The Parent–Infant Interaction Observation Scale: reliability and validity of a screening tool

Video feedback for young babies and maternal perinatal mental illness: intervention adaptation, feasibility and acceptability

AIMS/BACKGROUND

We aimed to adapt, pilot and explore experiences of receiving and delivering the video feedback intervention for positive parenting (VIPP) for 2 to 6 month old babies, mothers experiencing moderate to severe perinatal mental health difficulties and perinatal mental health clinicians.

DESIGN/METHODS

The VIPP intervention was adapted to include developmentally appropriate activities and developmental psychoeducation for 2 to 6 month olds, alongside psychoeducation on emotion regulation, and then piloted in 14 mothers experiencing moderate to severe perinatal mental health difficulties (registration ISRCTN64237883). Observational and self-reported pre-post outcome data on parenting and parent-infant mental health was collected, and post-intervention qualitative interviews were conducted with participating mothers and clinicians.

RESULTS

Consent (67%), intervention completion (79%) and follow-up rates (93%) were high. Effect sizes on pre-post outcome measures indicated large improvements in parenting confidence and perceptions of the parent-infant relationship, and a medium-size improvement in maternal sensitivity. In qualitative interviews, clinicians and mothers described how mothers' initial anxieties about being filmed were allayed through receiving positive and strengths-focussed feedback, boosting their self-confidence, and that the video feedback facilitated identification of young babies' subtle behavioural cues and moments of mother-infant connection. Streamlining the information provided on maternal emotion regulation, and allowing increased use of clinical judgement to tailor intervention delivery, were suggested to optimise intervention feasibility and acceptability.

CONCLUSION

It is feasible and acceptable to implement VIPP with very young babies and their mothers experiencing perinatal mental health difficulties. A fully powered randomised controlled trial is required to establish intervention efficacy.

Testing reliability and validity of practitioner-rated parental sensitivity: A novel tool for practice

Improving parental sensitivity is an important objective of interventions to support families. This study examined reliability and validity of parental sensitivity ratings using a novel package of an e-learning tool and an interactive decision tree provided through a mobile application, called the OK! package. Independent raters assessed parental sensitivity using the OK! package (N = 11 raters) and the NICHD Parental Sensitivity rating scales (N = 22 raters) on the basis of videotaped mother-child interactions at 10- or 12-months-old (N = 294) and at 24-months-old (N = 204) from the Dutch longitudinal cohort study Generation2 . Mothers reported on children's externalizing and internalizing problems and social competence when children were 4 and 7 years old. Results showed excellent single interrater reliability for raters using the OK! package (mean ICC = .79), and strong evidence for convergent validity at 10- or 12-month-old (r = .57) and 24-month-old (r = .65). Prospective associations of neither parental sensitivity rated using the OK! package or the NICHD Parental Sensitivity rating scales with child developmental outcomes were statistically significant (p > .05), with overlapping 95% confidence intervals for both measures. The OK! package provides a promising direction for testing alternatives to current training and instruction modalities.

Feasibility and acceptability of using the Alarm Distress BaBy (ADBB) scale within universal health visiting practice in England: a mixed-methods study protocol

INTRODUCTION

The Alarm Distress BaBy (ADBB) scale developed by Guedeney and Fermanian in 2001, is a validated screening tool designed for use by healthcare practitioners to identify infant social withdrawal. This study will explore the acceptability and feasibility of the use of the full ADBB scale and a modified ADBB (m-ADBB) scale as part of routine health visiting visits in England.

METHODS AND ANALYSIS

A mixed methods sequential exploratory design will be used. Five health visitors will be trained in using the ADBB scale and 20 in the m-ADBB scale, from two National Health Service sites in England. Qualitative semi-structured interviews will be carried out with health visitors after they receive the training and again 2 months after using the scales in routine family health visits. Quantitative data will also be collected from the same participants for a range of items during the study period. The theoretical framework of Normalisation Process Theory will underpin the study, to provide in-depth explanations of the implementation process. Qualitative data will be analysed using thematic analysis. Quantitative data will be analysed using descriptive analysis.

ETHICS AND DISSEMINATION

Ethical approval was granted by the University of Oxford Departmental Research Ethics Committee. Dissemination of results will be via organisational websites, social media platforms, newsletters, professional networks, conferences and journal articles.

Instruments to measure interaction of mothers and newborns: A systematic review

Interactions between newborns and their parents/primary caregivers are characterized by asymmetric and dependent relationships. This systematic review mapped, identified, and described the psychometric parameters, categories, and items of instruments used to assess mother-newborn interaction. Seven electronic databases were accessed in this study. Furthermore, this research included neonatal interaction studies describing instruments' items, domains, and psychometric properties while excluding studies that focused on maternal interactions and lacked items for assessing newborns. Additionally, studies validated with older infants that did not have a newborn in the sample were used for test validation, which is a criterion used to decrease the risk of bias. Fourteen observational instruments from 1047 identified citations were included that addressed interactions using varying techniques, constructs, and settings. Particularly, we focused on observational settings that assessed interactions with communication-based constructs in the context of proximity or distance as influenced by physical, behavioral, or procedural barriers. These tools are also used to predict risk behaviors in a psychological context, mitigate feeding difficulties, and conduct neurobehavioral assessments of mother-newborn interactions. The elicited imitation was also an observational setting. This study found that the most described properties in the included citations were inter-rater reliability followed by criterion validity. However, only two instruments reported content, construct, and criterion validity, as well as a description of an internal consistency assessment and inter-rater reliability. Finally, the synthesis of the instruments reported in this study can guide clinicians and researchers in selecting the most appropriate one for their own application.

The context and development of the early relational health screen

Early relational experiences are key drivers for developing social emotional capacities, educational achievement, mental health, physical health, and overall wellbeing. The child health sectors are committed to promotion, prevention, and early intervention that optimize children's health and development, often employing evidence-based screening as foundational practices. Despite a variety of validated parent-infant observational assessment tools, few are practical within busy practice settings, acceptable with all racial and ethnic groups and ready for universal adoption. In response to this need, a team of clinicians, early childhood educators, researchers and infant mental health specialists collaborated to develop and test a novel video-based, dyadic relational screening and monitoring tool, the Early Relational Health Screen (ERHS). This tool uniquely focuses on the early parent-child relationship (6-24 months), within the construct of early relational health (ERH). Initial testing demonstrated that the ERHS is a valid, reliable, feasible, and useful screening and monitoring tool for clinical applications. The ERHS was further developed within a population-based, prospective research study and adapted with brief video feedback for parents in the home visiting and child health sectors. The ERHS and its adaptations appear to advance ERH and equity within the transforming child health and public health care systems of today.

Implementing the Maternal Postnatal Attachment Scale (MPAS) in universal services: Qualitative interviews with health visitors

Background: A secure parent-infant relationship lays the foundations for children's development, however there are currently no measurement tools recommended for clinical practice. We evaluate the clinical utility of a structured assessment of the parent-infant relationship (the Maternal Postnatal Attachment Scale, MPAS) in a deprived, multi-ethnic urban community in England. This paper answers the question: what are health visitors' views on the parent-infant relationship, and experiences of piloting the MPAS? It explores the barriers and facilitators to implementation, and complements the paper on psychometric properties and representativeness reported in Dunn et al (submitted).   Methods: Semi-structured interviews were conducted with 11 health visitors and data were analysed using thematic analysis.  Results: Health visitors saw identification and support of the parent-infant relationship as an important part of their role, and reported benefits of the MPAS, including opening conversation, and identifying and reporting concerns. Challenges included timing and workload, the appropriateness of language, perceived intrusiveness and understanding of the questions, and the length of the tool. Suggestions for improvements to the tool were put forwards.  Conclusions: The experiences, benefits and challenges identified help to explain results in Dunn et al, and the wide-ranging challenges identified would hinder assessment of the parent-infant relationship in routine practice. Further work with health professionals and parents has been undertaken to co-produce an acceptable, feasible and reliable tool for clinical practice.

Implementing the Maternal Postnatal Attachment Scale (MPAS) in universal services: Qualitative interviews with health visitors

Background: A secure parent-infant relationship lays the foundations for children's development, however there are currently no measurement tools recommended for clinical practice. We evaluated the clinical utility of a structured assessment of the parent-infant relationship (the Maternal Postnatal Attachment Scale, MPAS) in a deprived, multi-ethnic urban community in England. This paper answers the question: what are health visitors' views on the parent-infant relationship, and experiences of piloting the MPAS? It explores the barriers and facilitators to implementation, and complements the paper on psychometric properties and representativeness reported in Dunn et al (2022).   Methods: Semi-structured interviews were conducted with 11 health visitors and data were analysed using thematic analysis.  Results: Health visitors saw identification and support of the parent-infant relationship as an important part of their role, and reported benefits of the MPAS, including opening conversation and identifying and reporting concerns. Challenges included timing and workload, the appropriateness of language, perceived intrusiveness and understanding of the questions, and the length of the tool. Suggestions for improvements to the tool were put forward.  Conclusions: The experiences, benefits and challenges identified help to explain results in Dunn et al, and the wide-ranging challenges identified would hinder assessment of the parent-infant relationship in routine practice. Further work with health professionals and parents has been undertaken to co-produce an acceptable, feasible and reliable tool for clinical practice.

Using an observation tool (Parent-Infant Interaction Observation Scale) to assess parent-infant interaction in the first 2 weeks of life: A feasibility study

BACKGROUND

Emotional maltreatment (EM) has profound effects on the developing brain but is hardest to identify in infancy. Early observations of parent-infant interactions may provide opportunities to identify babies at risk of neglect and EM. This prospective study tests, in the first fortnight of life, the feasibility of using an observation tool previously validated for use at 2 to 7 months of age.

METHODS

Women awaiting induction of labour were recruited in South Wales in July 2016. Women consented to being contacted postnatally and video recordings of mother-infant interaction at two home visits between 7 and 10 days (T1) and 8-12 weeks old (T2). Demographic details, information on the pregnancy, delivery, and infant condition were obtained at T1. A questionnaire was completed at T2 to capture any significant events affecting the parent-infant relationship. The Parent-Infant Interaction Observation Scale (PIIOS) was used to score the videos. Exclusion criteria included admission to neonatal unit.

RESULTS

Recruitment of suitable participants and full research data completion were feasible. Of 60 women who consented to be contacted post-delivery, 30 women (31 infants) participated at T1 and T2. Three babies were excluded. Women accepted being observed in their homes with their babies, with no attrition between T1 and T2. Using the PIIOS 10 of the 13 items could be scored with an awake infant under 2 weeks.

CONCLUSION

These encouraging findings can inform exploration of an observation tool to identify high-risk dyads for targeted support. A trial and test of a modified scoring system (based on the PIIOS) should be developed for a future study using a larger sample size. Further research should assess if this approach reliably produces a consistent valid screening tool to assess parental sensitive responsiveness and resilience promoting behaviours at this early stage of life.

Determinants of parent-delivered therapy interventions in children with cerebral palsy: A qualitative synthesis and checklist

INTRODUCTION

Parent-delivered therapy interventions for children with cerebral palsy can help achieve a sufficient therapy dose, improve parental mental well-being, and facilitate parent-child relationships creating a more relaxed familial environment. However, parent-delivered interventions may also lead to increased parental stress, guilt if the therapy is not delivered, and time constraints. The primary aim of this review was to gain a deeper understanding of the determinants of effective parent-delivered therapy interventions.

METHOD

Searches were conducted in the following databases: Medline, PubMed, Scopus, Embase, CINAHL, and Cochrane. Studies had to meet the following inclusion criteria: descriptions of parent/health care professional/child experiences of parent-delivered therapy interventions for children and young people age 0-18 years with cerebral palsy, published in the English language between January 1989 and May 2017, with qualitative or mixed methods research design. The articles were critically appraised, then synthesized using a meta-ethnographic approach.

RESULTS

A literature search identified 17 articles, which met the inclusion criteria. Three main themes were identified: (a) building trusting relationships, (b) enabling the parents to cope, and (c) for parents and health care professionals to see the intervention as a priority. Further synthesis presented three concepts identifying the important aspects of the interventions: empowerment, motivation, and relationships.

CONCLUSIONS

The themes and concepts emerging from this qualitative synthesis can be addressed by specific points of action to support parent-delivered therapy interventions. We have summarized these in a checklist for use by intervention developers, health care professionals, and parents.

Preparing parents for parenthood: protocol for a randomized controlled trial of a preventative parenting intervention for expectant parents

Background

Becoming the parent of a new baby comes with a range of challenges including difficulties with emotional adjustment, couple relationship issues and difficulty managing common infant behaviors, such as crying and sleep problems. This time can be especially challenging for couples who experience a range of risk factors. Previous parenting interventions for parents of babies have shown mixed results. This protocol paper describes a randomized controlled trial of a group-based parenting intervention for high-risk parents expecting their first baby.

Methods/design

Participants will be randomized to either Group Baby Triple P or Care as Usual (CAU). Group Baby Triple P involves 4 × 2 h group sessions delivered during pregnancy and 4 individual telephone sessions of 30 min each in the early postnatal period. Outcomes will be assessed via parent self-report questionnaire, home observations and a baby diary 10 weeks and 6 months post-birth. Primary outcomes will be parental confidence and perceived competence. Secondary outcomes will include parental responsiveness and bonding with the baby, relationship happiness, life satisfaction, depression, anxiety and stress, and infant crying and sleep. Analyses will involve a series of rANOVA and rMANOVAs, t-tests and a multilevel modeling approach.

Discussion

A brief summary, strengths and potential implications are discussed.

Trial registration

Australian New Zealand Clinical Trials Registry: ANZCTR 12613000948796. Registered 27 August, 2013.

Psychometrics and validation of a brief rating measure of parent-infant interaction

This study investigated the psychometrics of a recently developed global rating measure of videotaped parent-infant interaction, the Manchester Assessment of Caregiver–Infant Interaction (MACI), in a normative sample. Inter-rater reliability, stability over time, and convergent and discriminant validity were tested. Six-minute play interactions were blind-rated by trained coders in 147 healthy mother-infant dyads at 3–10 months postpartum using the MACI; 51% were re-assessed 4 or 7 months later. Infant cognitive functioning, language and temperament, parent-reported infant warmth and invasion, parental mood, and the parent’s own recalled experiences of being parented were measured. We report the internal psychometrics of the MACI, evidence of stability as predicted, and inter-rater reliability. MACI caregiver sensitive responsiveness showed convergent validity with parental state of mind (mood at 3–4 months; report of own childhood care and overprotection), while MACI infant affect (but not the caregiver scales) was associated with parent-rated infant warmth. All MACI scales showed discriminant validity with concurrent cognitive and language developmental status, and most temperament dimensions. In conclusion, the MACI demonstrates utility, reliability and preliminary validity data in a normative sample, which complements previous work using the MACI. Follow-up is needed to test predictive validity. The findings inform further improvements to the tool, and may guide those looking for a relatively brief way to examine the global qualities of parent, infant and dyadic interaction.