Developmental Science and Preventive Interventions for Children at Environmental Risk

Maternal and Child Health Following 2 Home Visiting Interventions vs Control: Five-Year Follow-Up of a Randomized Clinical Trial

Importance

Home-based interventions targeting socially disadvantaged families may help to improve maternal and child health. Only a few studies have investigated how different staffing models affect early home visiting program outcomes.

Objective

To assess the effects of 2 staffing models of an early childhood intervention on mother and child outcomes.

Design, Setting, and Participants

The baseline assessment of this randomized trial was conducted between November 2006 and December 2009 in 15 municipalities in Germany. The follow-up assessment at offspring age 7 years was carried out by interviewers masked to treatment conditions from April 2015 to December 2017. Data analysis was performed from March to August 2023. Pregnant women with no previous live birth, low-income, and at least 1 additional psychosocial risk factor were eligible. A total of 1157 women were referred to the study by gynecologists, psychosocial counseling services, or employment agencies; 755 were randomized to treatment conditions (2 intervention groups and 2 control groups); and 525 completed the follow-up.

Interventions

Based on the Nurse-Family Partnership program, women assigned to the intervention groups received visits by either a midwife (midwife-only model) or by a team consisting of a social worker and a midwife (tandem model) until child age 2 years. Women assigned to control groups had access to the standard health and social services.

Main Outcomes and Measures

Average treatment effects (ATEs) on the following primary outcomes were assessed using adjusted regression models with inverse probability weighting: developmental disorders, child behavioral problems, adverse, neglectful and abusive parenting, maternal mental health, and life satisfaction.

Results

The mean (SD) age at follow-up was 29.6 (4.36) years for mothers and 7.55 (0.75) years for children; 272 (52.2%) of the children were female. Mothers in the tandem model reported fewer internalizing child behavioral problems compared to their control group (ATE, 2.98; 95% CI, -5.49 to -0.47; absolute reduction, 13.3 percentage points). Beneficial intervention effects were found in the midwife-only group on abusive parenting (ATE, -4.00; 95% CI, -6.82 to -1.18), parenting stress (ATE, -0.13; 95% CI, -0.20 to -0.06), and maternal mental health burden (ATE, -3.63; 95% CI, -6.03 to -1.22; absolute reduction, 6.6 percentage points in depressive symptoms), but not in the tandem group.

Conclusions and Relevance

Both staffing models produced positive intervention effects, with more effects seen in the midwife-only model. These insights can guide future early childhood intervention designs and may help improve health care for socially disadvantaged families.

Trial Registration

German Clinical Trials Register Identifier: DRKS00007554.

Optimizing Engagement: Factors Influencing Family Participation in a Positive Parenting Program among Vulnerable Households with Young Children

Objective: This paper addresses a critical gap in family research by examining the risk of families with young children receiving the Minimum Living Income (MLI) in rejecting targeted social interventions, also known as non-take-up (NTU). Method: We analyze recruting process data from the first invitation to participate in a social benefit including the "Growing Happily in the Family-2" program developed in Madrid, Spain, to their written consent prior to its implementation. Measurements of subjective factors reported as reasons for NTU and objective factors of sociodemographic characteristics and detailed household patterns of prior engagement with social services to study NTU response were based on official records and project data. Results: Descriptive findings reveal that jobless parents with high economic hardship, poorer physical and mental health, heavy demanding childbearing, and poor family-job conciliation aggravated by adverse life events profile the NTU response. Linear probability models predicting the rejection/acceptance decision showed that lack of previous contact with the social services, younger parental age, male, and nonimmigrant status significantly elevate NTU risk. Notably, although a longer stay in social services increases the probability of NTU, this does not occur among the most vulnerable families that have received more intensive support, challenging the idea of intervention fatigue. Conclusions: These findings have implications for the design of policies and practices to support children and family as subjects of rights, underlining the need for preventive and capacity-building strategies that address specific barriers to program uptake. Overall, the study highlights innovation areas that lie in the interception of social and employment benefits to improve the reach of the intended population and the positive impact of parenting interventions aimed at supporting vulnerable families.

Introducing Parenting Support in Primary Care: Professionals’ Perspectives on the Implementation of a Positive Parenting Program

While positive parenting programs are an initiative aligned with the Family-Centered Care model and the Council of Europe’s Recommendation on Positive Parenting, implementation in healthcare centers remains a challenge. The aims of this study were to (1) investigate how the hybrid version (online course plus face-to-face activities) of the program “Gain Health & Wellbeing From 0 to 3” was implemented in Spain from professionals’ perspective, and (2) explore the perceived impact of this hybrid version of the program on the implementers’ professional development. We used a qualitative mixed-methods design that included focus groups and surveys. Fifty professionals from 17 centers completed the survey on professional development. Thirty-one of these also participated in the focus groups to address the first aim. The key themes identified from the focus group were professional training, parent recruitment, program features, organizational issues, parental responses, and program sustainability. Survey results related to positive professional impact fit nicely with subthemes concerning collaboration with parents, parental needs, center coordination, and future expectations. The perceived relevance of the parenting program and its positive impact on the implementers’ professional development were potential predictors for the adoption and sustainability of the program in the public health system.

mHealth developmental screening for preschool children in low-income communities

Children are often only identified with a developmental delay when they enter primary school due to developmental delays hindering academic progress. Detection of at-risk children in low-income communities is typically unavailable due to several challenges. This study validated an mHealth-based developmental screening tool as a potential time- and cost-effective way of delivering services for preschool children. This cross-sectional within-subject study screened 276 preschool children from low-income communities using the mHealth Parents' Evaluation of Developmental Status (PEDS) tools. The mHealth PEDS tools' performance was then evaluated by comparing caregiver concerns according to the PEDS tools with results obtained using a reference standard assessment tool, the Vineland-3. The mHealth PEDS tools identified 237 (85.9%) of children at risk of developmental delay compared to 80.1% (n = 221) of children identified with a developmental delay using the Vineland-3. Sensitivity of the PEDS tools was high (92.6%) with low specificity (22.5%) using US standardised criteria. Literacy skills were found to be most delayed, according to the PEDS: DM (89.3%; n = 142) and Vineland-3 (87.1%; n = 134). Low specificity of the prescribed criteria may require the implementation of adapted referral criteria within low socio-economic status (SES) settings. The mHealth PEDS tools may still be valuable for preschool developmental surveillance of children within low SES settings. It is recommended, however, that children who are identified with a developmental concern undergo a second screen to reduce false positives.

Developmental Risks in Vulnerable Children from a Low-Income South African Community

OBJECTIVE

To describe the developmental risks, and its influence, in young children from a low-income South African community.

METHOD

An exploratory, cross-sectional research study design was employed. Developmental screening was conducted during home visits with 126 caregivers and children between 0 and 42 months of age from a low-income South African community. Children who failed the rescreen were referred for diagnostic assessment. A binomial logistic regression was used to determine the effect of developmental risks on developmental outcomes.

RESULTS

Seventy-three percent of children screened were identified with a possible developmental delay (n = 59) according to caregiver-report using the PEDS tools. The regression model was statistically significant (χ² (3) = 34.902, p < 0.001) with exposure to multiple languages (p < 0.05; odds ratio 3.810, CI 1.2-12.4) most indicative of potential developmental delay. Older children (19-42 months) were also more at risk of developmental delay (p < 0.001) than younger children (0-18 months).

CONCLUSIONS FOR PRACTICE

Healthcare professionals serving these vulnerable populations should create awareness amongst caregivers about the effect of developmental risks, in particularly multiple language exposure, on development.

Applying the Developmental Systems Approach to Inclusive Community-Based Early Intervention Programs: Process and Practice

A developmentally oriented framework is presented designed to establish or enhance the quality of inclusive community-based early intervention systems. This conceptually and empirically integrated developmental approach supports a comprehensive family-centered model. Outlined is a process that coordinates children's goals with family priorities, identifies developmental pathways most likely to influence those goals, guides the selection of objectives and intervention activities, and provides an approach for evaluation and problem solving. Principles of relationships, comprehensiveness, and continuity are central to this framework and address the general problem of "what to implement" in inclusive community-based early childhood programs.

Feeding and developmental outcomes of infants in a South African community

BACKGROUND

Prevalent environmental risk factors place infants in lower-middle-income countries (LMICs) at an increased risk for feeding and developmental difficulties.

AIM

This study aimed to determine the relationship between feeding and developmental outcomes in infants, as early feeding difficulties may have a cascading effect on developmental outcomes and vice versa.

METHODS

Data on 144 infants' feeding and development [mean age (standard deviation) = 8.8 months (2.2)] from a primary health care clinic in Gauteng, South Africa were retrospectively analysed.

RESULTS

Early introduction of cup feeding was found to be a predictor of possible expressive language and articulation difficulties. Gagging, spitting, or vomiting, pocketing, the use of force feeding, and poor sucking and chewing abilities were significantly associated with behavioural and social-emotional difficulties. Breastfeeding was found to be a protective factor for language development. The results emphasise the importance of primary prevention and early identification of risks in late infancy in LMIC.

Service and Learning at a Residential Parenting Program for Incarcerated Mothers: Speech-Language Pathology Student Outcomes and Maternal Perspectives

Purpose

This article reports preliminary outcomes from a service-learning (SL) experience for graduate students in the Speech-Language Pathology program with incarcerated mothers who reside with their infants at a residential parenting program. We present an ecological model to serve as a framework for interpreting the impact of the experience on student learning and maternal perceptions.

Method

Graduate speech-language pathology students (total n = 30) participated in an SL project, called the Partnership for Healthy Parenting . With faculty guidance, students implemented parent education and child development workshops designed to foster secure attachment relationships, enhance the quality of mother–child interactions, and promote communication and language development. Students completed self-report scales measuring civic attitudes and self-efficacy before participating; they also provided written reflections about their experience that were analyzed qualitatively. Mothers completed voluntary feedback surveys after each workshop.

Results

Student reflections revealed a variety of perceived positive learning outcomes related to personal attitudes and beliefs about their role as a clinician, family-centered practices in early intervention, and knowledge about the population of interest. Feedback surveys administered to mothers who attended the workshops indicated satisfaction relating to the value of the services provided.

Conclusions

SL programs may benefit students, faculty, communities, higher education institutions, and the relationships among all these stakeholders. Results, limitations, and implications for strengthening university–community collaborations in the field of communication disorders are discussed.

Perceptions of disability, environmental risk factors and available services among local leaders and parents of young children with disabilities in West Timor, Indonesia

Purpose: As an underdeveloped region of Indonesia, West Timor faces a significant challenge of childhood disability compounded by environmental risk factors such as poverty, discrimination and stigma, and limited access to basic services. However, very little is currently known about how this important social issue is viewed from the perspective of parents and local leaders, who play an influential role in local society. This research aimed to explore the views of these groups, towards childhood disability, within an environmental risk context. Method: Data were collected via semi-structured interviews and photovoice with 23 parents and 15 local leaders such as a midwife, priest, headmaster and staff from international and local non-government organisations. Results: The results of the study suggest that local culture, including religion has a strong influence on the perceptions of disability and environmental risk factors, while available services are seen by parents as being inaccessible. Conclusions: Implications of the results are presented together with multi-sectoral recommendations for best supporting parents raising children with disabilities in rural areas in low-income jurisdictions such as West Timor. Implications for Rehabilitation Grass-root healthcare providers, such as community health centres in Indonesia should work with community leaders to improve health literacy and awareness on disability Initiatives like inclusive village might eliminate barriers to services such as stigma and distance to health centres Decision-makers should aim to empower religious and cultural figures to provide social support for parents of children with disabilities.

Early detection of communication delays with the PEDS tools in at-risk South African infants

Background

Prevalence of communication delays or disorders is increasing, possibly because of various environmental risk factors. Selection and implementation of effective screening tools are important to detect at-risk infants as early as possible. This study aimed to evaluate the accuracy of the Parents’ Evaluation of Developmental Status (PEDS), PEDS-Developmental Milestones and PEDS tools to detect communication delays in infants (6–12 months) in a South African primary healthcare context.

Method

A comparative study design evaluated the accuracy of the PEDS tools to detect communication delays, using an internationally accepted diagnostic assessment tool, the Rossetti Infant-Toddler Language Scale (RITLS). A convenience sample of 201 infants was selected at primary healthcare clinics.

Results

Expressive and receptive language sensitivity scores were low across all three screens (ranging between 14% and 44%). The PEDS tools had high sensitivity (71%) and specificity (73%) ratings for the receptive and expressive language and socio-emotional domain in combination.

Conclusion

In the sample population, the PEDS tools did not accurately detect receptive and expressive language delays; however, communication delays in general were identified. Future research determining accuracy of the PEDS, PEDS-Developmental Milestones and PEDS tools for children aged 2–5 years in detecting communication delays should be prioritised.

Merging Policy Initiatives and Developmental Perspectives in Early Intervention

The provision of early intervention services for vulnerable children and their families is now both accepted and expected by the international community. This article considers the importance of a developmental perspective as an essential guide to early intervention service systems. Emphasized in this framework are three critical features: relationship formation, the continuity of interventions, and the comprehensiveness of interventions. Guidance to early intervention systems design with respect to structural and values principles is also discussed. Future advances in early intervention may well depend upon the merging of these perspectives to create policy initiatives to enhance early intervention systems.

Language Problems Among Abused and Neglected Children: A Meta-Analytic Review

Research data show that exposure to abuse and neglect has detrimental effects on a child's language development. In this meta-analysis, we analyze studies (k = 23), to compare the language skills (receptive language, expressive language, pragmatics) of children who have experienced abuse and/or neglect with the language skills of children who have not experienced abuse and/or neglect and to examine whether age or type of maltreatment moderate the relationship between maltreatment and language skills. Results confirm that the language skills of children who have experienced abuse and/or neglect are delayed when compared to children who have not experienced abuse and/or neglect. Compared to older children, young children seem particularly vulnerable to abuse and neglect. No significant differences were demonstrated concerning the type of maltreatment suffered by the child. These findings support the necessity of early detection of language problems in abused and neglected children as well as early intervention in order to implement interventions that will positively stimulate their development.

Risks associated with communication delays in infants from underserved South African communities

Background

For optimal development young children need warm, responsive, enriched and communicative environments for learning social, language, and other skills. Infants and toddlers exposed to psychosocial risk lack enriched environments and may present with communication delays.

Aim

To investigate the relationship between psychosocial risks and communication delays in infants from underserved communities in South Africa.

Setting

Primary healthcare facilities in Tshwane district, South Africa.

Methods

A parent interview and Rossetti Infant Toddler Language Scales were used to collect data from caregivers of 201 infants aged 6–12 months, selected through convenience sampling. Associations between communication delays and risks were determined (Chi-square and Fisher's exact tests). A log-linear model analysis was used to model the simultaneous effect of significant risks on the probability of having communication delays.

Results

Communication delays were present in 13% of infants. Infants with two or more siblings, born from mothers aged 18–29 years who own their house, had a 39% chance of presenting with communication delays.

Conclusion

Developmental screening and early intervention is important in primary healthcare contexts in South Africa, as a clear relationship has been established between three risk factors and communication delays in infants.

Contexte

Risques associés à des retards de communication verbale chez les nourrissons des communautés sud-africaines non desservies.

Pour s'épanouir complètement les jeunes enfants ont besoin d'un environnement chaud, réceptif, enrichi et communicatif pour apprendre le langage social et d'autres compétences. Les nourrissons et les tout-petits exposés à des risques psychosociaux souffrent d'un manque d'environnements enrichissants et pourraient souffrir de retards de communication verbale.

Objectif

Pour étudier la relation entre les risques psychosociaux et les retards de communication verbale chez les nourrissons des communautés non desservies en Afrique du Sud.

Lieu

Services de soins primaires dans le district de Tshwane, en Afrique du Sud.

Méthodes

Une entrevue avec les parents et l'Echelle de Compétence linguistique pour les Nourrissons de Rossetti ont été utilisés pour rassembler les données de 201 nourrissons de 6 à 12 mois provenant de leurs gardiens, sélectionnés au moyen d'échantillonnages de proximité. On a remarqué un lien entre les retards et les risques de communication verbale (tests Chi carré et de Fisher). On a utilisé un modèle d'analyse log-linéaire pour modéliser l'effet simultané des risques importants sur la probabilité d'avoir des retards de communication verbale.

Résultats

On a trouvé des retards de communication verbale chez 13% des nourrissons. Les nourrissons qui vivent avec deux frères ou sœurs ou plus, nés de mères âgées de 18 à 29 ans qui ont leur propre maison, avaient 39% plus de chance d'avoir des retards de communication verbale.