The effect of family counselling on the mental health of 10-11-year-old children in low- and high-risk families: a longitudinal approach

Understanding Your Baby: protocol for a controlled parallel group study of a universal home-based educational program for first time parents

Background

Infant mental health represents a significant public health issue. The transition to parenthood provides optimal opportunities for supporting parenting competence. Especially parental mentalization, i.e. the caregiver’s ability to notice and interpret the child’s behavior in terms of mental states, is important in infancy where the caregiver-infant communication is based solely on the infant’s behavioral cues.

Methods

This study evaluates the efficacy of the intervention Understanding Your Baby (UYB) compared to Care As Usual (CAU) in 10 Danish municipalities. UYB aims at promoting parental competence in new parents by supporting them in noticing their infants’ behavioral cues and interpreting them in terms of mental states. Participants will be approximately 1,130 singletons and their parents. Inclusion criteria are first-time parents, minimum 18 years old, living in one of the 10 municipalities, and registered in the Danish Civil Registration Register (CPR). Around 230 health visitors deliver the UYB as part of their routine observation of infant social withdrawal in the Danish home visiting program. During an interaction between the health visitor and the infant, the health visitor articulates specific infant behaviors and helps the caregivers interpret these behaviors to mental states. The study is a controlled parallel group study with data obtained at four time points in two phases: First in the control group receiving the publicly available postnatal care (CAU), secondly in the intervention group after UYB implementation into the existing postnatal services. The primary outcome is maternal competence. Secondary measures include paternal competence, parental stress, parental mentalizing, and infant socioemotional development. Analysis will employ survey data and data from the health visitors’ register.

Discussion

Results will provide evidence regarding the efficacy of UYB in promoting parenting competences. If proved effective, the study will represent a notable advance to initiating the UYB intervention as part of a better infant mental health strategy in Denmark. Conversely, if UYB is inferior to CAU, this is also important knowledge in regard to promoting parenting competence and infant mental health in a general population.

Trial registrationhttps://ClinicalTrials.gov with ID no. NCT03991416. Registered at 19 June 2019—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03991416

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00924-3.

Effects of universally offered parenting interventions for parents with infants: a systematic review

OBJECTIVES

From a developmental perspective, infancy is a critical stage of life. Early childhood interventions aim to support caretakers, but the effects of universal interventions for parents with infants are unknown. The objective is to determine the effects of universal parenting interventions offered to parents with infants 0-12 months on measures of child development and parent-child relationship.

DESIGN

A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We extracted publications from 10 databases in June 2013, January 2015 and June 2016 and supplemented with grey and hand search. Risk of bias was assessed, and effect sizes were calculated.

PARTICIPANTS

Inclusion criteria are: (1) randomised controlled trials of structured, psychosocial interventions offered to a universal population of parents with infants 0-12 months old in western OECD countries, (2) interventions that include a minimum of 3 sessions with at least half of the sessions delivered postnatally and (3) programme outcomes reported for child development or parent-child relationship.

RESULTS

14 papers representing 7 studies are included. There were no statistically significant effects of the intervention for the majority of the primary outcomes across the studies.

CONCLUSIONS

The findings of this review are mixed. No clear conclusions can be drawn regarding the effects of universally offered parenting interventions on child development and parent-child relationship for this age group.

Dyads and triads of abuse, bereavement and separation: a survey in children attending a child and family centre

Objectives: To determine the frequency with which abuse, parental separation and bereavement occur on their own or together in children attending child psychiatry services and to assess the relationship between these traumas and attendance and outcome.

Method: A review of all case notes over a 12 month period (n = 435) was conducted and a proforma completed. Information was gathered on clinical presentation, rate of attendance, the presence of sexual abuse, non-sexual abuse including bullying, bereavement and parental separation and a measurement of outcome by subjective assessment was made.

Results: Fifty-nine per cent of the children had experienced at least one of the specified traumas; 13% had experienced two and 2.5% had experienced three. The children who had been abused or bereaved were more likely to require fairly long-term work; those who were adjusting to parental separation required less intervention over time. The children who had been sexually abused had, relatively, the poorest outcome in contrast to those adjusting to bereavement where 87% were considered to have made significant improvement.

Conclusions: Bereavement, abuse and parental separation are common in children referred to the child psychiatric services and these children often require long-term intervention. Increased resources will be required in order to continue to provide adequate intervention and treatment for these children.

[Early intervention and psycho-educational support: a review of the English language literature]

While research on early-intervention programs remains rare in France, there are numerous scientific publications in the English-language literature. This article attempts to describe the contribution of such programs in terms of children subsequent development and changes in their families. Twenty-six programs incorporating home intervention, care, social support and early-childhood education, have been conducted for more than a year within local and hospital populations selected through various scales of risk. The large majority of the programs have randomized trials. Intervention and early education applied essentially to families from deprived environment, families with premature or low-birth-weight infants, and families exhibiting psychosocial or psychiatric risks. Programs of relatively long-term and addressing to families' needs and well-being, initiated in the prenatal period, resulted in variable degrees of positive influences on children cognitive, behavioural and social development, and on parent-child relationships. The most remarkable results with the most prolonged effects concerned school attendance and school performance. Positive effects were also recorded in specific populations (adolescent mothers, mentally retarded mothers.). Nevertheless the efficacy of such programs remained limited and mainly dependent upon parents' motivation and involvement and concurrent family risk factors. Although evaluation of intervention programs regarding multiple risk factors remains difficult, qualitative analyses complementing the available statistical data appear necessary.

Childhood depressive symptoms predict psychiatric problems in young adults

OBJECTIVE

To evaluate the predictive value of childhood depressive symptoms for psychiatric symptoms, adaptive functioning, and self-performance in young adults.

METHOD

The study sample consisted of 111 young adults born during 1975-1976 in the Helsinki region. The young adults were assessed in childhood (10 to 11 years of age) using the Children's Depression Inventory (CDI) and at the age of 20 to 21 years using Achenbach's Young Adult Self Report (YASR), the Beck Depression Inventory (BDI), and the Wallston Self-Performance Survey.

RESULTS

Self-reported depressive symptoms in childhood predicted psychiatric symptoms (especially aggression), poor adaptive functioning, and low self-esteem in young adulthood.

CONCLUSIONS

Depressive symptoms in children should be addressed to prevent later psychiatric problems. The CDI may be a measure of nonspecific psychopathology rather than of pure depression--thus, it may be a good screening tool for child populations.

Effects of infant temperament and early intervention on the psychiatric symptoms of adolescents

OBJECTIVE

To evaluate effects of infant temperament traits and early home-based intervention on psychiatric symptoms in adolescence.

METHOD

The sample comprised 100 children born in 1975-1976. The families of 54 children received family counseling during the first 5 years of the child's life (10 times/year); 46 children served as a control group for counseling. At age 6 months the infants' temperament traits were evaluated by the Carey Infant Temperament Questionnaire filled out by the mother. At age 14 to 15 years the psychiatric symptoms of the adolescents were assessed by the Child Behavior Checklist and the Youth Self-Report.

RESULTS

A fussy/demanding temperament in infancy was found to predict psychiatric symptoms in adolescence. A family counseling program during infancy protected subjects from developing psychiatric symptoms in adolescence.

CONCLUSIONS

It may be possible to improve the psychosocial prognosis of children at temperamental risk by home-based intervention focused on parent-child interaction.

Long-term effects of an early home-based intervention

OBJECTIVE

To evaluate the long-term effects of an early home-based intervention on the quantity and quality of psychiatric symptoms in adolescents.

METHOD

The material consisted of 160 families with a baby born in 1975-1976. First, the families were classified with a weighted risk index into low- and high-risk families. Eighty families attended a 5-year-long family counseling program (10 times/year). The other half of the families served as a control group for the effects of counseling. The mental state of the adolescents was assessed at age 14 to 15 years by the Child Behavior Checklist and the Youth Self-Report.

RESULTS

The adolescents in the counseling families scored significantly fewer total symptoms on both the parent and the youth reports. The counseling reduced more effectively internalizing than externalizing symptoms. The counseling predicted better mental health in adolescence in both low- and high-risk families.

CONCLUSIONS

Home-based early intervention can have positive long-term effects on the mental state of adolescents. These results can be used when programs for primary prevention in families with small children are planned.