Early Parenting Programs Research Articles

Impact of a private sector residential early parenting program on clinically significant postnatal depressive symptoms experienced by women: Audit of routinely collected data.

Early parenting services in Australia offer brief structured residential programs to address moderate to severe non-psychotic mental health problems among women and unsettled infant/toddler behaviours. The aims were to (1) estimate the immediate and medium-term impact of a five-night psychoeducational residential early parenting program on postpartum depressive symptoms and (2) identify the factors associated with improvement or worsening of postpartum depressive symptoms after completing the program and six weeks post-discharge. Audit of routinely collected medical record data from pre-admission, pre-discharge and post-discharge assessments of a consecutive cohort of women admitted, with their infants/toddlers in a 15-month period to Masada Private Hospital Early Parenting Centre. Data included structured questions assessing: demographic characteristics, access to family and social support, past and current mental health problems, reproductive and obstetric health, chronic health conditions, breastfeeding problems, coincidental major life events, health risk behaviours and infant/toddler feeding, sleeping and crying behaviours. Standardised instruments included the Partner Interaction after Birth Scale (PIBS), the MacLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Modified Fatigue Assessment Scale (FAS) and selected items from the Karitane Parenting Confidence Scale. The primary outcomes were Edinburgh Postnatal Depression Scale scores at pre-discharge and follow up assessments. Data were analysed using multinomial logistic regression models in which individual and psychosocial characteristics at pre-admission were included as predictors of the likelihood of the changes of the outcomes from pre-admission to pre-discharge and follow up. Complete data from 1220 of 1290 (95%) eligible women were available to assess pre-admission to pre-discharge and from 559 (45.8%) to assess pre-discharge to six-week follow-up changes. The mean pre-admission EPDS score was 11.7 (95% CI: 11.5; 12.0), pre-discharge it was 7.1 (95% CI: 6.9; 7.4) and at six-week follow up it was 5.7 (95% CI: 5.3; 6.1). We found that almost all women experienced a clinically meaningful and rapid improvement in depressive symptoms of at least this magnitude (reduction in mean EPDS scores of 4.6 points from pre-admission to pre-discharge (five nights) and a further reduction of 1.2 points pre-discharge to follow up) (six weeks) and we identified an interpretable set of risk factors for symptoms that did not improve or worsened. The adverse outcomes were associated with having symptoms of borderline personality disorder, a partner experienced as lacking kindness and care, coincidental adverse events and having a child younger than six months. Residential early parenting programs, which take a psycho-educational approach to strengthening caregiving skills, maximising agency, and reducing helplessness, have a rapid beneficial effect on women's postpartum depressive symptoms. These programs provide a valuable and effective component of comprehensive mental health services. Long-term dialectical behaviour therapy is indicated for women with borderline personality disorder traits for whom early parenting programs alone are insufficient to improve depressive symptoms.

Exploring participation and engagement in a multi-component, universal early parenting programme

PurposeParenting programmes are increasingly a feature of services and policies aimed at improving outcomes for children and families and tackling inequality, yet they remain underused. This study aims to assess parent engagement and retention in the parent and infant (PIN) programme – a universal, multi-component intervention designed to support parents from birth to when their children reach two years of age. The programme can be tailored to parent/community needs but also includes standardised core elements including two Incredible Years parenting programmes. Programme provider perspectives on recruiting and supporting participation were also explored.Design/methodology/approachA mixed methods study was conducted involving parents (n = 106) and programme providers involved in the PIN programme. Logistic regression analyses were used to assess the impact of participant demographic characteristics on the likelihood of programme engagement and attendance. Semi-structured interviews explored facilitators’ experiences of parent recruitment and engagement, as well as barriers and facilitators of parental attendance.FindingsFirst-time mothers were more likely to initially enrol in the PIN programme than younger or lone parents. However, older age and married/cohabiting status were the strongest predictors of attending at least one-third of programme sessions. Qualitative findings highlighted the importance of relationship building and connection in supporting participant recruitment and engagement. Practical and psychological barriers to programme participation are also described.Originality/valueThe findings shed light on factors that influence engagement and attendance in universal, early parent support programmes. Barriers to parent engagement are multi-layered and tailored strategies to promote uptake of parenting programmes are needed.

Supporting families with complex early parenting needs through a virtual residential parenting service: An investigation of outcomes, facilitators and barriers.

To investigate clients' perspectives about outcomes of a telehealth residential unit (RU) program for families experiencing complex early parenting issues, and to explore facilitators and barriers to positive client outcomes. Qualitative study using semi-structured interviews. Semi-structured interviews were conducted with mothers (n = 18) admitted to a telehealth RU program. Interview transcripts were analysed using thematic analysis. Mothers reported short-term improvements in their child's presenting issues (e.g. feeding to sleep, night-time waking, co-sleeping), increased confidence and increased partner involvement. According to participants, program outcomes were facilitated by a positive parent-clinician relationship, the accessibility of clinicians and being able to take part in the program from their own home. Barriers included difficulties with technical equipment and connecting with the clinician overnight, and challenges with implementing strategies in the longer term. This nurse-led telehealth program was viewed positively by parents and the study identified a number of areas for improvement. Telehealth early parenting programs provide an important way for parents to receive support with early child sleep, settling and feeding issues. Clinicians working in this area should focus on the development of positive parent-nurse relationships, enhancing communication and availability for parents during overnight periods and supporting parents to develop early parenting skills that will be applicable across the early childhood period. The study is the first to address client experiences of a telehealth RU program. Facilitators and barriers identified will inform service improvements to the program going forward, and similar telehealth programs for families; to ensure benefits and service outcomes are maximised for parents for such a crucial service. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative research were followed.

Brief Parenting Seminars for Preventing Child Behavioral and Emotional Difficulties: a Pilot Randomized Controlled Trial

Early parenting programs can prevent the development of child behavioral and emotional difficulties. Despite the high prevalence of these difficulties in Greek children aged 2 to 12, no evidence-based parenting programs have been tested in randomized trials in Greece. We pilot-tested the efficacy of a brief parenting intervention for universal prevention of child behavioral and emotional difficulties. Parents from the general population (N = 124) were randomly assigned to receive the Triple P (Positive Parenting Program) Seminar Series (n = 83), or leaflet information on child health (n = 41). Most participants were highly educated mothers with boys and girls aged 2–12, from middle-income, inner-city households. Participants reported on child behavior, parenting style and parenting adjustment, before and after the intervention and six months later. At post-intervention, parent-reported behavioral problems were reduced in the intervention group, but increased in the control group (p = 0.001); these differences remained at 6-month follow-up. Of those in the clinical range (28%) at baseline, significantly more intervention children than control children moved to normal range six months later. Disrupted parenting practices were reduced more in intervention parents at post-intervention but were not maintained at follow-up. No significant differences were found in secondary child behavioral difficulties, child emotional difficulties, parenting confidence and distress over time. This Seminar Series is a brief, easily replicable and likely cost-effective early intervention leading to significant medium-sized reductions over six months in behavioral difficulties, and improvements in disrupted parenting. These findings broadly support other evidence about effective transportability of parenting interventions across countries.

Understanding the theoretical underpinnings of preventative early parenting interventions: A theory-based evaluation

Early parenting programmes which promote nurturing care for children aged 0–3 years are popular in community-based primary health care settings. However, little research has explored the causal and theoretical assumptions underpinning these programmes. This paper outlines a programme theory evaluation which was conducted to explore the change principles inherent in a complex early parenting intervention, the parent and infant programme, which aims to support parents and infants aged 0–2 years. A documentary analysis and qualitative interviews ( n = 19) with key stakeholders were undertaken to describe programme components, outline intervention objectives and identify the mechanisms assumed to be important to programme success. The interpretation of the findings was informed by the Consolidated Framework for Implementation Research, within which we explore and describe the theoretical perspectives that underpin the programme and guide its operationalisation and delivery. The importance of attending to the causal mechanisms underlying early parenting interventions is outlined.

Fathers in Early Parenting Programs. Impulses from the European and International Fatherhood Research

Prevention and intervention programs (early parenting programs) which are provided by regional multi-professional networks for families with infants are still addressed to mothers, primarily. The question is whether the European and international fatherhood research can supply valuable suggestions for a better involvement of fathers. We discuss determinants of lived fatherhoods that range from educated fathers of national middle class over fathers with migrant backgrounds up to educationally and economically disadvantaged fathers. We elucidate barriers which stand in the way of father involvement in the current parenting programs, and exemplary describe how the resistance could be successfully overcome.

The relationship of recalled adverse parenting styles with maladaptive schemas, trait anger, and symptoms of depression and anxiety

BackgroundYoung's contention that early maladaptive schemas mediate the relationship between adverse parenting and later emotional difficulties has been lrttle tested. Also, most relevant research focuses only on depression, and on maternal parenting. MethodsOne hundred and fifty-five non-clinical adults completed the Young Parenting Inventory (YPI) regarding both their mothers and fathers, Young's Schema Questionnaire (YSQ), the State/Trait Anger Scale (STAS) and the Depression Anxiety Stress Scale-21 (DASS-21). ResultsYoung's suggested 17-factor YPI structure was not supported. Rather, participants differentiated between recalled paternal and maternal parenting, with rejecting and controlling components emerging for each parent. There was an indirect effect of rejecting fathering on symptoms of depression, via the social isolation schema, in support of Young's theory. However, despite some significant relationships between parenting and schemas, and schemas and emotions, most effects of parenting on emotions were direct. Rejecting fathering had a direct positive effect on trait anger, and controlling mothering on symptoms of depression and anxiety. Controlling fathering had a negative effect on anxiety symptoms. LimitationsThe study was cross-sectional, limited to participants in a single city, and had a preponderance of female respondents. ConclusionsMost effects of adverse parenting seem to be direct rather than operating through schemas. Prevention through early parenting programs, and adult cognitive therapies that draw on a broad range of schemas, seem to be called for.

Postpartum fatigue, daytime sleepiness, and psychomotor vigilance are modifiable through a brief residential early parenting program

Objective/BackgroundIn the months after childbirth, women are vulnerable to sleep disturbances and sleep-related deficits in functioning, such as fatigue, daytime sleepiness, and attentional lapses. Currently there is limited evidence that these deficits are modifiable. Using both self-report and objective measures, this study examined changes in sleep-related daytime functioning among women attending a residential early parenting program for assistance with unsettled infant behavior and mild to moderate postpartum distress. MethodsParticipants were 78 women (age M = 34.16, SD = 4.16 years) attending a five-day program with their infants (age M = 8.67, SD = 4.82 months). Sleep was assessed via self-report. Sleep-related daytime functioning was operationalized as fatigue, sleepiness, and sustained attention, and measured using validated questionnaires (all women) and the 10-min visual Psychomotor Vigilance Test (PVT; subgroup of 47 women). All measures were administered on both admission (baseline) and discharge. ResultsOn admission, participants reported elevated sleep disturbance (94%), fatigue (91%), as well as trait (54%) and state (67%) sleepiness. From admission to discharge, there were medium effect size reductions in fatigue and sleepiness, and large effect size improvements in sleep quality related domains such as increased sleep efficiency and reduced nighttime awakenings (all p < 0.001); changes in total sleep time were nonsignificant (p = 0.22). PVT reciprocal mean reaction times were also significantly faster (p = 0.001; medium effect size). ConclusionsThis study demonstrated that among women attending a brief residential early parenting program, fatigue, daytime sleepiness, and objectively measured psychomotor vigilance can be improved. Implications for further research and potential treatments are discussed.

More than depression: a multi-dimensional assessment of postpartum distress symptoms before and after a residential early parenting program

IntroductionParents are vulnerable to psychological distress symptoms in the postpartum period. It is routine to screen for depressive symptoms, but anxiety, stress, fatigue, irritability and insomnia symptoms are less often assessed despite their prevalence. This study aimed to assess multiple dimensions of psychological distress, and their reliable change and clinically significant change among women admitted to a residential program for assistance with unsettled infant behaviors (UIB).MethodWomen admitted to a five-night residential early parenting program completed self-report measures: the Depression Anxiety Stress Scale, Irritability Depression Anxiety Scale, Fatigue Severity Scale, and Insomnia Severity Index. A sub-group completed a computerized emotional Go-NoGo (EGNG) task as a measure of emotional impulsivity.ResultsSeventy-eight women were recruited (Mage = 34.46, SDage = 4.16). On admission, 48% of women reported clinically elevated depressive symptoms and 97.5% of women not reporting elevated depressive symptoms reported clinical elevations in at least one other form of distress. Upon discharge, all self-report distress symptoms were significantly reduced (all p-values <.001), but reliable and clinically significant change only occurred in a subgroup of women. There were no significant changes in indicators of impulsivity based on the EGNG.ConclusionsIn addition to, and often in the absence of, depressive symptoms, women attending an early parenting program experienced a wide range of psychological distress, including fatigue, insomnia, anxiety and stress. Different forms of distress improved in different magnitudes to the treatment provided. These findings highlight the need for a multi-dimensional approach in the assessment and treatment of postpartum distress.

Early Parenting Intervention and Adverse Family Environments Affect Neural Function in Middle Childhood

BackgroundGrowing work points to the negative impact of early adverse experiences on the developing brain. An outstanding question concerns the extent to which early intervention can normalize trajectories of brain development in at-risk children. We tested this within the context of a randomized clinical trial of an early parenting program, the Attachment and Biobehavioral Catch-up (ABC), delivered to parents and infants monitored for maltreatment by Child Protective Services. MethodsFamilies participated in the randomized clinical trial when children were 2.5 years of age or younger. Parenting and home adversity was measured at baseline. Children were followed longitudinally, and resting brain activity was measured electrophysiologically (n = 106) when children reached 8 years of age. Spectral power was quantified and compared across children assigned to the experimental intervention (ABC), a control intervention, and a low-risk comparison group (n = 76) recruited at the follow-up assessment. ResultsHigher early home adversity was associated with electrophysiological profiles indicative of cortical delays/immaturity in middle childhood, based on relatively greater power in lower frequency bands (theta, 4–6 Hz, and low alpha, 6–9 Hz) and lower power in a higher frequency band (high alpha, 9–12 Hz). Children assigned to ABC showed relatively greater high-frequency power (beta, 12–20 Hz) than children assigned to the control intervention. Beta power in the ABC did not differ from that of the low-risk comparison group. ConclusionsMaltreatment risk and home adversity can affect indicators of middle childhood brain maturation. Early parenting programs can support more normative patterns of neural function during middle childhood.

Measuring postnatal demoralisation: adaptation of the Demoralisation Scale-II (DS-II) for postnatal use

ABSTRACTObjective: To examine the psychometric properties of the Demoralisation Scale II (DS-II) and adapt it for use with women in the postnatal period.Background: Demoralisation is a psychological state characterised by a sense of incompetence and feelings of helplessness and hopelessness in response to a stressful situation. The postnatal period is a life stage of many disruptions. Women may lose their confidence and become demoralised if feeling unprepared for the tasks of motherhood. The DS-II is a 16-item scale developed among cancer patients, but with content that is also relevant postnatally, including items on sense of failure, helplessness, hopelessness, isolation, entrapment and loss of purpose.Methods: Rasch analysis was used to investigate the psychometric properties of the DS-II and refine the scale for postnatal use.Results: Participants were 209 women admitted with their babies to a residential early parenting programme. A 14-item revised scale was derived, the Postnatal DS-II, showing good psychometric properties, discriminant validity and sensitivity to change, and being well targeted to the sample.Conclusion: The Postnatal DS-II could have utility as an assessment tool, helping clinicians to understand better women’s postnatal experiences, assess the effectiveness of interventions and communicate with women in a meaningful and non-stigmatising way.

Related but different: distinguishing postpartum depression and fatigue among women seeking help for unsettled infant behaviours

BackgroundA growing body of evidence in relatively healthy populations suggests that postpartum depression and fatigue are likely distinct but related experiences. However, differentiating depression and fatigue in clinical settings remains a challenge. This study aimed to assess if depression and fatigue are distinct constructs in women with relatively high fatigue and psychological distress symptoms attending a residential program that assists with unsettled infant behaviour.Methods167 women (age: M = 34.26, SD = 4.23) attending a private residential early parenting program completed the Depression Anxiety Stress Scale (DASS21-D), Fatigue Severity Scale (FSS) and self-report sleep variables before program commencement. Confirmatory Factor Analysis examined the associations between depression and fatigue latent factors.ResultsA two-factor model of separate but related depression and fatigue constructs provided a significantly better fit to the data than a one-factor model of combined depression and fatigue (p < .001). In the two-factor model, the depression and fatigue latent factors were moderately correlated (.41). Further predictive utility of this two-factor model was demonstrated as both depression and fatigue factors were independently predicted by worse self-reported sleep efficiency.ConclusionsThis study provides empirical evidence that for women attending a clinical service with relatively high fatigue and psychological distress, postpartum depression and fatigue remain separate but related experiences. These findings suggest that in women seeking clinical support in the postpartum period, both depression and fatigue need to be carefully assessed to ensure accurate diagnoses, and (b) whilst depression intervention may improve fatigue, targeted fatigue intervention may also be warranted.

Mothers’ perceptions of primary health-care providers: thematic analysis of responses to open-ended survey questions

General practitioners and maternal, child and family health nurses have a central role in postpartum primary health care for women and their infants. Positive client-provider relationships are particularly important for women experiencing mental health problems or unsettled infant behaviour. However, little is known about their experiences of postnatal primary health care. The study aimed to describe views of postnatal primary health care among women completing a residential early parenting programme and to identify potential strategies to enhance provider-patient interactions. Participants (n=138) were women admitted with their infants to a private or a public early parenting service in Melbourne, Australia. Women completed a detailed self-report survey, including open-ended questions about experiences of primary health-care services, and a structured psychiatric interview to diagnose anxiety and depression. Survey responses were analysed thematically. Womens' experiences of primary health care were influenced by their perceptions of provider competence and the quality of interactions. While similar positive characteristics of doctor and nurse care were valued, medical and nursing practices were judged in different ways. Women described GPs who listened, understood and were thorough as providing good care, and maternal, child and family health nurses were valued for providing support, advice and encouragement. Threats to therapeutic relationships with doctors included feeling rushed during consultations, believing that GPs were not mental health-care providers and the clinician not being 'good' with the infant; with nurses, problems included feeling judged or given advice that was inconsistent or lacked an evidence-base. Postpartum primary health care will be improved by unhurried consultations, empathic recognition, encouragement, evidence-informed guidance and absence of criticism.

A New Realistic Evaluation Analysis Method

In attempting to use a realistic evaluation approach to explore the role of Community Parents in early parenting programs in Toronto, a novel technique was developed to analyze the links between contexts (C), mechanisms (M) and outcomes (O) directly from experienced practitioner interviews. Rather than coding the interviews into themes in terms of context, intervention elements (mechanisms) and outcomes separately and which could be assembled into CMO configurations by the analyst, they were coded as linked dyads and triads directly from the practitioner narratives. Out of all of the linked codes entered, there were a maximum of three with the same combination, presenting challenges for typical qualitative data analysis. This article examines a novel technique that was developed in an attempt to expand this method beyond the circumstances described in the realistic evaluation literature to date. The bulk of the article focuses on the linked coding and analysis procedures, the challenges faced, and the original solutions that were developed to analyze the CMO relations and generate the mid-range theories necessary to move to the next stage of a realist evaluation approach. The features that distinguish this linked coding method from other methods (e.g. Qualitative Comparative Analysis), the major benefits and drawbacks, the utility of the approach within evaluation practice, and its application to realist synthesis and research are discussed.

Assisted conception is a risk factor for postnatal mood disturbance and early parenting difficulties

To investigate whether assisted conception is associated with an increased risk of admission to a residential early parenting program for treatment of maternal mood disorder or infant feeding or sleeping disorders in the postpartum year. Systematic audit of consecutive medical records. Masada Private Hospital Mother Baby Unit (MPHMBU), Melbourne, Australia. Medical records of all mother-infant dyads admitted to MPHMBU between July 2000 and August 2002. None. Modes of conception and delivery of index infant, maternal and infant age on admission, multiplicity of birth, infant birth weight, and Edinburgh Postnatal Depression Scale scores. A total of 745 records were audited, and mode of conception was recorded in 526 (70.6%) of records. Overall 6% (45/745) of the admitted infants had been conceived through assisted reproductive technologies compared with 1.52% in the general population (relative risk 4.0; 95% confidence interval, 3.0-5.4). Mothers who had conceived with assisted reproductive technologies were older and more likely to have had cesarean and multiple births than those who conceived spontaneously. Assisted conception appears to be associated with a significantly increased rate of early parenting difficulties. Women who experience assisted conception may require additional support before and after their babies are born.