects on a wide range of parenting aspects, including self-perception,
  • 21. -DRAFT-20coping, and mental health (Gardner and Deatrick 2006). In a model proposed by Kane, Wood, andBarlow (2007, p. 790), social support is core to the mechanisms by which parenting interventionsadvance parent and child well-being. An adapted version of the model, developed from a synthesis ofqualitative research, is shown in Figure 2.Figure 2. Social Support in Parent and Child Well-Being (adapted from Kane,Wood, and Barlow 2007)In addition to social support, almost all parent support programs include the following elements,among others (Taylor and Biglan 1998):• Information on children’s age and stage developmental capacities, gender differences, andtemperament, and other expressions of individuality to counter unrealistic expectations ofappropriate child behavior.• Promotion of positive parenting strategies and effective discipline.• Emphasis on the importance of listening to children and giving verbal explanations anddirectives in order to create channels for communication that displace coercive and other harshdisciplinary practices.• Explanation of pro-sociality, such as cooperative behavior with peers, compliance to parentalrequests, and verbal problem solving in preference to physical aggression.
  • 22. -DRAFT-21• Understanding of the parents’ perspective and responding to parental needs, and promotingself-efficacy, self-esteem, and self-confidence in parents.These goals are attained by a variety of methods that may set out in a formal manual or are morespontaneous or responsive to individual or group needs. Didactic teaching, demonstration andillustration, modeling, and group or videotape feedback are used, in conjunction with teaching aids,notebooks, diaries, homework assignments, and the like. Sessions may include both children andparents or combine parallel and joint sessions, and programs may run from a few days to severalyears.Home visiting is a mechanism used in many parent support programs. In some, home visiting is thecore method for conveying information, support, and linkages to at-risk parents and families, such asin the U.S. Nurse-Family Partnership devised by Olds et al. 1997; in others, it is one method within amulti-modal approach, such as in Fast Track (Greenberg, Domitrovich, and Bumbarger 2001), HeadStart, and Healthy Families America (LeCroy and Krysik 2011) in the United States, and Philani Plusin South Africa (Rotheram-Borus et al. 2011). It has been noted that few, if any, programs articulate atheory about the mechanisms of home visiting and, like other parenting interventions, the frequencyof home visits vary widely, from weekly to every two to three months. McNaughton (2004) lists 19different interventions in home-visiting programs. These include anticipatory guidance, assessment,breastfeeding promotion, counseling, developing the nurse-family relationship, encouraging the useof child preventive health services, enhancing parental self-esteem, establishing trust, focusing on themother’s concerns, provision of health and child development information, health and social services,listening, mobilizing social support for parenting, problem solving, promoting child development,referral, screening, and the provision of social support. Sweet and Appelbaum (2004) estimate thatthere are thousands of home-visiting programs in the United States, of widely differing kinds. Home-visiting programs range from those that are tightly constructed and implemented with maximumfidelity to the original design (such as the Nurse-Family Partnership of Olds et al. [1997]) to thosethat encourage local adaptation of the purposes and methods of home visits and other interventioncomponents, such as Sure Start in the United Kingdom (Melhuish and Hall 2007) and Communitiesfor Change in Australia (Edwards et al. 2011).In sum, parenting support interventions, including home visiting, have been designed in manyvariations tailored to the specific needs of the target population, the issues addressed, and theresources available. While the diversity of parent support programs is a strength, not all have beenfound to be effective. Unfortunately, as will become clear further on in the report, the knowledgebase is not yet sufficient to indicate which delivery mechanisms in which programs are most effectivefor different target groups with unique characteristics.EFFECTIVENESS OF PARENTINGSUPPORTOverviews of parenting support programs and interventions, such as this one, can be organized indifferent ways. For example, they can be organized by mode of the intervention, such as center-based, home visiting, individual counseling at services such as clinics, groups sessions at clinics, andso on, as was done by Walker (2011) in her review of interventions to promote equity through early
  • 23. -DRAFT-22child development programs. Or an overview can be organized by the title of the parent program,such as Incredible Years (Webster-Stratton 1992), Strengthening Families (Kumpfer, DeMarsh, andChild 1989), Triple P-Positive Parenting Program (Sanders 1999), or Systematic Training forEffective Parenting (STEP) (Robinson, Robinson, and Dunn 2003).However, there are problems with both these ways of organizing the available evidence. First, modesare not programs, nor do they have specific purposes. As pointed out earlier, home visiting may be afeature of many different programs and may be used to accomplish a very wide range of goals. Inmany programs, home visiting is used to follow up with especially vulnerable families who are notreached by community-based programs. Moreover, mode of delivery may not be relevant to theefficacy of the program; for example, no differences in effect have been found for Triple P programswhether delivered individually, in groups or through self-help (de Graaf et al. 2008).The problem with organizing material by the title of the program is that the best-known programs areall behavioral family interventions (BFI) based on social learning principles to reduce family riskfactors associated with child behavior problems (de Graaf et al. 2008). That is, they are parentingprograms that have been developed to reduce child non-compliance, aggression, oppositionalbehavior, tantrums, and acting-out behavior. These are not necessarily the key concerns of all parentsseeking support.In the following section, we provide very short overviews of the evidence in five categories of parentsupport interventions, organized by the central purpose of each program. These purposes are:• Preparing for parenthood• Promoting early child growth, development, learning, language, and education• Child behavior management• Family relations and child protection, and• Parental well-being.We also summarize some implementation issues remarked on in the literature. Although we did notundertake unique searches for papers on specific categories within these topics, we identified a largenumber of relevant individual studies, as listed in Appendix 5. The conclusions we draw are based onoverviews, comprehensive reviews, and meta-analyses (see Appendix 3). Between 2000 and 2012,with two important papers a year before (1999) and a year after (2013), we identified 83 overviews,qualitative reviews, and systematic reviews.The descriptions that follow are built up progressively, so that evidence presented in an earliersection, for example, on home visiting, is not repeated in a subsequent section.Preparation for parenthoodThese programs include intervention that helps prepare for parenthood and its progression throughvarious phases of childhood, including both first-time parents and parents facing new challenges.Groups included are teen parents, first-time parents, prospective parents, foster parents, parentsfacing challenging circumstances, such as those occasioned by a preterm baby or a child with achronic illness or disability, drug-using parents, parents living with a disability or mental illness, andprograms that aim to increase father engagement.
  • 24. -DRAFT-23Parents want:- To be involved- To be provided withinformation- To learn practical skills- Social support from family- Their confidence to be built- To meet people in the samecircumstances as themselves- To be referred to the servicesthey need.The available literature is clear that these groups of parents feel assisted and reassured byinterventions that involve them in the care of their child (Brett et al. 2011), provide them withthe information they need and practical skills for dealing with the problems they experience(Coren et al. 2010), aid them in making the transition to home care (Matson, Mahan, and LoVullo2009), facilitate increased social support from family and significant others (Letourneau, Stewart,and Barnfather 2004), help build their confidence as parents, connect them with peers withwhom they can share experiences (Kane, Wood, and Barlow 2007; Mercer and Walker 2006), andlink them to the types of services they need.All types of parents benefit from accurate factualinformation, using a range of media, though the gains aregreatest for high-risk groups (Moran, Ghate, and van derMerwe 2004; Shaw et al. 2006). Parent information andeducation programs are more effective when theyfocus on concrete issues, such as health care, homesafety, child development, harsh physical punishment,monitoring and protection, and substance use. Mass mediacan be used to emphasize the importance of parents inchildren’s lives, children’s normative ages and stages, socialnorms about discipline, household and child safety, theimportance of talking and reading to young children, andso on (Daro 1994; Daro and Gelles 1992; Kishchuk et al.1995). The preference for concrete information andexamples applies also to skill building, which has optimaluptake when it is practical and includes “take home and try” tips (Moran, Ghate, and van derMerwe 2004). Programs that attempt to change parental attitudes without providing parents withspecific child management and parent-child interactions skills, and opportunities to practice them, areless successful. Other broad-based approaches, especially those that involve social support, such as“befriending” programs, and outreach to isolated parents, are especially valuable (Moran, Ghate, andvan der Merwe 2004).The most extensive and substantial research has been published on teen parenting, particularly in theUnited States. Parent support programs have been found to help teen mothers to feel moreconfident, be more responsive to their babies, and enhance the quality of their interaction with theirchildren (Barlow et al. 2011; Coren, Barlow, and Stewart-Brown 2003; Riesch et al. 2010), as well asto improve clinic attendance, immunization rates, and child growth (Akinbami, Cheng, and Kornfeld2001).The most robust evidence for achieving improved parenting, children’s outcomes, and use of servicescomes from nurse home-visiting interventions for high-risk mothers that employ professional staff(McNaughton 2004). Among other benefits, studies have found that such programs enable teenmothers to continue their education (Sweet and Appelbaum 2004). Gardner and Deatrick (2006) alsofound positive effects for home-visiting programs that sensitize mothers to infant cues and teachspecific skills such as infant massage.
  • 25. -DRAFT-24In general, mothers prefer face-to-face contact to video instruction in preparing them for parenthoodor the challenges of parenthood (Mercer and Walker 2006), but there are also encouraging resultsfrom programs that provide telephone support to women during pregnancy and postpartum as anadjunct to other services (Dennis and Kingston 2008).In their review, Gagnon and Sandall (2007) determined that studies on antenatal education for thegeneral population were too variable to support any conclusions about benefits. However, a review ofsupport interventions for new parents found that programs beginning during the antenatal period andcontinuing during the postnatal period were associated with a significant positive effect on allassessed outcomes: parenting, parental stress, health-promoting behavior of parents, cognitive andsocial and motor development of the child, child mental health, parental mental health, and coupleadjustment (Pinquart and Teubert 2010). Evidence supports the implementation of a wide range ofinterventions in the perinatal and postnatal period, with beneficial impacts on parents and the parent-infant relationship (Barlow et al. 2010). Education after birth, including sleep enhancement, increasesmothers’ knowledge and has been found to have benefits for infant sleeping with the added effectson parental and couple well-being (Bryanton et al. 2010).… programs beginning antenatally and continuing postnatally, were associated withsignificant positive effect on all assessed outcomes.There appears to be too little methodologically acceptable evidence on parenting support programsfor parents with mental illness (Craig 2004), parents of children with chronic illness (Anderson andDavis 2011), and for programs to assist parents with children with disabilities in low- and middle-income countries (Einfield et al. 2012).There are also very few studies of interventions to improve father engagement. However, promisingfindings have been reported for programs that encourage men to interact with their child, sensitizemen to infant cues, and teach them specific skills involved in baby care (Magill-Evans et al. 2006).… promising findings have been reported for programs that encourage men to interact withtheir child … and teach them specific skills involved in baby care.In conclusion, while universal services should be used to identify high-risk groups, many parentsupport programs are better targeted with greater intensity and resources to high-risk groups than tothe population at large (Barlow et al. 2010). Free-floating interventions, for example, those that aremounted at clinics, with erratic membership and little active facilitation, have not shown positiveresults (Gardner and Deatrick 2006).Promoting children’s growth, development, learning, language, and educationThis category includes parent support interventions to promote child growth, learning anddevelopment, language and literacy, and school performance. However, we found only a handful ofoverviews and systematic reviews on these topics.In an overview of potentially feasible and effective strategies to strengthen families in the context ofHIV and AIDS, Chandan and Richter (2009) argued that intervention programs that enhancecaregiving and link caregivers with support and services play a pivotal role in strengthening familiesfor the benefit of children. In addition to structural interventions, including social security transfersfor the neediest families, they recommended two strategies given their demonstrated benefits in other
  • 26. -DRAFT-25settings: 1) home visiting for first-time, low-income pregnant mothers and their young children and2) early childhood development programmes for low-income children and families.Engle et al. (2011) reviewed parenting interventions in low- and middle-income countries, includingunpublished reports, which aimed to increase responsiveness to infants, encourage learning, andpromote positive discipline, among other outcomes. They found substantial positive effects on childdevelopment in all of the 11 effectiveness studies they reviewed, nine of which also found benefitsfor cognitive and socio-emotional development, and two of which encouraged parent knowledge,home stimulation, and learning activities with children. The authors concluded that the “mosteffective programmes were those with systematic training methods for the workers, a structured andevidence-based curriculum, and opportunities for parental practice with feedback” (p. 1341).However, neither economic interventions in the United States (Lucas et al. 2008) nor home-visitingprograms in the United States, Ireland, Bermuda, and Jamaica (Miller, Mauguire, and MacDonald2012) have been found by systematic review methods to be effective strategies for supporting thedevelopment of preschool children of socially disadvantaged parents. In both reviews, though,significant programmatic and/or methodological weaknesses were identified that cast doubt on anydefinitive conclusions.In the case of economic interventions, all nine studies reviewed (eight in the United States) involvedwelfare reform, in which cash payments were tied to work or other requirements. The payments werevery small (an average of U.S.$11.50 a week) and could not have been expected to be associated withmarked improvements at the family, parent, or child level. In addition, all involved some enforcementof low-status work that may have increased rather than decreased parental stress and adverselyaffected parent-child engagement. Despite these constraints, the interventions were associated withnon-significant benefits for child health and child emotional state, as well as language and cognitiveperformance, and educational achievement.Miller’s review on home support for socioeconomically disadvantaged parents in high-incomecountries, in which parents were trained to provide a more nurturing and stimulating environment fortheir young children, found no effects on children’s cognitive development. There were insufficientdata to perform meta-analyses on other outcomes (children’s socio-emotional and physicaldevelopment, parenting behavior, and the quality of the home environment), but no consistentpattern of findings was shown in any of the constituent studies. The reviewers concluded that poorreporting of the studies, particularly with respect to randomization and attrition, limit the extent towhich reliable conclusions about the effectiveness of such programs can be drawn.A review of child health partnerships involving multiple stakeholders from both government and civilsociety showed positive results for child development as well as for parenting and service utilization(e.g., immunization) (Jayaratne, Kelaher, and Dunt 2010). Examples include Sure Start and EveryChild Matters in the United Kingdom, First 5 California and Early Head Start in the United States,Healthy Child Manitoba and Toronto First Duty in Canada, and Families First, Best Start and EveryChance for Every Child in Australia. These partnerships provide a range of services whose relevanceis locally determined, from financial assistance to breastfeeding support to child care and facilitationof early learning. In fact, in most of the consortia, although generally led or coordinated by healthservices, children’s early learning is a core goal. Many programs use peer family advisors or mentors,who are reported to have credibility, and are able to engender trust and counter parents’ isolation andself-blame.
  • 27. -DRAFT-26Passive parent support approaches, such as sending books home without parent outreach andengagement, have not been shown to be effective (Moran, Ghate, and van der Merwe 2004).However, a systematic review of the impact of parent support interventions on education (Nye,Schwartz, and Turner 2006) concluded that parental involvement in schooling resulted in significantoverall positive effects on children’s academic achievement, raising children’s average performance tobe considerably above that of children in the control group. The largest effects occurred in programsin which parents offered some form of incentive for their child’s performance. The impacts onreading have been more extensively studied than those on mathematics or other school subjects.Reese, Sparks, and Leyva (2010) conducted a systematic review of parent interventions to promotepreschool children’s language and emergent literacy. The interventions were of three types—sharedbook reading, parent-child conversations and storytelling, and parent assistance for children’s writing.Shared book reading improved children’s expressive and, in some cases, their receptive vocabulary,and telling stories about personally experienced events was found to be a promising supplement tobook reading. Parents of low socioeconomic status, who are generally presumed to be unmotivatedand too stressed for high levels of parent-child engagement, were able to implement the program,with positive impacts on their children’s language and literacy development. The reviewers concludethat parents are an undertapped resource for children’s early learning. Telling stories and makingbooks have been incorporated into Head Start, especially for migrant families (Boyce et al. 2010), andMoran, Ghate, and van der Merwe (2004) also classify these strategies as promising parent programsfor improving children’s literacy.Child behavior managementPrograms that target better child behavior management, and conduct problems specifically, are themost extensively studied of all parent support interventions. It has been known for some time thatstructured parent group programs are effective interventions to improve parenting and better managethe behavior problems of preschool children (Thomas et al. 1999; Bunting 2004). Systematic reviewshave consistently reported positive results (Barlow and Parsons 2005; Barlow et al. 2010), some ofwhich endure through childhood, reducing delinquency in adolescence and other antisocial behaviorsin adulthood (Piquero et al. 2008; Sandler et al. 2011). Importantly, behavioral and cognitive, group-based parenting programs have also been shown to lead to significant reductions in harsh parentingpractices, according to both self-reports and independent assessments (Furlong et al. 2012).The most widely implemented parent-child relationship and behavior management programs are TheIncredible Years (Webster-Stratton 1992), Triple P Positive Parenting (Sanders 1999), and Parent-Child Interaction Therapy (Budd et al. 2011). No differences in effectiveness have been foundbetween different types of programs; for example, between behaviorally and non-behaviorallyoriented approaches (Gavita and Joyce 2008; Lundahl, Risser, and Lovejo 2006), or between Triple Pand Parent-Child Interaction Therapy (Thomas and Zimmer-Gembeck 2007). Self-help programsalso lead to similar outcomes to those achieved with more intensive professional inputs (de Graaf etal. 2008; O’Brien and Daley 2011). Some doubt has been cast on evidence of the effectiveness ofeven the best-known programs (Wilson, Havighurst, and Harley 2012). At this stage, it is unclearwhich interventions are likely to be of more benefit to which families, although group approachesseem to be more successful than individual programs. An exception is cases where parents and/orchildren have specific needs. Parents generally prefer an interactive style of facilitation to didacticteaching (Moran, Ghate, and van der Merwe 2004).
  • 28. -DRAFT-27Moderators of success include low socioeconomic status and single parenthood, with family adversitysignificantly undermining positive changes in parental attitudes and behavior problems (Lundahl,Risser, and Lovejo 2006). Parents whose children have severe behavior problems also benefit less,and such families probably need to be enrolled in individual supplemental services at the same time asgroup programs (Moran, Ghate, and van der Merwe 2004). These findings highlight the importanceof addressing stresses in parents’ lives, including socioeconomic disadvantage, as well as assistingfamilies to access other needed services, as an essential aspect of parenting support interventions.More limited success has been achieved in addressing adolescent conduct problems (Wolfenden et al.2001). Intensive approaches, such as cognitive behavior therapy, have been found to be as effectiveas behavioral parent training, though both are more effective when combined with broad systemicapproaches that include parents, young people, schools, and other relevant community structures(McCart et al. 2006; O’Connell, Boat, and Warner 2009). In the same way, active parental engagementhas been found to be an important feature of school-based and community programs to preventtobacco, drug, and alcohol abuse among young people. In this context, parent engagement is moresuccessful if it is holistic, including also the parent-child relationship and conflict management ratherthan focusing exclusively on substance use (Petrie et al. 2007).With respect to specific problems, parent training in contingency management (e.g., specifyingbehaviors to be changed, reinforcing desirable behavior and ignoring undesirable behavior, using“time out”) has been found to be effective with parents of children with attention deficit andhyperactivity disorder (ADHD). Parental confidence and self-esteem increased, parental stress wasreported to be reduced, as were ADHD symptoms and child non-compliance (Kohut and Andrews2004).A systematic review of six randomized controlled trials of interventions to help foster parentsmanage the difficult behavior of children in the context of the U.S. child welfare system showed littleevidence of improvement in psychological functioning among looked-after children, that of fosterparents or carers, and in foster agency outcomes. The reviewers conclude that, in order for foster careprograms to be effective, programs addressing parent support needs must be complemented by awide range of other services and interventions (Turner, MacDonald, and Dennis 2007).Family relations and child protectionUnder this heading are included parenting interventions that promote attachment, the parent-childrelationship, parent-couple relationships, household safety, and the prevention of non-accidentalinjuries, child neglect, and abuse. In this section, we will not repeat pertinent comments about homevisiting, parental confidence and effectiveness, behavior management, and parent-child relations,topics we have covered above.Attachment between mother and child can be promoted, and sensitivity to infant cues andresponsiveness to infant learning and communication improved, through videotaped feedback andguided facilitation, though these methods are often training- and labor-intensive (Zeanah et al. 2011).Target groups usually include clinic-referred parents (e.g., depressed mothers) and at-risk infants (e.g.,adopted children, very-low-birth-weight babies). Positive outcomes are associated with professionalas opposed to non-professional staff, children at risk rather than parents at risk, and sensitivity-enhancing interventions versus broad goals of improving attachment or mother-infant interaction(Bakermans-Kranenburg, Van Ijzendoorn, and Juffer 2005).
  • 29. -DRAFT-28Improving parental knowledge of child development through greater awareness of infant sensory,cognitive, and motor capacities has been shown to increase parental sensitivity and responsiveness toinfant signals. One of the most commonly used mechanisms for achieving this is the BrazeltonNeonatal Behavioral Assessment Scale (Beeghly et al. 1995). Infant responses to the scale aredemonstrated to parents in order to increase their awareness and responsiveness to the infant andenhance feelings of nurturance.A meta-analysis of studies in the United States to examine the safety, permanency, and well-being ofchildren in kinship versus institutional care (Winokur, Holtan, and Valentine 2009), is of particularrelevance to children affected by HIV and poverty in low- and middle-income countries. This isbecause of the inclination of some foreign donor organizations to promote institutional care ofchildren who have lost parents. Kinship foster care in the United States enables children to live withpersons they know and trust and is believed to reinforce children’s sense of identity, which comesfrom shared family history and culture (Winokur, Holtan, and Valentine 2009). The data fromWinokur and colleagues’ review indicate that children in kinship foster care have better behavioraldevelopment, mental health, and placement stability than children in non-kin foster care. In theUnited States, as in poor AIDS-affected countries, controversies abound regarding the unequalfinancial support, training, services, oversight, and certification received by kin as opposed to non-kincaregivers. Despite the methodological weaknesses of the studies included, the review provides animportant stimulus to the debates.Interventions to prevent unintentional injuries, especially the possession and use of safety equipmentand practices, usually include information provided in the media, parent education, and home visiting.A meta-analysis of nine randomized controlled trials found that intervention families had asignificantly lower risk of child injury. They had fewer home hazards and a home environment moreconducive to child safety. Parents also expressed an increased conviction about the importance ofprotecting young children (Kendrick et al. 2007; Kendrick et al. 2008), a finding also of relevance tochildren in poor countries, whose environments are frequently hazardous as a result of open fires,proximity to the road and waste deposits, unclean water, poisonous household fuels such as paraffin,and the like.A review of prevention of child maltreatment identified parent education and home visiting as amongthe most promising interventions (Mikton and Butchart 2009). Programs that have been shown toeffectively prevent child abuse and neglect target high-risk families, start at birth, and deliver intensiveservices of long duration that are implemented by well-trained professional staff (Geeraert et al. 2004;Macmillan 2000; Nelson et al. 2001). A trial of Triple P in 18 randomized U.S. counties demonstrateda significant prevention effect on child maltreatment as indexed by substantiated child maltreatmentcases, child out-of-home placements, and child maltreatment injuries (Prinz et al. 2009). There iscurrently no evidence that educational programs alone prevent child abuse (Macmillan 2000). It hasbeen argued that a significant limitation of current child abuse programs is that they do notadequately address poverty, which is a major risk factor for child maltreatment (MacLeod and Nelson2000; Nelson, Laurendeau, and Chamberland 2001).Parental well-beingA meta-analysis by Barlow, Coren, and Stewart-Brown (2003) and a more recent update (Barlow,Coren, and Stewart-Brown 2009) found 20 studies of the effects of parent support programs onmaternal psychosocial health with sufficient data to calculate an average effect size. This is one of thelargest meta-analyses we found in the field of parent support programs. The review found statistically
  • 30. -DRAFT-29significant differences favoring the intervention group on maternal depression, anxiety and stress,self-esteem, and marital adjustment.In a 2012 meta-analysis, Barlow et al. (2012) identified 48 eligible studies involving 4,937 participantswith outcomes related to parental psychosocial health. Overall, participants in the parentinginterventions (which were of three types: behavioral, cognitive, and multi-modal) showed statisticallysignificant short-term improvements in depression, anxiety, stress, anger, guilt, self-confidence, andsatisfaction with their spousal relationship. Only stress and confidence remained significantly better atone-year follow-up. There were only limited data on fathers, but men in programs showed statisticallysignificant short-term improvements in stress. The data gave the reviewers confidence to suggest that,together with evidence about the importance of paternal psychosocial functioning on the well-beingof children, parenting programs should make every attempt to include fathers; either throughencouraging father involvement in already-established programs (e.g., by holding classes onweekends) or by tailoring a paternal support component into the program.Overall, good results for parental well-being have been found as a consequence of participating inparent support programs. However, no such enthusiasm can be established for the effects of parentsupport programs on mothers with mental illness who have young children (Craig 2004). Whilementally ill parents share with others the common problems of parenting, they also experience anumber of issues due specifically to their mental illness. These require more individualized andintensive intervention than is available in standard parent support programs.ADAPTATION AND IMPLEMENTATIONMany of the best-known programs developed in high-income countries are culture-bound, especiallyfrom the perspective of their predominant focus on “problematic” child behavior: non-compliance,opposition, aggression, and so on. They are also labor-intensive and, even if they were completelysuited to the context of AIDS and poverty―and it is our view that they are not―they would be costlyand difficult to reproduce in low- and middle-income countries (Shaw et al. 2006).Parent support programs of various kinds have been adapted to diverse cultural groups in the UnitedStates, the United Kingdom, Australia, and Canada (e.g., Brotman et al. 2011; Hall et al. 2007;Kumpfer et al. 2008; 2012; Mares and Robinson 2012; Reid, Webster-Stratton, and Beauchaine 2001;Sanders, Turner, and Markie-Dadds 2002; Webster-Stratton 2009), as well as in low- and middle-income countries (Baker-Henningham 2011; Beardslee et al. 2011; Kagitcibasi, Sunar, and Bekman2001). In addition, several reviews attest to the success of various forms of parent support inenhancing a range of child and family outcomes in low- and middle-income countries (Engle et al.2007; Engle et al. 2011; Eshel et al. 2006; Knerr, Garnder, and Cluver 2013).The major issue for adaptation, as identified by Castro, Barrera, and Martinez (2004) is implementingevidence-based interventions with fidelity (top-down) but adapting them to be responsive to theresource constraints and cultural needs of a local community (bottom-up). Backer’s (2001; cited inCastro, Barrera, and Martinez 2004) program adaptation guidelines follow a logic model that aims topreserve the core components of an effective program, while making changes to facilitate theprogram’s effectiveness within the local environment. The guidelines involve assessing thefidelity/adaptation issues, identifying the program’s theory of change, assessing community concerns,
  • 31. -DRAFT-30determining the needed resources and available training, involving the community, and monitoringfidelity/adaption issues. The most important elements of adaptation usually involve modifying theprogram content and making changes to program delivery and, as Castro and colleagues note,attention must be given to maintaining the deep versus surface structure of programs that contributeto their success.Many parent support programs contain common elements (see Figures 2 and 3), and outcome studiesidentify general approaches rather than either specific content or specific modes of program deliverythat are necessary to success. For this reason, it would seem that programs could be designed tosupport parents in low- and middle-income countries affected by HIV with a fair degree of latitude,depending on the goals of the program.The general approaches that have been identified as important in local adaptation are the following(Moran, Ghate, and van der Merwe 2004):• Ensuring that programs respond to parents’ needs by asking parents what information, advice,and support they would find useful. This can be done by working with parents before they join aprogram, ensuring the program addresses their concerns, using trusted local staff where possible,ensuring that staff are well trained, that they don’t talk down to parents, that interactive ratherthan didactic styles of working are used, and ensuring that parent feedback is incorporated andthat services are changed as a consequence of feedback.• Assisting parents to stay in the program by hosting programs close to where parents live,providing or paying for transport, ensuring child care, and sharing meals. These have all beenfound to increase parent participation and retention, as has providing relevant incentives foruptake and continued engagement such as certification. If the program aims to reach the mostvulnerable families, non-attenders and dropouts must be pursued and efforts made to re-engagethese parents.• Being sensitive to parental sociocultural context, including poverty, unemployment, culture, andethnicity. Parent programs that incorporate specific assistance for parents facing socioeconomicdifficulties have better retention rates, are valued more by parents, and have better outcomes thanprograms that address only parent, child, or parent-child issues. It is thus especially important forparenting programs to link with other services and sources of assistance to which parents withparticular needs can be referred and linked.• Providing structured programs and programs with attractive and appropriate supportingmaterials. Materials include leaflets, simple books, photographs, and videotapes, and are mostappreciated when they incorporate parents’ own lives and situations, without being oversimplifiedor patronizing (Moran, Ghate, and van der Merwe 2004).• Contextualizing programmatic messages and approaches within different cultural perspectives onparenting, many examples of which are found in the United States in programs for African-American and Latino-American families (e.g., Farber 2009; Gross et al. 2009; Katz et al. 2011;Scott et al. 2010; Sheely and Bratton 2010) and among Aboriginal (Lee et al. 2010), West African,and other ethnic groups in Australia (Renzaho and Vignjevic 2011). Recruitment into parentprograms, content of programs, and style of presentation may need adjustment to encouragefathers to participate, as demonstrated by Alio et al. (2011), Cowan, Cowan, and Knox (2010),Cullen et al. (2011), Fletcher, Freeman, and Matthey (2011), and Magill-Evans et al. (2006).• Maintaining longer-running programs, which are generally more effective, but this is in terms ofmonths compared to weeks, rather than years, in comparison to months (Letourneau et al. 2004).
  • 32. -DRAFT-31A summary of some of Moran et al.’s (2004) key messages for “what works” in practice is shown inTable 1.Table 1. A Selection of Key Messages for Effective Parenting ProgramsEarly interventions report better and moredurable outcomes.Later interventions are better than none, andmay be especially useful for parents under stress.Interventions that have clear goals, are based ontheory, have an articulated theory of change, andwork toward measurable outcomes are moreeffective.General programs, without clear goals andanticipated outcomes, are less effective.Universal programs aimed at primary preventionamong high-risk families have more positiveoutcomes.Targeted interventions are needed for familieswith special needs in addition to universalprevention strategies.Universal approaches are best implementedthrough structured group programs.Individual sessions are best suited to parentsand/or children with severe problems and forparents who are less likely to access groupprograms (e.g.,, home visiting for teen mothers).Multicomponent interventions can addressparental concerns more adequately.These can be provided by the same or differentagencies or service providers but mustcoordinate with each other to meet parent’sneeds.Behavioral programs that focus on specificparenting skills and practical, take-home tips aremore effective.General directives are not useful for parents, andmay be experienced as patronizing. This is oneof the reasons why peer mentors seem to beappreciated.Interventions that work in parallel (though notnecessarily at the same time) with parents,families, and children are more effective.Sessions for children, parents, and familiestogether can be provided by the same ordifferent agencies or service providers but mustcoordinate with each other to meet the needs offamilies.The Triple P Positive Parenting Program uses five levels of intervention that provide a useful modelfor how parent support might be delivered in low- and middle-income settings. Each of these levelsneeds to be adapted to the purpose of the parent support program, whether to prepare forparenthood or particular challenges of parenthood, promote early child development and learning,advise parents on how to manage children’s difficult behavior, increase child protection, and/orimprove parental and family well-being. Not all these elements can be merged into a single program,as they vary in relevance by child age as well as by parent and family circumstance.At Level 1, universal, media-based information campaigns can be mounted that affirm theimportance of parents to children’s health, well-being and, educational achievement; alerts parents tochildren’s age- and stage-based competencies and needs; raises awareness of safety issues for childrenand the adverse effects of harsh punishment; and encourages parents to speak and read to theirchildren. At Level 2, more targeted information and education campaigns can be directed to parentswith shared concerns, such as a particular age group or stage, disclosure of HIV to children,
  • 33. -DRAFT-32developmental delay, improving children’s success at school, and so on. At Level 3, a brief group-parent training or support program can be convened if parents express the need or desire for suchsupport. At Level 4, an ongoing support group directed to a particular issue can be organized,provided it is responsive to expressed need; and Level 5 interventions may involve referral toavailable social welfare services. Interest in these various levels of parent support will need to betested in communities as well as practical aspects of implementation such as training of localcommunity workers, duration of programs, and support materials.STRUCTURAL ENABLERS FORPARENTINGThere are many reasons why children who experience social exclusion, deprivation, and hardshiphave poor psychological, health, and educational outcomes. Compromised caregiving is likely to be acontributor to these effects. But the causes of compromised caregiving and poor child outcomes aremultiple, often reinforcing each other at the personal, sociocultural, and political levels, as made clearin the final report of the World Health Organization’s Commission on the Social Determinants ofHealth (CSDH 2008).There is a strong policy focus on parenting in Australia (Bayer et al. 2007), Canada (Gfellner et al.2008), the United Kingdom1(Bunting 2004; Lewis 2011), the United States2(Weaver 2012), Norway(Ogden et al. 2005), and the Organisation for Economic Co-operation and Development (Adema etal. 2012; Rodrigo et al. 2010). At the same time, though, there is concern that the expansion ofparenting programs should not be at the expense of a simultaneous effort to address inequality,discrimination, poverty, exploitative work conditions, lack of access to services, and other structuraldrivers of both poor human development and poor parenting (Abelda 2011; MacLeod and Nelson2000).Critics have argued that it is convenient to construct parents as both the primary problem and thesolution (in the form of training to “fix” parenting) to issues such as poor school performance,behavior problems, school dropout, youth crime, and substance use (Lucas 2011). A similar line ofthinking has been followed in low- and middle-income countries highly impacted by HIV and AIDS.There is a tendency to see the difficulties experienced by children and the threats to their longer-termprospects as principally caused by parental illness, death, and family dissolution―at the expense ofaddressing underlying structural sources of suffering for parents and children, such as long-standingand widespread poverty, lack of services, and corruption (Richter 2008).Poverty is the major threat to the well-being of children and families, in both low- and high-incomecountries (Yoshikawa et al. 2012). At-risk families need not only person-centered intervention such asparenting support, but also policies and services that secure their human rights, basic income,employment, housing, education, health, transport, and childcare, to enable them to provide for theirchildren’s subsistence (Febbraro 1994). These basic provisions can also reduce the stresses that can1For example, Every Child Matters; Sure Start; National Services Framework for Children, Young People andMaternity Services; Choosing Health (Kane et al. 2007; Lucas 2011).2For example, Head Start and Early Head Start (Jones Harden et al. 2012).
  • 34. -DRAFT-33diminish and distort parenting capacities, affect parental mental health, and trigger neglectful, harsh,and even abusive parental behavior. In this respect, lessons can be learned from several Europeancountries (e.g., France, Germany, and Sweden) that have been able to reduce family poverty levels,with gains for parents and children, through family policies such as cash benefits, tax concessions,and child support (Peters et al. 2001).In response to this imperative, four structural approaches are important as foundational or parallelinterventions to parenting programs in low- and middle-income countries heavily impacted by HIVand AIDS. These are human rights and protection from discrimination, income strengthening, and,especially cash transfer programs, childcare, and free or assisted education. Each of these is brieflyreviewed below.Human rights and protection from discriminationIn countries that tolerate discrimination against groups of people based on color, ethnicity, language,religion, sexual preference, sexual practice, drug use, and so on, affected parents find it very difficultto fulfill their parenting roles. They may be forced to live apart from their children, as is the case withmany migrant workers; their children may suffer socioeconomic disadvantages because of thedifficulties they encounter in trying to find work or housing; their children may be discriminatedagainst and denied services or access to education, and they may be afraid that their children will beforcibly removed from their care and placed in an institution or a foster home (Beard et al. 2010;Rhodes et al. 2010).Supportive interventions include self-help and solidarity, education and empowerment, care,decriminalization and legal representation, safety and protection, and community-based childprotection networks (Rekart 2006).Cash transfersFamilies affected by HIV and AIDS get poorer as a result of loss of income and livelihood, additionalcosts associated with care seeking and treatment, increased dependency, asset selling to meet survivalneeds, and loss of access to support as a result of stigma and discrimination (Richter et al. 2009). Alarge amount of literature attests to the adverse effects on caregiving and children as a result of theseimpacts. For these reasons, programs to strengthen parenting should be an adjunct to broader-basedefforts to secure the survival and livelihoods of AIDS-affected families, the vast majority of whomstrive to do better by their children despite their destitution (Richter 2012). While there are severalmechanisms for addressing the economic difficulties facing AIDS-affected families, consensus isdeveloping for the ease and speed of cash transfers to the poorest households in high-HIVprevalence settings.Adato and Basset (2012) have updated their review of evidence on social protection and cashtransfers to strengthen families affected by HIV and AIDS, covering more than 300 documents andevidence on impacts of 10 unconditional cash transfer (UCT) programs in Southern and EasternAfrica and 10 conditional cash transfer (CCT) programs in Latin America. In addition, they considerthe relative strengths and weaknesses of cash transfers in comparison to food transfers and nutritionprograms, public works, microcredit and livelihood programs, and social services. They concede thatthe best evidence for cash transfers comes from settings that are not severely AIDS-affected, andtherefore the findings have to be generalized, with thought given to the way in which HIV may affectthe context. HIV is intertwined with a range of vulnerabilities, the most significant of which is
  • 35. -DRAFT-34poverty. For this reason, the authors argue, “Social protection is a moral and economic imperative.While preserving basic levels of comfort and human dignity among the sick, social protectioninterventions may also be the only means of preventing the destitution of entire households, as wellas irreversible health, nutrition, and education deprivation among children—with lifelongconsequences” (p. xiv).The evidence from Latin America of cash transfers for child benefits is strong, as it is for familyeconomic strengthening. Good evidence is now also available from several high-HIV prevalencecountries (Davis et al. 2012), including through the recent national evaluation of the Child SupportGrant (CSG) in South Africa (DSA, SASSA, and UNICEF 2012). Because the CSG is universallyavailable, the researchers compared children with early access to the grant to those with later access.Early access children, especially girls, not only did better at school, but also reported less recentillness and had lower reported risk behaviors during adolescence, including sexual activity, teenpregnancy, and drug and alcohol use.Cash transfers get much-needed money directly to families more quickly and with fewer overheadcosts, if they are unconditional, than other forms of economic strengthening. As Adato and Bassett(2012) point out, microcredit and livelihood activities are only suitable for households that have nolabor constraints and have some asset endowments off which to work. In conclusion, they argue that“’AIDS-affected families do not comprise a homogenous category; they embody many variationswith respect to wealth or poverty, education, household structure, stage of illness progression,dependency ratios, social status and access to assets. This argues for a mix of social protectionapproaches rather than a single approach. However, pursuing a mix does not conflict with a nationalstrategy of scaling up cash transfers for the most vulnerable families” (p. xvii).In addition to the known positive impacts of cash transfers on children’s health and education, anintensive study of a program in Tanzania, in which very small cash pensions were paid to destituteelderly caregivers, demonstrates clearly the impact of socioeconomic relief on the quality of parentingand its beneficial effects on children (Hofmann et al. 2008). Both grandparent carers and children inthis mixed-methods study attested to feeling loving and being loved when they were able to provideand access some of the most basic necessities―soap to wash with, kerosene with which to cook foodand to provide light, predictable meals, and foodstuffs in addition to a staple carbohydrate.In sum, we cannot strengthen parenting without supporting parents to be able to provide for lifeessentials for themselves and their children. Social grants, cash transfers, livelihood schemes, publicworks, micro lending, health insurance, and other mechanisms help to give basic social protection tothe poorest families. This is the first step toward strengthening parenting.Child careMany families in low- and middle-income countries need childcare. In Forgotten Families Heymann(2006), provides a startling picture of the extent of the gap in 180 countries. “There has been adramatic transformation in the workforce worldwide, with hundreds of millions of people leaving thehome or farm to join the formal [and informal3] labour force; the majority of both men and womenare in the labor force in nearly every region in the world; more that 930 million children under fifteenare being raised in households in which all of the adults work” (p. xi).3“And informal” added.
  • 36. -DRAFT-35In most low- and middle-income countries, formal childcare is expensive and largely urban-based―beyond the reach of the families who most need it. Informal childcare is less expensive, butalso unregulated and sometimes unsafe. Parents who lose income or pay because of caregivingresponsibilities are forced to leave children alone at home or take them along to their workenvironment. This may be an open fire by the side of a busy road where food is prepared for truckdrivers, or a polluted rubbish dump where a parent scrounges for food or objects that can bebartered or sold. In the Heymann study (2006), which involved analyses of data from 55,000 peoplein five regions of the world, 36 percent of families had left a child alone at home, 39 percent left asick child at home alone or sent a sick child to school, 27 percent left the child in the care of another(paid or unpaid) child, and 23 percent took a child with them to unsafe work conditions.AIDS-affected families especially need help with childcare, as the pressures on income, livelihood,and the care for sick household members mount, and less-able individuals (adolescents and theelderly) are obliged to take on the major responsibility for the care of children. Under thesecircumstances, young children are in danger of receiving less attention than they need, with adverseconsequences for their health and psychological development (Heymann et al. 2007)Community childcare programs, spaces, or centers, run by local women who are trained to providekind, safe, and hygienic childcare, with sufficient support to prepare one or more nutritious meals forchildren, can be of enormous relief to families with high burdens of care in the family, including carefor young children. As indicated earlier, childcare programs that promote parent-child interaction andoffer educational and language stimulation have been shown, also in low- and middle-incomecountries, to have positive benefits for children’s cognitive development, health, and education(Engle et al. 2011).Programs that aim to strengthen parenting must support childcare. This helps parents to continueworking, and to conduct livelihood and care activities in the home relieved of the anxiety of lookingafter young children. A wide variety of options for childcare support are available and can be tailoredto local circumstances. Childcare programs also provide a ready platform for other efforts tostrengthen parenting.Free or assisted educationBesides food, the second-highest expenditure item for poor families is education, and this remainsthe case even in the face of free education policies at the national level. Districts, schools, andindividual teachers levy a range of unofficial fees, schools demand that parents buy books and thatchildren wear specific uniforms, and households must meet the costs of transport to and fromschool. These constitute major impediments for poor families (Kadzamira and Rose 2003). Theeducational vulnerability of children affected by HIV and AIDS, parental anxiety related to enrollingand sending children to school, and children’s desire to attend school form a common refrain instudies examining the impacts of poverty and HIV on children and families (Boutayeb 2009).The Global Monitoring Report of Education for All indicates that more than 100 million children,the vast majority from developing countries, are not in school. It is estimated that only about 65percent of children are in primary school in Africa, and only 20 percent of children in sub-SaharanAfrica are in secondary school (Boutayeb 2009; Lewin 2009). Of course, access is not the completepicture, and what children in school learn is also important. However, there are indications thatefforts to strengthen parenting include involving parents in children’s education, and conversely, that
  • 37. -DRAFT-36assisting parents to access education for their children may increase parental investment in children(Jansen 2004; Therdikildsen 1998).Programs that enable free or assisted education for children affected by AIDS, through any numberof mechanisms―including advocacy at the national and local-government levels, block grants toschools, uniform and fee programs―are likely to reduce parental and family stress and facilitate amore positive environment for parenting.CONCLUSIONSFamilies, parents, and children affected by HIV and AIDS are very likely to benefit from parentsupport, though it is questionable whether there can be a uniform package delivered effectively usinga standardized approach. The deep structure comprising effective elements of parent support hasbeen identified as follows:• Support programs that respond to parents’ expressed needs• Group sessions, with outreach through home visits to marginalized and at-risk families• Social support and reassurance from professionals, or trained para-professionals and peermentors• Opportunities to meet with others in the same position or facing the same challenges, whoempathize and provide encouragement• Authoritative, simple information on topics requested by parents• Attractive materials for guidance• Concrete advice and direction• The chance to practice new approaches at home and report back• Referral to and assistance in accessing related services• Assistance with material needs, whether economic, housing, employment or discrimination,and help to overcome structural barriers to effective parenting.These elements need to be assembled in different ways for parents with varying needs andcircumstances and with children of different ages. Pregnant women newly diagnosed with HIV are areadily apparent group that is likely to appreciate parenting support and benefit from it, as suggestedby Mothers to Mothers-to-Be (McColl 2012) and other peer mentor approaches. New mothers areespecially appreciative of parent support, especially when they face additional challenges brought onby their circumstances or health, or the health of their baby. Families who take in children of kin whoare ill or recently deceased are another discernible group, as are older caregivers looking aftergrandchildren and sibling caregivers.Communities affected by AIDS and poverty are likely to have a variety of needs related to childrenand the challenges of parenting, including disclosure of their own or others’ HIV to children,speaking and reassuring children about illness and death, counseling against stigmatization anddiscrimination, supporting children undergoing difficult experiences when parents are ill or die, andhelping children stay in school.This review provides a resource of approaches and principles from which new programs for parentsof children affected by HIV and AIDS can be developed. However, such programs need to be basedon a thorough understanding of what parents would find useful, need to have meaningful parent
  • 38. -DRAFT-37participation, and need to address material and other challenges that parents face in meeting theneeds of their children in the context of AIDS and poverty.
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  • 44. -DRAFT-43APPENDICESAppendix 1: Methods of the ReviewAppendix 2: Quality of the EvidenceAppendix 3: Summaries of Overviews and Systematic ReviewsAppendix 4: Brief Descriptions of Parent Support ProgramsAppendix 5: List Of References Included in the Literature Review
  • 45. -DRAFT-44APPENDIX 1METHODS OFTHE REVIEWThe literature on the topic of parent support is extensive and complex. For a critical and evaluativeaccount of what has been published on the topic, we adopted the following approach:1. A literature search was conducted in accordance with best-practice review methodology (TheCochrane Collaboration, 2006).2. The focus of the search was parenting and/or caregiving in general.3. To supplement standard electronic database search techniques, we used probe search proceduresto identify recent reviews of interventions on particular topics, with follow-up of particularlyeffective or promising interventions for certain specific caregiving challenges.4. We summarized findings on interventions to support and strengthen caregiving.5. Lastly, we extracted from the review general principles of interventions to support andstrengthen child-caregiver relationships and parenting that can be taken forward in discussionsabout potential programming and implementation.LITERATURE SEARCHWe followed a systematic process for this literature search, using a combination of electronic andmanual approaches. Electronic databases efficiently generate large numbers of articles that containthe stipulated keywords, or search terms, that are linked to papers published in a variety of journals.The manual component consisted of meticulously sorting through the titles and abstracts generatedby the electronic database, deleting irrelevant entries, and tracking down the full texts of the relevantpapers, as well as important sources referenced in the selected papers.The literature search process is illustrated in Figure 1, beginning with the selection of relevantelectronic databases to search. Electronic databases were selected on the basis that they covered avariety of journals and disciplines relevant to this topic with minimal overlap (see Table 1). For thepurposes of academic discipline, the databases were limited to those covering, or at least extendinginto, the fields of social science and public health. The main databases used were EbscoHost andProQuest Central, as these cover the majority of journals and relevant secondary databases. PubMedextended the search into the biomedical field, and the Cochrane and Campbell Libraries includedsystematic reviews of specific subjects. Secondary databases or search engines included AcademicSearch Complete, Africa-Wide Information, Child Development and Adolescent Studies, EconLit, ERIC, Family &Society Studies Worldwide, Health Source, Left Index, Medline, PsychArticles, PsychCritique, and PsychInfo. Eachof these secondary databases offers access to numerous periodicals and peer-reviewed journals.The composition of search terms was critical, as it determined the results extracted from theelectronic databases. Once compiled, the list of search terms was adjusted to fit the search frameworkfor each database.Using the compiled list of terms, we then ran individual searches in each database. Result citationsand abstracts were downloaded into the EndNote reference management program. These results weredownloaded sequentially, beginning with the database yielding the most relevant results, e.g.
  • 46. -DRAFT-45EbscoHost. Results from the other databases were then downloaded and imported into the EndNotelibrary, which removed exact duplicates and stored the unique results in a new file. Ultimately, thenumber of results from each database was not necessarily indicative of the number of relevant paperson the topic in the database. While a database like EbscoHost is likely to contain more relevant papersthan a biomedical database, databases cannot be compared on the basis of relevance orcomprehensive hits due to the process of removing duplicates.The first step of the manual review component entailed examining each title and abstract within theEndNote library and eliminating duplicates that EndNote did not catch, due to transcription or othererrors. At this time, papers that ultimately did not fit the inclusion criteria were also removed.Selected papers were then manually examined and categorized as either significant papers or part of thebody of the review.In a second search phase, we combed the reference lists of papers in the body-of-review set for citationsthat might have been skipped in the initial electronic search. In a third phase, we used Google Scholarand the websites of specific journal publishers to further check for additional titles. Any new citationsand abstracts found in the second and third phases were then manually reviewed for finalinclusion/exclusion and classification, and the relevant papers were added to the EndNote library. Fulltext versions of all selected papers were then sourced and individually reviewed.This review ultimately only covered papers published between 2000 and 2012. Important paperspublished before 2000 did inform the review and are included in Appendix 4. This review does notcover unpublished, non-bibliographic or gray literature, as per the agreed terms of the assignment.Publications in other languages are often difficult to access, and English translations may not beavailable. For this reason, we only included literature published in English. Nevertheless, valuablecontributions to the issue of strengthening and supporting the caregiver-child relationship have beenmade in non-English publications. Whenever possible, relevant foreign-language publications wereincluded, when a translation into English was available or could be made using Google Translator;these publications also informed background considerations for the review.
  • 47. -DRAFT-46Figure 2. Diagram Illustrating the Review Procedure
  • 48. -DRAFT-47Table 1. Data SourcesEbscoHostEbscoHost is one of the worlds largestintermediaries between publishers and librariesand provides access to some 26,008 e-journalsacquired through Ebsco using numeroussecondary databases and publishers covering awide variety of disciplines.The Cochrane LibraryThe Cochrane Library contains high-quality,independent evidence to inform healthcaredecision-making. It includes comprehensivesystematic reviews including clinical trials.ProQuest CentralProQuest Central is an extensive aggregated full-text database including more than 17,580 journals.Its coverage is international and archives materialfrom 1971 to the present.The Campbell CollaborationThe Campbell Collaboration is the siblingorganization to the Cochrane Collaboration andfocuses on social and psychological interventions.It promotes the accessibility of systematic reviewsin areas such as education, criminal justice, socialpolicy, and social care.PubMedPubMed is a service of the U.S. National Libraryof Medicine that includes over 17 millioninternational citations, dating back to the 1950s.Although PubMed is primarily a biomedicaldatabase, numerous life science journals areincluded.Google ScholarGoogle Scholar is a search engine designed forbroad access to scholarly literature. Searchesextend across many disciplines and sources.Search termsIn order to conduct a comprehensive search, a list of search terms was compiled iteratively. Full titlesand abstracts of papers were searched using the search terms.Table 2 contains the list of the search terms used, with asterisks indicating a truncated search term.As agreed in the terms of reference, the search was restricted to children generally, and did notspecifically search for articles on adolescents or youth in particular. Efforts to support and/orstrengthen parenting for or by adolescents or caregiver-adolescent relationships were included insofaras they were identified by the generic search term “child*”.Table 2. Search Termsbabies attachment counsel?ingbaby Care educat*child* caregiving interventioninfant famil* program*
  • 49. -DRAFT-48orphan guardian stabilitytoddler Home strengthen*interaction support*involvement therapyone-parent train*parent* well?beingparent-childrelations*Single?parent*truncated words, e.g. parent* will result in hits for parent, parents, parental and parenting? wild cards, e.g. counsel?ing will result in hits for counseling and counsellingAs previously noted, search terms were adapted to the search framework of each database. Forexample, a search in one database, covering search terms in the abstract (AB) will accept the input:AB (child OR children OR infant OR orphan OR baby OR babies OR toddler) AND (parent* ORfamily OR guardian OR single?parent OR one?parent OR parenthood OR care OR caregiving ORparent-child OR relation* OR interaction OR attachment OR involvement OR "home structure")AND (support* OR strengthen* OR train* OR educate OR education OR therapy OR interventionOR stability OR counsel#ing OR well?being OR program* OR programme*)However, another database will require search input to be tailored to search within the title andabstract (tiab):#1 child [tiab] OR children [tiab] OR infant [tiab] OR orphan [tiab] OR baby [tiab] OR babies [tiab]OR toddler [tiab]#2 parent [tiab] OR parenting [tiab] OR family [tiab] OR guardian [tiab] OR “single parent” [tiab]OR “one parent” [tiab] OR parenthood [tiab] OR care [tiab] OR caregiving [tiab] OR parent-child[tiab] OR relation [tiab] OR relationship [tiab]OR interaction [tiab] OR attachment [tiab] ORinvolvement [tiab] OR "home structure" [tiab]#3 support [tiab] OR supporting [tiab] OR strengthen [tiab] OR strengthening [tiab] OR train [tiab]OR training [tiab] OR educate [tiab] OR education [tiab] OR therapy [tiab] OR intervention [tiab]OR stability [tiab] OR counseling [tiab] OR counselling [tiab] OR well-being [tiab] OR“well?being” [tiab] OR program [tiab] OR programme [tiab]#1 & #2 & #3Inclusion and exclusion criteriaIn the first phase of electronic searching, the time period was left open primarily because muchimportant work on parenting, such as that by Diana Baumrind, was conducted in the 1970s and1980s. Some of these references were retained as background material. In its final form, the review islimited to the period between 2000 and 2012.The review is also limited to the assessment of the published literature on supporting andstrengthening caregiver-child relationships and parenting in the English language.Certain topics were excluded because they were judged to be unrelated to the overall topic, oftenbecause they were too specific or detailed. Preference was given to interventions, approaches, and
  • 50. -DRAFT-49programmes with some evidence for their efficacy, effectiveness, or feasibility in a population-basedapproach. Table 3 includes the final inclusion and exclusion criteria for this literature review.Table 3. Inclusion and exclusion criteria used to focus search resultsInclusionPapers published in scholarly, peer-reviewed journalsEmpirical literature on supporting/strengthening caregiver-child relationshipsParenting support and methods for strengthening caregiver-child relationshipsDescriptions of interventionsEvaluations of interventionsFactors influencing the success/failure of interventionsCharacteristics of the intervention or the target group, participation/attrition, differentialbenefit, etc.Commentaries/opinionsSynthetic reviews, overviews, policy discussions, cost-benefit analysesExclusionTechnical reports, working/discussion papers, unpublished literaturePapers focused on specific pathologies, rare and uncommon illnesses, disorders ordisabilities, such as attention deficit disorder and hyperactivity, autism, etc.Papers focused on specific populations such as imprisoned parents, foster care in thecontext of welfare placement, divorce and court mediation in parenting, etc.Papers in which the focus was child outcomes (for example, a study of preterm babies at 5years) rather than on interventions to strengthen parenting or parental capabilities, etc.Descriptions of parenting or care environments in the absence of intervention; forexample, child caregivers in AIDS-affected families; parenting by depressed mothers, etc.Clinical applications, including prevention of mother-to-child transmission , psychiatrictreatment, individual psychotherapy, etc.
  • 51. -DRAFT-50Table 4 below shows the process of selection and elimination of finds from the initial search to thefinal set of papers included in and informing the review; 500 papers are included in the review listing.Additional references which are not included in the review listing are cited in the report.Table 4. Selection and Elimination of PapersSteps in search procedureCampbellLibraryCochrane LibraryEbscoHost ProQuest PubMedReferenceListsGoogleScholarInitial phase electronicsearch143 1,180 281,261 88,979 77,203Export citations and removedduplicates within databases143 1,180 19,674 7,060 10.003Results minus duplicatesbetween databases143 1,180 17,101 5,512 8,748TOTAL in Endnote Library 32,684First manual sorting throughtitles and abstracts14 111 970 65 60TOTAL in Endnote Library 1,220Second manual sortingthrough titles and abstracts11 67 528 44 30TOTAL in Endnote Library 680Second phase search ofreference lists in significantpapers11 67 528 44 30 6Third phase search in GoogleScholar11 67 528 44 30 6 7TOTAL in Endnote Library 693Separated by time period Pre-2000 2000-201240 653Manual sorting throughcomplete text of each paperPre-2000 Background papersPapers in thereview47 122 500TOTAL in Endnote Library 669
  • 52. -DRAFT-51APPENDIX 2THE QUALITY OFTHE EVIDENCE FORPARENTING SUPPORTCriteria for assessing the quality of a study include:RandomizationIn order to conclude that an intervention has an effect, it is necessary to take steps to eliminatesampling and selection bias in the distribution of participants to treatment and comparison groups.For example, more motivated parents might sign up for parent training in order to improve theirrelationships with their children. If beneficial effects are found in the parent training study, it may notbe easy to determine if the results are caused by the program or by pre-existing characteristics, suchas the parents’ motivation for healthy relationships with their children; it is also possible that theresults may be attributed to an interaction of both variables.Such potential bias is addressed by random allocation and blinding. Blinding involves concealing thegroup assignment—treatment or comparison— from both participants and from the investigatorswho assess outcomes (Jadad 1996). Acceptable groups for rigorous comparison include a no-treatmentgroup, a group eligible for the intervention but on a waiting list, and an as-usual group (normal serviceprovision).In theory, randomization should ensure that confounders (hidden or extraneous variables) are equallydistributed between the intervention and the comparison groups. However, small sample sizes maynot sufficiently control for confounding factors. This can occur when attributes, such as parentalmotivation or social class, are unevenly distributed between the intervention and control groups. Forthis reason, the distribution of known potential confounders must either be compared between thedifferent study groups at the outset, or researchers must adjust for confounders at the analysis stage.Measurement of Intervention EffectsMany studies rely on parental reporting—parents’ own attitudinal, emotional, and behaviouralchanges and those of their children—as a measure of outcome. Parental report can be biased towardpositive or negative outcomes for themselves, their children, and their families. Because of reportingbias, study outcomes should be assessed independently and through the use of standardisedinstruments (for example, psychological questionnaires and scales). Examples of standardized parent,child, parent-child relationship, and home environment outcome measures used in studies ofparenting programs are shown in Tables 1 and 2.
  • 53. -DRAFT-52Table 5. Examples Of Parent And Independent Outcome MeasuresParentalknowledgeParentalattitudes &behaviorsParental self-confidenceParentalwellbeingIndependentratingsInclude knowledge, skills (e.g. supervision, boundary setting,communication), attitudes, behavior (e.g. discipline, affection),wellbeing (e.g. depression, self-esteem)Measuresprovided byindependentobservers or incase recordsParentingKnowledgeTestParentalAttitudeQuestionnairePharis Self-Confidence inInfant CareEdinburghPostnatalDepressionScaleConner’sTeacher RatingScaleKnowledge ofInfantDevelopmentInventoryBehaviormanagementscenariosRosenberg Self-Efficacy ScaleBeckDepressionInventoryCase records ofinjuriesInfant FeedingQuestionnaireAdult-AdolescentParentingInventoryParenting Self-ConfidenceScaleParentingStress IndexTeacherAssessment ofSchoolBehaviorTable 6. Examples of Child and Home Environment Outcome MeasuresChilddevelopmentChild socio-emotionaldevelopmentChildlanguageParent-childrelationshipHomeenvironmentConduct problems, depression/anxiety, sleepdifficulties, drug use, school readiness, literacy andnumeracy, educational performanceAttachment, warmth,communication, punishment,home safetyBayley Scales ofInfantDevelopmentChild BehaviorTrait RatingBzoch-LeagueReceptive-ExpressiveEmergentLanguageParent ChildEarlyRelationalAssessmentCaldwellHOME ScaleDenverDevelopmentalScreening TestStrengths andDifficultiesQuestionnaireUtah Test ofLanguagedevelopmentVideotapedmother-childinteractionHome hazardsand safetymeasuresGriffiths MentalDevelopmentScaleChild BehaviorChecklistPeabodyPictureVocabularyMaternalInteractiveBehaviorDaily activities,shared mealtime,etc.
  • 54. -DRAFT-53Measurement challenges are compounded in settings for which measures have not been standardized,including most low- and middle-income countries, where foundational psychometric work on scaledevelopment and validation has not yet been completed. Researchers encounter similar problemswhen attempting to assess the current state of knowledge in a field, such as in a systematic review; thewide range of instruments (as well as scales and sub-scales) used make comparisons difficult, as doesthe fact that assessments are often made at different time points.Sample SizesIn general, sample sizes in effectiveness studies of parent support interventions are too small to testthe effects of sub-group differences. Furthermore, very few studies provide details on the sample sizecalculations or information about the size of the changes that the study measures were powered todetect (Barlow et al., 2011).Missing DataAttrition from parent support interventions is high; approximately 30–40 percent of recruitedparticipants drop out of programs (Thomas et al., 1999; Barlow et al., 2003; Barlow & Parsons, 2005;Bunting, 2004), largely due to logistical difficulties associated with transport, work schedules, andchild care. Programs that address these constraints tend to have better retention.Missing data is seldom subject to Intention to Treat (ITT) analysis. ITT includes all participants in theanalysis to counter the potential for bias from loss of participants with particular characteristics. Forexample, if the most-at-risk families drop out of the intervention, the effects of the program mightappear to be more successful than they would have been if more at-risk families had remained in thestudy.Follow-up EffectsAlthough most evaluations assess outcomes immediately post-intervention, few studies followparticipants beyond that point. The few studies that do longer follow-up tend to provide invaluableinformation on maintenance of effects.As is seen in the main report, the evidence base for parenting support interventions is regarded asgenerally average to poor, depending on the specific topic. The majority of individual studies ofprograms are of methodologically poor quality, with several threats to the validity of the datacollected and significant risk of bias. This is illustrated in Appendix 2, in the summary of overviewsand systematic reviews, which demonstrates that between only 15 (Lundhal, et al., 2006) and 50(Coren, et al., 2003) percent of relevant studies are found to be eligible for inclusion in systematicreviews.Bias in the excluded studies is most likely to be in the direction of Type I error, meaning theacceptance of a positive result which may not be justified. On the other hand, the very stringentcriteria for inclusion in randomized control trials may lead to an overall underestimation of thebenefits of programs in systematic reviews.
  • 55. -DRAFT-54APPENDIX 3SUMMARIES OF OVERVIEWS ANDSYSTEMATIC REVIEWS (2000-12)Review Description FindingsThomas, H., Camiletti, Y., Cava, M.,Feldman, L., Underwood, J., &Wade, K. (1999). Effectiveness ofparenting groups with professionalinvolvement in improving parentand child outcomes. Ontario,Canada: Public Health Research,Education and DevelopmentProgram (PHRED). 238 articles,shortlisted 31 andreviewed 4 strong and10 moderate qualitystudies. Criteria forquality included studydesign, confounders,blinding, measurement,and attrition. Only oneevaluation of a publichealth intervention wasfound.All interventions, especially group-basedbehavioral programs, reported positive effects onchild or parent behavior and/or parent–childinteractionBenefits were maintained in the 6 studies withfollow-up beyond 6 months.Macleod, J. & Nelson, G. (2000).Programs for the promotion offamily wellness and the preventionof child maltreatment: A meta-analytic review. Child Abuse &Neglect, 24, 1127-1149.Reviewed preventiveand reactive programspublished orunpublished between1979 and 1998,targeting children upto 12 years of age, withdata sufficient tocalculate an effect size.The review identified56 studiesMost programs which aim to promote familywellness and prevent child maltreatment aresuccessful, with the highest effect sizes foroutcomes measuring family wellness and thelowest effect sizes for outcomes measuring childmaltreatment.Social support/mutual aid programs had thehighest effects; lowest effects were found forhome programs with fewer than 12 visits and lessthan 6 months duration, and effects were greaterover time.Intensive family preservation, high levels ofparticipant involvement, anempowerment/strengths based approach, andsocial support appeared to be the most effectivecomponents.The reviewers caution that parenting programsare not a cure for poverty. Stresses due to povertyhave been linked to child maltreatment andefforts to address poverty should be prioritized.Macmillan, H. L., with the Canadian In an update of the Screening procedures not recommended because
  • 56. -DRAFT-55Task Force on Preventive HealthCare. (2000). Preventive healthcare2000 update: Prevention of childmaltreatment. Canadian MedicalAssociation Journal, 163(11), 1451-1458.1993 report, reviewed4 new observationalstudies and severallongitudinal studies ofscreening for riskfactors. With respectto prevention, 2 newhome visiting studiesusing professionals(Olds, Elmira) and 3with non-professionalvisitors; and 1studyeach oncomprehensive healthservices, parenteducation and supportand combined servicesand programs – allaimed specifically atpreventing sexualabuse.of high false positive rates.Two randomized control trials (RCTs) usingprofessional nurses, showed a reduction in theincidence of childhood maltreatment or outcomesrelated to physical abuse and neglect among first-time disadvantaged mothers and their infants whoreceived home visits, starting early and continuingwell into infancy.No effects with paraprofessionals, though thestudies were methodologically weak.None of the other approaches rendered sufficientevidence to justify expansion.Akinbami, L. J., Cheng, T. L., &Kornfeld, D. (2001). A review ofteen-tot programs: Comprehensiveclinical care for young parents andtheir children. Adolescence, 36(142),381-393.Identified 46 papers, ofwhich 4 met theeligibility criteria. All 4programs conducted inclinics or academicenvironments in urbanareas. As with otherprograms, thesereported very highattrition by 18 months.In general, infant outcomes favorable – betterclinic attendance, growth and immunization.Only one program found improved maternalbehavior e.g. in use of preventive health services,use of car seat belts.Generally little benefit demonstrated for childdevelopment knowledge, parenting skills.Despite attrition, benefits were retained amongfamilies followed up to 24 months.Nelson, G., Laurendeau, M.-C., &Chamberland, C. (2001). A reviewof programs to promote familywellness and prevent themaltreatment of children. CanadianJournal of Behavioral Science, 33(1), 1-13.Conducted a broadoverview of programs,organized according toBronfenbrenner’s(1986) ecologicalframework. Makereference to acomprehensive reviewby Todres andBunston (1993).Currently no evidence that educational programsprevent child sexual abuse.Only home visitation programs have been shownto prevent child physical abuse and neglect, andmulticomponent, community-based programshave been shown to promote family wellness.Most effective interventions begin at birth, lastseveral years, are intensive, and run by well-trained professional staff.A significant limitation of most programsreviewed is that they do not adequately addresspoverty, which is a major risk factor for childmaltreatment.
  • 57. -DRAFT-56Woolfenden, S., Williams, K. J., &Peat, J. (2001). Family and parentinginterventions in children andadolescents with conduct disorderand delinquency aged 10-17.Cochrane Database of SystematicReviews. 2001:2. DOI:10.1002/14651858.CD003015.Identified 970 papers,of which 8 evaluationtrials met the inclusioncriteria. Seven trialsincluded juveniledelinquents and onetrial included childrenand parents not yet incontact with the justicesystem. The reviewcovered a total of 749children and theirfamilies, randomizedto a family andparenting interventionor to a control group.Evidence that maternal mental health can affectchild outcomes.Focused on structured prevention programs tostrengthen parenting through group-basedformats.Sessions were frequently weekly and programswere based on 7-12 sessions.Few studies showed positive results on follow-up.Most studies included mothers only.Barlow, J., Coren, E., & Stewart-Brown, S. (2003). Parent-trainingprograms for improving maternalpsychosocial health. CochraneDatabase of Systematic Reviews.2003: 4. DOI:10.1002/14651858.CD002020.pub2.From 26 identifiedstudies, 20 providedsufficient data tocalculate effect sizesfor 5 outcomes(depression;anxiety/stress; self-esteem; social support;and relationship withspouse/maritaladjustment).Meta-analyses showed statistically significantresults favouring the intervention group fordepression; anxiety/stress; self-esteem; andrelationship with spouse/marital adjustment.No evidence for effects on social support.Coren, E., Barlow, J., & Stewart-Brown, S. (2003). The effectivenessof individual and group-basedparenting programs in improvingoutcomes for teenage mothers andtheir children: A systematic review.Journal of Adolescence, 26(1), 79.Reviewed individual orgroup-based programs,offered ante-orpostnatally to pregnantor parenting teens (ageless than 20 years),using a structuredformat and focused onimproving parentingattitudes, practices,skills or knowledge.Identified 24 papers, ofwhich 14 werereviewed. The 10excluded were notparenting programs.Teen births are higher among lowersocioeconomic groups, partly because moreaffluent teens terminate unwanted pregnancies.There was considerable diversity in programs.Despite consisting of only 1 or 2 sessions, somevideo interventions produced positive changes ina range of parent and child outcomes. Themajority were group-based, taking place on aweekly basis over the course of 12–16 weeks.The results indicate that parenting programs areeffective in improving a range of outcomes forboth teenage parents and their infants includingmaternal sensitivity, identity, self-confidence andthe infants’ responsiveness to their parents.It is hypothesized that group processes and peer-group support may play a significant role inproducing change.
  • 58. -DRAFT-57Robinson, P., Robinson, M. &Dunn, T. (2003). STEP parenting: Areview of the research. CanadianJournal of Counselling, 37, 270-278.This paper reviewsresearch on theeffectiveness ofSystematic Training forEffective Parenting(STEP) because of acontroversy arisingfrom prior publicationsand the importance ofensuring that thepublic is encouraged touse scientificallysupported programsThe review concluded that the evidence does notsupport the effectiveness of STEP.Evidence for changes in parental attitudes arecontradictory and the authors maintain that suchchanges are not sufficient to conclude that aparenting program is effective.While some researchers report that STEPimproves children’s self-esteem, the authorsquestion whether this is a sufficiently robustindicator of psychological health.No substantial body of evidence shows thatSTEP training improves children’s behavior.Bunting, L. (2004). Parentingprograms: The best availableevidence. Child Care in Practice, 10(4),327-343.Reviewed 3 CochraneReviews of parentingprograms, 2 systematicreviews on parentingprograms listed on theUK’s National HealthSystem’s Database ofAbstracts of Reviewsof Effectiveness andother studies identifiedby following upreferences fromrelevant articles.Summarized the 14 methodologically strong ormoderate studies reviewed by Thomas et al(1999).Craig, E. A. (2004). Parentingprograms for women with mentalillness who have young children: Areview. Australian and New ZealandJournal of Psychiatry, 38(11/12), 923-928.An overview of theeffects of maternalmental illness onchildren andinterventions that havebeen evaluated.Classifies parenting programs into: genericprograms and specific programs for at-riskparents.Despite enthusiasm for their application, there isa lack of empirical data relating to parentingprograms for mothers with mental illness.Many parenting programs are generic andpopulation-based. However, parents with mentalillness experience both the common problemsencountered by all parents, as well as a range ofissues due to their mental illness.Geeraert, L., Van Den Noortgate,W., Grietens, H., & Onghena, P.(2004). The effects of earlyprevention programs for familieswith young children at risk forphysical child abuse and neglect: Ameta-analysis. Child Maltreatment,This meta-analysissynthesizes results on40 evaluation studiesof early preventionprograms for familieswith young children atrisk for physical childA significant overall positive effect was found(similar in size to the results of other meta-analytic reviews of prevention programs for childabuse and neglect), demonstrating a significantdecrease in abusive and neglectful acts.Significant risk reduction in factors such as
  • 59. -DRAFT-589(3), 277-291. abuse and neglect.Most of the studiesemployed non-randomized designs.Studies, published andunpublished, wereincluded if publishedin English, French,German or Dutchbetween 1975-2002.Studies focused on theprevention of childabuse in familiesidentified to be at risk;programs in whichsupport or servicebegan before the birthof the child or in thefirst 3 years; thedefinition of childmaltreatment waslimited to physicalabuse and neglect.parent-child interaction, child functioning, parentfunctioning, family functioning and contextcharacteristics were identified.More research is needed around the relationshipbetween effects and program or target groupcharacteristics.Kohut, K. S., & Andrews, J. (2004).The efficacy of parent trainingprograms for ADHD children: Afifteen-year review. DevelopmentalDisabilities Bulletin, 32(2), 155-172.Reviews studiespublished in the last 15years that have focusedon training programsfor parents of school-aged children ADHD.Specifically tries tocompare programsbased on contingencymanagement principleswith parent trainingprograms that aim toimprove social skills orproblem-solving skillsamong children.Across all of the studies, both contingencymanagement and child training, parent trainingprograms seemed to be able to increase parentalconfidence in their management abilities andincrease their self-esteem.They also helped reduce parents’ stress, as well aslead to a reduction of ADHD symptoms andchild noncompliance.Letourneau, N. L., Stewart, M. J., &Barnfather, A. K. (2004).Adolescent mothers: Support needs,resources, and support-educationinterventions. Journal of AdolescentHealth, 35(6), 509-525.Reviewed researchpublished between1982 and 2003 withthe purpose of:describing the supportneeds of adolescents,the resources available,and review relevantSocial support is intended to counter the poorsocioeconomic conditions of many youngmothers, stress, family instability and limitededucational opportunities.Available literature suggests that adolescentsfrequently rely on family for support, especiallytheir mothers, followed by partners. Partner
  • 60. -DRAFT-59support educationintervention studies toprovide directions forfuture research.Identified 5 post-hocevaluations of existingprograms, 10 quasi-experimentalintervention studies,and 4 randomizedcontrol is correlated with the mother’spsychosocial well-being and favorabledevelopmental outcomes for the infant.Many studies report improvements in maternalknowledge, timing to subsequent pregnancy,return to schooling, knowledge of childdevelopment, responsiveness, child adjustmentand immunization etc., though all suffered fromone or other methodological weakness.Most interventions focus on education andinformational support provided by professionals.Given the influence of their peers, adolescentsmay benefit more from reciprocal lay support.No research was identified that examinedinterventions designed to enhance the natural (, partner) or peer support networks ofadolescents.Recommend that future interventions examineways to maintain supportive relationships withparents, partners and friends and to include themin support-education interventions.McNaughton, D. B. (2004). Nursehome visits to maternal-childclients: A review of interventionresearch. Public Health Nursing, 21(3),207-219.The review examines13 research studiespublished between1980 and 2000 that testthe effectiveness ofhome-visitinginterventions usingprofessional nurses ashome visitors.Participants in most studies were either pregnantor postpartum and had multiple risk factors suchas teen parenthood, single parenting, low income,lacking social support, drug or alcohol abuse,smokers, and being at risk for delivering a low-birthweight baby.Little consistent application of theory.Most studies report benefits, althoughinconsistent between studies, including health ofmother and child, mental health of the mother,improved parent–child interaction, homeenvironment, maternal perceptions of infantbehavior, reduction in child abuse and injuries,and use of health services.Moran, P., Ghate, D., & van derMerwe, A. (2004). What works inparenting support? A review of theinternational evidence. London: UKDepartment of Education andSkills. Research Report No 574.ISBN 1 84478 308 1.The aim of this reviewwas to give asystematic overview ofthe parent supportliterature for policymakers in the UK, tochart key findings in astandardized form, andThe summary from the review is that:While early interventions report better and moredurable outcomes for children, late intervention isbetter than none and may help parents deal withparenting under stress.Interventions with a strong theory-base andclearly articulated model of the predicted
  • 61. -DRAFT-60distil overarchingmessages in a succinctand accessible way.Thus reviewed a widerange of services,combining scientificrigour with practiceand policy relevanceand accessibility.Programs were sortedinto 4 categories: ‘whatworks’, ‘what ispromising’, ‘what doesnot work’, and those inwhich effectiveness isstill ‘not known’. Bothqualitative andquantitativeevaluations wereincluded.mechanism of change work better.As do interventions that have measurable,concrete objectives.And universal interventions (aimed at primaryprevention amongst whole communities) neededat the less severe end of the spectrum of commonparenting difficulties.Targeted interventions (aimed at specificpopulations or individuals deemed to be at riskfor parenting difficulties) to tackle more complextypes of parenting difficulties.Interventions that pay attention toimplementation factors for ‘getting’, ‘keeping’ and‘engaging’ parents.Services that allow multiple routes in for families.Interventions using more than one method ofdelivery (i.e., multi-component interventions).Group work, where the issues involved aresuitable to be addressed in a ‘public’ format, andwhere parents can benefit from the social supportof being with peers.Individual work, where problems are severe orentrenched or parents are not ready/able to workin a group, often including an element of homevisiting as part of a multi component service,providing one-to-one, tailored support.Interventions that have manualized programs.Interventions delivered by appropriately trainedand skilled staff, backed up by good managementand support.Interventions of longer duration, with follow-up/booster sessions, for problems of greaterseverity or for higher risk groups of parents.Short, low level interventions for deliveringfactual information to parents, increasingknowledge of child development.Behavioral interventions that focus on specificparenting skills and practical ‘take-home tips’ forchanging more complex parenting behaviors andimpacting on child behaviors.‘Cognitive’ interventions for changing beliefs,
  • 62. -DRAFT-61attitudes and self-perceptions about parenting.Interventions that work in parallel (though notnecessarily at the same time) with parents, familiesand children.Sweet, M. A., & Appelbaum, M. I.(2004). Is home visiting an effectivestrategy? A meta-analytic review ofhome visiting programs for familieswith young children. ChildDevelopment, 75(5), 1435-1456.Analysed results from60 home visitingprograms within 5child and 5 parentoutcome groups.In general, families benefitted from home visiting– both in terms of improved parent attitudes andbehavior and in terms of children’s functioning.Programs which targeted the prevention of childabuse and parent stress were less successful.Mothers in home visiting programs were morelikely to go back to school or continue educationbut did not differ from control groups in terms ofemployment or reliance on public assistance.Programs that employed professional staff, ascompared to nonprofessional or paraprofessionalstaff, had better outcomes.Other design features were not consistentlyrelated to outcomes. What makes a home visitingprogram successful is not clear.Bakermans-Kranenburg, M. J., VanIjzendoorn, M. H., & Juffer, F.(2005). Disorganized infantattachment and preventiveinterventions: A review and meta-analysis. Infant Mental Health Journal,26(3), 191-216.Disorganizedattachments areassociated withseparation, stress,parental ill-health, poorregulation inpremature, drug-exposed and othervulnerable infants andother conditions. Itpredicts later stressmanagement andproblematic behavior.The authors reviewed15 preventiveinterventions thatattempted to improvesensitivity, responsivityand engagement.Target groups included clinically referred families(e.g. postpartum depression), children at risk (e.g.adopted children, very low birth weight infants),parents at risk (e.g. poverty, single, unstable lifecircumstances).There was a wide range of outcomes, fromnegative effect sizes to positive.Positive outcomes were associated with later start(after 6 months of child age, as compared toantenatal or the first 6 months); professionalsversus non-professional staff; children at riskversus parents at risk; sensitivity-focusedinterventions versus broad goals.Barlow, J., & Parsons, J. (2005).Group-based parent-trainingprograms for improving emotionaland behavioral adjustment in 0-3year old children. CochraneThe objectives of thereview are to establishwhether group-basedparenting programs areeffective in improvingEmotional and behavioral problems (includingtantrums, immature and oppositional behaviors,aggression, whinging, thumbsucking, soiling,school phobia, etc.) among young children arecommon (between 7-21%), and frequently predict
  • 63. -DRAFT-62Database of Systematic Reviews.2005: 2. DOI: 10.4073/csr.2005.2.the emotional andbehavioral adjustmentof children less thanthree years of age, andto assess the role ofparenting programs inthe primary preventionof emotional andbehavioral problems.Only randomizedcontrolled trials ofgroup based parentingprograms wereincluded, and studiesthat had used at leastone standardizedinstrument to measureemotional andbehavioral adjustment.Only 5 out of 140studies met theselection criteria.mental and social problems in adolescence andadulthood.Parenting is an important contributor to theadjustment of young children.Overall, the findings provide support for the useof group-based parenting programs to improvethe emotional and behavioral adjustment ofchildren under the age of 3 years.There is insufficient data on follow-up and of theeffectiveness of parent training for primaryprevention.Hoagwood, K. E. (2005). Family-based services in childrens mentalhealth: A research review andsynthesis. Journal of Child Psychologyand Psychiatry, 46(7), 690-713.From 4 000 paperssince 1980, 41 studiesmet the setmethodologicalcriteria. The studies fellinto 3 categories:families as recipients ofinterventions ( education,support,empowerment);families as co-therapists; and studiesof the processes ofinvolvement.Too few experimental studies exist to concludethat family-based services improve child andyouth clinical outcomes.Majority of studies examine interventionsdesigned to educate, support, enroll in services,empower, or teach families particular skills, whichmay assist them in dealing with their children’sproblems.Methodologically acceptable studies demonstrateunequivocal improvements in outcomes, such asretention in services, knowledge about mentalhealth issues, self-efficacy, and improved familyinteractions.Johnson, G., Kent, G., & Leather, J.(2005). Strengthening the parent-child relationship: A review offamily interventions and their use inmedical settings. Child: Care, Health& Development, 31(1), 25-32.The review focused oninterventions thataimed to develop therelationship betweenparent and child. Itprovides an historicalreview of familyPsychological interventions aiming to strengthenthe bond between parents and children areextensive in child and family therapy servicesaimed at reducing stress and behavioral problemsin children.These interventions are effective, especially withthe inclusion of parent skills training.
  • 64. -DRAFT-63interventions which isthen followed withsuggestions on howthey are relevant forhealth professionals inmedical settings.The review traces thedevelopment of threeapproaches – filialtherapy, Hanf’soperant conditioningprocedure for thetreatment ofhandicapped youngchildren and theirmothers, and parenttraining interventionsbased on sociallearning theory.Barlow, J., Johnston, I., Kendrick,D., Polnay, L., & Stewart-Brown, S.(2006). Individual and group-basedparenting programs for thetreatment of physical child abuseand neglect. Cochrane Database ofSystematic Reviews. 2006:3. DOI:10.1002/14651858.CD005463.pub2.Reviewed short-term(6-30 weeks) groupand individual parenttraining programs.Included onlyrandomized controlledtrials with a controlgroup (waiting-list, no-treatment, oralternative treatmentgroup), and at least oneindicator of abuse,neglect ormaltreatment (e.g.placement on the childprotection register,maltreatment recordedin medical record, non-organic failure-to-thrive, or out-of-homeplacement of thechild). Of 132 studiesreviewed, 26 wererelevant and only 7were included in thereview.Child neglect and abuse are serious public healthproblems; abuse has a very strong link tosubsequent psychopathology.Maltreating and abusive parents are less positive,supportive and nurturing of their children, andmore negative, hostile, and punitive. They reactmore negatively to parental challenges such as acrying infant, frequently have inappropriateexpectations of the child, are unaware of thechild’s needs, believe in the value of punishment,and may look to the child for the satisfaction oftheir own emotional needs.Most studies reported positive results for parentand child behavior and family functioning, butfew were statistically significant.Programs that incorporate elements specific toabuse (for example, excessive parental anger,misattributions to child behavior, etc.) are moreeffective than those that don’t.
  • 65. -DRAFT-64Eshel, N., Daelmans, B., Cabral deMello, M. & Martines, J. (2006).Responsive parenting: Interventionsand outcomes. Bulletin of the WorldHealth Organization, 84, 991-998.From 200 papers andbook chapters onresponsive care, theauthors chose 50 asrepresentative withpriority given to RCTsand both developedand developingcountry studies wereincluded.Responsive care involves observation,interpretation and action.Maternal responsiveness is linked to improvedchild health and development.The most common interventions to improveresponsiveness include home visits or acombination of home visits and clinic care.Interventions have modest effects onresponsiveness.Gardner, M. R., & Deatrick, J. A.(2006). Understanding interventionsand outcomes in mothers of infants.Issues in Comprehensive PediatricNursing, 29(1), 25-44.Examines strategiesthat nurses and otherhealth care providerscan use to facilitateeffective motheringduring the first 2 yearsof life. Reviewed 23studies conductedbetween 1994 and2004 describinginterventions designedto strengthenmothering (non-teenage mothers) ofinfants less than 24months old.Mothering in the first two years is critical to infanthealth, development, and wellbeing.Classified interventions into five broad categories:individual education and support (e.g., pre- andpostpartum orientation toward infant cues andbehaviors and skill development; group programs;mother-infant contact (e.g., Kangaroo care);home visiting by nurses and non-professionals,and multicomponent programs incorporatingseveral strategies.There is some evidence for the effectiveness of all5 strategies.However, the evidence is strongest for nursehome-visiting interventions in high social-riskpopulations; and groups with free-floatingmembership, such as those constituted on an ad-hoc basis during clinic visits seem to have lessinfluence on mothering processes.More evidence is needed on the effectiveness ofsocial support by family and peers, which has apositive influence on perceptions of motheringcapabilities, coping, and overall maternal mental.It also facilitates parental coping, decreasesparental stress and anxiety, and promoteseffective family functioning for parents ofchronically ill children.Lundahl, B., Risser, H. J., &Lovejoy, M. C. (2006). A meta-analysis of parent training:Moderators and follow-up effects.Clinical Psychology Review, 26(1), 86-104.Reviewed 63 of 430studies between 1974and 2003 that met thefollowing 9 criteria –published in anEnglish peer-reviewedjournal; reported onDisruptive child behaviors, including aggressionand noncompliance, are the most commonproblems for which parents seek assistance.Behavioral and non-behaviorally oriented parenttraining programs did not differ significantly intheir impact on child or parental functioning.
  • 66. -DRAFT-65non-laboratory basedparent trainingprograms targetingdisruptive childbehaviors; group-based; had at least 1treatment and 1control group whichwere drawn from thesame population;reported on outcomesin addition to parentsatisfaction; includeddata sufficient formeta-analysis; andexcludeddevelopmental delay.Moderators of effects included: individualprograms (improved more) clinical significance ofchildren’s problems (more); single parenting(less); socioeconomic stress (less).Age of child did not affect outcomes.Improvements are retained for up to 1 year offollow-up of behavioral programs but decreaseover time.Family adversity significantly undermined positivechanges in parental behavior.Magill-Evans, J., Harrison, M. J.,Rempel, G., & Slater, L. (2006).Interventions with fathers of youngchildren: Systematic literaturereview. Journal of Advanced Nursing,55(2), 248-264.Reviewed 14intervention studiespublished in Englishbetween 1998 and2003 that met thefollowing criteria -included a controlgroup or used a pretestand post-test design;measured an aspect offather-childinteraction, andanalysed fatheroutcomes separatelyfrom motheroutcomes. The reviewidentified 12 differentinterventions.The majority of the interventions (9/12) targetedfathers of newborns or infants (addressedsensitivity to infant behavior, taught specific skillssuch as infant massage or infant-care skills. Onestudy addressed the social and physicalenvironment for labour and delivery. Theremaining 3 interventions were for fathers oftoddlers or preschool age children.Those interventions that showed a significantinfluence on the father’s behavior with his childwere: prenatal education; infant massage;observation of infant behavior by mother andfather; enhanced participation for fathers in aHead Start program including a support groupand father-child recreation activities, and adiscussion group for fathers of toddlersaccompanied by father-child playtime (McBride1991).In all interventions, there was opportunity forfathers to learn how to observe and interpretchild behavior.Although the number of intervention studies islimited, there is evidence that, if interventionsinvolve active participation with or observation ofthe father’s own child, the intervention may beeffective in enhancing the father’s interactionswith the child and a positive perception of thechild.
  • 67. -DRAFT-66There is less information on how interventionsinfluence child development.McCart, M. R., Priester, P. E.,Davies, W. H., & Azen, R. (2006).Differential effectiveness ofbehavioral parent-training andcognitive-behavioral therapy forantisocial youth: A meta-analysis.Journal of Abnormal Child Psychology,34(4), 527-543.Reviewed the results of30 studies ofBehavioral Parenttraining (BPT) and 41studies of CognitiveBehavior Therapy(CBT) for youth withanti-social problems.Seventy-six (18%) of apotential 426 studies(1973 to 2004) met theinclusion criteria. Ofthese, 73 reportedpost-treatmentoutcome data and 17reported follow-upoutcome data. Theeffectiveness of bothapproaches has beendemonstrated in anumber of controlledpsychotherapyoutcome studies.Parenting styles characterized by coercive parent–child interchanges, inconsistent discipline, andpoor parental monitoring place youth at risk forthe development of antisocial behavior problems.BPT typically aims to alter maladaptive parent–child interactions by training parents to usebehavioral techniques to reinforce youth’sprosocial behavior and decrease youth’s antisocialbehavior.The mean effect sizes of both BPT and CBT arein the small to medium range, suggesting both areeffective in reducing youth antisocial behavior.There are a number of convincing studiessuggesting that broad-based interventions thatinclude involvement with parents, youth, andother systems (e.g. schools) are more effectivethan either BPT or CBT alone.Mercer, R. T., & Walker, L. O.(2006). A review of nursinginterventions to foster becoming amother. Journal of Obstetric, Gynecologicand Neonatal Nursing, 35(5), 568-582.Reviewed nursinginterventions to assistwomen to enter therole of mother,classified into 5overlapping categories:instructions for infantcaregiving (N = 5),building awareness ofand responsiveness toinfant interactivecapabilities (11),fostering maternal-infant attachment (6),maternal social rolepreparation (3), andinteractive therapeuticnurse-clientrelationships (3).Mothers preferred live to video or audiotapedinstruction.Interventions to promote attachment were largelyineffective.Interactive nurse-mother relationships wereassociated with greater maternal competence inhigh-risk settings.Less competent mothers do better with intensiveintervention.More intensive, longer-term interventions weremore effective.Speculate that perhaps too much emphasis beenplaced on teaching care of the infant, and toolittle on problem solving with the mother abouthow she can care for herself and her family.Emphasize the role of family and friends inproviding support, physical and emotional care,and guidance.
  • 68. -DRAFT-67Nye, C., Schwartz, J., & Turner, H.(2006). Approaches to parentinvolvement for improving theacademic performance ofelementary school age children.Campbell Systematic Reviews.2006:4. DOI: 10.4073/csr.2006.4.The review was limitedto randomized controltrials with a controlgroup; 19 studies metthe criteria. A keyelement is howparental involvement isdefined. The reviewuses a focuseddefinition of parentinvolvement that is aprogram in which theparent has a directinteraction with thechild in either thedelivery or monitoringof the program ofintervention.Parent involvement results in a positive andsignificant overall effect on children’sachievement; academic performance of childrenin the combined parent involvement group wasapproximately half a standard deviation higherthan the performance of children in the controlgroup.The achievement outcome most frequentlystudied is reading; only a borderline significantimprovement was found in mathematicsachievement.Programs in which parents provided some kind ofreward or incentive for their child’s academicperformance produced the largest average effect,followed by programs in which parents wereprovided with education and training to improvetheir child’s general academic performance.Duration of parental involvement did not appearto be important to outcomes.Shaw, E., Levitt, C., Wong, S.,Kaczorowski, J., & the McMasterUniversity Postpartum ResearchGroup (2006). Systematic review ofthe literature on postpartum care:Effectiveness of postpartumsupport to improve maternalparenting, mental health, quality oflife, and physical health. Birth, 33(3),210-220.Reviewed 22postpartum supportprograms to improvematernal knowledge,attitudes, and skillsrelated to parenting,maternal mentalhealth, maternal qualityof life, and maternalphysical health. Usedthe Jadad et al (1996)scale to assess themethodological qualityof each study. Thescale assigns a numericscore forrandomization,blinding, anddescription ofdropouts.Universal postpartum support for unselectedwomen at low risk did not result in statisticallysignificant improvements for any outcomesexamined.Home visits, peer support and educational visitsto a paediatrician each showed statisticallysignificant improvements in maternal-infantparenting skills in low-income primiparouswomen at high risk for family dysfunction.Whether these improvements translate into areduced incidence of child abuse or neglectremains to be determined.Maternal satisfaction was higher with homevisitation programs.In conclusion, there is some evidence that high-risk populations may benefit from postpartumsupport.
  • 69. -DRAFT-68Gagnon, A. J., & Sandall, J. (2007).Individual or group antenataleducation for childbirth orparenthood, or both. CochraneDatabase of Systematic Reviews.2007:3. DOI:10.1002/14651858.CD002869.pub2.Antenatal educationaims to helpprospective parentsprepare for childbirthand parenthood. Thepaper reviewed 9randomized controltrials out of 46 studies,involving 2284women. Criteria forinclusion: controlledtrial evaluatingstructured forms ofantenatal educationclasses provided toindividual or groups offuture parents; randomallocation to treatmentand control groups;loss to follow upinsufficient tomaterially affect thecomparison, and dataavailable in a formsuitable for analysis.Programs range from intensive one-day to severalclasses over several weeks; individual vs. groupsessions; venues include teachers’ homes,community centres, hospitals and clinics; andclasses or groups may be for pregnant womenonly or for women and their partners.Women report their main reason for attendingchildbirth classes is to reduce their anxiety aboutlabour and birth; men attend to satisfy the wishesof their partners and to learn about infant care.Interventions varied greatly and no consistentoutcomes were measured. Thus the usual benefitof meta-analyses, increasing statistical power bycombining small studies, could not be achieved,since each study tested the effect of a differentintervention on one or more different outcomes.The effects of general antenatal education forchildbirth or parenthood, or both, thereforeremain largely unknown.Kane, G. A., Wood, V. A., &Barlow, J. (2007). Parentingprograms: A systematic review andsynthesis of qualitative research.Child: Care, Health & Development,33(6), 784-793.Systematic reviews andmeta-analyses ofrandomized controlledtrials have indicatedthat parentingprograms can improvemany aspects of familylife. However, there isa dearth ofinformationconcerning what it isthat makes parentingprograms meaningfuland helpful to parents.This paper criticallyappraises 4 of 6purposively selectedpapers (from a pool of40) and develops anargument on whataspects of trainingThe authors conclude that the acquisition ofknowledge, skills and understanding, togetherwith feelings of acceptance and support fromother parents in the group, enable parents toregain control and feel more able to cope. Thisleads to a reduction in feelings of guilt and socialisolation, increased empathy with their childrenand confidence in dealing with child behavior.
  • 70. -DRAFT-69programs are mosthelpful to parents,Kendrick, D., Barlow, J.,Hampshire, A., Polnay, L., &Stewart-Brown, S. (2007). Parentinginterventions for the prevention ofunintentional injuries in childhood.Cochrane Database of SystematicReviews. 2007:4. DOI:10.1002/14651858.CD006020.pub2.The review included 11randomized controlledtrials, 1 non-randomized controlledtrial and 2 controlledbefore and afterstudies, whichevaluated parentinginterventionsadministered toparents of childrenaged 18 years andunder, and reportedoutcome data oninjuries (unintentionalor unspecified intent),and possession and useof safety equipment orsafety practices.Parenting interventionswere defined as thosewith a specifiedprotocol, manual orcurriculum aimed atchanging knowledge,attitudes or skillscovering a range ofparenting topics.Most common interventions were parenteducation and support services, and homevisiting.Based on 9 RCTs included in the meta-analysis,intervention families had a significantly lower riskof child injury.Several studies found fewer home hazards, ahome environment more conducive to childsafety, or a greater number of safety practices inintervention families.Reduction in injuries may have occurred via arange of mechanisms including increasing theability of parents to manage minor injurieswithout medical help, improvements in the qualityof child care provided, improved home safety,and an increased conviction that children must beprotected.Petrie, J., Bunn, F., & Byrne, G.(2007). Parenting programs forpreventing tobacco, alcohol ordrugs misuse in children <18: Asystematic review. Health EducationResearch, 22(2), 177-191.Forty six reports in 20studies (from apotential 122) met theinclusion criteria.Studies had to includean objective or self-reported measure of atleast one of thefollowing: smoking,drinking or drug use bychild; intention ofchild to smoke, drinkor take drugs; alcoholand drug use incriminal offending,antisocial behavior,Recent trends show a growth in heavy drinkingwith an associated increase of smoking and illegaldrug use among children and youth.Despite some methodological shortcoming, theevidence suggests that parenting programs can beeffective in reducing substance misuse in children.Strongest evidence came from work with preteenand early adolescent children.Many interventions were brief.Although the most effective interventions wereschool-based, active parental involvement is animportant feature of successful interventions,especially involving adolescents in familyactivities, maintaining good familial bonds and
  • 71. -DRAFT-70risky sexual behavior,and antecedentbehaviors such astruancy, conductdisorders or pooracademic performance.Studies took placealmost exclusively inthe United States.managing conflict, rather than exclusivelyfocusing on substance use.Robinson, P., Robinson, M., &Dunn, T. (2007). STEP parenting: Areview of the research. CanadianJournal of Counseling, 37, 270-278.This review providesan overview of thecontroversysurrounding the originsand knowneffectiveness ofSystematic Training forEffective Parenting(STEP). The reviewspecifically examines 4questions: whetherSTEP workshopspositively changeparental attitudes;whether parental useof STEP results inhealthier psychosocialdevelopment amongchildren, and whetherit produces positivebehavior change inchildren; whetherspecific behaviorchange proceduresadvocated by STEPhave empiricalsupport.STEP was published in 1976, based on the 1973publication of Dinkelmeyer and McKay entitledRaising a Responsible Child.STEP teaches “parents to understand and accepttheir child’s behavior, emotion and lifestyle, whileapplying correct discipline techniques,encouragement, reflective listening, anddemocratic family structure” (p. 271).STEP has been found, in some studies, to resultin positive changes in parental attitudes.But changes in parental attitudes are notconsistently reflected in children’s behavior. Infact, there is very little evidence to suggest thatSTEP changes children’s behavior.Refraining from physical punishment, asadvocated by STEP, is generally regarded aspositive parenting, but is unevenly related tochildren’s self-esteem.Thomas, R., & Zimmer-Gembeck,M. J. (2007). Behavioral outcomesof parent-child interaction therapyand Triple P-Positive ParentingProgram: A review and meta-analysis. Journal of Abnormal ChildPsychology, 35(3), 475-495.Examined 24 (out of apossible 50) studiespublished between1980 and 2004 toevaluate and comparethe outcomes of twowidely disseminatedparentingParenting interventions tend to focus on childmanagement.Both programs have received substantial fundingin the US and Australia.In general, the analyses revealed positive effectsof both interventions, but effects varieddepending on intervention length, components,and source of outcome data.
  • 72. -DRAFT-71interventions—Parent–childInteraction Therapy(PCIT) and Triple P-Positive ParentingProgram. Inclusioncriteria comprised theinclusion of at leastone parent or childbehavior problemoutcome measure, andempirical data neededfor meta-analysis.Participants in allstudies were caregiversand 3- to 12-year-oldchildren.Both interventions reduced parent-reported childbehavior and parenting problems.The effect sizes were large when outcomes ofchild and parent behaviors were assessed withparent-report.There are no published dissemination ortransportability studies from either intervention,meaning there is no current evidence foreffectiveness of either Triple P or PCIT in acommunity setting.Turner, W., Macdonald, G., &Dennis, J. A. (2007). Behavioral andcognitive behavioral traininginterventions for assisting fostercarers in the management ofdifficult behavior. CochraneDatabase of Systematic Reviews.2007:1. DOI:10.1002/14651858.CD003760.pub3.To assess theeffectiveness ofcognitive-behavioraltraining interventionsin improving a)looked-after children’sbehavioral/relationshipproblems, b) fostercarers’ psychologicalwell-being andfunctioning, c) fosterfamily functioning, d)foster agencyoutcomes. Foster carertraining typically refersto an educational ortraining processdesigned to providefoster carers withinformation and skillsdesigned to help themfulfil theirresponsibilities. Sixrandomized controltrials involving 463foster carers wereincluded out of apotential pool of 25Providing training for foster carers is thought toenhance caring attitudes and skills, help fostercarers deal more effectively with foster children’sbehavior, and decrease foster carer attrition.Most interventions were based on cognitivebehavior therapy.Results suggest little evidence of effect on thepsychological functioning of looked-afterchildren, foster carers and fostering agencyoutcomes.The authors conclude that it is likely that in orderfor foster care intervention to be successful,training needs to be supported by other servicesand interventions.
  • 73. -DRAFT-72studies.Bennett, C., Macdonald, G., DennisJane, A., Coren, E., Patterson, J.,Astin, M., & Abbott, J. (2008).Home-based support fordisadvantaged adult mothers.Cochrane Database of SystematicReviews. 2008:1. DOI:10.1002/14651858.CD003759.pub3.The review waswithdrawn in responsereceived during thefeedback processrelating to themethodological qualityof the review. Arevision has not yetbeen published.Review Graaf, I., Speetjens, P., Smit, F.,de Wolff, M. & Tavecchio, L.(2008). Effectiveness of the Triple PPostive Parenting program onparenting: A meta-analysis. FamilyRelations, 57, 553-566.The paper reports ontwo meta-analyses. Thefirst deals with theeffectiveness of TripleP to improve parentingstyle and the secondwith the maintenanceof positive changesover time. The reviewis restricted to Level 4,which can best bedescribed as ParentTraining. Of 25relevant studies, 19were reviewed, 18 ofwhich were RCTs.Most targeted high-riskareas rather than high-risk groups. 16 studieswere conducted inAustralia, and one eachin Germany, HongKong and Switzerland.Outcome wasmeasured by self-report, using either theParenting Scale or theParenting Sense ofConcern Scale.Triple P is a behavioral family intervention (BFI)which aims to reduce family risk factorsassociated with child behavior problems byenhancing the skills and confidence of parents toapply child management techniques.Reported parenting styles improved significantlyafter participation in Triple P Level 4 programs.These results were maintained for periodsbetween 3 and 12 months.Parents reported greater satisfaction with theirparenting role and had positive expectations ofchange.Positive effects are independent of the form ofdelivery – individual, group or self-help.Positive effects were similar across families withchildren in the normal and clinical range ofbehavior problems, and across child gender.Dennis, C.-L., & Kingston, D.(2008). A systematic review oftelephone support for womenduring pregnancy and the earlypostpartum period. Journal ofObstetric, Gynecologic and NeonatalThe review aimed toassess the effects oftelephone-basedsupport on smoking,preterm birth, lowbirthweight,Perinatal support has traditionally been deliveredface-to-face, but the findings of this reviewsuggest that telephone support (provided by aprofessional) as an adjunct intervention appearsinfluential in reducing various perinatal riskfactors
  • 74. -DRAFT-73Nursing, 37(3), 301-314. breastfeeding, andpostpartumdepression. Criteria forinclusion were:randomized controlledtrials; aim was toreduce the risk ofadverse healthoutcomes for womenand their infants, andtelephone support wasprovided by alayperson or healthprofessionalantenatally or duringthe first 2 monthspostpartum. Fourteentrials publishedbetween 1986 and2004 were included inthe review. All thestudies took place inthe USA, UK orCanada.The findings suggest that telephone support mayprevent smoking relapse, contribute to preventinglow birth weight, increase breastfeeding durationand exclusivity, and decrease postpartumdepression sympotomatology.The authors conclude that the results areencouraging.Gavita, O., & Joyce, M. (2008). Areview of the effectiveness of groupcognitively enhanced behavioralbased parent programs designed forreducing disruptive behavior inchildren. Journal of Cognitive andBehavioral Psychotherapies, 8(2), 185-199.The review aimed toexamine the effects ofvarying the level ofintensity of a parentingintervention in thetreatment of conductproblems in children.In particular, toexamine whetheradjunct cognitiveinterventions to reduceparental stress add tothe efficacy anddurability of standardparenting skillstraining. Between 1970and 2008, only 5 out of66 studies met theinclusion criteria:randomized controltrials and include atleast one group-basedThe results indicate that cognitively enhancedparenting programs can be highly effective inimproving both child disruptive behavior andparental distress and the improvements aremaintained at 3 years follow-up.However, cognitively enhanced programs addonly a small effect when compared with standardparent programs on all the studied outcomes.Further, the meta-analysis of the cognitive datashowed no evidence of effectiveness of thecognitively enhanced condition in improvingparents’ sense of self-competence.
  • 75. -DRAFT-74parenting program forparents enhanced witha cognitive module forreducing parentaldistress.Kaminski Wyatt, J., Valle, L. A.,Filene, J. H., & Boyle, C. L. (2008).A meta-analytic review ofcomponents associated with parenttraining program effectiveness.Journal of Abnormal Child Psychology,36(4), 567-589.Used meta-analytictechniques tosynthesize the resultsof 77 publishedevaluations of trainingprograms (to improveparenting skills, out ofa pool of 576 studiesconducted between1990 and 2002. Alsoexamined 3 commonlyheld, but rarely tested,assumptions aboutparent training: thatinstruction in childdevelopment is notonly necessary, butalso sufficient, toensure parentalbehavioral changes;that manualizedprograms producebetter outcomes thanprograms without acurriculum; and that“more is better”, thatis, providing familieswith more servicesleads to betteroutcomes. Parenttraining programsoften includesupplemental services,such as anger or stressmanagement,substance abusetreatment, or job skillstrainingThere was a significant positive overall effect size,supporting the use of parent training programs inpreventing or ameliorating early child behaviorproblems.As has been found in other reviews, the meaneffect size for parenting outcomes was larger thanthe mean effect size for child outcomes, andlarger for parent knowledge and attitudes ascompared to parental behavior and skills.After controlling for a large number of factors,program components associated with largerdifferences were: increasing positive parent–childinteractions and emotional communication skills,teaching parents to use time out and consistency,and requiring parents to practice new skills withtheir children during parent training sessions.Program components consistently associated withsmaller effects included teaching parents problemsolving, to promote children’s cognitive,academic, or social skills and providing additionalservices.Neither instruction in child development,manualized programs or additional servicesproduced greater benefits in the studies examined.Kendrick, D., Barlow, J.,Hampshire, A., Stewart-Brown, S.,& Polnay, L. (2008). ParentingThis review is a peer-reviewed journalpublication of the 2007Reviewed above.
  • 76. -DRAFT-75interventions and the prevention ofunintentional injuries in childhood:Systematic review and meta-analysis.Child: Care, Health & Development,34(5), 682-695.Cochrane Reviewincluded earlier in thistable.Lucas, P., McIntosh, K., Petticrew,M., Roberts, H. M., & Shiell, A.(2008). Financial benefits for childhealth and well-being in low incomeor socially disadvantaged families indeveloped world countries.Cochrane Database of SystematicReviews. 2008:2. DOI:10.1002/14651858.CD006358.pub2.The review aimed toassess the effectivenessof direct provision ofadditional monies tosocially oreconomicallydisadvantaged familiesin improving children’shealth, well-being andeducational attainment.Studies selectedprovided money torelatively poor families(which included a childunder the age of 18 ora pregnant woman),were randomized orquasi-randomized,measured outcomesrelated to child healthor wellbeing and wereconducted in a highincome country. Ninerandomized controltrials, excluding 63potential other studies,were included in thereview, involving morethan 25,000participants. All studieswere conducted in theUSA, except one inCanada. All involvedwelfare reform andcombined cashincentives (e.g.negative taxation,income supplements)with work support orrequirement to workalong with otherThere is some resistance to the use of trials insocial interventions on practical, ethical orpolitical grounds, and universal policyinterventions can be documented only across acohort as a whole.The monetary value of many interventions waslow; in most studies the total increase in incometo families was less than US$11.50 per week,despite the fact that many parents were compelledto work full time.Interventions did increase employment, but theyalso introduced new controls on participants;enforcing the uptake of low status work mayincrease stigma and stress rather than reducing it.No effect was observed on child health, mentalhealth or emotional state.There was a trend toward improved earlylanguage performance among children.Non-significant effects favouring the interventiongroup were seen for child cognitive developmentand educational achievement.The reviewers conclude that large scaleevaluations of conditional payments of smallvalue have been thoroughly tested and,notwithstanding the limited child outcome data inthe studies reviewed, probably do not need to berepeated.
  • 77. -DRAFT-76changes to provisionof welfare payments.Macdonald, G., Bennett, C., Dennis,J. A., Coren, E., Patterson, J., Astin,M., & Abbott, J. (2008). Home-based support for disadvantagedteenage mothers. CochraneDatabase of Systematic Reviews.2008:1. DOI:10.1002/14651858.CD006723.pub2.The review waswithdrawn in responsereceived during thefeedback processrelating to themethodological qualityof the review. Arevision has not yetbeen published.Review withdrawn.Piquero, A. R., Farrington, D.,Jennings, W. G., Tremblay, R.,Piquero, A., & Welsh, B. (2008).Effects of early family/parenttraining programs on antisocialbehavior and delinquency. CampbellSystematic Reviews. 2008:11. DOI:10.4073/csr.2008.11.Reviewed studiesbetween 1976 and2008 that investigatedthe effects of earlyfamily/parent trainingon child behaviorproblems such asconduct problems,antisocial behavior anddelinquency. Studieswere only included ifthey had enrolledfamilies with childrenunder 5 years of age,used a randomizedcontrolled evaluationdesign that providedbefore-and-aftermeasures of childbehavior problemsamong experimentaland control subjects,and independentfindings. Studies usedindividual or group-based parent trainingsessions that wereconducted in a clinic,school, or some othercommunity-based siteprovided byprofessionals or non-professionals.Early antisocial behavior is a key risk factor forcontinued delinquency and crime throughout thelife course.The main parenting intervention programs werethe Incredible Years Parenting Program, theTriple P-Positive Parenting Program, and Parent–child Interaction Therapy. The mostinternationally recognizable was Webster-Stratton’s Incredible Years Parenting Program.There was an overall positive effect of parenttraining on children’s subsequent delinquentbehavior.Involvement in early family/parent training hasbeen shown to result in fewer teacher-ratedbehavior problems at ages 8-11, and fewerinstances of running away, fewer arrests,convictions, and probation violations, fewersmoked cigarettes per day, fewer days consumingalcohol, and fewer behavioral problems related touse of alcohol and other drugs at age 15, lowerrates of juvenile and violent arrests at age 18,lower prevalence of arrests for violent, property,drug, and other crimes up to age 27 and also upto age 40.Barlow, J., Coren, E., & Stewart- This is an update Review update.
  • 78. -DRAFT-77Brown, S. (2009). Parent-trainingprograms for improving maternalpsychosocial health. CochraneDatabase of Systematic Revies.2009:1. DOI:10.1002/14651858.CD002020.pub2.version of the 2003review, with no changein the conclusionsdrawn.Chandan, U., & Richter, L. (2009).Strengthening families through earlyintervention in high HIV prevalencecountries. AIDS Care, 21, 76-82.Reviews the evidencefor familystrengthening in thecontext of earlychildhoodinterventions,particularly in thecontext of high HIVprevalence and poorlyresourced settings.High quality home visiting for first-time, low-income pregnant mothers and their youngchildren and ECD programs for low-incomechildren and families are promising in theirpotential to strengthen families.Consideration for the application of suchinterventions should occur on a country-by-country basis.Dretzke, J., Davenport, C., Frew,E., Barlow, J., Stewart-Brown, S.,Bayliss, S., et al. (2009). The clinicaleffectiveness of different parentingprograms for children with conductproblems: A systematic review ofrandomised controlled trials. Child& Adolescent Psychiatry and MentalHealth, 3(7). DOI: 10.1186/1753-2000-3-7.Studies were includedif they were RCTs;sample comprisedparents/carers ofchildren up to the ageof 18; at least 50% hada conduct problem(defined usingobjective clinicalcriteria the clinical cut-off point on a wellvalidated behaviorscale or informaldiagnostic criteria; theintervention was astructured, repeatable(manualized) parentingprogram; and therewas at least onestandardized outcomemeasuring childbehavior. Studies wereexcluded if theintervention was aimedat prevention ratherthan treatment, aimedat children or teachers,and was unstructurede.g. informal supportgroup or unstructuredThere has been a rapid expansion of group-basedparent-training programs for the treatment ofchildren with conduct problems in a number ofcountries over the past 10 years.Using both parent report and independentobservations of outcome, parenting programs areeffective in improving conduct problems.Independent observations of change were on thewhole smaller than parent-report.There was insufficient evidence to determine therelative effectiveness of different approaches todelivering parenting programs. i.e. group versusone to one; duration; child involvement;adjunctive treatment; etc.
  • 79. -DRAFT-78home visits. Fifty-seven studies wereincluded, of which 40had a control group.Law, J., Plunkett, C., Taylor, J., &Gunning, M. (2009). Developingpolicy in the provision of parentingprograms: Integrating a review ofreviews with the perspectives ofboth parents and professionals.Child: Care, Health & Development,35(3), 302-312.This paper aimed tointegrate the findingsfrom a summary of 27systematic reviews,together with theresults of a series offocus groups withparents andprofessionals involvedin parenting across 3agencies (health,education and socialwork) in a regional areain the UK.There is a great deal of evidence to support theuse of parenting intervention in the promotion ofinfant mental health through targeting themother-infant relationship; methods with a clearfocus are more effective (e.g. skin contact, videofeedback).There is good evidence to support the use ofparenting groups as an intervention for youngchildren with emotional and behavioraldifficulties; cognitive and behavioral approachesare most effective.Behavioral parent training has been found to beparticularly effective in reducing externalizing anddisruptive behaviors in middle childhood.There is little evidence to support the use ofparenting intervention in the treatment of neglectand for abuse the evidence is mixed, exceptamong teen mothers.The use of incentives encourages parentalinvolvement in parenting groups.There is limited evidence on the role ofparaprofessionals in parenting support.Lutz, K. F., Anderson, L. S.,Pridham, K. A., Riesch, S. K., &Becker, P. T. (2009). Furthering theunderstanding of parent-childrelationships: A NursingScholarship Review Series. Part 1:Introduction. Journal for Specialists inPediatric Nursing, 14(4), 256-261.The review describesand critiques nursingscholarship publishedfrom 1980–2008 (165papers) divided into 4categories: parents’perspectives on earlyparenting; interactionand the parent–childrelationship; parent–child relationships atrisk; and parent-adolescentrelationships.The review proceeds from the 1984 review byMcBride of 53 studies published in the nursingliterature on the topic of being a parent.Increasing importance of fathers and social-cultural context.The integrative review reported in four papers isto follow.
  • 80. -DRAFT-79Lutz, K. F., Anderson, L. S., Riesch,S. K., Pridham, K. A., & Becker, P.T. (2009). Furthering theunderstanding of parent-childrelationships: A NursingScholarship Review Series. Part 2:Grasping the early parentingexperience - The insider view.Journal for Specialists in PediatricNursing, 14(4), 262-283.This is the second in aseries of 5 papersexamining thecontribution of nursingresearch to knowledgeabout the parent–childrelationship. Thisreview focuses onparents’ perspectivesof the parent–childrelationship duringinfancy. Forty-onequalitative andquantitative studies ofparental perceptions ofand experiences withthe parent–childrelationship duringinfancy are reviewedand include families ofterm healthy infantsand preterm infants.Studies were fromAustralia (5), Canada(5), Europe (8) and theUSA (23).Numerous barriers and facilitators influencing theparent–child relations are relevant to nursing,giving nurses important opportunities topositively affect the developing parent–infantrelationship.Common themes across studies were the parent–child relationship as a process, the importanceand influence of support, and interaction with andcaregiving for the infant as facilitators of parentalcommitment and connection.Also explored high-risk infants, the neonatalintensive care unit, the infant in the context of thepartner relationship, transition to home.Compelling evidence emerged from this reviewabout parents’ perceptions of the influence ofnurses on the developing parent–infantrelationship, particularly in the NICU.Though interest in fathers’ perceptions,experiences, and relationships has been growing,mothers were the primary participants in mostinvestigations.Study participants were primarily White, middleclass, and often married.Matson, J. L., Mahan, S., &LoVullo, S. V. (2009). Parenttraining: A review of methods forchildren with developmentaldisabilities. Research in DevelopmentalDisabilities, 30(5), 961-968.An overview, not asystematic review, ofparent training forfamilies with a childwith developmentaldifficulties.Children with developmental disabilities are aheterogeneous group.Agreement on the need for parental involvementin programs for disabled children.The most critical element of parent trainingprograms is generalization of skills from the clinicor school to the home setting.Interventions should be based on soundtheoretical principles and evidence demonstratingeffectiveness of the treatments – these aims havetypically been achieved in the framework ofapplied behavioral analysis and/or behaviortherapy.
  • 81. -DRAFT-80Maulik, P. K., & Darmstadt, G. L.(2009). Community-basedinterventions to optimize earlychildhood development in lowresource settings. Journal ofPerinatology, 29(8), 531-542.The aim of the reviewwas to summariseevidence regarding theeffectiveness ofinterventions targetingthe early childhoodperiod (between 0 and3 years). Specificallythe effectiveness ofplay, reading, music,tactile and/or motorstimulation and basicmaternal and childcare. The feasibility ofimplementing suchstrategies in low- andmiddle incomecountries was alsoevaluated. Studies wereobtained from searchesin electronic databases,review of referencelists and snow-ballingtechniques. Overall, 76articles were identifiesdealing with 53 studies.Of these, 24 RCTswere identifies (16from low- and middleincome countries).Music was evaluated primarily in intensive caresettings and more research is needed tosubstantiate its effectiveness.Play and reading were effective interventions inlow- and middle income countries.Both Kangaroo care and massage showedbeneficial effects, the latter to a lesser extent.Kangaroo care was found to be effective inresource poor settings for low birth weightinfants; however, more research is needed incommunity settings. More rigorous research isneeded to assess the effectiveness of massage,particularly in community-level interventions.Improvements in parent-child interaction werecommon in all interventions which in turn arethought to lead to better care for children andimproved cognitive development.Pridham, K., Lutz, K., Anderson,L., Riesch, S. & Becker, P. (2009).Furthering the understanding ofparent-child relationships: ANursing Scholarship Review Series.Part 3: Interaction and the parent-child relationship – assessment andintervention studies. Journal forSpecialists in Pediatric Nursing, 15, 33-61.This is the third in aseries of 5 articlesexamining thecontribution of nursingresearch tounderstanding theparent-childrelationship. Nursingcan influence andsupport parenting. Thereview coversassessment researchand interventionresearch. The reviewidentified 56 studiesconducted betweenUneven results of nursing interventions to assistparents. The assessment review demonstratedclearly that prematurity and other medicalconditions influence parent-child interaction.Health infant interventions include foetalpalpation and massage (no effect); rooming in(positive effects on attachment); massage (noeffect on child growth but improved mother-childplay); information, demonstration or video aboutinfant responsiveness (improved maternalcontingency); individualized support for nursingand crying (no effect in one study but effects onmaternal sensitivity in others).Healthy infants in stressful conditions, such ascircumcision (positive maternal support
  • 82. -DRAFT-811980 and 2008, butonly 22 interventionstudies are examinedhere, organized bypopulation.behavior); infant colic (ambiguous outcome);maternal depression (increase in maternalresponsiveness).Premature babies using a variety of approachesshow increased sensitivity and improved maternalcoping in some studies but non-significantfindings in others.Father interaction skills using videotape feedbackimproved sensitivity that was maintained.Winokur, M., Holtan, A., &Valentine, D. (2009). Kinship carefor the safety, permanency, andwell-being of children removedfrom the home for maltreatment.Cochrane Database of SystematicReviews. 2009:1. DOI:10.1002/14651858.CD006546.pub2.Review wasundertaken becauselarge numbers ofchildren are placed ininstitutional carebecause they aremaltreated orneglected; but childrenin out-of-homeplacements typicallydisplay moreeducational,behavioral, andpsychologicalproblems than do theirpeers. More recently,there has been a moveto placing childrenwho cannot live athome with othermembers of theirfamily or with friendsof the family. Thereview includedrandomizedexperimental andquasi-experimentalstudies and outcomesexamined related towell-being,permanency and safety.Sixty two quasi-experimental studieswere included, out of apotential 251. All but 5were conducted inUSA, with theThe most common perceived benefits are thatkinship care "enables children to live with personswhom they know and trust, reduces the traumachildren may experience when they are placedwith persons who are initially unknown to them,and reinforces childrens sense of identity andself-esteem which flows from their family historyand culture".Controversies surround the unequal financialsupport, training, services, oversight andcertification received by kin.Data suggest that children in kinship foster carehave better behavioral development, mentalhealth functioning, and placement stability thando children in non-kinship foster care.There was no difference in reunification rates.Children in foster care were more likely to beadopted while children in kinship care were morelikely to be in guardianship.Children in foster care were more likely to utilizemental health services.The conclusions are tempered by pronouncedmethodological and design weaknesses of theincluded studies.
  • 83. -DRAFT-82remaining comingfrom other highincome countries.Anderson, L. S., Riesch, S. K.,Pridham, K. A., Lutz, K. F., &Becker, P. T. (2010). Furthering theunderstanding of parent-childrelationships: A NursingScholarship Review Series. Part 4:parent-child relationships at risk.Journal for Specialists in PediatricNursing, 15(2), 111-134.The presence of afamily member with achronic illness mayinterfere with theparent–childrelationship, andnurses have a role toplay in supportingfamilies. Theintroduction to thisseries of papers ingiven by Lutz et al(2009). Forty twopapers met the criteriafor inclusion.The findings from the studies were classified intofour categories: normalizing, extraordinaryparenting, and negative and positiveconsequences for the parent–child relationship.Family communication can become impaired,parenting stress can increase, and familyfunctioning can decline.Nurses who are aware are in a position to supportfamilies.Many of these factors are amenable to nurseintervention, and nurses have tested a number ofinterventions intended to provide support for theparent–child relationship.It is also important to recognize that theconsequences of the at-risk parent–childrelationship are not always negative and thatfamilies can became stronger under conditions ofadversity.Barlow, J., McMillan, A. S.,Kirkpatrick, S., Ghate, D., Barnes,J., & Smith, M. (2010). Health-ledinterventions in the early years toenhance infant and maternal mentalhealth: A review of reviews. Child &Adolescent Mental Health, 15(4), 178-185.The aim of the reviewwas to identifyeffective health-ledinterventions tosupport parents,parenting and theparent–infantrelationship during theperinatal period andbeyond and methodsfor promotingcloseness and sensitiveparenting, awarenessof infant sensory andperceptual capabilities,positive parenting, andaddressing infantregulatory problems,maternal mental healthproblems, and parent–infant relationshipproblems. IdentifiedIt is now clear that parent–infant interactionduring the postnatal period is a strongdeterminant of early neurological developmentand thereby all aspects of later functioning.Identified methods of debriefing; addressingmental health problems, drug and alcohol use andearly parent–infant problems (throughanticipatory guidance, interaction guidance,attachment promotion, etc.); strengthening theparent–infant relationship (through promotion ofcloseness, information about infant perceptualcapacities, infant massage, supporting fathers,parenting programs).Evidence supports the use of a range ofinterventions and methods of supporting parents,parenting and the parent–infant relationshipduring the perinatal period.Recommends the use of the delivery of universalservices to identify parents and infants with bothmoderate and high level needs and to use
  • 84. -DRAFT-8333 systematic reviewsand 2 reviews ofreviews which met theinclusion criteria.evidence-based approaches such as the FamilyPartnership Model.Barlow, J., Smailagic, N., Ferriter,M., Bennett, C., & Jones, H. (2010).Group-based parent-trainingprograms for improving emotionaland behavioral adjustment inchildren from birth to three yearsold. Cochrane Database ofSystematic Reviews. 2010:3. DOI:10.1002/14651858.CD003680.pub2.Aim of the review wasto establish whethergroup-based parentingprograms are effectivein improving theemotional andbehavioral adjustmentof children youngerthan 4 years of age.The review coveredrandomized controlledtrials of group-basedparenting programsthat had used at leastone standardizedinstrument to measurechildren’s emotionaland behavioraladjustment. Eightstudies were includedin the review. All wereof behavioral,cognitive-behavioral,or video-tape modelingparenting programs.There were sufficientdata from 6 studies tocombine the results ina meta-analysis.Emotional and behavioral problems in childrenare common. Parenting has an important role toplay in helping children to become well-adjusted,and that the first few months and years areespecially important.The review provides some support for the use ofgroup-based parenting programs to improve theemotional and behavioral adjustment of children.There was some evidence to suggest thatinterventions longer than 10 weeks might be ofmore benefit.There is insufficient evidence to reach firmconclusions regarding the role that parentingprograms might play in the primary prevention ofsuch problems.There are also limited data on the long-termeffectiveness of these programs.Beard, J., Biemba, G., Brooks, M. I.,Costello, J., Ommerborn, M.,Bresnahan, M., et al. (2010).Children of female sex workers anddrug users: A review ofvulnerability, resilience and family-centred models of care. Journal of theInternational AIDS Society, 13(Suppl2), 1-8.Many of the adultswho take drugs or aresex workers are alsoparents. Because theiractivities are oftenillegal and hidden, it isfrequently difficult toidentify their childrenand may increasechildren’s vulnerabilityand marginalization.Undertook acomprehensiveThere is a large literature assessing thevulnerability and resilience of children of drugusers and alcoholics in developed countries,yielding a relatively long list of possible negativeoutcomes for children, ranging from cognitivedevelopmental delays to neglect and abuse as aresult of prenatal and postnatal exposure toparental addiction.Research on the situation of the children of sexworkers is extremely limited and, with a fewexceptions, largely qualitative and ethnographic,identifying risks associated with separation from
  • 85. -DRAFT-84overview of availableliterature.parents, sexual abuse, early sexual debut,introduction to sex work as adolescents, lowschool enrolment, psychosocial issues arisingfrom witnessing their mothers’ sexual interactionswith clients, and social marginalization; the focushas largely been on girls.Studies come almost solely from high-incomecountries.Any attempt to document children’s needs or toprovide them with interventions must take carenot to expose or further compromise fragilefamilies frequently existing on the fringes of thelaw.Bryanton, J., & Beck Cheryl, T.(2010). Postnatal parental educationfor optimizing infant general healthand parent-infant relationships.Cochrane Database of SystematicReviews. 2010:1. DOI:10.1002/14651858.CD004068.pub3.The aim of the reviewwas to examineinterventions used toeducate new parentsabout caring for theirnewborns and focusedon structured postnataleducation delivered byan educator to anindividual or group oninfant general healthand parent–infantrelationships. Onlyrandomized controlledtrials of structuredpostnatal educationprovided by aneducator to individualparents or groups ofparents within the firsttwo months post-birthrelated to the care ofan infant or parent–infant relationshipswere included.Excluded were studiesof educationalinterventions forparents of infants inneonatal intensive careunits. Of 25 trials, only15 (2868 mothers and613 fathers) reportedGenerally poor quality studies and highly variableoutcome measures precluded detailed analysis.Interventions included infant sleep enhancement,information about infant behavior, general postbirth health, infant care, infant safety, and one onfather involvement/skills with infants.The benefits of educational programs toparticipants and their newborns remain unclear.Education on sleep enhancement appears toincrease infant sleep and education about infantbehavior potentially enhances mothers’knowledge.
  • 86. -DRAFT-85useable data.Coren, E., Hutchfield, J., Thomae,M., & Gustafsson, C. (2010).Parent-training interventions tosupport intellectually disabledparents. Campbell SystematicReviews. 2010:3. DOI:10.4073/csr.2010.3.Parents withintellectual or learningdisabilities may needsupport to provideadequate care for theirchildren and preventproblems that can arisein childrens welfare ordevelopment. Thereview included onlyrandomized controlledtrials comparing parenttraining interventionsfor parents withintellectual disabilitieswith usual care or witha control group.Outcomes of interestwere the attainment ofparenting skills specificto the intervention,safe home practicesand the understandingof child health.Diagnostic criteria forintellectual disabilitywere broad. Threetrials met the inclusioncriteria for this reviewbut no meta-analysiswas possible.There is evidence that some parents withintellectual disabilities are able to learn parentingskills and provide adequate child care if they aregiven appropriate training and support to do so.Parent training interventions, particularly thosebased at home, can and do help intellectuallydisabled parents to learn a range of parentingskills.Hoagwood, K., Cavaleri, M., SereneOlin, S., Burns, B., Slaton, E.,Gruttadaro, D., & Hughes, R.(2010). Family support in children’smental health: A review andsynthesis. Clinical Child & FamilyPsychology Review, 13(1), 1-45.This is acomprehensive reviewof structured familysupport programs inchildren’s mentalhealth. The goals wereto identify typologiesof family supportservices for whichevaluation data existedand identify researchgaps. Over 200programs wereexamined, of which 50Programs were categorized by whether they weredelivered by peer family members, clinicians, orteams.Five components of family support wereidentified: informational, instructional, emotional,instrumental and advocacy.Most programs were delivered by clinicians.Family and team-led programs were more oftendelivered in community settings.In general, support services for parents producedsuperior child outcomes to standard treatmentalone.
  • 87. -DRAFT-86met criteria forinclusion.Family-delivered support may be an importantadjunct to existing services for parents, althoughthe research base is small.Because of their personal experience, peer familyadvisors often have credibility with parents andare able to engender trust.Family support services are designed to assistparents in clarifying their own needs or concerns,reducing their sense of isolation, stress, or self-blame, and empowering them to take an activerole in their children’s services.Jayaratne, K., Kelaher, M., & Dunt,D. (2010). Child health partnerships:A review of program characteristics,outcomes and their relationship.BMC Health Services Research, 10, 172-181.In order to address thesocial determinants ofhealth of children,approaches have beendeveloped involvingmultiple stakeholders.A comprehensiveliterature search (1989-2009) identified 11major Child HealthPartnerships in 4comparable developedcountries. They areSure Start and EveryChild Matters (UK);First 5 California andEarly Head Start (USA);Healthy Child Manitobaand Toronto First Duty(Canada); and FamiliesFirst, Stronger Familiesand Communities, EveryChance for Every Childand Best Start(Australia).Most partnerships consisted of a consortium oflocal government bodies with different sectors,civil society organization and communitystakeholders.Health services most often took the lead role.Most programs started with antenatal support,breastfeeding promotion, early learningfacilitation (which was the core of all programs),school education and services for young people.Most used outreach, home services and groupsessions; reorganization of existing services, andcollaboration across areas.Family support consisted of financial support,provision of basic family needs, parenting supportand different modes of child care services.Financial assistance was provided in differentways e.g. tax credits to cover childcare costs,health insurance enrolment assistance andprovision of basic family needs (food, clothingand housing).Similarly with child care services, differentprograms have used different approached -traditional child care services, child minding, outof school childcare and assistance in childcarecosts.There was evidence of success in several majorareas from the formation of effective jointoperations of partners in different partnershipmodels to improvement in both child well-beingand parenting.For example, better utilization of services by
  • 88. -DRAFT-87families; improved child development, parentingand immunization. There is emerging evidencethat Child Health Partnerships are cost-effective.Pinquart, M., & Teubert, D. (2010).Effects of parenting education withexpectant and new parents: A meta-analysis. Journal of Family Psychology,24(3), 316-327.The birth of a childmarks a majortransition in parents’lives. It may beassociated withpositive experiences,but for many couples,and for mothers inparticular, parenthoodalso causes negativeexperiences, such asdecline in the quality ofthe couple relationship,physical exhaustion,increase inpsychological distress,and difficulties withdeveloping effectiveparenting behaviors.This meta-analysisintegrates the effects ofrandomized controlledtrials that focus onpromoting effectiveparenting in thetransition toparenthood. It covers142 papers oninterventions whichstarted duringpregnancy or in thefirst 6 months afterbirth.The review finds that early parenting educationprograms for expectant and new parents producea significant positive effect on all assessedoutcomes – parenting, parental stress, child abuse,health-promoting behavior of parents, cognitiveand social and motor development of the child,child mental health, parental mental health andcouple adjustment.Larger effect sizes on parental mental health werefound in studies that comprised mothers ratherthan couples, and for selective prevention ascompared to universal prevention.Successful interventions were the promotion ofsensitive parenting, effective baby care and thepromotion of cognitive development; theseinterventions were more likely to be led byprofessionals.The largest effect sizes were found forinterventions lasting for 3 to 6 months; there wasno evidence for stronger effects if interventionsbegin during pregnancy.Most of the effects were maintained at follow-up.Interventions with parents at social risk includedfamilies with heterogeneous risk factors (e.g. lackof social support, substance abuse, and poverty),and it is necessary to know which group ofparents would benefit most from what kind ofintervention with regard to which outcomes.Pridham, K. A., Lutz, K. F.,Anderson, L. S., Riesch, S. K., &Becker, P. T. (2010). Furthering theunderstanding of parent-childrelationships: A NursingScholarship Review Series. Part 3:Interaction and the parent-childrelationship - Assessment andThis is part of a seriesof 5 papers examiningthe contribution ofnursing research toknowledge about theparent–childrelationship. Thisintegrative reviewAlthough there are a large number of studies inthe assessment category, their contribution toknowledge of the parent–child relationship isdiminished by the fragmented character of theresearch and limited number of programmaticefforts to develop a body of systematicallyaccumulated knowledge.Studies in the intervention category give some
  • 89. -DRAFT-88intervention studies. Journal forSpecialists in Pediatric Nursing, 15(1),33-61.concerns nursingresearch on parent–child interaction andrelationships publishedfrom 1980 through2008 and includesassessment andintervention studies inclinically importantsettings (e.g. feeding,teaching, play). Fifty-six studies publishedbetween 1980 and2008 that were peerreviewed wereincluded in this review– 34 on observationand 22 on intervention.indication that nursing processes may enhanceinteraction and qualities of the parent–childrelationship (e.g. sensitivity, responsiveness,mutuality).However, whether these effects can be replicatedwith larger or different populations or whetherdifferent effects would prevail with adequatelypowered studies needs investigation.No matter what observational approach was used,studies in the assessment category clearly andconsistently indicated that prematurity or medicalvulnerabilities influence parent–child interaction.Reese, E., Sparks, A., & Leyva, D.(2010). A review of parentinterventions for preschoolchildrens language and emergentliteracy. Journal of Early ChildhoodLiteracy, 10(1), 97-117.Given that parents aretheir children’s firstteachers, it isimperative to considerhow parents can helpimprove theirchildren’s language andemergent literacydevelopment prior toformal schooling. Thisarticle reviews parent-training studies ofchildren’s language andliteracy in threecontexts: parent–childbook-reading, parent–child conversations,and parent–childwriting. Selectioncriteria for the reviewwere: the study had tobe experimental innature (treatment andcontrol groups);include a direct parent-training component(not just distributebooks or informationThree types of intervention – most commoninvolves teaching parents to read storybooks tochildren as a way to enhance their language andliteracy; the second is parent–child conversationsas a springboard for children’s language andnarrative development; the third focuses onparents’ assistance for children’s writing.Found that shared book-reading interventionsthat train parents to adopt dialogic readingtechniques are an effective way to enhancechildren’s expressive vocabulary, and in somestudies, their receptive vocabulary.However, dialogic reading interventions were notas effective for children from low-income familiesor for older preschoolers.Storytelling about personally experienced events isone promising alternative or supplement to bookreading for children from a range of social classesand cultures especially narrative development.Fewer studies on emergent writing, but is apromising area that deserves future exploration.Techniques are similar to those used for childrenwith language delay - following the child’s talkwith particular types of questions, repeating andexpanding upon the child’s utterances, and usingpraise and encouragement.
  • 90. -DRAFT-89to parents); focus onparents of preschool orkindergarten childrenwho were not receivingformal readinginstruction, and theparent trainingattempted to improvechildren’s languageand/or emergentliteracy.Conclude that the most highly motivated tutors,parents, are not always involved in interventionprograms.Programs, particularly those working with low-SES communities, prefer to train non-familialadults and not parents for several reasons: suchadults are considered more easily trained,knowledgeable and skilled; they are seen as morereliable and to have higher fidelity ofimplementation; finally, parents struggle withcompeting duties at home and at work; askingthem to participate in an intervention programmight add more stress to their life.Nonetheless, the reviewed literature review showsthat low-SES parents, who typically have morestressful lives, are able to incorporate strategieswhen interacting with their children that have apositive impact on their children’s language andliteracy development.Review concludes that parents are an undertapped resource for children’s early learning.Riesch, S., Anderson, L., Prodham,K., Lutz, K. & Becker, P. (2010).Furthering the understanding ofparent-child relationships: ANursing Scholarship Review Series.Part 5: Parent-adolescent and teenparent-child relationships. Journal forSpecialists in Pediatric Nursing, 15, 182-201.This is the fifth in aseries of five toexamine nursingresearch contributionsto understandingparent-childrelationships. Thereview includes 21papers on parent-adolescentrelationships and 11papers on teen parents.The papers arereviewed under threeheadings: discovery,assessment andintervention. The latterare of major interest inthis review (fourpapers).With respect to parent-adolescent relationship,one study aimed at general improvement inparent-child relationships, two at reducing sexualrisk and one at reducing diabetes risk amongobese adolescents. This is an under-researchedarea in nursing scholarship and there are fewconclusive findings.With respect to teen parenting, all four studiesreviewed showed beneficial effects, includingimproved sensitivity to infant cues, and loweradverse parenting behaviors (eg marijuanasmoking).Anderson, T., & Davis, C. (2011).Evidence-based practice withfamilies of chronically ill children: AEstimates are thatabout one third ofchildren have a chronicThe review found no Level I studies, 3 Level II, 3Level III, and 11 Level IV studies; i.e. mostinterventions had not been empirically tested.
  • 91. -DRAFT-90critical literature review. Journal ofEvidence-Based Social Work, 8(4), 416-425.illness - asthma,cancer, cardiac disease,cerebral palsy,congenital disabilities,cystic fibrosis, epilepsy,gastrointestinaldisorders,haematological disease,juvenile rheumatoidarthritis, inflammatorybowel disease,nephritic syndrome,rheumatic disease,sickle cell disease, andspina bifida. Theseconditions aredemanding for allfamily members andchanges family life.Parents face 2 basicissues: learning to dealwith their child’s healthand coping with thestress. The paperreviews studiespublished between1990 and 2004,classified into levels:Level I evidenceincluded a systematicreview of allrandomized controltrials; Level II evidencecontained at least 1randomized controlledtrial; Level III evidenceincluded well designedcontrolled studies,withoutrandomization; andLevel IV evidenceincluded descriptivestudies, case studies,and reports of expertcommittees.Generally, interventions consisted of disease-specific educational training interventions, stressinterventions, problem solving training, ortherapeutic interventions.There was a marked lack of diversity in theliterature; none of the articles identified culturallyappropriate interventions.Another limitation was the absence of empiricallybased interventions for siblings.Although the literature has identified a plethora ofrisks, stressors, and needs of the families with achronically ill child, there is a scarcity of evidence-based interventions.
  • 92. -DRAFT-91Barlow, J., Coren, E., Smailagic, N.,Bennett, C., Huband, N., & Jones,H. (2011). Individual and groupbased parenting for improvingpsychosocial outcomes for teenageparents and their children. CampbellSystematic Reviews. 2011:2. DOI:10.4073/csr.20011.2.Adolescent parentsface a range ofproblems. They areoften from verydeprived backgrounds;they can experience arange of mental healthproblems with littlesocial support; theyoften lack knowledgeabout childdevelopment andeffective parentingskills, and they havedevelopmental needsof their own. The aimof the review was toexamine theeffectiveness ofparenting programs inimprovingpsychosocial outcomesfor teenage parentsand developmentaloutcomes among theirchildren. Randomizedcontrolled trialsassessing short-termparenting interventionsaimed specifically atteenage parents and acontrol group (no-treatment, waiting listor treatment-as-usual)were included in thereview. This resulted in8 studies with 513participants, providinga total of 47comparisons ofoutcome betweenintervention andcontrol conditions.Standard parenting programs are focused short-term interventions aimed at helping parentsimprove their functioning as a parent, theirrelationship with their child, and preventing ortreating a range of child emotional and behavioralproblems by increasing the knowledge, skills andunderstanding of parents. They typically involvethe use of a manualized and standardizedprogram or curriculum.These standard conditions may be adapted forteen parents to increase their uptake andcontinuation with the program, and in specificallyaddressing their needs. Programs may also focusmore explicitly on aspects of parenting thatresearch suggests may be difficult for teenageparents, such as understanding the developmentalneeds of their child.Nineteen comparisons were statisticallysignificant, all favouring the intervention group,as were 9 meta-analyses using data from 4 studies.The review concludes that parenting programsmay be effective in improving parentresponsiveness to the child, and parent–childinteraction, both post-intervention and at follow-up.Infant responsiveness to the mother also showedimprovement at follow-up.With one exception (which did not report theresults for teenage fathers), all the studies weredirected at teenage mothers only.One study was specifically directed at African-Caribbean mothers and a number of other studiesincluded a mixed ethnic profile; this suggests thatthe findings are relevant to parents from a rangeof ethnic groups. However, all of the studies wereconducted in the USA or Canada.Belsky, J., & de Haan, M. (2011).Annual Research Review: Parentingand childrens brain development:This paper is anoverview of studies ofhow parenting maySections of the brain and its functions develop atdifferent rates and so are differentially susceptibleto environmental influences.
  • 93. -DRAFT-92the end of the beginning. Journal ofChild Psychology and Psychiatry, 52(4),409-428.affect brain structureand function duringearly development,relying particularly onstudies of early neglectand maltreatment.One intervention study, amongst parents ofpreterm infants, showed effects on brainstructure.Consideration also needs to be given to thehypothesis that children vary in their susceptibilityto parenting on the developing brain.Brett, J., Staniszewska, S., Newburn,M., Jones, N., & Taylor, L. (2011).A systematic mapping review ofeffective interventions forcommunicating with, supportingand providing information toparents of preterm infants. BMJOpen, 1(1), e000023. DOI:10.1136/bmjopen-2010-000023.The aim of thissystematic review is toidentify and mapeffective interventionsfor communicatingwith and supportingparents of preterminfants. Studies wereincluded if theyprovided parent-reported outcomesrelating to information,communicationand/or support priorto birth, during care atthe neonatal intensivecare unit and aftergoing home. Of the 72studies identified, 19were randomizedcontrolled trials, 16were cohort or quasi-experimental studies,and 37 were non-intervention studies.Highlights the importance of encouraging andinvolving parents in the care of their preterminfant at the neonatal unit to enhance their abilityto cope with and improve their confidence incaring for their infant, which may also lead toimproved infant outcomes and reduced length ofstay in the neonatal unit.Interventions for supporting parents included:involving parents in individualized developmentalcare programs and behavioral assessmentprograms; breastfeeding, kangaroo-care and infantmassage; support forums for parents;interventions to alleviate parental stress;preparation of parents, for example, seeing theirinfant for the first time, preparing to go home,and home-support programs.Parents report feeling supported through careprograms, being taught behavioral assessmentscales, and through breastfeeding, kangaroo-careand baby massage programs.Parents also felt supported through organizedsupport groups and through provision of anenvironment where parents can meet and supporteach other.Charles, J. M., Bywater, T., &Edwards, R. T. (2011). Parentinginterventions: A systematic reviewof the economic evidence. Child:Care, Health & Development, 37(4),462-474.Close to half of allchildren with conductdisorders (CD) go onto develop antisocialpersonality problems.CD is also associatedwith failure at school,joblessness, failure inrelationships, financialdependence on thestate, and criminalbehavior. The paperreports on the firstspecific systematicPrograms have a range of costs with the highestitems being staff salaries, staff training and modeof delivery.The costs of group parenting programs rangedfrom £629.00 to £3839.00. Cost-effectiveness wasinfluenced by intervention type and deliverymethod, i.e. individual versus group program.Costs are accrued by health, educational andsocial services, and these need to all be taken intoaccount.If parenting programs have a positive effect onfamilies facing the greatest socio-economic
  • 94. -DRAFT-93review of thepublished economicevidence of parentingprograms as a meansto support familieswith children with orat risk of developingCD. Ninety-threepapers were identified,of which six fulfilledthe inclusion criteria.The search found onereview article, mainlyfocusing on clinicalevidence withsecondary focus oncost-effectiveness, onecost-effectivenessstudy, two partialeconomic evaluationsand two cost studies.challenges, this may be more important thantechnical efficiency (absolute ratio of costs andbenefits of such programs).Parenting programs have been shown to reduceCD. Studies from the USA have shown thepotential for long-term economic benefit of suchprograms, but there is a lack of UK cost-effectiveness research.OBrien, M., & Daley, D. (2011).Self-help parenting interventions forchildhood behavior disorders: Areview of the evidence. Child: Care,Health & Development, 37(5), 623-637.Group-based parenttraining programs areresource- and costintensive, and requireextensive therapisttime through trainingand supervision. Thereare also logisticalbarriers for someparents, such as lack ofchildcare, transportcosts and workschedules. 201abstracts wereidentified, and 13included by thefollowing criteria –English; published ina peer-reviewedjournal; child age 3–12years; excludedchildren with alearning disability;child showed evidenceof behavioralOverall, there is good evidence supporting theefficacy of self-help programs in improving childbehavior, over the short and longer term.Self-help programs led to outcomes similar tothose achieved with more intensive therapistinput.Including minimal levels of therapist support inaddition to self-help materials enhances childoutcomes, and are preferred by parents.There is a need for longer-term follow-ups, theidentification of moderators of outcome andeconomic evaluations.The review concludes that more considerationneeds to be paid to the type of parent and childthat will benefit the most from a self-helpintervention.
  • 95. -DRAFT-94difficulties, with aminimum criteria beingparental concern aboutthe child’s behavior.All but one dependedon self-referral. Thereview evaluated 2modes of delivery:bibliotherapy (writtenmaterials, in the formof an instructionmanual that typicallyincluded informationabout the problem, keystrategies for managingit, and homeworkassignments) andmultimedia (videotapeand television).Programs that includedminimal therapistsupport were alsoincluded.Sandler, I. N., Schoenfelder, E. N.,Wolchik, S. A., & MacKinnon, D.P. (2011). Long-term impact ofprevention programs to promoteeffective parenting: Lasting effectsbut uncertain processes. AnnualReview of Psychology, 62(1), 299-329.This paper asks whatare the long-termeffects of parentingprograms on childoutcomes, and whatprocesses account forthese long-termeffects? Selectedstudies in whichparticipants wererandomly allocatedeither to aninterventioncomponent topromote effectiveparenting or acomparison condition;there was a minimumof 1 year follow-up;and the trial could beconsidered a universal,selective, or indicatedprevention orThe findings provide evidence of effects toprevent a wide range of problem outcomes and topromote competencies from one to 20 years later.But there is a paucity of evidence concerning theprocesses that account for program effects.The authors outline 3 possible processes: throughprogram effects on parenting skills, perceptionsof parental efficacy, and reduction in barriers toeffective parenting; through program-inducedreductions in short-term problems of youth thatpersist over time, in youth adaptation to stress, inyouth belief systems concerning the self and theirrelationships with others; and through effects oncontexts in which youth become involved and onyouth-environment transactions.The outcomes that are changed by parentingprograms include problems with high individualand societal costs, such as mental disorder, childabuse, substance use, delinquency, risky sexualbehaviors, and academic difficulties.The reviewers recommend that a robust programof implementation and dissemination research is
  • 96. -DRAFT-95promotionintervention wereconsidered. Forty-sixtrials of preventiveparenting interventionswere included in thereview.needed to integrate the programs shown to beeffective in experimental trials into health,education, and community settings so they canhave a significant public health impact.Zeanah, C. H., Berlin, L. J., & Boris,N. W. (2011). Practitioner review:Clinical applications of attachmenttheory and research for infants andyoung children. Journal of ChildPsychology and Psychiatry, 52(8), 819-833.This is an overviewand synthesis ofattachment researchfor practitioners,covering howattachments develop,individual differencesin attachmentsmanifest, and clinicaldisorders ofattachment. Theauthors also describethe clinical relevanceof attachment research,and 4 interventions foryoung children andtheir families which areclosely derived fromattachment theory, andare supported byrigorous evaluations.Attachment refers to the infant’s or young child’semotional connection to an adult caregiver – anattachment figure, as inferred from the child’stendency to turn selectively to that adult toincrease proximity when needing comfort,support, nurturance or protection.Human infants are born without being attachedto any particular caregivers; attachments developduring the first few years of life with landmarkchanges at 2-3 months of age, 7-9, and 18-20months.Risk factors increase insecure attachment, whichitself predicts further risk.4 intervention approaches, all extremely training-,labour- and cost-intensive are: Child-ParentPsychotherapy; Video-based Intervention toPromote Positive Parenting (4 visits to the home);Circle of Security (short-term grouppsychotherapy using video feedback), andAttachment and Biobehavioral Catch-up (10sessions).Contraindicated are re-attachment approaches,such as coercive holding and rebirthing.Barlow, J., Smailagic, N., Huband,N., Roloff, V., & Bennett, C. (2012).Group-based parent trainingprograms for improving parentalpsychosocial health. CampbellSystematic Reviews. 2012:15. DOI:10.4073/csr.2012.15.Parental psychosocialhealth can have asignificant effect onthe parent–childrelationship, withconsequences for thepsychological health ofthe child. Parentingprograms have beenshown to have animpact on theemotional andbehavioral adjustmentOverall, group-based parenting programs led tostatistically significant short-term improvementsin depression, anxiety, stress, anger, guilt, self-confidence, and satisfaction with the partnerrelationship.However, only stress and confidence continued tobe statistically significant at six month follow-up,and none were significant at one year.There was no evidence of any effect on self-esteem.There was only limited data for fathers, but
  • 97. -DRAFT-96of children, but therehave been no reviewsto date of their impacton parentalpsychosocial wellbeing.This review includedrandomized controlledtrials that compared agroup-based parentingprogram with a controlcondition and used atleast one standardizedmeasure of parentalpsychosocial health.Control conditionscould be waiting-list,no treatment,treatment as usual or aplacebo. Forty-eightstudies involving 4937participants wereincluded in the reviewand covered threetypes of program:behavioral, cognitive-behavioral andmultimodal.programs showed a statistically significant short-term improvement in paternal stress.In conclusion, the review supports the use ofparenting programs to improve the short-termpsychosocial well-being of parents.Further input may be required to ensure thatthese results are maintained.More research is needed that explicitly addressesthe benefits for fathers, and that examines thecomparative effectiveness of different types ofprograms along with the mechanisms by whichsuch programs bring about improvements inparental psychosocial functioning.Evidence about the importance of paternalpsychosocial functioning on the wellbeing ofchildren, alongside numerous policy directivespointing to the need to provide better support forfathers, suggest that parenting programs shouldalso be offered to fathers.Einfeld, S. L., Stancliffe, R. J., Gray,K. M., Sofronoff, K., Rice, L.,Emerson, E., & Yasamy, M. T.(2012). Interventions provided byparents for children with intellectualdisabilities in low and middleincome countries. Journal of AppliedResearch in Intellectual Disabilities,25(2), 135-142.Considering the lack ofwell-trained therapistswho provide specialistinterventions tosupport children withintellectual disabilitiesand their families inlow- and middle-income (LAMI)countries, this paperaimed to reviewprograms which couldameliorate the effectsof intellectualdisability, and assess ifthey could be deliveredby non-specialistcommunity workers orby parents ofThe quality of evidence for parent-ledinterventions was generally low across all domainsof outcomes; however this does not necessarilymean that the interventions were ineffective, butthat more evidence is needed.Few intervention studies for children withintellectual disabilities have been conducted inLAMI countries and many of those that havebeen conducted are methodologically flawed.Manualized interventions supplemented withmedia (which have proved efficacious in high-income countries) reduce the necessity forexpensive and scarce individual specialist care,and could be adapted for use in LAMI countries.
  • 98. -DRAFT-97handicapped children.20 papers wereobtained that matchedthe authors’ purpose.GRADE methodologywas used to rate thequality of evidence forinterventions providedby parents for childrenwith intellectualdisabilities.Furlong, M., McGilloway, S.,Bywater, T., Hutchings, J., Smith, S.M., & Donnelly, M. (2012).Behavioral and cognitive-behavioralgroup-based parenting programs forearly-onset conduct problems inchildren aged 3 to 12 years.Cochrane Database of SystematicReviews. 2012:2. DOI:10.1002/14651858.CD008225.pub2.Early-onset childconduct problems arecommon and costly.The prognosis forearly-onset conductproblems is poor andnegative outcomes inadolescence andadulthood may includeantisocial and criminalbehavior; psychiatricdisorders; drug andalcohol abuse; higherrates of hospitalizationand mortality; higherrates of school drop-out and lower levels ofeducational attainment;greater unemployment;family breakdown; andintergenerationaltransmission ofconduct problems tochildren. The reviewincluded studies if:they involvedrandomized controlledtrials or quasi-randomized controlledtrials of behavioral andcognitive-behavioralgroup-based parentinginterventions forparents of childrenaged 3 to 12 years withBoth parent and independent reports producedmoderate clinically statistically significant effectsin favour of parent training.There were also statistically significantimprovements in parental mental health, andpositive parenting skills, based on both parent andindependent reports.Parent training also produced a statisticallysignificant reduction in negative or harshparenting practices according to both parentreports and independent assessments.The intervention demonstrated evidence of cost-effectiveness. When compared to a waiting listcontrol group, there was a cost of approximately$2500 per family to bring the average child withclinical levels of conduct problems into the non-clinical range.These costs are modest when compared with thelong-term health, social, educational and legalcosts associated with childhood conductproblems, estimated to be approximately$355,100.The return on investment is likely to beunderestimated as economic analyses typically donot examine wider societal benefits, including thegeneralization of positive effects to other familymembers and the potential societal benefits ofimproved parental mental health.
  • 99. -DRAFT-98conduct problems;incorporated anintervention groupversus a waiting list, notreatment or standardtreatment controlgroup; and studies thatused at least onestandardizedinstrument to measurechild conductproblems. The reviewcovered 13 trials (10RCTs and three quasi-randomized trials), aswell as two economicevaluations based ontwo of the trials;overall, there were1078 participants (646in the interventiongroup; 432 in thecontrol group).Mejia, A., Calam, R., & Sanders, M.(2012). A review of parentingprograms in developing countries:Opportunities and challenges forpreventing emotional andbehavioral difficulties in children.Clinical Child & Family PsychologyReview, 15(2), 163-175.Many children indeveloping countriesare at risk of emotionaland behavioraldifficulties, likelyelevated by the effectsof poverty. Parentingprograms have shownto be effective in high-income countries, butresearch on programsin lower-incomecountries is limited. Acall for interventions indeveloping countrieswas recently made bythe World HealthOrganization (WHO),specifically to preventbehavioral difficultiesand child maltreatmentthrough thedevelopment of stableInterventions were offered as home visits orcenter-based.None of the studies provided information on whodelivered the intervention or contained sufficientinformation to calculate effect sizes.Most studies evaluated programs for enhancingpsychosocial stimulation at home or forpreventing malnutrition and anemia.Few studies evaluated parenting programs toprevent or treat psychological difficulties inchildren.While there are efforts toward the prevention ofgrowth failure and illness in children fromdeveloping countries, less has been done toprevent or manage emotional and behavioralproblems.The reviewers recommend that cost-effectivenessanalyses should be carried out.That studies should examine the effectiveness ofinterventions that can be remotely accessed, suchas technology-based interventions.
  • 100. -DRAFT-99relationships betweenchildren and theirparents. Reviewsreport on internationalorganizations to gainan overview of thefield, and anonsystematic reviewwas also carried out.Only 1 study out of 44published from 1990onwards had a strongmethodology.Selection criteria were:qualitative orquantitativeevaluations of aparenting program; theintervention targetedchildren up to 12 yearsof age.That consideration of culturally appropriatemeasures and intervention protocols is essential.And that there is a need to invest resources in theevaluation and implementation of evidence-basedparenting interventions in developing countries.Miller, S., & Eakin, A. (2012).Home-based child developmentinterventions for pre-schoolchildren from socially disadvantagedfamilies. Campbell SystematicReviews. 2012:1. DOI:10.4073/csr.2012.1.Social disadvantage canhave a significantimpact on early childdevelopment, healthand wellbeing.Parenting and thequality of theenvironment play animportant role insupportingdevelopment in youngchildren mitigating thenegative effects ofsocial disadvantage.Home-based childdevelopment programsdelivered by trained layor professional familyvisitors aim tooptimize childrensdevelopment byeducating, training andsupporting parents intheir own home toprovide a moreThe studies identified for inclusion wereconducted in the USA, Canada, Bermuda, Jamaicaand Ireland.Compared to the control group, there was nostatistically significant impact of the interventionon cognitive development.There were insufficient data to perform a meta-analysis on the other outcomes: socio-emotionaldevelopment, physical development, parentingbehavior, parenting attitudes and the quality ofthe home environment.Nevertheless, no consistent pattern of findingsemerged from the individual studies in relation tothese particular outcomes.Details pertaining to the randomization processand allocation, levels of attrition and reasons forattrition were poorly reported, if at all, and it isthis poor reporting that limits our capacity todraw reliable conclusions about the effectivenessof such programs in improving child developmentoutcomes.
  • 101. -DRAFT-100nurturing andstimulatingenvironment for theirchild. There were anumber ofinterventions that didnot meet the inclusioncriteria on the basisthat they were notspecifically (and only) achild developmentprogram, for example,the Nurse FamilyPartnership of Olds etal, or they contained agroup parentingelement, such as EarlyHead Start. The reviewincluded seven studies,which involved 723participants. Four trialsinvolving 285participants measuredcognitive developmentand the data wassynthesized in a meta-analysis. Only threestudies reported socio-emotional outcomesand there wasinsufficient data tocombine into a meta-analysis.Because of its particular relevance, we include also a systematic review published in 2013Knerr, W., Gardner,F. & Cluver, L.(2013). Improvedpositive parentingskills and reducingharsh and abusiveparenting in low- andmiddle-incomecountries: Asystematic review.Prevention Science,published online 12The review was undertaken in linewith Cochrane Review Handbookguidelines. The search identified 12studies that included 1 580 parentsin nine countries (Brazil, Chile,China, Ethiopia, Iran, Jamaica,Pakistan, South Africa, Turkey).Although the title of the reviewrefers to the reduction of harsh andabusive parenting, the studiesincluded aimed more generally toimprove parenting across a wideMethodologies were too varied to allow meta-analysis.Overall the studies reviewed showed positiveeffects of intervention on a range of parentingmeasures.Enrolment of participants was variously based onresidence and attendance at child care or healthservices.Most interventions involved home visiting, but twowere provided in groups.
  • 102. -DRAFT-101January 2013doi:10.1007/s/11121-012-0314-1.range of children’s ages, from birthto 12 years of age. Seven of thestudies aimed to improve parentingin the first three years of life, andfour of the 12 studies included onlypregnant women. Dates ofpublication ranged from 1983 to2010.All but one intervention was delivered byprofessionals or paraprofessionals.Common components of interventions includedindividual or group counseling; role play,videotaped modeling and guided positiveparenting; educational communication materials,and use of home-made toys.The studies included 10 different parentingoutcomes.All five studies that aimed to improve parent-childinteraction reported positive results.Both studies that aimed to reduce harsh punishmentreported positive results.One study to reduce child abuse was inconclusive.Three studies that aimed to improve parentingknowledge and attitudes showed mixed results.
  • 103. -DRAFT-102APPENDIX 4BRIEF DESCRIPTIONS OF PARENTSUPPORT PROGRAMSThe following is a list of the parent support interventions identified during the review process. Many of theseprograms are constructed around strengthening child-caregiver relationships and use a variety of theoretical andmethodological approaches to do so. Others, while recognizing the importance of child-parent interactions andthe need to improve them, have other primary objectives such as the prevention of child maltreatment or theprevention and treatment of children’s conduct problems.1-2-3 Magic ProgramPhelan, T. W. (1984). 1-2-3 magic: Effectivediscipline for children 2–12 (1st ed.). Glen Ellyn,IL: Child Management,Inc.Phelan, T. W. (2003). 1-2-3 magic: Effectivediscipline for children 2-12 (3rd ed.). Glen Ellyn,IL: Parent Magic, Inc.USA This program was designed primarily to target, manage, and reduceundesirable behaviour among children aged 2-12 years old. The coregoals are to stop ‘unwanted’ behavior, encourage ‘positive’ behavior,and enhance the parent-child relationship. The design is based on thepremise of ‘skills acquisition,’ in which simple techniques areprovided directly to caregivers by trained practitioners. These skillscan be refined and consolidated through a combination of groupdiscussion, role play, feedback from the practitioner and real-worldapplication.. Throughout the training process emphasis is placed onimproving confidence in parent skills and abilities.A child abuseprevention programAhn, H.-Y. (2004). Theeffect of a child abuseprevention program forparents with disabledchildren (Korean).Taehan Kanho HakhoeChi, 34(5), 663-672.SouthKoreaA community child abuse prevention program held in an earlyeducation center. The program consists of handouts, small grouplectures, and support group meetings in which participants learnrelevant skillsets and information related to understanding childrenwith disabilities, parenting relationships, improving communication,non-punitive discipline techniques, and the effects of child abuse.A parenting psycho-educational groupBerge, J.M., Law, D.D.,Johnson, J., & Wells,M.G. (2010).Effectiveness of apsycho-educationalMinneapolis, USAThis psychoeducational parenting group within a primary care clinictargets child behavioural problems within a primary care clinic withthe aim of improving integrated care options for children and theirfamilies. Parenting psycho-education groups in primary care clinicscan be a resource to the primary care doctor, the patient and the child.In addition, they provide an avenue to access and engage populationsthat are usually hard to reach. The program consists of 12 sessions
  • 104. -DRAFT-103parenting group on child,parent, and familybehavior: A pilot study ina family practice clinicwith an underservedpopulation. Families,Systems and Health,28(3), 224-235.and included 10-14 parents and their children between 5 and 10 yearsold. Parents were invited to bring their partners. Sessions ran for 12weeks for 2 hours on a weeknight. Parents would attend the parentinggroup while children attended a skills-based class that focused onteaching basic social skills through activities and play. Babysittingresources were provided for the younger children of participants.After the classes ended parents and children would reconvene to eat afamily meal and participate in a family connecting activity.ABCD Parenting YoungAdolescents ProgramBurke, K., Brennan, L.,& Roney, S. (2010). Arandomized controlledtrial of the efficacy of theABCD Parenting YoungAdolescents Program:Rationale andmethodology. Child &Adolescent Psychiatry &Mental Health, 4, 22-35.Australia ABCD is a group program for parents of children aged from 9 to14years old. This brief psychoeducational intervention places anemphasis on active skills building and problem solving, together withother strategies that have been shown to reduce distress ininterpersonal relationships. Parents are provided with informationand skills for developing and maintaining trusting, positive, andaccepting relationships with their young adolescents. The program isdelivered over six consecutive weeks. During each two-hour sessionparents have an opportunity to discuss, practice and receive feedbackon a range of parenting strategies and concepts. The program’scontent is designed to enhance parental understanding and give themskills to assist their children during their transition to adolescence.Content is organized under four themes: 1) developing understandingand empathy for adolescents; 2) building strong relationships; 3)building responsibility and autonomy in children; and 4) parentalself-care.ACT Raising Safe KidsProgram (ACT RSK)Silva, J., Sterne, M. L., &Anderson, M. P. (2000).ACT against violencetraining. Washington,DC: AmericanPsychologicalAssociation and NationalAssociation for theEducation of YoungChildren.USA The ACT RSK Program is a community-based violence preventionintervention that provides skills training and education to familieswith young children. The program is based on the CDC’s BestPractices of Youth Violence Prevention guidelines. These practicesinclude social-cognitive interventions that use didactic instruction,modeling, and role play to help children master positive social skillsand social problem solving as well as developing or maintainingattitudes and beliefs supportive of nonviolence. These practices alsopromote parent- and family-based activities involving training inparenting skills, lessons on both child development and the factorsthat predispose children to violence . Activities to improve effectivecommunication between parents and children are also included. Theprogram is built around eight8 sessions and is fully manualized inboth English and Spanish.Active ParentingPopkin, M. (2002).Active Parenting Now:Parent’s guide for parentsof children ages 5–12.USA The Active Parenting Program covers children between the ages of 5and 12 years old. The program is delivered in 6 2-hour sessionsinvolving group discussion, role play and video vignettes. The coreelements of the program focus on what children need to succeed,styles of parenting, mutual respect, handling problems, building
  • 105. -DRAFT-104Kennesaw, GA: ActiveParenting Publishers.cooperation, active communication, teaching responsibility, effectivediscipline techniques, ‘I’ messages, logical consequences, whychildren misbehave, self-esteem, stimulating independence, thepower of encouragement, and family council meetings.Adventures inParenting ProgramBert, S. S. C., Farris, J.R., & Borkowski, J. G.(2008). Parent training:Implementation strategiesfor Adventures inParenting. The Journal ofPrimary Prevention, 29,243–261.USA The National Institute of Child Health and Human Development(NICHD) developed an information booklet, Adventures inParenting, designed to educate parents on basic principles ofparenting and encourage them to build on these principles in theirdaily lives using a cognitively-based model of parenting. The bookletoffers five principles (RPM3) that parents can use: Responding,Preventing, Monitoring, Mentoring, and Modeling. The Adventures inParenting booklet was structured to inform parents about the value ofthe RPM3 principles and to provide examples of how they can beapplied in everyday parenting. Sets of vignettes are providedfeaturing children who range from birth to age 3, ages 4 through 10,and ages 11 through 14. In each section, parents are provided with anage-appropriate vignette for each of the five principles followed bydiscussion questions and an explanation of the vignette.Apoyo Personal yFamiliar (APF;Personal and FamilySupport Program)Rodrigo, M. J., Correa,A. D., Maiquez, M. L.,Martin, J. C., &Rodriguez, G.(2006).Familypreservation services onthe Canary Islands:Predictors of the efficacyof a parenting programfor families at-risk ofsocial exclusion.European Psychologist,11, 57–70.CanaryIslandsApoyo Personal y Familiar (Personal and Family Support Program) ispart of the Family Preservation Services developed by the CanaryIslands. The program is targeted at poorly educated parents offamilies at high psychosocial risk. The program involves 32 weeklygroup sessions for at-risk parents of children from 0 to adolescence.Group sessions are held in community centers; parents are exposed toparental views and practices in specific child-rearing episodes andthey are encourage to reflect on their own views and theconsequences of their actions on child development.Attachment andBiobehavioral Catch-up(ABC) ProgramDozier, M., Peloso, E.,Lindhiem, O., Gordon,M.K., Manni, M.,Sepulveda, S., &USA The Attachment and Biobehavioral Catch-up (ABC) Program ABCprogram is a ten-week-long home-based skills-training program thathelps the foster parents of children who are between zero and fiveyears old provide a nurturing environment. The program targetsdysregulation (a disorder in which emotional responses are poorlymodulated) in children by teaching foster care parents nurturing skillsto create environments that enhance regulatory capabilities. Theintervention attempts to enhance child regulatory capacities using 3
  • 106. -DRAFT-105Ackerman, J. (2006).Developing evidence-based interventions forfoster children: Anexample of a randomizedclinical trial with infantsand toddlers. Journal ofSocial Issues, 62, 767-785.techniques: 1) Helping caregivers to re-interpret children’s alienatingbehaviors, 2) helping caregivers overcome personal issues thatinterfere with their ability to provide nurturing care, and 3) helpingcaregivers provide an environment that helps children developregulatory capabilities. There are 10 weekly sessions in which bothfoster parents and foster children are led by a trainedparaprofessional. Sessions are interactive in nature and involve theparent and trainer discussing concepts, practicing learned techniqueswith the child and discussing successes and failures in the use of theconcepts learned in the prior weeks.Baby Business ProgramCook, F., Bayer, J., NDLe, H., Mensah, F., Cann,W., & Hiscock, H.(2012). Baby Business: Arandomized controlledtrial of a universalparenting program thataims to prevent earlyinfant sleep and cryproblems and associatedparental depression. BMCPediatrics, 12(1), 13-13.Australia The Baby Business program provides parents with information aboutinfant sleep and crying via a DVD and booklet (mailed to parentssoon after birth), telephone consultation (at infant 6-8 weeks) andparent group session (at infant age 12 weeks). All English speakingparents of healthy newborn infants born at > 32 weeks gestation andreferred by their maternal and child health nurse at their firstpostpartum home visit (day 7-10 postpartum), are eligible. Thetelephone consultation and parent groups are facilitated by trainedhealth professionals with a background in infant care. The 27-pagebooklet provides parents with information about normal infant sleeppatterns and sleep cycles. Various other issues are discussed, such asbenefits of infants falling asleep independently, the disadvantages ofinfants relying on parent dependent cues to fall asleep at thebeginning of the night, the dangers of sharing a bed with children,normal infant crying patterns, strategies for managing infant cryingand signs and symptoms of uncommon medical causes of crying. TheDVD covers similar content but also includes footage of parentsdiscussing the methods they use to settle their infants, the signs oftiredness their infant displays, etc. The telephone consultationexpands on the content of the booklet and the DVD. The facilitatorhelps the parent apply the information in a way that is suitable for thefamily. Parents are also encouraged to discuss issues that are coveredin the booklet and DVD. Parents are invited to attend a 1.5 hourgroup session at local venues where problem troubleshooting is done.Better BeginningsBarratt-Pugh, C. N.(2011). Making adifference: Findings fromBetter Beginnings afamily literacyintervention programme.Australian LibraryJournal, 60(3), 195.Australia Better Beginnings is an early intervention family literacy programthat provides families with strategies and resources to promote andsupport book-sharing from birth. Better Beginnings is introduced toparents and caregivers at the 6-8 week health check by thecommunity child health nurse. The community child health nurseshares a reading pack with the parent and explains the importance ofsharing books and accessing early literacy resources and activitiesthrough the local libraries. The Better Beginnings program consistsof: a handbook and training module developed for librarians andcommunity child health nurses; a reading pack for parents of young
  • 107. -DRAFT-106babies, Baby Rhyme time and Story time sessions and workshops forparents, Outreach Story Time Boxes that contain a range of literacyresources for children and families, family resource centres that arelocated in libraries and provide interactive early childhood learningand parenting resources, and a website providing information aboutBetter Beginnings.Better ParentingProgramme (BPP)Brown, J. (2000).Evaluation report of theBetter Parenting Project.Amman, Jordan:UNICEF.Al-Hassan, S. (2009).Evaluation of the betterparenting program: Astudy conducted forUNICEF. Amman:UNICEF.Jordan This parenting programme was designed to enhance parenting withinthe cultural context of Jordan after the results of a national KAPsurvey revealed gaps in parents’ knowledge in effective childrearing.The BPP has been implemented in more than 2000 centresnationwide. In a 2000 evaluation, it was found that the cost ofreaching out to parents and their children was US$3 per child. Alsohighlighted was the need to expand the BPP scope to a more holisticearly childhood care and development approach, including protectionof children from abuse and neglect. The BPP was revised in 2003.The current aim is to empower parents and caregivers to provide astimulating, loving, and protective environment at home byequipping parents and caregivers with skills and information toenable them to promote the psychosocial, cognitive, and physicaldevelopment of their children aged 0–8 years. The program issupported by UNICEF and other key government and civil partners.Boot Camp for NewDadsCapuozzo, R. M.,Sheppard, B.S., & Uba,G. (2010). Boot Camp forNew Dads: Theimportance of infant-father attachment. YoungChildren, 65(3), 24-28.USA Boot Camp for New Dads is a program for expectant fathers wheremen learn how to make the home safe and secure for their newbornchild, how to support their partners before and after birth, and prepareto bond with the baby. Expecting fathers and fathers with children areinvolved in the program and in men-mentoring-men. The programresponds to what the rookie and veteran fathers indicate they want tolearn about. Veteran fathers bring their children to sessions and manyrookie fathers are able to interact with the attending children.Coaches run the sessions and follow a ‘game plan’ which iscontained in the resource guide. Generally, sessions begin with thecoach describing what can be expected during the session, and thenquestions and concerns from rookie fathers are taken. Each man isalso encouraged to talk about their own experience with their father.Topics focused on in some of the sessions include supporting themother, preparations for the hospital stay, what to do during delivery,bonding with the newborn at the hospital, adjustments at home and infamily responsibilities, and bringing the baby home. Crying,changing diapers, feeding and playing interrupt sessions and are usedas ‘teachable moments’.Brazelton NeonatalBehavioural AssessmentScale (BNBAS)USA Originally designed as an assessment tool for newborns, the BNBAShas also been used as a means of enhancing parent-infant interactionand attachment in both high and low risk families by increasing the
  • 108. -DRAFT-107Beeghly, M., Brazelton,T.B,; Flannery, K.A.,Nugent, J.K, et-al (1995)Specificity ofpreventative pediatricintervention effects inearly infancy, Journal ofDevelopmental andbehavioural Pediatrics,16,158-166.parents’ awareness of the infant’s individuality and capabilities. TheScale contains 32 behavioural and 18 reflex items to assess theinfant’s capabilities across different developmental areas. Using theScale, responses are elicited from the infant to assess his or herneurological condition as well as how the different developmentalareas (autonomic, motor, social-interactive system, etc.) areintegrated as the infant adapts to his or her environment. This is thendemonstrated to parents in order to increase their awareness andresponsiveness to the infant and enhance feelings of nurturance.Brief parent discussiongroupMorawska, A., Haslam,D., Milne, D., & Sanders,M.R. (2011). Evaluationof a brief parentingdiscussion group forparents of youngchildren. Journal ofDevelopmental &Behavioral Pediatrics,32(2), 136-145.Brisbane,AustraliaThe article assessed the use of a new brief parent discussion groupformat for the provision of parenting advice based on the Triple Pmodel of intervention, in the context of managing child disobedience.The key objectives of the brief discussion group format include thefollowing: increase parents’ skills in promoting social, emotional,and behavioural competence in children; reduce parents’ use ofcoercive and punitive methods of discipline; improve communicationabout parenting; and reduce parental stress associated with raisingchildren. The intervention is a 2-hour discussion group on child non-compliance with an average of 6 families per group, facilitated by apsychologist. The group is interactive and discussion-based; and aPowerpoint presentation, with embedded videoclips, is used to aid thefacilitator. Parents received a workbook that includes the contentcovered in the discussion group. The intervention also included twobrief telephone consultations for each family in the two weeks afterthe discussion group. Telephone consultations were used to helpparents tailor the strategies to their family situation and to maximizepotential gains from the program.Building Blocks (BB)Mendelsohn, A.L.,Huberman, H.S., Berkule,S.B., Brockmeyer, C.A.,Morrow, L.M., Dreyer,B.P. (2011). Primary carestrategies for promotingparent-child interactionsand school readiness inat-risk families: TheBellevue Project forEarly Language,Literacy, and EducationSuccess (BELLE).Archives of Pediatrics &Adolescent Medicine,New York,USAThe BB intervention takes place from birth to three years of age anddelivers a curriculum focused on supporting verbal interaction in thecontext of pretend play, shared reading, and daily routines to enhancechild development and school readiness. This curriculum is deliveredthrough written pamphlets and learning materials that are mailedmonthly to the family in addition to being delivered by a practitioner.The intervention strategies include age-specific newsletterssuggesting interactive activities, learning materials, and parent-completed developmental questionnaires.
  • 109. -DRAFT-108165(1), 33-41.Butler County SuccessProgram (BCSP)Bush, K., & D. Bergen(2010). Evaluation of anholistic case managementintervention program forlow-income families ofK-6 grade children: TheButler County SuccessProgram (BCSP).International Journal ofInterdisciplinary SocialSciences, 5(8), 337-352.Ohio, USA The BCSP was designed to assist students in grades Kindergartenthrough 6th grade who qualify for Temporary Aid to Needy Families(TANF) in assessing and meeting basic non-cognitive needs. A keyconcept of the program is the connection to the community thoughhome visits to families and working with local agencies andresources. A liaison is assigned to work in one of the participatingschools but is based out of the school. The liaison person meets withstudents and their families, attends individualized education planmeetings and works with school personnel to coordinate and provideservices. Once clients are in the program, based on the specific needsof the family, the liaison person provides support and assistance andrefers/facilitates connecting the child/family to appropriate resourcesand/or services. These may include access to child care, health care,financial assistance, food banks and related services, employmentservices, parenting classes/education, counseling, and transportation.An integral component of the BCSP is the partnership between theprogram, community resources/agencies, schools, and families inneed. Each school and school district uses specific agencies andresources that are unique to the area, although a few resources workacross all the schools. The program objectives of the BCSP are todevelop and maintain an infrastructure between schools andcommunities and link these to TANF families; to identify, secure andprovide needed resources, to coordinate the provision of theseservices, to help families access services and to provide children andparents opportunities to develop the necessary skills for long-termsufficiency.Child FIRSTLowell, D. I., Carter, A.S., Godoy, L., Paulicin,B., & Briggs-Gowan, M.J. (2011). A randomizedcontrolled trial of ChildFIRST: A comprehensivehome-based interventiontranslating research intoearly childhood practice.Child Development,82(1), 193-208.10.1111/j.1467-8624.2010.01550.xUSA Child FIRST (Child and Family Interagency, Resource, Support, andTraining) is a comprehensive, home-based, therapeutic interventionthat targets multi-risk young children and families. The overall aim isto prevent serious emotional disturbance, learning and developmentaldisabilities, and abuse and neglect. The first of two components inChild FIRST is a system of care approach that providescomprehensive and integrated services and supports such as earlyeducation, housing and substance abuse treatment to the child andfamily in an attempt to decrease psychosocial stress and promotepositive outcomes. The second component is a relationship-basedapproach to enhance nurturing, responsive parent-child interactionsand promote positive social-emotional and cognitive development.Services are offered in the home to reduce barriers to treatment,increase engagement and intervene in the child’s naturalenvironment.Child-Parent Multi- CPRT is a therapeutic method based on the belief that that the
  • 110. -DRAFT-109Relationship Therapy(CPRT)Landreth, G. L., &Bratton, S. C. (2006).Child parent relationshiptherapy: A 10-sessionFilial therapy model.New York: relationship between a caregiver and child is fundamental. The mainobjectives of CPRT are to make positive changes within the child-parent relationship and to empower parents to become primary agentsof change. Trained therapists use didactic instruction, demonstrationsof play sessions, and supervision to teach parents how to use play asa therapeutic agent in the home. The aim is to increasecommunication, positive child-caregiver interactions and theenjoyment of being a parent. Through CPRT parents and caregiverslearn to communicate effectively, regain control as a parent, helptheir children develop self-control and effectively discipline and setlimits. Skills learnt throughout the process include reflectivelistening, recognizing and responding to children’s feelings, limitsetting, and building children’s self-esteem. Specialists trained inplay therapy deliver the manualized 10-session therapy with parentsand teach the skills and principles of CPRT.Circle of Security(COS) ProjectMarvin, R. S., Cooper,G., Hoffman, K., &Powell, B. (2002). TheCircle of Security project:Attachment-basedintervention withcaregiver-preschool childdyads. Attachment andHuman Development, 1,107-124.USA,Japan,Italy, NewZealandThe COS protocol is a manualized 20-week program for participants(mothers, and occasionally fathers) of children ages 11 months to 5years. Series of taped interactions help to discern where a parent isable to meet a child’s needs and where they are unable. Vignettes arechosen to illustrate particular aspects of the relationship.Interventions are delivered in groups where highly trained andexperienced therapists deliver the intervention to 6-8 parents at atime, including extensive and careful review of videotaped child-parent interactions for each parent in the group.Communities forChange (CfC)Edwards, B., Gray, M.,Wise, S., Hayes, A.,Katz, I., Muir, K., &Patulny, R. (2011). Earlyimpacts of Communitiesfor Children on childrenand families: Findingsfrom a quasi-experimental cohortstudy. Journal ofEpidemiology &Community Health,65(10), 909-914.10.1136/jech.2010.11813Australia CfC is a large scale area-based initiative that is designed to enhancethe development of children in disadvantaged community sitesaround Australia. The overall aim is to improve the coordination ofservices for children aged 0-5 years and their families, and to provideservices to address unmet needs, build community capacity and toengage in service delivery. The intervention involves providingfunding to a large non-government organization in each area whichwould be considered as the facilitating partner. The facilitatingpartner then establishes committees of other local service providerswith community representatives, who together decide on the servicesrequired in specific communities. Funding for these services isallocated to local service providers. Services include home visiting,programmes on early learning and literacy, parenting and familysupport, child nutrition and community events. The facilitatingpartners are also funded to increase service coordination andcooperation between service providers.
  • 111. -DRAFT-1103Comprehensive ChildDevelopment Program(CCDP)St. Pierre, R.G., &Layzer, J.I. (1999). Usinghome visits for multiplepurposes: TheComprehensive ChildDevelopment Program.The Future of Children,9(1), 134-151.USA CCDP is a comprehensive five-year intervention targeting low-income families. The goals of CCDP are to enhance the physical,social, emotional and intellectual development of children in low-income families from birth to age 5. In addition, the program aimedto provide support to parents and other family members and assistfamilies in becoming economically self-sufficient. CCDP was thecentre of a five-year demonstration project funded by theAdministration on Children, Youth and Families in the USA. Eligiblefamilies had to have incomes below the federal poverty line. Two keyservices were delivered to families, case management and earlychildhood education, both through home visits. Visits, beginningduring the child’s first year of life, continued until the child enteredschool; they occurred twice a month and lasted an hour. Casemanagers conducted home visits at least twice a month and assessedthe goals and service needs of individual family members and of thefamily as a whole, developing a service plan, referring the family toservices in the community, monitoring and recording the family’sreceipt of services, and providing counseling and support to familymembers, especially mothers. Formal family needs assessments wereconducted within 3 months of enrollment in the program. The needsassessment formed the basis for a service-delivery plan developed byboth the case manager and family members. The goals mostcommonly specified by families were obtaining better housing,improving parenting skills, accessing child care and health care,obtaining transportation, increasing income, and accessingcommunity resources. The plan was updated every three months andincluded an assessment of the extent to which goals were achieved.Confident ParentingProgramCenter for theImprovement of ChildCaring. (1987).Confident Parenting:Contemporary skills andtechniques for achievingharmony in the home.North Hollywood, CA:Authors.USA The Confident Parenting Program teaches a restricted range of social-principles, primarily those which govern the effectiveness of variouskinds of positive reinforcement. These consequences can be non-social (food, money, privileges, etc.) or social (praise, punishment,attention). Although initially intended for use in child mental healthsettings with parents whose children aged 2-12 were experiencingbehaviour or emotional problems, the program has been extended to awider range of institutional settings and to parents of both older andyounger children. The program follows 10 sessions (about 2 hourslong). As a starting point parents are taught that their children’sbehaviour is shaped by its consequences. The sessions include smallgroups of parents to enable individualized consultation with theinstructor on the home behavioural change projects that are assigned.Group discussions and role-playing are strategies used in the groupwork. A one-day seminar version of the program for large numbersof parents has been recently created.
  • 112. -DRAFT-111Creating Opportunitiesfor ParentEmpowerment (COPE)Melnyk, B. M., Alpert-Gillis, L., Feinstein, N.F.,Crean, H.F., Johnson, J.,Fairbanks, E., Small, L.,Rubenstein, J., Slota, M.,& Corbo-Richert, B.(2004). CreatingOpportunities for ParentEmpowerment: Programeffects on the mentalhealth/coping outcomesof critically ill youngchildren and theirmothers. Pediatrics,113(6), e597-e607.USA A preventive educational-behavioural intervention program initiatedearly in the intensive care unit to improve the mentalhealth/psychosocial outcomes of critically ill young children andtheir mothers. It is a program for parents at the neonatal unit focusingon aspects such as the behavioural characteristics of preterm infants,how parents can participate in their infant’s care and have morepositive interactions with their infant. Mothers received a 3-phaseeducational-behavioural intervention program 1) 6 to 16 hours afterPICU admission, 2) 2 to 16 hours after transfer to the generalpediatric unit, and 3) 2 to 3 days after their children are dischargedfrom the hospital. The COPE program, which was delivered withaudiotapes and matching written information, as well as a parent-child activity workbook that facilitated implementing the audiotapedinformation, focused on increasing 1) parents’ knowledge andunderstanding of the range of behaviours and emotions that youngchildren typically display during and after hospitalization and 2)parent participation in their children’s emotional and physical care.The COPE workbook, which was provided to parents and childrenafter transfer from the PICU to the general pediatric unit, contained 3activities to be completed before discharge from the hospital, i.e., 1)puppet play to encourage expression of emotions in a nonthreateningmanner, 2) therapeutic medical play to assist children in obtainingsome sense of mastery and control over the hospital experience, and3) reading and discussing Jenny’s Wish, a story about a young childwho successfully copes with a stressful hospitalization.Criando a NuestrosNin˜os hacia el E´ xito(CANNE) (Spanishadaptation of PACE)Dumas, J. E., Arriaga, X.,Begle, A. M., &Longoria, Z. (2010).“When will your programbe available in Spanish?”Adapting an earlyparenting intervention forLatino families.Cognitive and BehavioralPractice, 17, 176–187.Midwestern USACANNE was developed in response to repeated calls for a Spanishprogram from the Indianapolis communities in which PACE wasevaluated. CANNE is the outcome of a systematic adaptation processof adaptation balancing emic and etic considerations by relying on (a)extensive consultation with parents, service providers, andcommunity leaders; (b) and translation of the manual and evaluationof the degree of correspondence between the Spanish and Englishversions; and (c) translation and cross-language comparison ofmeasures available in English only. This resulted in a Spanishprogram with close conceptual and methodological correspondencewith the original but with a distinct cultural and practical orientationthat makes it much more than a translation. Conceptually, CANNE isa health promotion, not a treatment, program. It focuses on biculturaleffectiveness to help participants promote their own and theirchildren’s ability to navigate effectively within and across bothLatino and U.S. cultures. Methodologically, the program’s contentsand methods of presentation were modified to integrate Latinocultural assumptions and priorities and to address child-rearingdifferences between the USA, Mexico, and other Latin Americancountries. For example, adaptation included consideration of Latino
  • 113. -DRAFT-112cultural values (e.g. respeto, familismo) in the presentation ofencouragement, reward, and discipline strategies, and knowledge andcommunication issues to facilitate family access to communityresources. Sessions cover eight topics, group leaders conduct guideddiscussions, use role plays, and show short video clips to present eachtopic.DADS Family ProjectCornille, T. A., Barlow,L. O., & Cleveland, A. D.(2005). DADS FamilyProject: An experientialgroup approach tosupport fathers in theirrelationships with theirchildren. Social Workwith Groups, 28(2), 41-57.USA The Dads Actively Developing Stable Families Family Project(DADS) is a program designed to help fathers improve theirunderstanding of the essential role of fathering, develop new attitudestowards parenting and to teach them new parenting skills. Theprogram is adaptable to various settings including schools, churches,prisons and businesses. The goals of the program are for fathers torecognise their potential positive impact on children, improveattitudes towards wanting to be an equal parent, understanding andlearning strategies for establishing a safe and secure homeenvironment, appreciation of the value of play for children,improvement in communication skills, stress management anddiscipline. The program is based on group processes and experientialactivities in the form of 8 two-hour sessions. Activities include role-play, video modelling and group interaction.Early Head StartLove, J., Kisker, E.E.,Ross, C., Raikes, H.,Constantine, J., Boller,K., Brooks-Gunn, J.,Chazan-Cohen, R.,Tarullo, L.B., Brady-Smith, C., Fuligni, A.S.,Schochet, P.Z., Paulsell,D., & Vogel, C. (2005).The Effectiveness ofEarly Head Start for 3-year-old children andtheir parents: Lessons forpolicy and programs.DevelopmentalPsychology, 41(6), 885-901.USA Early Head Start is a sub program of Head Start. The comprehensivetwo-generation multi-program intervention began in 1995 for low-income women and families with infants and toddlers and focuses onenhancing children’s development while strengthening families. Itcomprises a combination of home- and centre-based programmes;services can be provided in the home of the family, at a licensedfamily child care home or at a center. This comprehensive earlyeducation program includes young children with disabilities. Inaddition to comprehensive early education, other services includeproviding and linking families with health, mental health, disability,nutrition and social services. Early Head Start has strong parentinvolvement and services specifically designed for pregnant women.Families are eligible if the family income is below the federal povertyline.Empowering Parents,EmpoweringCommunities (EPEC)UK EPEC is a community-based program that trains parents to runparenting groups in their own communities. The assumption is thatthis method is cost-effective and provides accessible help for parents
  • 114. -DRAFT-113Day, C., Michelson, D.,Thomson, S., Penney, C.,& Draper, L. (2012).Innovations in Practice:Empowering Parents,EmpoweringCommunities: A pilotevaluation of a peer-ledparenting programme.Child & AdolescentMental Health, 17(1), 52-57.whose children are experiencing behavioural difficulties. There aretwo manualized components to the EPEC program. The first is a PeerFacilitator Training Course and the second is a Being A Parent (BAP)intervention. Parents are selected for training as peer facilitatorsbased on a semi-structured interview conducted by the EPECtrainers. Selection is based on the potential facilitator’s ability to self-reflect, understand and empathize with the difficulties of others aswell as the capacity to understand and deliver the tasks involved infacilitating the parenting groups. Many peer facilitators gainexperience from being part of the BAP groups. Facilitator traininginvolved didactic teaching, group discussion, role-play, skills practiceand written assignments. Facilitators receive payment and anaccredited qualification. These trained facilitators deliver BAP inareas of high social disadvantage. BAP is designed for caregivers ofchildren aged 2-11 years of age and aims to improve parent-childrelationships and interactions, reduces child disruptive behaviour andother problems, and increase participants’ confidence in theirparenting abilities. The intervention spans 8 weekly 2-hour sessionsto groups of between 6 and 14 parents.Even StartSt Pierre, R.G., Robert,G., & Swartz, J.P. (1995).The Even Start FamilyLiteracy Program. InSmith, S. (Ed). Twogeneration programs forfamilies in poverty: Anew intervention strategy.Advances in AppliedDevelopmentalPsychology, Vol 9, (pp37-66). Westport, CT,US: Ablex Publishing.US Department ofEducation (2003) Thirdnational Even Startevaluation: Programimpacts and implicationsfor Even Start is a one year family-focused program that includes 3 coreservices: early childhood education, adult literacy training and parenteducation. Criteria for participation in the program include one adultwith eligibility for an adult basic education program and a childunder the age of 8 in the family. The early childhood educationcomponent of the program focuses on enhancing cognitive, languageand social skills as well as general school readiness among childrenfrom birth up to 8 years of age. The adult education component aimsto develop parents’ basic educational and literacy skills. Theparenting education aspect focuses on improving parents’understanding of their child’s development, child behaviourmanagement training, enhancing parents’ capacity to support theirchild’s education, and life skills. Supplementary services also offeredEven Start include transportation, sibling child care, counseling andreferrals for employment.Every Person Influences USA Every Person Influences Children, Inc. is a national not-for-profit
  • 115. -DRAFT-114Children (EPIC)EPIC. (1993). A familyinvolvement and supportprogram for parents ofyoung children. ParentManual. Buffalo: NY:Authors.organization that provides effective programs and resources forparents, teachers and school administrators that help adults raiseresponsible and academically successful children. EPIC offers acomprehensive program that links the home, the school and thecommunity. EPIC’s Parent Program offers training for facilitatorsfrom their own communities and prepares them to lead parentingworkshops. Through small, supportive discussion groups, parentscome together to discuss parenting concerns and to exchange ideasand parenting techniques. EPIC workshops are offered to parents ofchildren from birth through adolescence with accompanyingparenting manuals, which are available in both English and Spanish.These workshops help parents and guardians strengthen theirparenting skills. The workshops also empower parents to becomemore involved in their child’s education.Families OverComingUnder Stress (FOCUS)Lester, P., Saltzman, W.R., Woodward, K.,Glover, D. A., Leskin, G.A., Bursch, B., et al.(2012). Evaluation of afamily-centeredprevention interventionfor military children andfamilies facing wartimedeployments. AmericanJournal of Public Health,102 (Suppl 1), S48-S54.Lester, P., Mogil, C.,Saltzman, W.,Woodward, K., William,N., Leskin, G., Bursch,B., Green, S., Pynoos, R.,& Beardslee, W. (2011).Families OverComingUnder Stress:Implementing family-centered prevention formilitary families facingwartime deployments andcombat operational stress.Military Medicine,176(1),19-25.USA,JapanFOCUS is a manualized family-centred prevention intervention thatcenters on resiliency training. It provides education and skills trainingfor military parents and children. Training is designed to enhancecoping with deployment-related issues and experiences, including theinjury of a service member. Using a structured narrative approach,family members are able to share unique experiences in efforts toimprove shared understandings, communication and family cohesion.Core intervention components include psycho-education, emotionalregulation skills, goal setting and problem solving skills, traumaticstress reminder management techniques, and family communicationskills.
  • 116. -DRAFT-115Family Check-up (FCU)Dishion, T.J., Shaw, D.,Connell, A., Gardner, F.,Weaver, C., & Wilson,M. (2008). The FamilyCheck-Up with high-riskindigent families:Preventing problembehavior by increasingparents’ positive behaviorsupport in earlychildhood. ChildDevelopment, 79(5),1395-1414.USA This is a brief intervention that contains a broad assessment of thefamily context and parenting practices. The overall goal is to reduceproblem behaviour and promote emotional well-being in children andfamilies. The program comprises 3 sessions – the initial contactsession, the multi-agency, multi-method assessment session and thefeedback session. The first step is a meeting with parents to exploretheir perceptions and concerns regarding their family and child’sbehaviour. The second step is a comprehensive assessment thatincludes videotaping parent–child interactions. The third step is astructured feedback session that is based on the results of theassessment and that emphasizes parenting and family strengths yetdraws attention to possible areas of change. The intervention ismotivational in that it stimulates caregivers to address key problemsin parenting either on their own or with the support of a professional.Interventions that follow the FCU are thus tailored to each family’sneeds on the basis of the assessment and of the parents’ motivation tochange. Some parents may focus on only one dimension of theirparenting and this differs from conventional parenting interventionprograms that tend to emphasize a standard curriculum of parentingpractices to all parents.Family Connections(FC)DePanfilis, D. &Dubowitz, H. (2005).Family Connections: Aprogram for preventingchild neglect. ChildMaltreatment, 10, 108-123.San MateoCounty,CaliforniaFC is a multi-faceted community-based program that works withfamilies in their homes communities to help them meet the basicneeds of their children and reduce the risk of child neglect. Ninepractice principles guide FC interventions: community outreach,individualized family assessment, tailored interventions, helpingalliance, empowerment approaches, strengths perspective, culturalcompetence, developmental appropriateness, and outcome-drivenservice plans. Individualized intervention is geared to increaseprotective factors and decrease risk factors. The core components ofthe intervention are manualized for practitioners - emergencyassistance, home-based family intervention, service coordination withreferrals targeted toward risk and protective factors, and multifamilysupportive recreational activities.Family Foundations(FF)Brown, L. D., Feinberg,M. E., & Kan, M. L.(2012). Predictingengagement in atransition to parenthoodprogram for couples.Evaluation & ProgramPlanning, 35(1), 1-8.USA Family Foundations (FF) is a universal preventive intervention tohelp couples manage the transition to parenthood. Couples attendeight interactive, skills-based classes that each last approximately 2hours. Four classes occur before childbirth and four afterward.Couples also complete homework assignments between classes.Relationship skills and parenting skills are combined so as to aid inthe development of mutually supportive co-parenting strategieswhich are delivered as part of hospital childbirth education classes.
  • 117. -DRAFT-116Fast TrackGreenberg, M. T. (1998).Testing developmentaltheory of antisocialbehavior with outcomesfrom the Fast TrackPrevention Project. Paperpresented at theAmerican PsychologicalAssociation, Chicago, IL.USA Fast Track is a long term, multi-site, multi-component preventiveintervention addressing classroom, school, individual child andfamily risk factors. The universal component comprises a curriculumdelivered in classrooms by the teacher and covers 4 domains of skills– skills for emotional understanding and communication, friendshipskills, self-control skills, and social problem-solving skills. Theselective component involves parent groups, child social skillstraining, parent-child sharing time, home visiting, child peer pairing(to promote friendship) and academic tutoring. These are offered tohigh-risk children and their parents and are delivered by counselorsand social workers. Parent skills training focusing on establishingpositive family-school relationships, building parental self-control,promoting developmentally appropriate expectations for childbehaviour and improving parent-child interaction. Various deliverystrategies are used. The high-risk family-focused component includes5-22 sessions per year of family group meetings, 30 minute parent-child sharing sessions after family group meetings and bi-weeklyhome visitations aimed at improving parenting skills, enhancingfeelings of efficacy and empowerment and increasing problem-solving skills.Good BeginningsProgramStipek, D.J., Feiler, R.,Byler, P., Ryan, R.,Milburn, S., Salmon, J.M.(1998). GoodBeginnings: Whatdifference does theprogram make inpreparing young childrenfor school? Journal ofApplied DevelopmentalPsychology, 19(1), 41-66.Australia A home visiting program with the objective to build strong parent-child relationships, foster positive attachments and subsequentlyreduce the incidences of child abuse and neglect. The programprovides education and support to first-time, at-risk pregnant andparenting young women though home visiting, prenatal and parentinggroups and labour or birthing assistance.Hands-On ParentEmpowerment (HOPE)programLeung, C., Tsang, S., &Suzanne, D. (2011).Outcome evaluation ofthe Hands-On ParentEmpowerment (HOPE)China The HOPE program is designed as a targeted preventive intervention.It aims to equip socially disadvantaged parents with the skills topromote the development of their children and enables them to takeresponsibility for their children’s development. There is also a strongfocus on building positive parent–child relationships. In addition, theHOPE program provides training for new immigrant parents andaims to enhance social support for these parents through thedevelopment of a social network. The program comprises 30 weekly2-hour group sessions and is delivered within a preschool setting by
  • 118. -DRAFT-117Program. Research onSocial Work Practice,21(5), 549-561.10.1177/1049731511404904Leung, C., Tsang, S.,Dean, S., & Chow, P.(2009). Development andpilot evaluation of the‘‘Hands on ParentEmpowerment’’ (HOPE)project—a parenteducation programme toestablish sociallydisadvantaged parents asfacilitators of preschoolchildren’s learning.Journal of Children’sServices, 4, workers, with the support of preschool teachers. A variety ofteaching methods and activities are used, including mini lectures,interactive group discussions, role play, and homework activities forboth parents and children. The program is manualized withinstructions for facilitators, PowerPoint slides, class worksheets, andparent homework activities.Head Start ProgramAdministration onChildren, Youth, andFamilies. (1999). Leadingthe way: Characteristicsand early experiences ofselected Early Head Startprograms. Vol. I: Cross-site perspectives(Publication U. S.Government PrintingOffice-2000–519–425/94725). Washington,DC: U. S. Department ofHealth and HumanServices.USA Head Start is a federally funded preschool program for low-incomefamilies and provides and coordinates a variety of services forchildren and families with multiple needs, including nutrition, familysocial services, and physical, oral and mental health. It is designed toprovide high-quality, comprehensive child development servicesdelivered through home visits, child care, case management,parenting education, health care and referrals, and family support.Head Start is family-centered and is aimed at fostering a parents roleas the principal influence on their childrens development and as theirchildrens primary educators, nurturers, and advocates. Parents areencouraged to become involved in all aspects of Head Start,including direct involvement in policy and program decisions thatrespond to their interests and needs. Head Start programs arecommunity-based, with services based on the unique needs of thediverse communities they serve. Services are offered to meet thespecial needs of children with disabilities. The target group is low-income families with children aged 2 to 3 years.Healthy FamiliesAmericaHealthy FamiliesAmerica (2009).Retrieved from: The main aims of the program are to promote positive parenting,enhance child health and development and prevent child abuse andneglect. The program works with prenatal and new parents to providea range of services and supports. Once families agree to participatethey receive home visiting services. Families are screened in ahospital and need to meet cut off scores that identify them as at riskand can benefit from the program. Home visitors assist parents withtheir life circumstances, personal issues, parenting needs, and
  • 119. -DRAFT-118us/index.shtml.LeCroy, C. W. & J.Krysik (2011).Randomized trial of theHealthy Families Arizonahome visiting program.Children and YouthServices Review, 33(10),1761-1766.successful adaptation to new infants. Home visitors are also availableto help mobilize critical services to address substance abuse,domestic violence, and mental health issues. The home visitors modelgood parenting behaviour, follow the child’s developmental progress,ensure home safety and provide emotional support to parents.Healthy Steps forYoung ChildrenProgramCaughy, M. O. B.,Huang, K.-Y., Miller, T.,& Genevro, J. L. (2004).The effects of theHealthy Steps for YoungChildren Program:Results fromobservations of parentingand child development.Early ChildhoodResearch Quarterly,19(4), 611-630.10.1016/j.ecresq.2004.10.004USA The Healthy Steps for Young Children Program is designed to beuniversally applicable to all families with children up to 3 years old,not only families at risk. In its family-centered model of health carethe Healthy Steps specialist is introduced into paediatric practice andhe or she offers expertise in child development and oversees thedelivery of the Healthy Steps (HS) services.HS is a package of services including enhanced well child visits,home visits, telephone support for development and behaviouralconcerns, written informational materials for parents, parent groupsand links to community resources.During the first three years HS families are offered nine standardpaediatric office visits and six home visits. Unlimited telephonecontact and participation in parenting group sessions are also offered.The well child appointments are conducted jointly or sequentially bya team consisting of a physician/paediatric nurse practitioner and theHS specialist.Help Us GrowSuccessfully (HUGS)McCabe, B. K., Potash,D., Omohundro, E., &Taylor, C. R. (2012).Design andImplementation of anIntegrated, ContinuousEvaluation, and QualityImprovement System fora State-Based Home-Visiting Program. Journalof Maternal & ChildHealth. DOI10.1007/s10995-011-0906-6Tennessee,USAHelp Us Grow Successfully (HUGS) is a statewide home visitingprogram that provides services to at-risk pregnant, and post-partumwomen with children (0–5 years), and their families in 95 counties inTennessee. The program goals are to improve parenting skills andconnect families to needed services and thus improve the health ofthe service population. The HUGS program actively targets thefollowing populations: low income families, teen mothers, prematureinfants/low birth weight infants and infants with significant medicalproblems, community and public health system referrals for at-riskfamilies, and families in the state child welfare system. When afamily accepts services, the core family is enrolled; this includes thereferred client or one parent/guardian and all children younger than 6years. Additional child caregivers may be enrolled. Once enrolled,the family must have an initial assessment within 60 days and a homevisit at least every 30 days.
  • 120. -DRAFT-119Home Visit Service forNewborns/Home VisitProject for All InfantsFujiwara, T., Natsume,K., Okuyama, M., Sato,T., & Kawachi, I. (2012).Do home-visit programsfor mothers with infantsreduce parenting stressand increase socialcapital in Japan? Journalof Epidemiology &Community Health.DOI:10.1136/jech-2011-200793Japan Since 1961 the home-visiting program has existed in Japan formothers in need with newborns based on the Maternal and ChildHealth Act. Visits are conducted by a public health nurse or midwifefollowing discharge from the maternity ward. In this home-visitingprogram, the nurse or midwife instructs mothers in need (e.g.,mothers with premature infants) on how to take care of the infants.Some municipalities have expanded this program to all mothers whoexpressed interest in the service when infants were 1-2 months ofage. Under the Child Welfare Law, the Ministry of Health, Labourand Welfare initiated the Home Visit Project for All Infants in 2007in which trained community staff visit all families with infantsyounger than 4 months of age to focus on parenting stress and shareinformation to aid parenting. This home-visit was designed to be thepoint of first contact between mothers and their infants with thecommunity. By fostering social connections, the home-visit programcould be considered to be a ‘social capital’ intervention because theprogram provides mothers with greater access to social services andother resources in the community.Home-Start ProgramFrost, N., Johnson, L.,Stein, M., & Wallis, L.(1996). Negotiatedfriendship: Home-Startand the delivery of familysupport. Leicester:Home-Start UK.Frost, N., Johnson, L.,Stein, M., & Wallis, L.(2000). Home-Start andthe delivery of familysupport. Children andSociety, 14, 328–342.UK This program is designed to support parents with young children, theprogram is offered to families who have at least one child under theage of 6 years and are experiencing difficulties in child rearing. Theprogram is delivered by Home-Start volunteers who attend a 3-daytraining program where they are taught to be supportive in anondirective way. The volunteers attend training once a year andreceive supervision once a month. Volunteers visit mothers for half aday, once a week. These volunteers provide social support whichaims to increase maternal well-being. The range of support is variedaccording to the individual mother’s needs.Incredible YearsParenting ProgrammeWebster-Stratton, C.(1992). The IncredibleYears: Basic programmanual. Seattle, WA: TheIncredible Years.Webster-Stratton, C.(2001). The IncredibleYears: Parents, Teachers,Multi-countryPrimarily a behavioural parenting programme the aims are to prevent,reduce and treat aggression and conduct problems in young children,and enhance child social competence. A multidisciplinary approachwhich works to cooperate with families to reduce risk factors andsupport protective factors. The primary goals of the program are toimprove the parent’s skill and confidence at managing their child’saggression and problem behaviour and to improve the parent-childrelationship. The comprehensive set of interventions includessessions lasting about 2 hours each, once a week for 10 weeks. TheIncredible Years Parenting Program is a 15-week psycho-educationprogram for parents of children ages 6-12. It is offered in group
  • 121. -DRAFT-120and Children TrainingSeries. ResidentialTreatment for Children &Youth, 18(3), 31-45.format through weekly, 2-hour sessions. Activities include videovignettes of parent-child interactions, group discussions, role play,rehearsal of parenting techniques, and home practice. About 60percent of a session is group discussion, problem solving andsupport; 25 percent is allocated to video modeling (about 25-30minutes of video footage); and 15 percent for teaching. Techniquescovered include play and positive interaction with the child, clearcommands, limit setting, ignoring undesirable behaviour, praisingand rewarding desirable behaviour, and following through withdiscipline. Curriculum topics include parent-child play skills, praise,limit setting, ignoring, reward systems, and effective consequences.The Incredible Years parenting series includes three programstargeting parents of high-risk children and/or those displayingbehaviour problems. The BASIC program emphasizes parentingskills known to promote children’s social competence and reducebehaviour problems such as: how to play with children, ways topromote children’s cognitive, language, social, and academic skills,effective praise and use of incentives, effective limit-setting, andstrategies to handle misbehaviour. The ADVANCE programemphasizes parent interpersonal skills such as: effectivecommunication skills, anger and depression management, problemsolving between adults, and ways to give and get support. TheSUPPORTING YOUR CHILD’S EDUCATION program (known asSCHOOL) emphasizes parenting approaches designed to promotechildren’s academic skills such as: reading skills, parentalinvolvement in setting up predictable homework routines, andbuilding collaborative relationships with teachers.One notable feature of the Incredible Years series is the use of videomodeling and feedback. The BASIC parent training series involvesgroup discussion of a series of 250 brief video vignettes of parentsinteracting with children in family life situations to demonstratechildrearing concepts. These video vignettes are used to facilitategroup discussion and problem solving and principles and skills arethen practiced through role-playing and home practice activities.Theoretically video modeling approaches to learning suggests thatparents can improve their parenting skills by watching videotapedexamples of parents interacting with their children in ways thatpromote prosocial behaviours and decrease undesirable behaviours.This method is more accessible and has been shown to promotegeneralization and long-term maintenance of positive behaviours.Marte Meo (MM)Aarts, M. (2000). MarteMeo: Basic manual.Harderwijk, theScandinaviancountries,IrelandMarte Meo (MM) is a method based on the notion that childrendevelop and grow in interaction with supportive adults. It wasdesigned to help children and adults restore and build a supportivedialogue when their communication has been adversely affected bydisturbances. The two elements of MM are analysis and intervention.
  • 122. -DRAFT-121Netherlands: AartsProductions.The first step is to take a 5-10 minute video recording of the child-parent or child-teacher interaction which is later analysed by atherapist. After analysis the therapist and adults view and discuss thevideo. The focus of the discussion is to help the adult to see thesupportive needs of the child and to stimulate the adult to modify hisor her behaviour accordingly so as to promote the child’sdevelopment. The adult is given the task of practicing new types ofbehaviour in daily situations. During the next recording andreviewing, feedback is generated on whether the previousintervention was successful.Mellow ParentingPuckering, C. (2004).Mellow Parenting: Anintensive intervention tochange relationships. TheSignal, Bulletin of theWorld Association forInfant Mental Health, 12,1-5.Glasgow,Scotland,Germany,Russia,NewZealandMellow Parenting is a family of early intervention programmesdesigned to promote positive relationships in vulnerable, hard toreach families. This is an intensive course with both mother and childinvolving psychotherapy, behavioural techniques and videoing ofparent-child interactions. The program goal is to support parentswhose relationships with their children are under severe stress. Theprogram enables parents to find their own solutions to familymanagement problems through mutual support, with a minimum ofguidance from professionals. The program is designed for childrenunder the age of 5 and lasts 14 weeks. It combines personal grouptherapy with parenting support using behaviour modificationtechniques. Mellow Bumps is an antenatal program aimed atreducing parental stress and engaging parents at the earliest stages inunderstanding the emotional needs of their babies. The 6 week group-based antenatal program supports families with additional health andsocial care needs.Mentor mother supportinterventionLoeffen, M. J., Lo FoWong, S. H., Wester, F.P., Laurant, M. G., &Lagro-Janssen, A. L.(2011). Implementingmentor mothers in familypractice to supportabused mothers: studyprotocol. BMC FamilyPractitioner, 12, 113.TheNetherlandsMentor mother support is a low threshold intervention for abusedmothers in family practice. The training for mentor mothers wasfurther developed focusing on empowerment regarding four mainthemes: 1) safety, 2) social support, 3) depressive symptoms, and 4)children witnessing intimate partner violence. Mentor mother supportconsists of 1 hour weekly visits by a mentor mother over a period of4 months, providing non-judgmental active listening and support,developing a trusting relationship and empowering. The aim of thesupport is to 1) achieve a reduction of the violence, 2) an expansionof social support and an increase of the acceptance of professionalhelp, 3) help the abused mother to cope with depression/depressivesymptoms, and 4) assist abused mothers to become aware of theeffect on their children. To lower the threshold for acceptance ofhelp, mentor mother support was offered as support for mothers whoexperience difficulties with children living at home and not as adomestic violence support. Visits take place at home, at the familypractice or any other place where the mother feels safe andcomfortable.
  • 123. -DRAFT-122Mindful ParentingProgram (MPP)Altmaier, E. and R.Maloney (2007). Aninitial evaluation of amindful parentingprogram. Journal ofClinical Psychology,63(12), 1231-1238.Placone-Willey, P. M.(2002). A curriculum formindful parenting: Amodel developmentdissertation. DissertationsAbstracts International,63 (01), 568B. (UMI No.3040781)USA The MPP was proposed as a method to integrate mindfulness traininginto a parent-focused intervention. The objectives are to enhance andsustain connectedness between parent and child by facilitatingparents’ self-awareness, mindfulness and intentionality in parenting.MPP helps parents identify interactions that lead to disconnectednesswith their children, such as criticizing, projecting anger, humiliatingchildren and emotional withdrawal. These are replaced withintentional connectedness-focused interactions that are characterizedby listening, the display of affection, calm responses and themodeling of self-soothing behaviours. Mindfulness practices includebreathing, body awareness, centering and mediation. Parents usethese techniques to learn to be more intentional in their parenting andthus choose ways that enhance and sustain a positive emotionalconnection. The program delivers training over 8-12 weeks in smallgroups according to an MPP manual.Mindfulness-BasedCognitive Therapy(MBCT)Bailie, C., Kuyken, W.,& Sonnenberg, S. (2012).The experiences ofparents in mindfulness-based cognitive therapy.Clinical ChildPsychology & Psychiatry,17(1), 103-119.Multi-countryMBCT is a relatively new intervention, derived from cognitivetherapy and mindfulness-based stress reduction. It is especially usefulfor people with a history of recurrent depression. It teaches people tobecome aware of their bodily sensations, thoughts and feelings andrelate constructively to these experiences. The aim is to cultivatemindfulness and compassion so that individuals can be moreresponsive to stress and work to improve their mood. Parenting isenhanced by parents becoming more aware of their feelings andneeds and more responsive in their interactions with their children.MBCT is generally delivered to groups of 9-14 individuals in 2-hoursessions that span 8 weeks. Four subsequent follow-up sessions arespread out over a year. The sessions follow a MBCT manual andinclude guided mindfulness practice, enquiry into the participant’sexperiences of practice, weekly homework reviews, and cognitivebehavior therapy skills.Mindfulness-EnhancedStrengthening FamiliesProgram (MSFP)Coatsworth, J. D.,Duncan, L. G.,Greenberg, M. T., & Nix,R. L. (2010). Changingparents mindfulness,child management skillsand relationship qualityUSA A model of mindful parenting was proposed drawing on concepts andpractices of psychological mindfulness and mindfulness-basedinterventions. This model highlights 5 dimensions of parenting thatcomplement mindfulness training for parents. These include listeningwith full attention, non-judgmental acceptance of self and child,emotional awareness of self and child, self-regulation in the parentingrelationship, and compassion for self and child. The evidence-basedStrengthening Families Program (SFP): For Parents and Youth 10-14was adapted to incorporate mindfulness activities. The format ofMSFP remains the same as the SFP. Mindfulness activities wereincorporated into the parent sessions only. This was done by
  • 124. -DRAFT-123with their youth: Resultsfrom a randomized pilotintervention trial. Journalof Child and FamilyStudies, 19(2), 203-217.Duncan, L. G.,Coatsworth, J. D., &Greenberg, M. T. (2009).A model of mindfulparenting: Implicationsfor parent–childrelationships andprevention research.Clinical Child & FamilyPsychology Review,12(3), 255-270.shortening some activities in the original SFP, moving around someactivities, and modifying language so that messages of mindfulparenting were emphasized. New activities were based on the 5dimensions of parenting. Facilitators lead didactic presentations ofmindfulness principles, teaching of mindfulness practices, practiceexercises and group interactive activities. Short reflections are doneat the beginning and end of the sessions.Mother-InfantTransactionProgramme (MITP)Rauh, V.A., Nurcombe,B., Achenbach, T., &Howell, C. (1990). TheMother-InfantTransaction Program.The content andimplications of anintervention for themothers of low-birthweight infants.Clinics in Perinatology,17,31e45.USA A programme designed to help parents to appreciate their infant’sunique characteristics, temperament and developmental potential,sensitizing parents to their infant’s cues so that can respondappropriately. It aims to sensitize the mother to the infants signals,and teach her to be sensitive to and respond in a sensitive andcontingent way, in particular to avoid stimulus overload and torespond when the infant is in a state most conducive to interaction, toteach the mothers to respond appropriately and in a timely fashion, toenable the mother to imbed her sensitivity and contingentresponsiveness in everyday tasks and to enhance the mother’senjoyment of her baby. The program consists of 7 sessions beforedischarge, 4 home visits within 3 months after discharge. The revisedMITP includes a 1 hour debriefing session initially and encouragesboth parents to participate in the sessions.Mothers and ToddlersProgram (MTP)Suchman, N. E.,DeCoste, C., Castiglioni,N., McMahon, T.J.,Rounsaville, B., &Mayes, L. (2010). TheMothers and ToddlersProgram, an attachment-based parentingintervention for substanceusing women: Post-USA The Mothers and Toddlers Program (MTP) is a 12-week individualpsychotherapy intervention designed as an adjunct to outpatientsubstance abuse treatment. Mothers meet weekly with an individualclinician for one hour. Mothers and children also complete a brief,videotaped, structured interaction to assess maternal sensitivity andresponsiveness to child cues and child responsiveness to the mother.
  • 125. -DRAFT-124treatment results from arandomized clinical pilot.Attachment & HumanDevelopment, 12(5), 483-504.Neonatal IndividualizedDevelopmental Careand AssessmentProgramme (NIDCAP)Als, H., Gilkerson, L.,Duffy, F.H., McAnulty,G.B., Buehler, D.,Vandenburg, K., Sweet,N., Sell, E., Parad, R.B.,Ringer, S., Butler, S.,Blickman, J., & Jones,K.J., (2003). A three-center, randomized,controlled trial ofindividualizeddevelopmental care forvery low birth weightpreterm infants: Medical,neurodevelopmental,parenting, and caregivingeffects. Journal ofDevelopmental &Behavioral Pediatrics,24,399e408.Als, H. (1982). Toward asynactive theory ofdevelopment: promise forthe assessment andsupport of infantindividuality. InfantMental Health Journal, 3,229-243.USA,Europe,SouthAmericaAn intervention that provides family-centered developmentallysupportive care of very low birth weight infants, stimulates preterminfants and improves the interaction between mothers and infants. Akey focus of the NIDCAP program is educational and consultativesupport and assistance in NICU and special care nursery settings. Thetherapeutic framework and method of NIDCAP provides earlydevelopmental support and preventive intervention, beginningimmediately with birth. The NIDCAP approach uses methods ofdetailed documentation of an infants ongoing communication toteach parents and caregivers skills in observing an infantsbehavioural signals. These sometimes subtle signals provide the basisfor interpreting what the infant is trying to communicate and can beused to guide parents and caregivers to adapt interaction and care tobe supportive of the infants behaviour. Suggestions for care are madein support of the infants self-regulation, calmness, well-being and theinfants sense of competence and effectiveness. Such suggestionsbegin with support, nurturance, and respect for the infants parentsand family, who are the primary co-regulators of the infantsdevelopment. These practices ensure that a developmentalperspective and an infants environment are incorporated into theinfants careNew BeginningsProgramBaradon, T., Fonagy, P.,Bland, K., Lenard, K., &Sleed, M. (2008). NewBeginnings - anUSA This accredited learning and experience-based parenting programaddresses the early attachment relationship between mothers andbabies in prison. It also aims to prepare both the mother and baby forseparation if that should happen. The program rests on the premisethat the early months of a mother’s pattern of relating to their baby ispotentially fluid and so intervention is directed at this time.
  • 126. -DRAFT-125experience-basedprogramme addressingthe attachmentrelationship betweenmothers and their babiesin prisons. Journal ofChild Psychotherapy,34(2), 240-258.Sandler, I. N.,Schoenfelder, E. N.,Wolchik, S. A., &MacKinnon, D. P.(2010). Long-TermImpact of PreventionPrograms to PromoteEffective Parenting:Lasting Effects butUncertain Processes.Annual Review ofPsychology, 62(1), 299-329.Importantly, it recognizes the baby as a partner in the process and aparticipant in the process in his or her own right. The program workswith the baby’s attachment needs and capacities through mirroringemotional states, verbalizing experience and anxieties that areperceived in the baby and then creates opportunities forintersubjective connectedness through the use of play. In addition torecognizing the impact of the prison environment on the mother’sstate of mind and consequent abilities for emotional attachment, theprogram incorporates the effects of the mothers own experiences ofbeing parented on her attitude and behaviour towards the baby; in thisway intergenerational repetitions likely to pose as risks to the babyare addressed. The program consists of 8 2-hour sessions which runover four consecutive weeks for up to six mother and baby pairs in agroup. These sessions are structured around 8 topics which cover thehistory of the pregnancy, the family tree of the baby, the mother’srepresentations of her own childhood experiences, the mother’sperceptions of her baby, her experiences of motherhood, and heraspirations for herself and her baby. Illustrated handouts, worksheetsand homework are part of the program. Mothers are encouraged toadd to their folder drawings, poetry or letters that they produceduring the course. The New Beginnings Program is also designed toimprove parenting by residential mother following divorce in an 11-session program.New Parent InfantNetwork (NEWPIN)Pound, A. (1994).NEWPIN: A befriendingand therapeutic networkfor carers of youngchildren. London:HMSO.Australia NEWPIN is a centre-based, early intervention program directed atstrengthening family functioning and supporting stressed families,with a particular focus on the mother-child relationship. The programprovides parent education, development and support as well as playtherapy and instruction. Specific programs in the NEWPIN modelinclude: Our Skills as Parents – a 10 week program in whichparticipants explore their feelings and share their knowledge aroundparenthood. The aim is to improve parenting skills by building self-esteem, confidence and a deeper understanding of children’s needs.Weekly Support Group – where members explore issues from theirown lives that are impacting on their parenting. Keeping ChildrenSafe – a 6 week program offering practical strategies designed tokeep children safe and free from abuse and neglect. The Family PlayProgram – an 8 week program aimed at increasing the understandingof the importance of creative play in a child’s development andassisting the parent-child attachment process. SEER Program –explores the 5 core NEWPIN values of support, equality, empathy,and respect which guide every aspect of the intervention and governthe behaviours in relation to a member’s personal life, the NEWPINcentre and society as a whole. Learning for Life – the NEWPINfoundation course prepares established members to befriend others.Regular Self Evaluation and Child Appraisal – where members are
  • 127. -DRAFT-126invited to identify and reflect on their own and child’s progress withstaff members.Nobody’s PerfectProgramKennett, D. J., Chislett,G., & Olver, A. L. S.(2012). A reappraisal ofthe Nobodys Perfectprogram. Journal of Childand Family Studies,21(2), 228-236.Canada The Nobody’s Perfect program is an education and support programfor parents of children up to 5 years of age. It is designed for parentswho are young, single, socially or geographically isolated, or whohave limited formal education or low income. Parent development isthe primary goal although Nobody’s Perfect helps parents to increasetheir knowledge and skills and promote the healthy development oftheir children. Groups of parents usually meet once a week in a seriesof 8 2-hour sessions. Trained facilitators lead the group using amanualized process. Topics include child development, childbehaviour management, nutrition, health, safety, financialmanagement, mood management and healthy relationships. Parentsare invited to select from these topics according to their needs, toexamine their experiences, relate their observations to their lives,problem-solve and apply their learning. The program is offered freeof charge, and parenting books, transportation assistance, childcareand snacks are provided. At completion, parents earn a certificatebased on attendance.Nurse FamilyPartnership (NFP)Olds, D.L., Henderson,C.R. Jr., & Kitzman, H.(1994). Does prenatal andinfancy nurse homevisitation have enduringeffects on qualities ofparental caregiving andchild health at 25 to 50months of life?Pediatrics, 93, 89–98. The NFP is an evidence-based community health program whoseoutcomes include long-term improvements in family health,education and economic self-sufficiency. The Nurse-FamilyPartnership National Service Office, a non-profit organization,provides implementing agencies with the specialized expertise andsupport necessary to deliver NFP. This home-visiting intervention forfirst-time mothers utilizes trained nurses who visit mothers at homeduring the pregnancy and/or during the first 2 years of the child’s lifeto provide education about healthy prenatal behaviours, competentearly child-care, and strategies to improve the maternal life-course,such as planning future pregnancies and seeking education andemployment. The NFP model comprises 18 elements: The clientparticipates voluntarily in the NFP Program; is a first-time motherwho meets low-income criteria at intake; is enrolled in the programearly in her pregnancy and receives her first home visit by no laterthan the end of week 28 of pregnancy; is visited one-to-on at home,one nurse home visitor to one first-time mother or family; visitedthroughout her pregnancy and the first two years of her childs life inaccordance with the NFP guidelines; nurse home visitors and nursesupervisors are registered professional nurses; they complete coreeducational sessions required by the NFP National Service Office anddeliver the intervention with fidelity to the NFP model; usingprofessional knowledge, judgment, and skill, they apply the NFP visitguidelines, individualizing them to the strengths and challenges ofeach family and apportioning time across defined program domains;
  • 128. -DRAFT-127they also apply the theoretical framework that underpins the program,emphasizing self-efficacy, human ecology, and attachment theories,through current clinical methods; each full-time home visitor carriesa caseload of no more than 25 active clients; a supervisor providessupervision to no more than 8 nurse home visitors; supervisorsprovide nurse home visitors clinical supervision with reflection,demonstrate integration of the theories, and facilitate professionaldevelopment essential to the nurse home visitor role through specificsupervisory activities including one-to-one clinical supervision, caseconferences, team meetings, and field supervision; home visitorssupervisors collect data as specified by the NFP National ServiceOffice and use NFP reports to guide their practice, assess and guideprogram implementation, inform clinical supervision, enhanceprogram quality, and demonstrate program fidelity. An NFPimplementing agency is located in and operated by an organizationknown in the community for being a successful provider ofprevention services to low-income families; it convenes a long-termcommunity advisory board that meets at least quarterly to promote acommunity support system to the program and to promote programquality and sustainability. Adequate support and structure is pute inplace to support nurse home visitors and nurse supervisors toimplement the program and to assure that data are accurately enteredinto the database in a timely mannerNursing ChildAssessment TeachingScale (NCATS)Sumner, G., & Spietz, A.(1994). NCATSCaregiver/Parent-ChildInteraction TeachingManual. Seattle, WA:NCATS Publications,University ofWashington, School ofNursing, 1994.USA Examines the mother-child relationship in conjunction with teachingmothers how to interact with the baby, teaching behavioural cues andhow to play. The Nursing Child Assessment Teaching Scale(NCATS) is used to assess the quality of the caregiver-child teachinginteraction for children from birth to 3 years of age. The 73-itemteaching scale is organized into 6 subscales, 4 of which assess thecaregiver’s behaviour and 2 the child’s. The 4 caregiver subscalesassess the caregiver’s sensitivity to cues, response to the child’sdistress, fostering of social-emotional growth, and fostering ofcognitive growth. The 2 child subscales assess the clarity of thechild’s cues and responsiveness to the caregiver. The teaching scaleidentifies areas of strengths and weaknesses in the caregiver-childteaching interaction. The results can be used to build the caregiver’sskills to facilitate the development of the child. To learn essentialchild care skills, users of NCATS are strongly recommended to viewNCAST’s “Keys to Caregiving” video series. Workshops are alsoavailable through NCAST or NCAST certified instructors.Nurturing ParentFamily DevelopmentResources. (2007).Community basedUSA This is a community-based education intervention in nurturingparenting. In the 10 sessions involving group discussion, role playand homework tasks the following issues are covered: the philosophyand practices of nurturing parenting; ages and stages of growth;
  • 129. -DRAFT-128education in nurturingparenting. Park City, UT:Authors.enhancing brain development in children and teens; communicatingwith respect; building self-worth; understanding feelings;understanding and developing family morals, values and rules;praising children; alternatives to spanking; and learning positiveways to deal with stress and anger.Nurturing ParentingProgramBavolek, S., & Dellinger-Bavolek, J. (1985).Increasing the nurturingparenting skills offamilies in head start:Validation of theNurturing Parentingprogram for parents andchildren birth to fiveyears. Retrieved from The Nurturing Parenting Program for Children Birth to Five Yearsaims to build positive parent-child interactions in families enrollingin home-based and center-based Head Start programs. Emphasis isplaced on building personal growth and growth as a nurturing parent.By establishing a positive self-concept and self-esteem and becomingmore empathically aware of children’s needs parents are less likely toengage in child maltreatment. Unlike other parent educationprograms whose focus is primarily teaching child development andbehaviour management to parents, the focus of the NurturingParenting Program is to work with the entire family in building moreempathic parent-child interactions.The Nurturing Parenting Program consists of 45 individual sessionswith a sequential curriculum. Separate curricula are developed forparents and children. The content of the program focuses onincreasing the self-esteem and self-concept of parents while teachingnurturing parenting skills appropriate for children up to five years ofage.In the home-based program sessions are run on a weekly basis andlast about one and a half hours. During these home visits the first halfis spent with the whole family and home visitor working together.Parents are encouraged to take the role of the primary teacher and thehome visitor serves as a source of support. The second half of thevisit is spent with only parents and the home visitor dealing with theirrole as parents or on issues related to self.In the center-based program parents and their children attend weeklyseparate group sessions, coming together for a meal which is aimedat building family cohesion and nurturing interactions through playand food. Generally, one facilitator leads the parent group while twoor three facilitate the children’s program.Parent ManagementTraining (PMT)Kazdin, A. E., Esveldt-Dawson, K., French, N.H., & Unis, A. S. (1987).Effects of parentmanagement training andproblem-solving skillsUSA PMT works on the principle that since family interaction may cause,maintain or aggravate conduct disorder, the mobilization of familyrelationships as a potential therapeutic agent can reduce undesirablebehaviours. Parents are trained to identify, define and observebehaviours in new ways, to positively reinforce prosocial behavioursand to mildly punish anti-social behaviour. The program is directed atchildren aged 3-10 years. The course combines cognitive, behaviourand affective components with features such as video clips,structured sequences of topic (e.g. play, praise, incentives, limit
  • 130. -DRAFT-129training combined in thetreatment of antisocialchild behavior. Journal ofthe American Academy ofChild and AdolescentPsychiatry, 26, 416-424.setting, discipline), and a detailed manual. Children do not participatein the program. Generally in PMT parents with be seen individuallyfor up to 16 sessions over a period of 6 to 8 months.Parent PlusByrne, E., Holland, S., &Jerzembek, G. (2010). APilot Study on the Impactof a Home-basedParenting Intervention:Parents Plus. Child Carein Practice, 16(2), 111-127.UK Parent Plus is a parenting intervention offered by Flying Start(formerly Sure Start) in South Wales, UK. The Welsh AssembleGovernment subsumed Sure Start into its own initiative – FlyingStart. Parent Plus offers home-based, time-limited, targeted andindividualized programmes to families who have difficulties withtheir children aged 0-4 years. These families are either self-referredor referred by health visitors who have visited the home. Thecomponents of the program are mainly behaviourally based and usecounseling skills and motivational interviewing. Service deliverytakes a ‘parenting positively’ approach and is aimed at promotingownership and empowerment; it is expected that parents work outsuccessful ways to play with their children and deal with their child’sbehaviour themselves.Parent-ChildInteraction Therapy(PCIT)Budd, K. S., Hella, B.,Bae, H., Meyerson, D.A., & Watkin, S. C.(2011). Deliveringparent-child interactiontherapy in an urbancommunity clinic.Cognitive and BehavioralPractice, 18(4), 502-514.Multi-countryPCIT is a manualized intervention for children ages 2 to 7 withdisruptive behaviour problems. PCIT draws on Baumrind’sdevelopment research on authoritative parenting, social learningtheory and attachment theory in efforts to promote positive consistentparenting practices. There are 2 phases of PCIT treatment, child-directed interaction (CDI) and parent-directed interaction (PDI). Bothphases start with a ‘teach’ session that introduces skills throughinstruction, demonstration and role play. Coach sessions follow the‘teach’ sessions, in which the therapist observes from behind one-way mirror and provides immediate feedback and support on theparent’s use of skills through an inner ear hearing device while theparent and child play. Both the CDI and PDI phases are considerednecessary for the treatment, along with individualized live coachingsessions, coding of parent-child interactions in coaching sessions,homework assignments and the use of standardized assessmentinstruments to guide the treatment.Parent-ChildPsychological SupportProgramme(PCPS/PAPMI, Spanishversion)Cerezo, M. A., Pons-Salvador, G., & Trenado,R. (2008). Child abuseSpain The PCPS aims to support the tasks of parenting, the child’sdevelopment and the parent-child relationship during the infant’s first2 years of life, through a calendar of 6 visits, from 3 to 18 monthspreceded by an introductory visit. The program provides support toparenting through checking the development and growth of the childand anticipating their next expected developmental changes andneeds. The parents receive specific information about their child’sprogress, forthcoming developments and guidelines about solving or
  • 131. -DRAFT-130potential and quality ofmother-child attachmentin the context of acommunity basedprevention program.Paper presented at theXVIIth ISPCANInternational Congress onChild Abuse and Neglect.Hong Kong, ChinaBujia-Couso, Pilar;ORourke, Anita; andCerezo, M. Ángeles(2010). Criteria basedcase review: The ParentChild PsychologicalSupport Program. IrishJournal of Applied SocialStudies, 10(1).preventing conflict. The empowerment of parents in solving conflicts(e.g. feeding, sleeping and crying) is coupled with encouragementand modeling synchronous interaction which is tailored to eachspecific parent-child dyad. Likewise, factors that affect parenting areaddressed with the parents, to find solutions that make their taskmore manageable and predictable; thus impacting positively on theparent-child relationship. The program is delivered by amultidisciplinary team with backgrounds including public healthnursing, psychology, social care, psychotherapy and family therapy,and can include social work, speech and language therapy andoccupational therapy.ParentCorpsBrotman, L. M., Calzada,E., Huang, K.-Y.,Kingston, S., Dawson-McClure, S.,Kamboukos, D., …Petkova, E. (2011).Promoting effectiveparenting practices andpreventing child behaviorproblems in schoolamong ethnically diversefamilies fromunderserved, urbancommunities. ChildDevelopment, 82(1), 258-276.USA This culturally informed family intervention is designed to bedistributed as a universal preventive intervention to ethnically diversechildren attending Pre-K programs in public schools in disadvantagedurban communities. Intervention content and delivery strategies weredesigned to be relevant and engaging to all families and, at the sametime, to be sufficient to address the needs of the highest risk children.The intervention focuses on issues relevant to living indisadvantaged, urban communities and is based on the understandingthat families living in high-risk environments have a broad spectrumof strengths. ParentCorps recognizes that parenting practices varywithin and between cultures and that a parent’s culture informsnearly all aspects of being a parent, including family roles andresponsibilities, concerns about child behaviour, expectations andaspirations for the future, and the kind of parenting strategies that aredeemed appropriate to use. The intervention is delivered in schoolsettings and co-facilitated by Pre-K teachers and other school staff.Thirteen weekly groups are held in school settings and assessmentsinclude home visits with videotaped observations of parent-childinteractions.Parenting Now!Saks, M., Rusch, J. &Poasa, K. (2001).Parenting Now! A group-based positive parentingMulti-countryParenting Now! is a community-based parenting education programaimed at strengthening families. This group program is based on acurriculum and observation of and interaction with their own andother children. Parent groups are set up according to the date of achild’s birth; each group includes a broad range of parental socio-economic status, culture, and education and both mothers and fathers
  • 132. -DRAFT-131curriculum. Eugene,Oregon: Birth to Three.are invited to participate in the program. The program has amanualized group-based positive parenting curriculum for parenteducators who work with parents of children between the ages of 0and 6 years. The curriculum is adaptable for home visiting andgeared for the universal population. The contents of the curriculuminclude 7 modules, 15 parent booklets with reproducible handouts, 2short videos and graduation certificates. The 7 modules of theParenting Now curricula focus on identifying parent values, stressand anger management, realistic expectations, positive discipline,learning questions, effective communication skills, and what to dowhen things break down. The strategies used are group discussion,homework activities and small group discussions.Parenting Our Childrento Excellence (PACE)Dumas, J.E. (2001).PACE–Parenting OurChildren to Excellence. Aprogram to promoteparenting effectivenessand child coping-competence in thepreschool years.Unpublished manuscript,2001Indianapolis, USAPACE is a research-based preventive intervention designed tosupport parents of preschoolers through discussions and activitiesthat address practical child-rearing issues and promote child-copingcompetence. It is a prevention intervention designed to promoteparenting effectiveness and reduce child maltreatment. This is astructured group parenting programme on parenting and childoutcome, with emphasis on the process of engagement and itsrelationship to those outcomes. The programme includes 8 2-hoursessions designed for groups of 10-15 parents of preschoolers ages 3-6 years and is delivered at the daycare centers the children attend. Todecrease barriers to engagement, the program is delivered at a timethat is most convenient for the participating parents (i.e., followingschool, in the evenings); dinner is served to parents and children;childcare is provided; and parents are reimbursed for transportationcosts.Parenting ThroughChangeForgatch, M.S., &DeGarmo, D.S. (1999).Parenting ThroughChange: an effectiveprevention program forsingle mothers. Journalof Consulting andClinical Psychology,67(5), 711-724.USA This intervention aims to prevent internalizing and externalizingconduct behaviours and promote healthy child development. It isbased on the Oregon Parent Management Training model. Theintervention is generally used with recently separated single mothersbut has been used with two-parent families. The program structureconsists of 14 weekly group sessions in which parents learn effectiveparenting practices including, skill encouragement, limit-setting,problem-solving, monitoring, and positive involvement. Parents arealso taught how to decrease coercive interactions with their childrenand use more contingent positive reinforcements in their parentingpractices. Among the outcome categories which the program targetsare family relationships.Parenting WiselyGordon, D. (2004).Parenting Wiselyprogram workbookyoung children’s version.USA Parenting Wisely is a self-administered, highly interactive computer-based program that teaches parents and children, ages 9-18, skills toimprove their relationships and decrease conflict through support andbehaviour management. The program utilizes an interactive website(or CD-ROM) with nine video scenarios depicting common
  • 133. -DRAFT-132Athens, OH: FamilyWorks, Inc.challenges with adolescents. Parents are provided the choice of 3solutions to these challenges and are able to view the scenariosenacted, while receiving feedback about each choice. Parents arequizzed periodically and receive feedback. Computer experience orliteracy is not required. Parents and children can use the programtogether as a family intervention. The Parenting Wisely program usesa risk-focused approach to reduce family conflict and child behaviourproblems. With younger children issues of redirection, activelistening, “I” statements, non-directive play, fostering social skills,communication with the school, time out and settinglimits/consequences are dealt with.Parents in Partnership:Parent Infant Network(PIPPIN)Parr, M. (1995). WhyPIPPIN was developed:Some research findings.Stevenage, UK: PIPPIN.UK PIPPIN works with expecting and new parents and their partners. Itoffers fathers and mothers advice on how to build strong andnurturing relationships with their babies. This program complementstraditional ante-natal classes where the focus is primarily givingwomen advice on coping with pregnancy, childbirth and practicalaspects of infant care. Both mothers and fathers-to-be, starting in thefourth month of pregnancy and continuing for four months after birthwith babies actively participate in the program. Parents work in smallgroups and are given help and information in understanding theemotional aspects of pregnancy the birth and the effects of a newbaby on the mother, the father and the other members of the family.Parents are trained on how to improve their communication, listeningand problem-solving skills as well as how to respond sensitively andconfidently to their baby’s needs. The full PIPPIN programcomprises 35 hours of education and support to families. This isstructured into 6-8 group sessions before birth, a home visit shortlyafter birth and 8 post-natal sessions with the mother, father and baby.A second delivery model is the Informed Birth and Parenting Model,in which a NHS midwife and the PIPPIN facilitator run 4 antenatalsessions which integrate the medical and social/emotional aspects ofbecoming a parent. After birth parents are visited at home by thefacilitator and attend 6 postnatal sessions.PIPPIN also trains family and social workers who work one-on-onewith vulnerable young mothers.Parents Matter!Program (PMP)Miller, K. S., Maxwell,K. D., Fasula, A. M.,Parker, J. T., Zackery, S.,& Wyckoff, S. C. (2010).Pre-risk HIV-preventionparadigm shift: TheUSA PMP, a parent-focused community-level intervention developed byCDC, is an innovative pre-risk HIV-prevention program for parentsof children aged 9 to 12 years aimed at promoting positive parentingand effective parent-child communication about sexuality and sexualrisk reduction through overcoming parent-child communicationbarriers and enhancing parenting skills. PMP is delivered in five 2and a half sessions over a five week period. Sessions are delivered bytrained PMP facilitators and include activities for increasing parents’awareness of the sexual risks that maybe teens face and encouraging
  • 134. -DRAFT-133feasibility andacceptability of theParents Matter! Programin HIV risk communities.Public Health Reports,125, 38-46.general parenting practices such as relationship building andmonitoring.Philani Plus (+)Intervention ProgramRotheram-Borus, M.,Roux, I., Tomlinson, M.,Mbewu, N., Comulada,W., Roux, K., et al.(2011). Philani Plus (+):A Mentor MotherCommunity HealthWorker Home VisitingProgram to ImproveMaternal and InfantsOutcomes. PreventionScience, 12(4), 372-388.SouthAfricaThe Philani Plus (+) Intervention Program builds on the originalPhilani Community Health Worker home-visiting interventionprogram for maternal and child nutrition by integrating content andactivities to address HIV, alcohol, and mental health. MentorMothers were trained over a 2-month period initially and acomprehensive intervention manual was designed. The MentorMothers work half-time (4 hours daily), making home visits on 4days and attending supervision 1 day weekly. Twice monthly, asupervisor attends the home visits with the Mentor Mother. A mobilephone intervention gives delivery support through study-specificapplications loaded onto it. When a mother prepares to enter a homefor a visit she enters the client’s identifying information into thephone and receives a confirmatory prompt as to which pre- orpostnatal session needs to be delivered. Four antenatal and fourpostnatal sessions were specifically targeted for mothers at risk(MAR) – mentor mothers visit MAR once every 2 weeks over 2months to deliver the four antenatal sessions and then once every 2weeks over 2 months after birth to deliver the four postnatal sessions.They check in once a month afterwards to deliver support as needed.Mentor Mothers address topics such as living with HIV, alcohol use,nutrition, child assistance grant and other resources, and self-care andsocial support.Prenatal to ThreeInitiative (Pre to 3)Peifer, K. (2002).Prenatal to ThreeInitiative Evaluation. SanMateo, California.California,USAThe Prenatal to Three Initiative is a collaboration of agencies andindividuals working together to provide information, support and carefor families of pregnant women and child up to the age of 5 years inthe San Mateo County. The goals of Pre to 3 are to build parentingskills and confidence, to facilitate early identification and treatmentof potential problems, and improving access to the health caresystem. The multidisciplinary program offers a range of servicesincluding: Home visiting and case management – health screeningsand linkages to resources/services, information on growth anddevelopment, referrals to recovery programs related to substanceabuse, nutrition counseling, parenting classes, and drop-in supportgroups. Healthy Moms, Health Children Programs – a registereddietician provides in-home nutrition/breastfeeding assessment andlinks to service providers and resources Substance abuse/Recoverysupport – a Perinatal Addiction Outreach Team conducts home visitsand provides a range of comprehensive services such as education on
  • 135. -DRAFT-134child development, parenting, and chemical dependency,developmental screenings, advocacy and supportive counseling topregnant and/or parenting women identified to be at risk forsubstance use. Parenting education classes – this 14 week coursefocuses on building a positive parent-child relationship, learning theimportance of culture in the family, teaching positive discipline,involving the family and the community in rearing children, andcreating a healthy family environment.Pride in Parenting (PIP)Katz, K., Jarrett, M., El-Mohandes, A., Schneider,S., McNeely-Johnson, D.,& Kiely, M. (2011).Effectiveness of acombined home visitingand group interventionfor low income AfricanAmerican mothers: ThePride in ParentingProgram. Maternal &Child Health Journal,15(S1), 75-84.10.1007/s10995-011-0858-xUSA The PIP intervention model aims to influence parenting knowledge,attitudes and skills in order to improve child-rearing environmentsand health care utilization for mothers and their infants. PIP uses anecological intervention model focused on parenting, infant health,individual coping skills, and recruitment and maintenance of socialsupport systems. Lay home visitors deliver the home-basedinterventions, who, as paraprofessionals, enhance trust andcommunication. Target groups are women who are identified ashaving inadequate prenatal care (5 or fewer prenatal visits, careinitiated in the third trimester or no prenatal care). The home visitcurriculum is designed to improve knowledge, influence attitudes andpromote life skills that would assist low income mothers in offering amore optimal health and developmental environment for their infants.The main objectives are to improve use of maternal and child healthand social service resources, identify and maintain existingcommunity systems, develop effective coping strategies, establishfamily routines and personal goals, and improve responsiveness tothe child’s needs. A parent group curriculum supplements the homevisits. Group sessions comprise 45 minute parent-infant playgroupand focus on developmental issues, followed by a 45 minute parentgroup discussion.Project 12 WaysLutzker, J. R., Bigelow,K. M., Doctor, R. M.,Gershater, R. M., &Greene, B. F. (1998). Anecobehavioural model forthe prevention andtreatment of child abuseand neglect. In J. R.Lutzker (Ed.), Handbookof child abuse researchand treatment (pp. 239-266). New York, NY:Plenum.USA Project 12-ways is a comprehensive program aimed at preventingchild abuse and neglect, using an ecobehavioural approach. Familiesare referred to the program through the Illinois Department of ChildAbuse and Neglect. Participating families receive training in parent-child interaction, structuring daily routines, health maintenance andnutrition, stress reduction, home safety and cleanliness, infant careand development, teaching basic childhood skills, problem solving,and money management. Parents also receive self-esteem andassertiveness training in resolving conflicts in a positive way.Assistance in obtaining employment and access to communityservices is also provided. Project 12-ways is the precursor to theSafeCare program.
  • 136. -DRAFT-135Project HealthyGrandparentsKelley, S. J., Yorker, B.C., Whitley, D. M., &Sipe, T. A. (2001). Amultimodal interventionfor grandparents raisinggrandchildren: Results ofan exploratory study.Child Welfare, 80(1), 27–50.Georgia,USAThis case management program uses a strengths-based nurse/socialwork team approach and serves both the urban and rural populations.The program includes social work case management, grandparentsupport groups, parenting education classes, nursing visitations, andlegal consultation. The nursing interventions include monthly healthassessments of the children and grandparents, along with medicationmonitoring, individualized health promotion guidance, and referralsbased on the family’s goals and strengths.Project Teens andAdults Learning toCommunicate (TALC)Rotheram-Borus, M. J.,Lee, M. B., Gwadz, M.,& Draiman, B. (2001).An intervention forparents with AIDS andtheir adolescent children.American Journal ofPublic Health, 91, 8,1294-1302.Rotheram-Borus, M. J.,D. Swendeman, et al.(2011). Interventions forfamilies affected by HIV.Translational BehavioralMedicine, 1(2), 313-326.MulticountryProject TALC (Teens and Adults Learning to Communicate) isdesigned to improve behavioural, social, and mental health outcomesamong parents living with AIDS and their adolescent children. Theintervention, based on social learning theory, includes 24 sessionsspaced out over a period of 12 weeks. The first 8 sessions aredelivered only to parents. These sessions address issues of disclosure,emotional reactions to AIDS, and coping with stigma. The remaining16 sessions are delivered to both parents and adolescents. Thesesessions address issues such as making custody plans, expressinglove and affection, and maintaining positive family routines with avery ill parent. Each of these sessions involves some activities forwhich parents and children are separated and some activities forwhich parents and children meet together. All sessions include goal-setting and problem-solving activities. Modified versions of ProjectTALC are used around the world with variations in the setting,delivery agent, intervention format and session structure.Protecting FamiliesProgram (PFP)Boyd, R. C., Diamond,G. S., & Bourjolly, J. N.(2006). Developing afamily-based depressionprevention program inurban community mentalhealth clinics: Aqualitative investigation.Family Process, 45(2),187-203.USA PFP targets low-income urban children whose mothers are intreatment for depression at community mental health clinics. This 10-week family-based multicomponent prevention program is designedfor depressed mothers and their school-aged children (ages 9–14).Each session begins with a community meal that serves to buildrelationships and social support between participating families. Afterthe meal, mothers participate in a 90-minute parent training programthat (a) provides psycho-education about depression, its impact onchildren, and child development, and (b) teaches parenting skills thatcan improve children’s affect regulation and behavioural control. Atthe same time children participate in a cognitive-behavioural groupthat teaches cognitive restructuring and coping skills. In addition togroup training sessions, individual family sessions are forums where
  • 137. -DRAFT-136family members can discussion the impact of depression on thefamily.Reading TogetherProgramSukhram, D. P. and A.Hsu (2012). Developingreading partnershipsbetween parents andchildren: A reflection onthe reading togetherprogram. EarlyChildhood EducationJournal, 40(2), 115-121.USA The Reading Together Program has its roots in the Family StrengthsModel which is designed to effectively meet children’s literacyneeds. The importance of the family environment and culture in thedevelopment of meaningful literacy and language experiences isemphasized, along with the significance of the active role andengagement of families in this development. The family-centeredapproach to the reading process empowers parents and children tobuild positive relationships through daily interactions whicheventually lead to developed literacy skills. Parents are taught variousstrategies to build the early literacy skills of their children throughmodeling. The 6 week program is generally carried out in a publiclibrary and is open to all children between 6 and 36 months of ageand their caregivers. The sessions last about 45 minutes and beginwith an overview of the day’s activities. Topics covered during thesessions include concerns and questions raised by caregivers. Parentswork individually with children as they read and employ thestrategies of Reading Together.Ready Set Parent!(RSP)Tomasello, N. M., Kazi,M. A. F., Prabhu, S.,Harvey, S. J., & Rittner,B. (2011). Ready SetParent: Evaluation of aparenting educationprogram in New YorkState. InternationalJournal ofInterdisciplinary SocialSciences, 5(9), 1-14.USA RSP is provided by Every Person Influences Children (EPIC), a non-profit organization, and Baker Victory Services (BVS). RSP followsan active learning delivery model that provides services to parentswho are identified as having potential parenting problems based onidentified risk factors such as low birth weight, living in poverty,lower parent education levels, living in communities with limitedresources and being considered inexperienced as parents. RSPfocuses on parenting skills, literacy and maternal and baby wellness.There are 3 components within the RSP program model. The first isvisitation; RSP coordinators visit parents in maternity hospitalswithin 48 hours of the birth of the baby. During these visits, parentsare informed about community resources and are provided withwritten and oral information on parenting, literacy, nutrition, safety,health and wellness. The second component is a newborn class heldin hospital where parents are invited to a one-hour program to learnmore about infant development. Specific parenting skills are taughtduring this class including the benefits of regularly reading tochildren, parents are also given children’s books. The finalcomponent is an eight-week workshop series designed to increaseknowledge, attitude, and confidence about being parents. The aim ofthis workshop is to promote high quality interaction with infants andto enhance development of cognitive, language, social, gross motorand fine motor skills in children. During the workshop parents areprovided with information on parent-child interaction, the role ofplaying in child development, coping strategies, benefits of structures
  • 138. -DRAFT-137parenting, discipline and literacy enhancement. After the workshopparticipants are regularly updated on programs scheduled in theircommunities.Right from the StartProgrammeNiccols, A. (2008).“Right from the Start”:Randomized trialcomparing an attachmentgroup intervention tosupportive home visiting.Journal of ChildPsychology andPsychiatry, 49, 754-764.DOI: 10.1111/j.1469-7610.2008.01888.xWestVirginia,USAThe Right From The Start Project (RFTS) is a statewide program inWest Virginia committed to producing improvements in birthoutcomes for low income pregnant women and their families. TheRFTS Project uses a program of home visitation provided byregistered nurses and licensed social workers, who work and reside inthe community they serve. The home visitors help women to achievethe following goals: 1) Improve pregnancy outcomes by helpingwomen engage in good preventive health practices including earlycomprehensive prenatal car, good nutrition, and reducing use ofcigarettes, alcohol and other illegal substances. 2) Help parentsincrease their knowledge of child development, offering parenteducation, and facilitating access to community resources. 3)Improve families economic and personal self-sufficiency byempowering parents to develop a vision for their own future, planfuture pregnancies, continue their education and find jobs. An 8-session parent group is also used to enhance caregiver skills inreading infant cues and responding sensitively.SafeCare Model(originally Project 12-Ways)Lutzker, J., & Bigelow,K.M. (2002). ReducingChild Maltreatment: AGuidebook for ParentServices. New York, NY:Guilford Press; 2002.Chaffin, M., Hecht, D.,Bard, D., Silovsky, J. F.,& Beasley, W. H. (2012).A statewide trial of theSafeCare home-basedservices model withparents in child protectiveservices. Pediatrics,129(3), 509.USA The SafeCare model was developed as a home-based treatment ofparents in the US Child Protection Service for child neglect. Thisstructured behavioural skills training program focuses on concretecaregiving, household management and parenting skills. Themanualized nature of SafeCare addresses 1) parent-child or parent-infant interaction, basic caregiving structure and parenting routines,2) home safety, and 3) child health. The SafeCare model can bedelivered as a freestanding intervention or as a component of abroader home visiting service. Trained professionals work with at-risk families in their home environments to improve parents’ skills inseveral domains. SafeCare is generally provided in weekly homevisits lasting from 1-2 hours. The program typically lasts 18-20weeks for each family.Steps to Effective andEnjoyable Parenting(STEEP) ProgrammeEgeland, B., & Erickson,USA STEEP works on the premise that a secure attachment betweenparent and infant establishes ongoing patterns of healthy interactionand promotes sensitivity in maternal caregiving. Through home visitsand group sessions, STEEP facilitators work alongside parents to
  • 139. -DRAFT-138M. F. (2004). Lessonsfrom STEEP: Linkingtheory, research, andpractice for the well-being of infants andparents. In A. Sameroff,S. C. McDonough, &K.L. Rosenblum (Eds.),Treating parent-infantrelationship problems:Strategies forintervention (pp. 213-242). New York, NY:The Guilford them understand their childs development. Parents learn torespond sensitively and predictably to their childs needs and to makedecisions that ensure a safe and supportive environment for the wholefamily. The approach involved home visits and group sessionsbeginning prenatally and continuing for two years (the originalprogram was designed for one year). Seeing Is Believing training is acomponent of STEEP, but can also be used independently fromSTEEP. Through filming and guided viewing, parents are enabled toincrease their sensitivity and responsiveness to their babies cues. Theprimary goal of using filming is to promote the parents’ self-observation and reinforce their growing knowledge of and sensitivityto their babies.Strengthening FamiliesProgramKumpfer, K.L. (1998).The StrengtheningFamilies Program. InR.S. Ashery, E.Robertson, & K.L.Kumpfer (Eds.) (1998).Drug Abuse PreventionThrough FamilyInterventions, NIDAResearch Monograph#177, DHHS, NationalInstitute on Drug Abuse,Rockville, MD, NIHPublication No. 97-4135.Multi-countryThe Strengthening Families Program (SFP) is a nationally andinternationally recognized parenting and family strengtheningprogram for high-risk and regular families. The original 14-sessionSFP for high-risk families with children ages 6-11 years wasdeveloped in the 1980s (SPF6-11). In the 1990s, a short 7-sessionversion was developed for low-risk families with pre- and early teens.In the 2000s new 14 session versions for high risk families weredeveloped with both younger children (SPF3-5) and early teens(SPF12-16). In 2011 a 10-session Home-use DVD version and groupcurriculum was developed. The SFP is used internationally and hadbeen translated into numerous other languages. The 3 components ofSFP include Parent Skills Training, Children’s Skills Training andFamily Life Skills Training. The Parent Skills Training course isimplemented using lectures, exercises, discussions and role-plays,and focuses on developing parents’ ability to increase desirablebehaviours in children by using attention and rewards, clearcommunication, effective discipline and limit-setting. Parentalproblem-solving skills, stress and anger management skills, andsubstance abuse education are also provided. The parent and childsessions generally end with the Family Life Skills Training, whichaims to increase cooperation between family members. The skillsacquired through the child and parent training are practiced instructure family activities, therapeutic child play and familymeetings.Strong AfricanAmerican FamiliesProgram (SAAF)Brody, G. H., Murry, V.M., Gerrard, M.,Gibbons, F. X., McNair,USA SAAF builds on other family-centered programs that enhance parentand youth competence to protect youths from engaging in substanceuse and high-risk sexual behaviour. SAAF was designed for low-income African American children who are nearing adolescence. Theintervention consists of 7 consecutive weekly meetings lasting 2 anda half hours each held at community facilities. At sessions, families
  • 140. -DRAFT-139L., Brown, A. C., Wills,T. A., Molgaard, V.,Spoth, R. L., Luo, Z., &Chen, Y. (2006). TheStrong African AmericanFamilies program:Prevention of youthshigh-risk behavior and atest of the model ofchange. Journal ofFamily Psychology,20(1), a meal together and then divide into parent and child small groupsfor discussion. For the final hour of each session, the groups reunitefor a large-group meeting. The focus of the sessions are on effectiveparenting behaviours, providing guidance and support for children,helping children appreciate their parents, and teaching children skillsto deal with stress and peer pressure. To facilitate attendance,families in the program are provided with transportation and childcare if needed. Sessions are taught by community members who aretrained in the curriculum.Sure Start LocalProgrammes(SSLP)/Sure StartChildren’s CentresMelhuish, E., & Hall, D.(2007). The policybackground to Sure Start.In: Belsky J, Barnes J,Melhuish E, eds. Thenational evaluation ofSure Start: does area-based early interventionwork? Bristol: PolicyPress, 2007.UK Sure Start is a large government initiative that is aimed at preventingthe social exclusion of disadvantage children. The originalprogrammes (set up between 1999 and 2003) were area-based, withall young children and their families living in a prescribed geographicarea being the targets of the intervention. These area-basedinterventions aimed to improve services for young children and theirfamilies in deprived communities, promote health and development,and reduce inequalities. Programs were managed by a partnership ofhealth, education, social services and voluntary sectors. SSLPsinitially did not have a prescribed set of services; instead each localprogramme was responsible for working with the community toimprove existing services according to local needs while coveringcore services. Sure Start aims to promote physical, emotional,intellectual and social development in pre-school children byincreasing childcare availability, supporting parents in employmentand in developing their careers, providing parent skills training andeducation on child development, health and family support services.During 2004-2006 the model of service delivery changed bybecoming Sure Start Children’s Centres. With it came clearerspecifications of services with a strong emphasis on child wellbeingand the need to reach the most vulnerable, in addition to theadjustment of service provision to the degree of family disadvantage.Sure Start services include childcare, children’s centres, children’sinformation services (information on nursery education and childcareavailability), early excellence centres (a range of educational and careservices for parents and children), extended schools (coordinatingchildcare services), health and family support (parental education onchild development, promoting awareness of healthy living, earlyidentification of difficulties), neighbourhood nurseries, out-of-schoolchildcare, local programmes (including family support, advice onnurturing, health services, and early learning opportunities).Survival Skills for USA The Survival Skills for Healthy Families program was designed to
  • 141. -DRAFT-140Healthy FamiliesprogramFamily WellnessAssociation. (2004).Survival skills for healthyfamilies. Instructormanual, six session videopackage and coupleworkbooks. ScottsValley, CA: Author.serve low-income multicultural communities in California. Theprogram is offered to families involved in court-ordered violence andgang prevention services and in drug and alcohol, child abuse, anddomestic violence prevention and intervention programs. The contentfocuses on several areas: 1) building stronger families, 2) enhancingthe couple relationship, 3) skills necessary to prevent domesticviolence, and 4) intervention with stepfamilies. Several features ofthe program are directed to low-income populations.Systematic Training forEffective Parenting(STEP)Dinkemeyer, D., McKay,G. D. & Dinkmeyer, D.(1997). SystematicTraining for EffectiveParenting: The parent’shandbook. BowlingGreen, KY: STEPPublishers.Angeli, N. (1997) STEPsfor positive parenting.Health Visitor, 70, 336–338.Multi-countrySTEP targets families with parent-child relationship problems,including those at risk for child maltreatment in addition to familiesinterested in enhancing child social and cognitive development. TheSTEP course is an educational program for parents that teaches themthe ideas and skills they need for raising responsible children andfeeling more adequate and satisfied as parents. A package ofmaterials designed for 9 training sessions is available. Each sessionprovides an opportunity to: 1) discuss specific activity assignmentswhich involve the application of the ideas with ones own children, 2)discuss readings presented in the book accompanying the course, 3)listen to a brief professional lecture by the authors, 4) participate inskill building exercises, and 5) consider general problem situations aswell as the application of these ideas to ones own concerns. Thepurpose of STEP is to help: 1) develop understanding of a practicaltheory of human behaviour; 2) learn new procedures for developingmore effective relationships with your children; 3) improvecommunication between parents and children through developingskills for listening, resolving conflicts with children; 4) develop skillsin using encouragement, logical consequences and other activeoriented procedures; and 5) develop more self-confidence in onesideas about children and ones abilities as a parent. Early ChildhoodSTEP is tailored for parents with children younger than 6 years ofage and deals with understanding young children, understanding theirbehaviour, building self-esteem in the early years, communicatingwith young children, helping young children learn to communicateand nurturing their emotional and social development.The BoomerangsParenting ProgramLee, L., Griffiths, C.,Glossop, P., & Eapen, V.(2010). The BoomerangsParenting Program forAboriginal parents andAustralia The Boomerangs Program is a parenting program based on the Circleof Security Program (an early intervention group program based onattachment theory) and the Marte Meo Program (a developmentalsupport program aimed at enhancing constructive interaction betweenparent and child). Combining the two approaches the BoomerangsProgram aims to promote a healthy mother-child relationship at bothinteractional and relational levels. Videotapes are used as atherapeutic tool and video clips of interactions between mother and
  • 142. -DRAFT-141their young children.Australasian Psychiatry,18(6), 527-533.10.3109/10398562.2010.499435child are used to reflect and improve on parental sensitivity andcommunicating capacity.The program comprises 20 sessions and focuses on braindevelopment, attachment, reading and highlighting parentcompetencies and vulnerabilities.The Children andParents Service (CAPS)White, C., & Verduyn, C.(2006). The Children andParents Service (CAPS):A multi-agency earlyintervention initiative foryoung children and theirfamilies. Child &Adolescent MentalHealth, 11(4), 192-197.10.1111/j.1475-3588.2006.00410.xEngland CAPS is a multi-agency partnership whose model of service deliveryis based on four principles: a) evidence-based practice using theIncredible Years Webster Stratton model of parent training, b) theprovision of a conceptual model that professionals deliver focusingon user involvement, c) emphasis on community capacity building,and d)a flexible approach where need can be converted into demandand services are responsive. The CAPS service includes fivecomponents. The parent training courses take place at children’scentres and other family and community based resources andsupplementary individual work where needed. Participation byprofessional and self-referral and is targeted at parents experiencingdifficulties with their young children’s behaviour. Courses run for10-12 weeks at a time and use the Incredible Years Programme. Co-leaders facilitate the course through videotape modeling and roleplay. Telephone contact is maintained before each session and co-leaders provide individual sessions at home for parents who areunable to attend a session. The second component is the training ofcommunity based professionals in running effective parent courses intheir own agencies. The third component comprises supervision ofprofessions running the parent training courses. Video-basedsupervision is provided every 6 weeks on which accreditation isbased.The Early Risers‘‘Skills for Success’’ProgramAugust, G. J., Realmuto,G. M., Hektner, J. M., &Bloomquist, M. L.(2001). An integratedcomponents preventiveintervention foraggressive elementaryschool children: TheEarly Risers program.Jounal of Consulting andClinical Psychology,69(4), 614-626.August, G. J.,USA The Early Risers “Skills for Success” program aims to reduceaggressive behaviours using a summer program for children as wellas a parent education and skills training program. The goal is topromote positive socio-emotional development into middle childhoodand adolescence by targeting younger children who exhibitaggressive behaviours. There are two main components to the EarlyRisers intervention program; a child-focused intervention (CORE)and a family-focused support and empowerment program (FLEX).The CORE component includes a series of evidence-based education,skill-building, and mentoring interventions that are delivered duringannual 6-week summer school sessions, ongoing teacher consultationand student mentoring during the course of the school year, and a bi-weekly family program that involves parent education and skillstraining in addition to child social skills training groups.The FLEX component is delivered along with the CORE componentand can be seen as a prevention case management tool that can deal
  • 143. -DRAFT-142Bloomquist, M. L.,Realmuto, G. M., &Hektner, J. M. (2007).The Early Risers ‘‘Skillsfor Success’’ Program: Atargeted intervention forpreventing conductproblems and substanceabuse in aggressiveelementary schoolchildren. In P. H. Tolan,J. Szapocznick, & S.Sambrano (Eds.).Preventing youthsubstance abuse: Science-based programs forchildren and adolescents(pp. 137–158).Washington, DC:American PsychologicalAssociation.with unique family issues that the CORE component may not be ableto address. The FLEX component is a home-visitation program inwhich families work with family advocates to decide what actions arenecessary for family and child wellness.The Family Tree’s(TFT) PositiveParenting ProgramWoodruff, K., & Young,R. H. (2009). Evaluatingoutcomes for at-riskfamilies participating inthe Family Tree’sPositive ParentingProgram: A retrospectivestudy—Interim report.Community & School-based Research:Systematic Reviews.Center for Families andChildren. University ofMaryland, Baltimore.USA The Family Tree is a non-profit organization with the goal ofstrengthening families to prevent child abuse and neglect. The FamilyTree’s (TFT) Positive Parenting Program is designed to help parentsand caregivers acquire life skills and parenting skills that promotepositive family functioning and strengthen families in order toprevent abuse and neglect, as well as to preserve families. Theprogram rests on the assumption that child maltreatment is associatedwith multiple risk factors. Group-based skills training targets theserisk factors and enhances protective factors enabling parents toprovide more appropriate care for their children and preserving thefamily unit. Family educators follow a TFT PPP manual whichincludes information on self-awareness, values and beliefs,communication, stress reduction and anger management, nurturingchildren’s self-esteem, child development, managing children anddiscipline, home safety and child well-being, and goal setting.The Helping FamiliesProgrammeDay, C., S. Kowalenko,et al. (2011). The HelpingFamilies Programme: AUK This program aims to help multi-stressed families who have childrenwith severe conduct problems by reducing conduct problems inchildren, reducing family harm and increasing parent and familyresilience. Five domains are addressed: 1) Improving interpersonalconflict management by increasing parents’ ability to interactpositively, build and maintain relationships and reduce conflict with
  • 144. -DRAFT-143new parentingintervention for childrenwith severe and persistentconduct problems. Child& Adolescent MentalHealth, 16(3), 167-171.the child (or children), partner, family and/or key professionals 2)Improve mood stability and regulation by increasing parents’ abilitiesto be tolerant, feel calm, happy and satisfied3) Improve supportivesocial and family networks by increasing the frequency andavailability of constructive parenting support 4) Reduce the harmfuleffects of drugs and/or alcohol by working towards cessation or harmminimization 5) Strengthen instrumental and emotional coping byincreasing adaptive problem management and improving emotionalregulation and distress tolerance in relation to problems that cannotbe immediately managed. The program consists of a manual and aparent toolkit. Program structure comprises 20 sessions over amaximum of 6 months, with the possibility of additional contactsessions during each week.Through the LookingGlass (TtLG)Aylward, P., Murphy, P.,Colmer, K., & O’Neill,M. (2010). Findings froman evaluation of anintervention targetingAustralian parents ofyoung children withattachment issues: TheThrough the Lookingglass (TtLG) project.Australasian Journal ofEarly Childhood, 35(3),13-23.Australia The TtLG project provides intensive psychosocial support,therapeutic intervention and child care as a package for high-riskfamilies, in order to develop and support secure attachmentrelationships between mother and child. The primary target group ismothers of children aged birth to 5 years. The intervention involves amultifaceted approach, with each childcare centre site employing aclinician (an experienced social worker trained in attachment and the‘Circle of Security’), co-facilitator and primary caregiver (both ofwhom were experienced childcare workers) to work with eachrecruited family. Parents are required to attend weekly psychosocialgroup work sessions and individual counseling is available formothers as needed. The weekly therapeutic sessions followed aschedule that introduces mothers to concepts of attachment theoryand uses video footage of each of the mothers interacting with theirchild for group reflection.Triple P PositiveParenting ProgrammeSanders, M. R. (1999).Triple P-PositiveParenting Program:Towards an empiricallyvalidated multilevelparenting and familysupport strategy for theprevention of behaviourand emotional problemsin children. ClinicalChild and FamilyPsychology Review, 2,71–89.Multi-countryThe program known as Triple P-Positive Parenting Program is amultilevel system of family intervention, which provides 5 levels ofintervention of increasing strength. Triple P emphasizes thedevelopment of parental self-regulation as a central skill.Specifically, the programme focuses on developing parental self-sufficiency, self-efficacy, self-management skills (self-monitoring,self-determination of goals, self-evaluation and self-selection ofchange strategies) and personal agency or empowerment. These skillsare considered necessary for achieving the key principles of positiveparenting. The 5 levels of intervention include a universalpopulation-level media information campaign targeting all parents, 2levels of brief primary care consultations targeting mild behaviourproblems, and 2 more intensive parent training and familyintervention programs for children at risk for more severebehavioural problems. The program aims to determine the minimallysufficient intervention a parent requires in order to deflect a child
  • 145. -DRAFT-144away from a trajectory towards more serious problems. The dose orstrength of intervention required is determined by the severity ofchild behavioural problems. Level 1, a universal parent informationstrategy, provides all interested parents with access to usefulinformation about parenting through a coordinated media andpromotional campaign using print and electronic media, as well asuser-friendly parenting tip sheets and videotapes which demonstratespecific parenting strategies. This level of intervention aims toincrease community awareness of parenting resources, receptivity ofparents to participating in programs, and to create a sense ofoptimism by depicting solutions to common behavioural anddevelopmental concerns. Level 2 is a brief, one- to two-session,primary health care intervention providing early anticipatorydevelopmental guidance to parents of children with mild behaviourdifficulties. Level 3, a four-session intervention, targets children withmild to moderate behaviour difficulties and includes active skillstraining for parents. Level 4 is an intensive eight- to ten sessionindividual or group parent training program for children with moresevere behavioural difficulties. It comprises group-basedinterventions and this level is also referred to as Group Triple P, andis conducted for groups consisting of 10-12 parents. Level 5 is anenhanced behavioural family intervention program for families whereparenting difficulties are complicated by other sources of familydistress (e.g., marital conflict, parental depression, or high levels ofstress). Triple P International offers the course translated into anumber of languages.UCLA FamilyDevelopment ProjectHeinicke, C. M.,Fineman, N., Ponce, V.A., & Guthrie, D. (2001).Relationship basedintervention with at-riskmothers: Outcome in thesecond year of life. InfantMental Health Journal,22,431-462.LosAngeles,USAThe UCLA Family Development Project is a relationship-basedhome visiting program for pregnant mothers who are at risk forinadequate parenting. This intervention is designed to start in thethird trimester and continue until the infant is 24 months old. UCLAresearchers created the Family Development Project with 5 goals: 1)Decrease maternal depression and anxiety; 2) Increase partner andfamily support; 3) Increase responsiveness of the new mothers andincrease infant security in attachment to their mothers; 4) Encouragechild autonomy; and 5) Encourage child task involvement. To realizethese goals, a social worker begins visiting the mother’s homeweekly during the third trimester of her pregnancy. During thesevisits, the worker’s goal is to establish trust and give social support tothe expecting mother. Then, the visits focus on giving positivereinforcement to the mother to increase her sense of competence.Finally, the mother receives specific interventions designed toincrease her knowledge in parenting, family systems, and infanthealth. The mother also receives referrals to other health programsand additional contacts for support as needed.
  • 146. -DRAFT-145Video InteractionProject (VIP)Mendelsohn, A.L.,Huberman, H.S., Berkule,S.B., Brockmeyer, C.A.,Morrow, L.M., Dreyer,B.P. (2011). Primary carestrategies for promotingparent-child interactionsand school readiness inat-risk families: TheBellevue Project forEarly Language,Literacy, and EducationSuccess (BELLE).Archives of Pediatrics &Adolescent Medicine,165(1), 33-41.New York,USAThe VIP intervention takes place from birth to 3 years of age, withfifteen 30-45 minute sessions taking place primarily on the day ofprimary care visits. Sessions are facilitated by a child developmentspecialist who meets 1 on 1 with families, providing anindividualized, relationship-based intervention. The specialistdelivers a curriculum focused on supporting verbal interactions in thecontext of pretend play, shared reading, and daily routines to enhancechild development and school readiness. The VIP intervention uses 3strategies: videotaping of mother-child interaction followed byreview with the child development specialist, provision of learningmaterials, and provision of parenting pamphlets.Video-feedbackIntervention to promotePositive Parenting(VIPP)Lawrence, P., Davies, B.,& Ramchandani, P.G.(2012). Using videofeedback to improveearly father-infantinteraction: A pilot study.Clinical ChildPsychology andPsychiatry, DOI:10.1177/1359104512437210UK VIPP is an early preventive intervention used in the first 2 years oflife. It is used to engage and work with fathers in an attempt toimprove their parenting capacities and thereby improve children’soutcomes. The optimal case is to include both mothers and fathers inthe intervention. VIPP incorporates both attachment and sociallearning perspectives and specifically targets parenting capacities thatare implicated in the aetiology of a range of childhood problems. Theintervention comprises a brief (4-6 sessions), home-basedintervention. It focuses primarily on positive aspects of parent-childinteraction and builds on them through the use of video. Instead of ageneric film, video mirroring their own daily interactions with theirchild allows for the individual tailoring of the treatment in each case.The aim is not to make fathers more like mothers but to improve theimportant aspects of father-infant interaction. VIPP-R is anadaptation of the original intervention with an additional focus onmothers’ mental representations of attachment. VIPP-SD is anotheradaptation with a focus on sensitive discipline, used with motherswith children aged 1-3 years.Videotaped self-modeling and feedbackBenzies, K., Magill-Evans, J., Harrison, M.J.,MacPhail, S., & Kimak,C. (2008). Strengtheningnew fathers skills inCanada This program is delivered during home visits when infants arebetween 5 and 6 months old because this stage is characterized by avariety of interactive behaviours. Nurses are trained on givingfeedback to fathers on their interactions. Each family has one nurseand first contact is made with a telephone call to schedule a 1-hourhome visit at a time when the child would be awake. During the visitit is explained that the intervention focuses on father-infant
  • 147. -DRAFT-146interaction with their 5-month-old infants: Whobenefits from a briefintervention? PublicHealth Nursing, 25(5),431-439.interaction and only the father and the infant are to remain in theroom. After reviewing a standardized list of activities, fathers areasked to choose one that is new to the infant. The play interactionbetween the father and the infant is videotaped and immediately afterthe nurse and father review the session together. The nurse providesthe father with suggestions and feedback. Handouts are left behind toreinforce the nurse’s verbal feedback to the father. The second visitbuilds on the first visit and follows the same structure.What Were WeThinking! (WWWT)Rowe, H. J., & Fisher, J.R. W. (2010).Development of auniversal psycho-educational interventionto prevent commonpostpartum mentaldisorders in primiparouswomen: A multiplemethod approach. BMCPublic Health, 10, 499-513.Australia WWWT is a structured psycho-educational program for mothers,fathers and their first newborn. The aims of the program are topromote confident caregiving, to optimize infant manageability andfamily functioning, and to reduce common postnatal mental disordersin women by providing couples with specific skills and knowledgeabout infant caretaking and managing the change to the intimatepartner relationship after the baby is born. The theoretical foundationof the WWWT program proposes that both maternal anxiety anddepression are important in the caregiver-child relationship and areaddressed most effectively together. By working on this premise, theprogram looks to decrease caregiver-child interactions that contributeto maternal depression and anxiety, and increase those that promotematernal confidence and competence. The program is designed to beintegrated into community health care. The program consists ofgroup discussion, focused tasks to be done individually and thendiscussed as a couple, problem-solving and negotiation practice,hands-on supported practice in infant settling, short talks andpractical demonstrations. The program content has been manualizedinto 13 sections – with 2 components “About Babies” and “AboutMothers and Fathers”. A half day training session has been developedto train facilitators about the underlying theory, the use of gender-sensitive language and supporting parents in practicing infantsettling. The actual program is designed to be delivered in one halfday session with groups of up to 5 couples and their 4 to 6 week oldbabies.
  • 148. -DRAFT-147APPENDIX 5LIST OF REFERENCES INCLUDED INTHE LITERATURE REVIEWAbendroth, A.-K., van der Lippe, T., & Maas, I. (2012). Social support and the working hours ofemployed mothers in Europe: The relevance of the state, the workplace, and the family. SocialScience Research, 41(3), 581-597.Adams, G., & Rohacek, M. (2002). More than a work support? Issues around integrating childdevelopment goals into the child care subsidy system. Early Childhood Research Quarterly, 17(4),418-440.Adema, W. (2012). Setting the scene: The mix of family policy objectives and packages across theOECD. Children & Youth Services Review, 34(3), 487-498.Ahuja, A. (2009). Helping parents with challenging children: Positive family intervention -Facilitator’s Guide. Child & Adolescent Mental Health, 14(1), 54-55.Akinbami, L. J., Cheng, T. L., & Kornfeld, D. (2001). A review of teen-tot programs: Comprehensiveclinical care for young parents and their children. Adolescence, 36(142), 381-393.Akister, J. (2009). Protecting children through supporting parents. Journal of Public Mental Health, 8(4),11-17.Al-Hassan, S. M., & Lansford, J. E. (2011). Evaluation of the Better Parenting Programme in Jordan.Early Child Development & Care, 181(5), 587-598.Alio, A. P., Bond, M. J., Padilla, Y. C., Heidelbaugh, J. J., Lu, M., & Parker, W. J. (2011). Addressingpolicy barriers to paternal involvement during pregnancy. Maternal & Child Health Journal,15(4), 425-430.Allen, D., Hawkins, S., & Cooper, V. (2006). Parents’ use of physical interventions in themanagement of their childrens severe challenging behaviour. Journal of Applied Research inIntellectual Disabilities, 19(4), 356-363.Allen, S. F., & Miller, J. (2010). A community initiative to support family financial well-being.Community, Work & Family, 13(1), 89-100.Almeida, A., Abreu-Lima, I., Cruz, O., Gaspar, M. F., Brandão, T., Alarcão, M., et al. (2012). Parenteducation interventions: Results from a national study in Portugal. European Journal ofDevelopmental Psychology, 9(1), 135-149.Altmaier, E., & Maloney, R. (2007). An initial evaluation of a mindful parenting program. Journal of
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