Universal programmes for parenting support - a Swedish national strategy for promoting public health. Sven Bremberg, Statens folkhälsoinstitut.

1. Universal programmes for parenting
support - a Swedish national strategy
for promoting public health
Sven Bremberg
MD PhD

2. Formal and informal expenditures for
children 0-17 years of age, Sweden 1995

3. 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%

4. Health promotion by improving parenting
skills 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.

5. Diana Baumrind - parenting styles
Warm/accepti Hostile/negative
ng
Restrictive Authoritative Authoritarian
Accepting Yielding Neglecting

6. Universal health promotion
6

7. 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

8. To develop parenting competences
• Role models
– Own childhood
– Other adults
• Media
• Professionnels
• Courses
8

9. The parent couple - communication
9

10. 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

11. New attachment promoting programmes
(ICDP) introduced into established CHC
parent 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

12. Child age 3-10 yrs
COPE
12

13. Structured methods for parents of children age
3-9 years, based on methods like PMT, COPE
etc. adapted for universal use in Sweden…
• Parental groups
• Starting with
videotaped problem
situations
• Modelling
• Role play

14. 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.

15. Fraction of all first child parents who have
participated in a parental group, child age 3-10
yrs, Sweden 2004 - 2008
15

16. National parental programme launched in
Sweden 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

17. Research themes
• Swedish RCT:s of
internationally established
programmes
• New Swedish programmes
• Social and gender equality
• Systems for delivery:
multiple actors with
municipalital coordination

18. Google