Working with Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD): A case study

The impact of trauma and how to intervene: a narrative review of psychotraumatology over the past 15 years

To mark 15 years of the European Journal of Psychotraumatology, editors reviewed the past 15-year years of research on trauma exposure and its consequences, as well as developments in (early) psychological, pharmacological and complementary interventions. In all sections of this paper, we provide perspectives on sex/gender aspects, life course trends, and cross-cultural/global and systemic societal contexts. Globally, the majority of people experience stressful events that may be characterized as traumatic. However, definitions of what is traumatic are not necessarily straightforward or universal. Traumatic events may have a wide range of transdiagnostic mental and physical health consequences, not limited to posttraumatic stress disorder (PTSD). Research on genetic, molecular, and neurobiological influences show promise for further understanding underlying risk and resilience for trauma-related consequences. Symptom presentation, prevalence, and course, in response to traumatic experiences, differ depending on individuals' age and developmental phase, sex/gender, sociocultural and environmental contexts, and systemic socio-political forces. Early interventions have the potential to prevent acute posttraumatic stress reactions from escalating to a PTSD diagnosis whether delivered in the golden hours or weeks after trauma. However, research on prevention is still scarce compared to treatment research where several evidence-based psychological, pharmacological and complementary/ integrative interventions exist, and novel forms of delivery have become available. Here, we focus on how best to address the range of negative health outcomes following trauma, how to serve individuals across the age spectrum, including the very young and old, and include considerations of sex/gender, ethnicity, and culture in diverse contexts, beyond Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We conclude with providing directions for future research aimed at improving the well-being of all people impacted by trauma around the world. The 15 years EJPT webinar provides a 90-minute summary of this paper and can be downloaded here [http://bit.ly/4jdtx6k].

Virtual Delivery of Parent Coaching Interventions in Early Childhood Mental Health: A Scoping Review

Parent-coaching interventions positively impact child development. Virtual delivery of such interventions is supported by literature reviews and a practice guideline, however, none of these focused on children under age six. A scoping review of virtually-delivered parent-coaching interventions for disruptive behaviour, anxiety, and parent-child relationship concerns in children under age six was conducted between Dec. 15, 2020 and April 22, 2021. Iterative searches of the databases PubMed, CINAHL, and PsycINFO were complemented by reference list searches and clinician expert review (N = 1146). After relevance screening and duplicate removal, collaboratively-developed inclusion criteria were applied to records, followed by data extraction from eligible articles (n = 30). Most literature documented behavioural-based interventions targeting disruptive behaviour which were delivered individually, by therapists, to White, non-Hispanic parents. Evidence supports feasibility and efficacy of virtually-delivered parent-coaching interventions to improve child disruptive behaviour (strong), anxiety (moderate), and parent-child relationship (weak). There is a significant gap in the literature regarding the virtual delivery of attachment-based parent-coaching interventions. In sum, virtual parent coaching can be an efficacious approach for children under age six, particularly for behavioural challenges.

Effectiveness of the positive discipline program applied to parents of preschool children: A randomized-controlled trial

BACKGROUND

Although the Positive Discipline Program is used extensively internationally, there are very few evidence-based studies on it. This study aims to examine the experimental results of the Positive Discipline Program.

METHOD

This randomized-controlled study had the following types of groups: intervention, active control, and non-contact control. The study sample consisted of 72 parents with children aged between 3 and 6 years. The intervention group participated in an eight-session online Positive Discipline Program, the active control group participated in an eight-session online free interaction program, and the non-contact control group received no intervention.

RESULTS

Parents in the intervention group demonstrated an increase in cooperation with their children after the training and during the follow-up period. In the intervention group, parents' oppressive and authoritarian attitudes decreased after the training and during the follow-up period; spouses' democratic attitudes increased after the training and their overprotective attitudes decreased in the follow-up period. Parent-child communication and unhindered listening increased in the intervention and active control groups. The problem-solving skills of the intervention group increased after the training and during the follow-up period, and sensitivity increased in the follow-up period.

CONCLUSION

As one of the few experimental studies implementing the Positive Discipline Program, this study revealed the strengths of the program as well as culture-specific aspects that need to be improved. Further, this program was effective in improving parents' relationships with their children, attitudes, and problem-solving skills, and it provided evidence for the program's positive contributions to raising a child.

IMPLICATIONS FOR PRACTICE

The Positive Discipline Program can guide parents in solving the developmental and school-related problems of preschool children as well as school and adolescence children.

A Systematic Review of Infant Mental Health Prevention and Treatment Programs

Although many prevention and treatment programs exist for children and families, there have been no reviews specifically examining their impact on infant mental health at the program level. Therefore, the purpose of the current review was to a) systematically examine prevention and treatment programs targeting infant mental health outcomes (i.e., internalizing problems, externalizing problems, social-emotional development, trauma) or the parent-infant relationship/ attachment in children from pregnancy to 2 years; b) classify each program by level of empirical support; and c) highlight strengths and identify gaps in the existing literature to inform future mental health intervention science. From over 121,341 publications initially identified, 60 prevention and treatment programs met inclusion criteria for this review. Each program was reviewed for level of scientific evidence. Of the 60 programs reviewed, 29 (48.33%) were classified as promising, while only six (10.0%) were classified as effective. Lastly, only two programs (3.33%; Attachment and Biobehavioral Catch-Up and Video-feedback Intervention Parenting Program) were classified as evidence-based specific to infant mental health and/or parent-infant relationship/attachment outcomes. Implications related to disseminating evidence-based prevention/treatment programs are discussed.

The prenatal video-feedback intervention to promote positive parenting for expectant fathers (VIPP-PRE): Two case studies

Although parenting interventions including expectant fathers are scarce, they yield promising results. The Prenatal Video‐feedback Intervention to promote Positive Parenting (VIPP‐PRE) is a recently developed intervention, that is both manualized and personalized, aiming to enhance paternal sensitivity and involvement before the birth of the baby. Illustrating the intervention process, the current study presents two case studies of expectant fathers receiving VIPP‐PRE (clinical trial registration NL62696.058.17). The VIPP‐PRE program is described along with the individual dyads’ prenatal video fragments and feedback specific for each father‐fetus dyad. In addition, changes in paternal sensitivity and involvement levels are presented, as well as fathers’ and intervener's evaluation of the intervention. VIPP‐PRE promises to be a feasible short‐term and potentially effective parenting intervention for expectant fathers. Currently, a randomized controlled trial (RCT) is under review that systematically investigates the efficacy of the VIPP‐PRE. Here we aim to provide further information on the intervention process, as well as fathers’ and intervener's evaluations of this process, and the benefits of using ultrasound imaging in a parenting intervention.

Advocating the need for neuro-informed working with intercountry adoptees

BACKGROUND

Intercountry adoption is declining and many adoptees at any point of their life are in search of therapeutic services. Specialized care is scare and regular services seem to be missing the point. Regular therapeutic services do not cater to the specific needs of adoptees because they often forget to take the early adversity into account. Adoption specific therapeutic services are called for worldwide, this needs not be very difficult. Affective neurobiology, trauma and attachment research next to adoption studies have given practitioners many tools to design a sustainable therapeutical practice for both adoption aware assessment as well as adoption aware treatment.

OBJECTIVE

Advocating a neuro-informed approach to treatment when intercountry adoptees present developmental or other mental health problems. This approach is based on a combination of professional reflection as well as on theory and the idea is that it can be used broadly by clinicians, even when not specifically trained or focused on intercountry adoptions.

PARTICIPANTS AND SETTING

Theoretical insights are combined with clinical experience in De Adoptiepraktijk, a private, specialized mental health practice, making the argument for embracing a neuro informed approach in working with intercountry adoptees in the Netherlands.

METHODS

Theoretical evaluation, argumentation and personal reflection illustrated by a small case study. Results Overview of problems, models and methods to be used in clinical work with intercountry adoptees.

CONCLUSIONS

Proposition to use theoretical and practical insights from the neurosequential network, dyadic developmental psychotherapy, sensorimotor psychotherapy¹ and the polyvagal theory to help clinicians assess the problems adopted clients encounter and plan interventions accordingly.

The Preventive Child and Youth Healthcare Service in the Netherlands: The State of the Art and Challenges Ahead

The Netherlands has a unique system for promoting child and youth health, known as the preventive Child and Youth Healthcare service (CYH). The CYH makes an important contribution to the development and health of children and young people by offering (anticipatory) information, immunisation, and screening, identifying care needs and providing preventive support to children and their families from birth up to the age of 18 years. The CYH is offered free of charge and offers basic preventive care to all children and special preventive care to children who grow up in disadvantaged situations, such as children growing up in poverty or in a family where one of the members has a chronic health condition. Basic care is supported by 35 evidence-based guidelines and validated screening tools. Special care is supported by effective interventions. The impact of the CYH is high. It is estimated that every EUR 1 spent on the CYH provides EUR 11 back. Although the Dutch CYH is a solid public health system with a reach of up to 95% among young children, the access to this service could be further improved by paying more attention to health literacy, making special care available to all children in need and improving transmural and integrated care coordination. In addition, the generation of nationwide data could help to demonstrate the impact of the CYH and will direct and prioritise the necessary care. By continuously developing care on the basis of new (scientific) insights and (societal) issues, the CYH will continue to offer all children in the Netherlands the best preventive healthcare.

The Infant Health Study - Promoting mental health and healthy weight through sensitive parenting to infants with cognitive, emotional, and regulatory vulnerabilities: protocol for a stepped-wedge cluster-randomized trial and a process evaluation within municipality settings

Background

Child mental health problems are a major public health concern associated with poor mental and physical health later in development. The study evaluates a new community-based intervention to promote sensitive parenting and reduce enduring mental health problems and unhealthy weight among vulnerable infants aged 9-24 months.

Methods

We use a step-wedge cluster randomized controlled trial design conducted within a home visiting program offered by community health nurses to infant families in Denmark. Sixteen municipalities are randomly allocated to implement the intervention starting at three successive time points from May 1, 2022 to January 1, 2023. A total of 900-1000 families will be included. A standardized program, Psykisk Udvikling og Funktion (PUF), is used to identify infants with major problems of eating, sleep, emotional or behavioral regulation or developmental problems. The intervention builds on the Video-Feedback Intervention to Promote Positive Parenting (VIPP) program, adapted to the PUF-context and named the VIPP-PUF. Children will be followed up at ages 18 and 24 months. Primary outcome measure is the Strengths and Difficulties Questionnaire (SDQ) at child age 24 months. The other outcome measures include body mass index z-scores, the Ages and Stages Questionnaire Social-Emotional (ASQ:SE2); the Child Behavior Checklist (CBCL 1½ -5); Eating behavior Questionnaires; the Being a Mother-questionnaire (BaM13); the Parental Stress Scale (PSS); and the WHO-5 well-being index (WHO-5). Data on child and family factors are obtained from National registries and the Child Health Database.

Quantitative measures are applied to examine the effectiveness of the VIPP-PUF intervention and the implementation process. Qualitative measures include interviews with CHNs, parents and municipality stakeholders to explore factors that may influence the adherence and effectiveness of the intervention.

Discussion

The study examines a service-setting based intervention building on the promotion of sensitive parenting to vulnerable infants. We use a mixed methods approach to evaluate the intervention, taking into account the influences of COVID-19 pandemic running since March 2020. Overall, the study has potential to add to the knowledge on the possibilities of prevention within the municipality child health care to reduce the risk of mental health problems and unhealthy weight in early childhood.

Trial registration

www.ClinicalTrials.gov; IDNCT04601779; Protocol ID 95-110-21307. Registered 25 June 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12551-z.

Longitudinal Outcomes of Child Parent Psychotherapy: Response to Commentaries

In response to the commentaries provided by Chu et al. (2020), Harmon et al. (2020), and McMahon & Maxwell (2020) on our longitudinal follow-up of Child-Parent Psychotherapy (CPP) with mothers with depression and their children, we focus on two domains: accessibility and scalability of CPP and identifying empirically supported mechanisms of change in attachment intervention research. In considering the accessibility and scalability of CPP, we discuss issues related to attrition, length of intervention, and implementation with caregivers with depression. Our discussion of mechanisms of change in attachment interventions explores active comparison conditions, theorized mediators, intervention modalities, assessment methods, and longitudinal research designs. This conversation is intended to highlight important areas for future research in the field of attachment interventions, with the goal of informing clinical and systems-level policies and practices.

Delivering Clinically on Our Knowledge of Oxytocin and Sensory Stimulation: The Potential of Infant Carrying in Primary Prevention

Oxytocin (OT) is one of the most intensively researched neuropeptides during the three past decades. In benign social contexts, OT exerts a range of desirable socioemotional, stress-reducing, and immunoregulatory effects in mammals and humans and influences mammalian parenting. Consequentially, research in potential pharmacological applications of OT toward human social deficits/disorders and physical illness has increased substantially. Regrettably, the results from the administration of exogenous OT are still relatively inconclusive. Research in rodent maternal developmental programming has demonstrated the susceptibility of offspring endogenous OT systems to maternal somatosensory stimulation, with consequences for behavioral, epigenetic, cognitive, and neurological outcomes. A translation of this animal research into practically feasible human parenting recommendations has yet to happen, despite the significant prevention potential implied by the maternal developmental programming research. Extended physical contact with full-term healthy infants in the months following birth (infant carrying) might constitute the human equivalent of those specific rodent maternal behaviors, found to positively influence emerging OT systems. Findings from both OT and maternal programming research parallel those found for infants exposed to such extended parental physical contact, whether through skin-to-skin contact or infant carrying. Clinical support of parents to engage in extended physical contact represents a feasible intervention to create optimum conditions for the development of infant OT systems, with potential beneficial long-term health effects.

Does Postpartum Depression Affect Parental Embodied Mentalizing in Mothers With 4-Months old Infants?

Parental Embodied Mentalizing (PEM) regards parents' nonverbal capacity to understand the infant's bodily manifested mental states and adjust his or her own movements accordingly. Little is known about how mothers suffering from postpartum depression (PPD) mentalize the infant on an embodied level. The aims of the present study were to investigate whether mothers meeting criteria for a PPD diagnosis differ from non-clinical mothers in regard to their PEM capacities and whether the severity of depressive symptoms was associated with PEM in mothers meeting criteria for a PPD diagnosis compared to non-clinical mothers. 10-minute long lab-based face-to-face interactions were coded with the PEM coding scheme at 4-months postpartum in mother-infant dyads with mothers meeting criteria for a PPD diagnosis (n = 29) and non-clinical mothers (n = 51). Results showed that mothers with and without a PPD diagnosis differ in their capacity to mentalize on an embodied level, but only when controlling for scores on the Edinburgh Postnatal Depression Scale (EPDS). However, more depressive symptoms as measured with the EPDS was not in itself associated with lower PEM in either group. This finding may indicate the presence of a threshold effect, i.e. that maternal PEM may be affected only when a certain degree of severity and duration in depressive symptoms is beyond a certain threshold. The importance of the findings in regard to the assessment of depression as well as more clinical perspectives are discussed.

Working with Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD): A case study

Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD), based on attachment theory and social learning theory, is an intervention aimed at enhancing sensitivity and firm limit setting in parents, and reducing behavior problems in children. The VIPP-SD program has been tested in populations of vulnerable children and parents at risk in twelve randomized controlled trials, and shows significant effects on both positive parenting and child outcomes. Here, we present a case study of an adoptive mother and her two-and-a-half-year-old adopted daughter. During the VIPP-SD program, including one introduction visit and six intervention sessions with video feedback, the mother-child interaction revealed important changes in positive parenting and child outcomes. By describing the intervention process in some detail we hope to shed light on how the VIPP-SD program can be used by clinicians and practitioners who support families in need of parenting support.