Universal programmes for parentingsupport - a Swedish national strategyfor promoting public health Sven Bremberg MD PhD
Formal and informal expenditures forchildren 0-17 years of age, Sweden 1995
Swedish family support • Fully paid parental leave 13 months, partly paid for additional 3 months • Subsidised pre-schools with child centred pedagogy • Universal child health services • Child poverty rate 4%
Health promotion by improving parentingskills during childrens early years • Behaviour problems • Depression and anxiety • Smoking • Alcohol and illegal drugs • Obesity and food habits • Cardiovascular disease Source: Stewart-Brown, S. (2008). Improving parenting: the why and the how. Arch Dis Child, 93(2), 102- 104.
Parental support: the potential • Counselling by a nurse - RCT – Counselling at home, once a month, 0-5 yrs – At age 20: 40 % reduction of depression. – Aronen et al, Finland, Am J Orthopsych, 2000 • Counselling by a GP - RCT – 10 visits, 20 minutes, 0-6 yrs – Follow up at age 6: less anxiety, sleep, aggression – At age 27-29: less depression, smoking, obesity. Better education. – Cullen et al, Australia, J Pediatr, 1996
To develop parenting competences • Role models – Own childhood – Other adults • Media • Professionnels • Courses 8
Attachment enhancing programmes • In high income countries - 40% insecure attachment by age 18 months • Structured programmes are effective - 70 RCTs • Interpretation of infant signals use of photos or video clips
New attachment promoting programmes(ICDP) introduced into established CHCparent groups • Child health nurses have been trained as facilitators for ICDP • Photos rather that video clips • Interpretation of infant signals • ICDP is used also after infancy
Structured methods for parents of children age3-9 years, based on methods like PMT, COPEetc. adapted for universal use in Sweden… • Parental groups • Starting with videotaped problem situations • Modelling • Role play
Systematic review of 77 RCT - Analysis of componets in effective programmes • Consistent reduction of behaviour problems, anxiety and depression • Emphasis on a positive interplay • Learing by practice - “home work” • Models for handling “bad behaviour”Source: Kaminski,et al. (2008). J Abnorm Child Psychol, 36(4), 567-589.
Fraction of all first child parents who haveparticipated in a parental group, child age 3-10yrs, Sweden 2004 - 2008 15
National parental programme launched inSweden 2009 • Child age 0-18 yrs • Different actors • Health services Municipalities, NGOs • Different methods • In 2009-2010 €7 million for development and €8 million for research
Research themes • Swedish RCT:s of internationally established programmes • New Swedish programmes • Social and gender equality • Systems for delivery: multiple actors with municipalital coordination