A non-randomized controlled study to assess the impact of the "Appui Parental", an early and intensive support programme for vulnerable families: Study protocol

INTRODUCTION

Early home visit programmes have been developed to help parents build an adequate relationship with their baby and to prevent child developmental delays and affective disorders. The "Appui Parental" programme is an intervention carried out by nursery nurses to provide intensive parental support to vulnerable families. Before extending this programme, it seemed necessary to evaluate its impact objectively.

OBJECTIVES

The main aim is to determine the impact of the "Appui Parental" programme on the change in the child's symptoms. The secondary objectives are to evaluate its effects on mother-child interactions, self-assessed parental competence, perception of social support, primary caregiver's anxiety-depression symptoms, alliance with the nursery nurse, frequency of out-of-home placements, and nursery nurses' stress.

METHOD

This non-randomized prospective multicentre study would include 44 families who receive the "Appui Parental" intervention for a one to 20-month-old child (intervention group) and 44 families with the same vulnerability criteria who receive care as usual by the maternal and child protection services (control group). The child, parents, mother-child interaction, nursery nurse-mother alliance, and nursery nurse's stress will be assessed at month one and month 18 after inclusion. Comparisons between groups will be performed.

CONCLUSION

This study should provide the public authorities with objective data on this programme's impact and allow them to pursue its generalization. For professionals, the study should confirm the interest in close early parental support through home visits or should lead to rethinking some aspects of the programme.

Distance Education for children with a disability and/or from vulnerable families

Different reasons may hinder the right to education of children with a disability and/or from vulnerable families; for example, living in rural areas where they do not have access to public transport, restriction of opportunities to access schools, precarious economic situations, lack of minimum services that meet the needs of hygiene and personal care, among other reasons. This has made it necessary to implement changes in traditional education systems. For this reason, the objective of this study is to build a theoretical base that facilitates the understanding of the requirements of these children in terms of distance education. To do this, the authors interviewed primary education teachers who work with children with a disability and/or from vulnerable families. A qualitative research methodology was used with the focus group as a technique for collecting information. Ten primary school teachers participated in an interview made up of a set of open-ended questions that facilitated their narratives regarding education strategies used for students with a disability and/or those living in vulnerable families, which were later grouped into categories. As a result of this research, the following strategies used by the participating teachers were collected: recreating the feeling of the physical classroom in the virtual classroom, fostering friendship and companionship among students, designing engagement strategies, and considering the socio-cultural variables that influence learning. The teachers assured that distance education is a perfectly viable alternative for children with a disability and/or from vulnerable families.

The Best Services Trial (BeST?): a cluster randomised controlled trial comparing the clinical and cost-effectiveness of New Orleans Intervention Model with services as usual (SAU) for infants and young children entering care

Background

Abused and neglected children are at increased risk of health problems throughout life, but negative effects may be ameliorated by nurturing family care. It is not known whether it is better to place these children permanently with substitute (foster or adoptive) families or to attempt to reform their birth families.

Previously, we conducted a feasibility randomised controlled trial (RCT) of the New Orleans Intervention Model (NIM) for children aged 0–60 months coming into foster care in Glasgow. NIM is delivered by a multidisciplinary health and social care team and offers families, whose child has been taken into foster care, a structured assessment of family relationships followed by a trial of treatment aiming to improve family functioning. A recommendation is then made for the child to return home or for adoption.

In the feasibility RCT, families were willing to be randomised to NIM or optimised social work services as usual and equipoise was maintained. Here we present the protocol of a substantive RCT of NIM including a new London site.

Methods

The study is a multi-site, pragmatic, single-blind, parallel group, cluster randomised controlled superiority trial with an allocation ratio of 1:1. We plan to recruit approximately 390 families across the sites, including those recruited in our feasibility RCT. They will be randomly allocated to NIM or optimised services as usual and followed up to 2.5 years post-randomisation. The principal outcome measure will be child mental health, and secondary outcomes will be child quality of life, the time taken for the child to be placed in permanent care (rehabilitation home or adoption) and the quality of the relationship with the primary caregiver.

Discussion

The study is novel in that infant mental health professionals rarely have a role in judicial decisions about children’s care placements, and RCTs are rare in the judicial context. The trial will allow us to determine whether NIM is clinically and cost-effective in the UK and findings may have important implications for the use of mental health assessment and treatment as part of the decision-making about children in the care system.

The FACAM study: protocol for a randomized controlled study of an early interdisciplinary intervention to support women in vulnerable positions through pregnancy and the first 5 years of motherhood

BACKGROUND

Inequality in health can have profound short- and long-term effects on a child's life. Infants develop in a responsive environment, and the relationship between mother and infant begins to develop during pregnancy. The mother's ability to bond with the fetus and newborn child may be challenged by mental health issues which can cause impaired functioning and poorer health outcomes. Families with complex problems need interdisciplinary interventions starting in early pregnancy to be prepared for motherhood and to ensure healthy child development. This study aims to examine the effects of an early and coordinated intervention (the Family Clinic and Municipality (FACAM) intervention) offered to vulnerable pregnant women during pregnancy and the child's first year of life on the mother-child relationship, maternal social functioning, mental health, reflective functioning, well-being, parental stress, and the development and well-being of the child.

METHODS

The study is a prospective randomized controlled trial where we will randomize 320 pregnant women enrolled to receive antenatal care at the family clinic at Odense University Hospital, to either FACAM intervention or usual care. The FACAM intervention consists of extra support by a health nurse or family therapist during pregnancy and until the child starts school. The intervention is most intensive in the first 12 months and also includes attachment-based support provided either individually or in groups. The participants are assessed at baseline, and when the infant is 3 and 12 months old. The primary outcome is maternal sensitivity measured by the Coding Interactive Behavior (CIB) instrument. Secondary outcomes include prenatal parental reflective functioning, mental well-being, depressive symptoms, breastfeeding duration, maternal satisfaction, child development, parent competence, parental stress, and activities with the child.

DISCUSSION

The trial is expected to contribute knowledge about the effect of early coordinated support in antenatal and postnatal care for vulnerable pregnant women and their families.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03659721 . Registered on September 6, 2018.

[Early childhood intervention from a distance-opportunities and challenges in supporting psychosocially stressed families in the COVID-19 pandemic]

Kontaktbeschränkende Maßnahmen waren zur Eindämmung des SARS-CoV-2-Infektionsgeschehens ab Frühjahr 2020 in Deutschland notwendig. Jedoch stellten sie Familien, insbesondere Familien in Belastungslagen, vor besondere Herausforderungen. Der Beitrag geht der Frage nach, inwieweit sich die Coronapandemie bis zum Mai 2021 auf die Lebenssituation der Familien ausgewirkt hat und wie eine längerfristige Betreuung im Kontext der Frühen Hilfen fortgeführt werden konnte. Die Analysen basieren hauptsächlich auf einer qualitativen Studie mit psychosozial belasteten Müttern von jungen Kindern, 2 Befragungen von Gesundheitsfachkräften, die Familien in den Frühen Hilfen längerfristig unterstützen, sowie einer Befragung von kommunalen Akteuren, die für die Steuerung und Umsetzung der Frühen Hilfen in den Kommunen verantwortlich sind.

Psychosozial belastete Familien erleben existenzielle Ängste und eine generelle Überforderung in der Pandemie. Innerfamiliale Konflikte scheinen zuzunehmen. Die längerfristige Unterstützung durch die Frühen Hilfen wurde vom persönlichen Kontakt im häuslichen Umfeld vorrangig in die Distanz verlagert. Obwohl im Verlauf der Pandemie viele Fachkräfte wieder zum ursprünglichen Versorgungskonzept zurückkehrten, werden Elemente der „Hilfe auf Distanz“ weiterhin ergänzend eingesetzt.

Aufgrund der pandemiebedingten zusätzlichen Belastungen der Familien, die in den Frühen Hilfen begleitet werden, war die Fortführung der Unterstützung noch wichtiger als ohnehin schon. Die Formate einer „Hilfe auf Distanz“, die in der Pandemie notgedrungen erprobt wurden, könnten das Potenzial haben, die Hilfeleistungen der Gesundheitsfachkräfte in den Frühen Hilfen zu ergänzen und so zu einem Qualitätsentwicklungsschub beizutragen.

Domestic violence in families in the Netherlands during the coronavirus crisis: A mixed method study

BACKGROUND

The consequences of the coronavirus crisis are considerable for everyone in the Netherlands. Although there were concerns about the many vulnerable families who were forced to stay at home because of the measures taken by the government to contain the coronavirus in the Netherlands, there has been no increase in the number of reports of domestic violence or child abuse.

OBJECTIVE

To gain insight by a mixed method study on what has happened during the lockdown within families who were already known to social services.

METHODS

A quantitative study was performed among 159 families recruited before the coronavirus crisis, and 87 families recruited during the lockdown in the Netherlands through child protection services. Family members (parents, children) completed questionnaires about interparental violence, (historical) child abuse and neglect, and emotional security. In a qualitative study 39 of these respondents and 13 professionals were interviewed.

RESULTS

No difference was found in violence between families who participated before and after the lockdown. The level of violence is still high in most families. The absence of assistance promoted the self-reliance of children and parents to deal with this difficult period. Professionals found new ways of connecting to families at risk. Every form of support is important to these families because it made children feel seen and heard. Isolation of families where domestic violence and child abuse occurred, remains a risk factor, even outside the coronavirus crisis.

Psychological distress and living conditions among Japanese single-mothers with preschool-age children: An analysis of 2016 Comprehensive Survey of Living Conditions

BACKGROUND

The early life period provides a critical foundation for child health and development, and mothers exert great influence as primary caregivers. Previous studies have shown that single-motherhood is associated with negative child outcomes. In Japan, few studies have addressed the situation faced by single-mothers with young children, such as living conditions and mental health issues.

METHODS

We utilized nationwide data from the Comprehensive Survey of Living Conditions (2016), collected by the Japanese Ministry of Health, Labour and Welfare and compared mothers from single-mother households with those from two-parent households, with further subdivision by intergenerational cohabitation. Socio-demographic characteristics, lifestyle habits, psychological distress, subjective health status, and stress were examined.

RESULTS

We observed that single-mothers without intergenerational cohabitation seemed to experience harsh living conditions compared to other types of households. Severe psychological distress was observed in 11% of single-mothers without cohabitation compared with 6% among single-mothers with cohabitation and 4% among mothers of two-parent households. Multivariate analysis adjusting for demographic variables showed about a two-fold increased risk of severe psychological distress (OR=2.34, 95% CI: 1.71-3.22) associated with single-mothers without intergenerational cohabitation compared to mothers from two-parent household without cohabitation. Single-mothers without cohabitation tended to smoke and drink alcohol frequently and seemed sleep-deprived.

LIMITATIONS

Due to the cross-sectional design, we could not make inference on causality.

CONCLUSIONS

Our study highlighted needs for targeted support for single-mothers without intergenerational cohabitation. Efforts in public health and other related fields may present opportunities to reduce negative intergenerational impacts of adversities among socially vulnerable families.

Risk and resilience of vulnerable families in Hong Kong under the impact of COVID-19: an ecological resilience perspective

PURPOSE

Hong Kong has experienced four waves of COVID-19 since the first case was confirmed in January 2020. Several studies have highlighted the psychological impacts of the outbreak in Hong Kong but have largely ignored the protective factors that contribute to resilience among vulnerable families. This study adopted an ecological resilience framework to explore the impact of this epidemic on members of families with youth with a delinquent tendency/mental health concerns and the ecological protective factors for these vulnerable families.

METHODS

Random sampling based on a sampling frame provided by one of the largest local social service organizations in Hong Kong led to the recruitment of 407 respondents who were interviewed using a battery of standardized questionnaires.

RESULTS

The results showed that 30.6% and 11.5% of respondents reported a moderate and a severe level of psychological distress, respectively, almost double the percentages reported in a previous study conducted in Hong Kong before the COVID-19 outbreak. Around 36.6% of respondents indicated they had encountered financial problems and almost 40% indicated aggravated financial circumstances since the outbreak. Hierarchical regression analysis revealed that financial stress was the strongest predictor of psychological distress. Structural equation modeling indicated that family support, indoor leisure activities and community resources significantly mediated the negative influence of COVID-19-related stressors on psychological distress of family members.

CONCLUSION

Family leisure activities, family support, community spirit and mutual help within the context of social-distancing restrictions may need to be promoted to benefit vulnerable families in Hong Kong under the COVID-19 epidemic.

Revision and validation of a short scale to assess home environment for elementary school children in transnational families in Taiwan

PURPOSE

To develop and test a brief scale of the home environment of elementary school children in transnational families or vulnerable families.

DESIGN AND METHODS

The scale development process took place in three phases. In the first phase, a 61-item scale was generated by an expert panel based upon related literature and Chinese Home Observation for Measurement of the Environment (C-HOME). In the second phase 15 individual transnational families with elementary school children were interviewed, and items were reduced from 61 to 55 due to understandability or other practical considerations. Phase three's item analysis with 200 such families, reduced items to 41. Factor analysis followed, further reducing items to 27. Finally, the resulting 27-item scale underwent a test-retest with 57 subsample participants.

RESULTS

An iterative process of item and factor analyses identified a seven-dimensional, 27-item Home Environment Assessment Scale (HEAS), which accounted for 52.28% of the total variance. K-R 20 was 0.76. The test-retest reliability for the full sample total score was 0.97.

CONCLUSIONS

The results provide evidence supporting the scale consistency, content validity, and construct validity, and offer a useful instrument for health care professionals, especially pediatric nurses, to identify home environment interventions for young children in vulnerable families.

PRACTICE IMPLICATIONS

The findings of HEAS-27 can serve to guide pediatric health care professionals in promptly screening, evaluating, and teaching families so that children in a vulnerable population have adequate quality and quantity of support in the home environment.

Inter-agency indicators of out-of-home-care placement by age 13-14 years: A population record linkage study

BACKGROUND

Cross-agency administrative data can improve cost-effective triage systems for child protection and other human service delivery.

OBJECTIVE

To determine the minimum set of cross-agency indicators that could accurately classify placement in out-of-home-care (OOHC) before age 13-14 years.

PARTICIPANTS AND SETTING

Participants were 72,079 Australian children (mean age = 13.16 years; SD = 0.37; 51.4% male) and their parents, for whom linked administrative records spanning the years 1994-2016 were available for analysis within the 'New South Wales Child Development Study'.

METHODS

First, a series of logistic regression analyses were conducted to examine associations between cross-agency (health, justice, education) risk indicators and membership of the sub-cohort of 1239 children who had an OOHC placement prior to age 13-14 years, relative to (1) the sub-cohort of 55,473 children who had no previous contact with child protection services, and (2) the sub-cohort of 15,367 children who had been reported to child protection services but had no record of OOHC placement. We then explored the classification characteristics associated with a smaller combination of risk factors, and the utility of specific familial risk factors, for classifying membership of the OOHC subgroup.

RESULTS

A combination of six risk indicators evident before OOHC placement can classify children placed in OOHC with approximately 95% accuracy, and the presence of at least four of these risk indicators provides excellent specificity (99.6%).

CONCLUSIONS

A combination of risk factors observable in administrative datasets held by multiple government agencies may be used to target support services to prevent entry into OOHC for children from vulnerable families.

Promoting Alcohol Reduction in Non-Treatment Seeking parents (PAReNTS): a protocol for a pilot feasibility cluster randomised controlled trial of alcohol screening and brief interventions to reduce parental alcohol use disorders in vulnerable families

Background

Research estimates that 30% of children under the age of 16 years in the UK live with at least one parent with an alcohol use disorder (AUD). Parental AUDs are associated with adverse childhood experiences and poorer outcomes for children. The PAReNTS (Promoting Alcohol Reduction in Non-Treatment Seeking parents) trial aims to examine the feasibility and acceptability of a randomised controlled trial of brief alcohol interventions to reduce parental alcohol misuse.

Methods

The cluster randomised controlled trial will be conducted within early help family support and children’s social care services in three local authorities in the North East of England: Newcastle, Durham and North Tyneside. All eligible parents the caseloads of participating practitioners will be screened for an AUD using the Alcohol Use Disorder Identification Test – Consumption (AUDIT-C) screening tool by the social care practitioners within routine appointments. All parents who score 5 or more on the AUDIT-C will be invited to participate in the trial. Consenting participants will complete a baseline questionnaire before receiving one of three randomised interventions: (i) healthy lifestyle leaflet (control intervention); (ii) a brief alcohol advice intervention delivered by the social care practitioner plus healthy lifestyle leaflet; (iii) a brief alcohol advice intervention delivered by the social care practitioner, healthy lifestyle leaflet plus a 40-min behaviour change intervention with an optional review session delivered by the local alcohol service. Follow-up data will be collected 6 and 12 months post recruitment. A linked qualitative study will explore participating parent and practitioner views on the acceptability of trial processes and interventions.

Discussion

The PAReNTS trial will provide a robust estimate of recruitment, retention and consent rates in order to inform the design of a future definitive study examining the effectiveness and cost-effectiveness of alcohol screening and brief interventions to reduce parental AUDs within vulnerable families.

Trial registration

ISRCTN registry ISRCTN60291091; protocol version 2; 17.10.2016

Electronic supplementary material

The online version of this article (10.1186/s40814-018-0305-5) contains supplementary material, which is available to authorized users.

Postnatal screening and care for non-medical risk factors by preventive child healthcare in deprived and non-deprived neighbourhoods

Background

Children born in families with non-medical risk factors, such as deprivation, have higher odds of preterm birth (< 37 weeks of gestation) or being born small for gestational age (birth weight < 10th percentile). In addition, growing up they are at risk for growth and developmental problems. Preventive Child Healthcare (PCHC) monitors growth and development of babies and children. Early identification of children at risk could result in early interventions to prevent growth and developmental problems in later life. Therefore, we aimed to assess current practices in postnatal risk screening and care for non-medical risk factors and the collaboration with other healthcare professionals, in both deprived and non-deprived neighbourhoods in the Netherlands.

Methods

Eight out of ten invited PCHC organisations, from different areas in the Netherlands, consented to participate in this study. A questionnaire was designed and digitally distributed to professionals working at these organisations, where 370 physicians and nurses were employed. Data was collected between June and September 2016. Descriptive statistics, chi square tests and t-tests were applied.

Results

Eighty-nine questionnaires were eligible for analyses. Twenty percent of the respondents were working in a deprived neighbourhood and 70.8% of the respondents were employed as nurse. Most of them performed screening for non-medical risk factors in at least 50% of their consultations. PCHC professionals working in deprived neighbourhoods encountered significantly more often families with non-medical risk factors and experienced significantly more communication problems than their colleagues working in non-deprived neighbourhoods. 48.2% of the respondents were satisfied with the current form of postnatal risk screening in their organisation, whereas 41.2% felt a need for a structured postnatal risk assessment. Intensified collaboration is preferred with district-teams, general practitioners and midwifes, concerning clients with non-medical risk factors.

Conclusion

This study shows that postnatal screening for non-medical risk factors is part of current PCHC practice, regardless the neighbourhood status they are deployed. PCHC professionals consider screening for non-medical risk factors as their responsibility. Consequently, they felt a need for a structured postnatal risk assessment and for an intensified collaboration with other healthcare professionals.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3243-2) contains supplementary material, which is available to authorized users.