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Background Recent government initiatives in the UK encourage collaborative working among professionals and highlight the importance of a co-ordinated and collaborative approach in early years for families and children. There are many models of collaborative working but the evidence base for its effectiveness in early years (0-2.5 years) in a community setting in the UK is patchy. The aim of this study is to objectively evaluate the transdisciplinary model of collaborative working in this setting. Methods This paper describes the development of a transdisciplinary early intervention team providing services to a 0- to 2.5-year-old age group in a community setting in the UK, between 2004 and 2007. The effects on waiting times, therapy session attendance and caseload were evaluated. Results Statistically significant reduction in waiting times from an average 114-35.6 days for the highest priority children was demonstrated. Attendance at therapy sessions increased significantly from 49% in 2005 to 56% in 2006 and 75% 2007, despite an increasing case load from 29 in 2004 to 64 in 2008 through more efficient utilization of time and resources. Conclusion It is felt that this paper demonstrates, for the first time, the objective benefits to clients and fundholders/Primary Care Trust (PCT) of practical application of the theory of transdisciplinary working in a community paediatric service setting in the UK. [ABSTRACT FROM AUTHOR]

Research groups across Europe have been networking to share information and ideas about research on preschool children with autism. The paper describes preliminary work to develop capacity for future multi-site randomized controlled trials of early intervention, with a specific focus on the need to measure treatment adherence where parents deliver therapy. The paper includes a review of randomized and controlled studies of parent-mediated early intervention from two sources, a recent Cochrane Collaboration review and a mapping of European early intervention studies in autism published since 2002. The data extracted focused on methods for describing parent adherence, that is, how and to what extent parents carry out the strategies taught them by therapists. Less than half of the 32 studies reviewed included any measure of parent adherence. Only seven included a direct assessment method. The challenges of developing pan- European early intervention evaluation studies are discussed, including choice of intervention model and of important outcomes, the need for translation of measurement tools and achievement of joint training to reliability of assessors. Measurement of parent-child interaction style and of adherence to strategies taught need further study. [ABSTRACT FROM AUTHOR]

Family‐centred care (FCC) has been established as a best practice model for child disability services internationally. However, further empirical support is required to explore the operationalization and efficacy of FCC, in the absence of a universal practice model. This review aimed to identify the key processes and outcomes of FCC in early intervention (EI) settings and the factors that impact FCC. A systemic review was conducted exploring the processes and outcomes of FCC delivered to children predominantly aged 0–6 years with disabilities/suspected disabilities and families as part of EI or early services. The search procedure was informed by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines (Moher et al., 2009). Narrative analysis of data was guided by Braun and Clarke (2006, 2014). Data were presented as per the standards for reporting qualitative research (SRQR; O'Brien et al., 2014). Forty‐two studies were included. The majority (90.5%) outlined the processes of FCC, with 59.5% of studies detailing outcomes. Processes were largely reported as qualitative data and/or subscales of the Measure of Processes of Care (MPOC; King et al., 1995), which were subsequently collated. Findings indicated eight key operational processes and corresponding outcomes. Variables that hinder or facilitate FCC included family/professional characteristics, family/service resources, and parent attitudes, engagement and agency. FCC was largely conceptualized as the application of services to children and their families. Critical perspectives on FCC are discussed. It is hoped this research will contribute to the development of a framework of FCC in EI to inform services provided to young children with complex needs and their families and future research. [ABSTRACT FROM AUTHOR]

This paper outlines the presentation, aetiology and treatment of attention deficit hyperactivity disorder (ADHD) in pre-school children. A review of current parenting training interventions demonstrates that there is good evidence for their efficacy in reducing symptoms of ADHD in pre-school children, and three interventions are evaluated: The new forest parent training programme (NFPP); the triple P--positive parenting programme and the incredible years parent training programme (IY). The evaluation of the NFPP provides strong evidence demonstrating its effectiveness for pre-school children with ADHD, while the efficacy of the Triple--P and the IY programme have, to date, only been demonstrated on children with conduct problems and co-morbid ADHD. It is suggested that parent training should be the first choice treatment for pre-school children presenting signs of ADHD, and medication introduced only for those children where parent training is not effective. Few moderators of outcome have been identified for these interventions, with the exception of parental ADHD. Barriers to intervention and implementation fidelity will need to be addressed to achieve high levels of attendance, completion and efficacy. The IY programme is a good model for addressing fidelity issues and for overcoming barriers to intervention. The future directions for parent training are also discussed. [ABSTRACT FROM AUTHOR]

Background Portage provides home-based, early intervention and support to families who have a young child with additional needs. Working in the context of the Every Child Matters agenda, the National Portage Association (NPA) aims to develop inclusive, high-quality provision. This paper reviews their recent work, presents a summary of the findings of a national survey of Portage and discusses their implications. Methods All Portage services known to the NPA and local authorities in England were asked to complete a questionnaire and forward another to families using early years' services to evaluate the support they receive. Results The survey identified the extent and gaps in Portage provision and the level of unmet need. Families who contributed said they valued Portage because it helped their child and provided support for the whole family. Discussion of findings The survey identified 31 local authorities in England, where Portage is not available. Geographical gaps were most notable in the North East and West Midlands regions. Despite a small increase in the extent of Portage provision, it is estimated that services only meet the needs of a small proportion of families that are eligible. Current work may help overcome geographical gaps through supporting the development of high-quality Portage services but, in endeavouring to meet the needs of families waiting for Portage, it is important not to diminish the quality of support already provided. Portage aims to provide flexible support for families to respond to their individual needs. Evaluating its effectiveness is problematic because of its complex nature but this survey provided an opportunity for families to share their views at a national level. Conclusions Continued development work can help Portage provision become more accessible and one of the options routinely available to families who have a young child with additional needs. [ABSTRACT FROM AUTHOR]

Background Congenital visual impairment has serious consequences for early development, particularly in those with the most profound impairment. Although there is individual variation, developmental delays and risks, including ‘developmental setback’, are widespread. There is no scientifically robust developmental framework grounded in contemporary theory and scientific knowledge to guide early intervention which may prevent or minimize the risk factors and developmental difficulties. The UK governmental initiative, Early Support, gave the impetus for developing a new developmental framework for babies and young children with visual impairment. Methods This paper reports on the scientific literature that underpins the new framework and the limitations of existing intervention materials. The case for focusing on particular vulnerable areas and developing a new developmental framework, the Early Support Developmental Journal for babies and children with severe visual impairment, is presented. Conclusions The future direction for service delivery and evaluation is briefly described. [ABSTRACT FROM AUTHOR]

Abstract Given the numbers of disabled children in Bangladesh and the lack of trained professionals, innovative forms of service delivery are required. The Bangladesh Protibondhi Foundation has developed an outreach parent training service based at two centres, one urban and one rural. Mothers are shown how to use pictorially based Distance Training Packages (DTP), which they take home. This paper presents findings concerning factors which seem to affect mothers’ attendance with their children at DTP advisory sessions. The study followed 47 children with cerebral palsy, aged between 2 and 5.5 years, over a period of around 18 months. The main factors predicting higher attendance were the child’s sex (i.e. boys were brought back more often), particularly in the rural area, and lower adaptation to the child reported by the mother. The problems described by mothers in using the DTP advisory service were economic (such as transport costs), cultural (such as mothers not being permitted out alone), and medical (such as the child having repeated fits). The implications for future service development are discussed. [ABSTRACT FROM AUTHOR]

For many children and families, a multidisciplinary team evaluation is their introduction to special education systems. Increasingly, federal guidelines man-dating parent involvement in all aspects of service provision have meant that parents are being asked to participate as part of the evaluation team. If families and professionals are to serve as partners in the evaluation process, mutual respect and understanding of one anothers' perspectives will be crucial. This paper uses survey data from 39 parents and 81 professionals to examine the various expectations and perceptions brought by participants to the assessment process. Results indicated that there is substantial variability of perceptions among parents and professionals about the nature of child assessment and their respective roles in it, implications for research and practice are discussed, along with techniques for involving families in the assessment process in more meaningful ways. [ABSTRACT FROM AUTHOR]

Background: Emphasis on parental engagement strategies within occupational therapy and physiotherapy early intervention (EI) programmes for infants at high risk of cerebral palsy (CP) has increased. This reflects consensus that increasing parent participation enhances treatment efficacy, potentially improving infant and parent outcomes. However, evaluation of parental engagement in EI is complex. Despite the growing application of parental engagement strategies, aligned with family‐centred care practice, theoretical evaluation is currently lacking within the literature. This realist synthesis aimed to identify component theories underlying EI strategies to support parental engagement and to use empirical findings to evaluate how these work in practice. Methods: Realist synthesis: Databases Medline, Embase, Amed, CINAHL and PsychInfo were searched (from February 1985 ‐ February 2020); further articles were sourced from reference lists. A data extraction form was used, and a Critical Appraisal Skills Programme tool was used to assess study rigour. Results: Twenty‐six articles were included. Quality of relationships, parent education and intervention co‐design were the key themes related to parental engagement strategies. Findings indicate that constructive parent reasoning mechanisms of trust, belief, sense of control, perceived feasibility of home programme delivery and ultimately motivation are linked to the underlying intervention resources afforded by specific strategies (e.g., coaching pedagogy). These responses are precursors to engagement outcomes that include increased parental self‐efficacy and adherence. Importantly, parental self‐efficacy can initiate a process of change leading to improved parental confidence and anxiety. Conclusions: Sensitively designed programme strategies, centred on relational quality between parent, infant and therapist, are fundamental for effective parent connection, involvement and investment within EI for infants with CP. [ABSTRACT FROM AUTHOR]

Background: Family‐centred practice (FCP) has become a recommended practice for early intervention services for children with disabilities in many countries. However, its feasibility in Chinese context has been unclear. This study is the first to explore the perceptions of early intervention service practitioners about the implementation of FCP in mainland China. Methods: Focus groups were employed to collect data from 37 early intervention practitioners who attended a workshop about FCP in Wuhan, China and two officers from the provincial disabled persons' federation. The data were analysed thematically. Results: Four themes were identified: (a) family‐centred early intervention is possible, (b) traditional concepts are not friendly towards FCP, (c) parents do not collaborate and (d) financing and personal resources are not sufficient to implement FCP. Chinese practitioners agreed with the philosophies of FCP; however, there was concern that widespread implementation may meet conceptual and practical challenges. Conclusions: The results highlighted practitioners were optimistic and keen for FCP implementation in the Chinese context, but to do so across China may still be some way in the future. [ABSTRACT FROM AUTHOR]

A study of programme quality of early intervention in a large governmental early special education service in Queensland, Australia employed a collaborative methodology of participatory action research. This approach has been encouraged strongly for disability-focused research, but the approach is demanding and few examples have been reported. In this multistage 4-year project, indicators of programme quality were generated from staff and parents in the service, validated throughout the service, and generalized across the nation. Examples of the implementation of this methodology across these stages are reported, and benefits and compromises are examined. [ABSTRACT FROM AUTHOR]

Background: Preterm infants have a higher risk of development disorders. Prematurity can be considered a source of stress, in both children and their parents, due to the high number of interventions that they require. Early intervention (EI) programmes have shown to have a positive influence on the neurodevelopment of children with neurological risk. On the other hand, parenting stress has a negative influence on the development of any child. This systematic review aimed to identify the effect of EI programmes on decreasing parenting stress suffered by parents of preterm babies. Methods: Systematic review and meta‐analysis of experimental studies in accordance with the PRISMA declaration guidelines were applied in this work. Results: Fifteen randomized clinical trials were included whose methodological quality was assessed using the PEDro scale. Stress data extraction was meta‐analysed using the inverse variance method in a random effects model. Statistical heterogeneity was assessed with the I2 heterogeneity statistic. The domains most commonly reported in the trials were the childcare‐related stress (Child Domain), personal discomfort (Parent Domain) and computation of both (Total Stress). The results showed significant (P < 0,05) and clinically relevant differences in favour of the EI programme group at 18 months and 5 years. Conclusions: This review found moderate to strong evidence of the impact of EI programmes on the reduction of parenting stress in parents of preterm babies. These findings offer useful insights regarding the delivery of current support and the development of future family interventions. Finally, recommendations are provided for future intervention evaluation studies in this area. [ABSTRACT FROM AUTHOR]

Background: In Spain, as in other countries, there has been a deep and intense process of change towards the adoption and use of family‐centred practices (FCPs) on early intervention (EI). Despite that several international organizations have recommended FCPs be embedded in EI services, researchers on this field have highlighted a recommendation–implementation gap, as well as the need to point investigation on practitioners and intervention variables involved. Consequently, our goals were to describe and compare the practitioners' appraisals on actual and desired practices in Spain and to explore the relationships between practitioners and intervention characteristics and the use of recommended practices. Methods: A survey including practitioner and intervention characteristics measures was used to obtain data needed. The actual and desired practices were explored through the Family Orientation of Community and Agency Services Scale. The participants were 119 EI Spanish practitioners whose programmes were in the first stages of different FCP implementation projects. Results: Practitioners reported actual practices to be less family centred than they would like, moderately in line with FCP. They reported desired practices as quite close to recommended practices. Intervention characteristics were related to actual practices, whereas practitioner characteristics were not. Conclusions: The results suggest that the recommendation–implementation gap still exists in our context, as well as in other countries. Intervention characteristics seem to be one of the key elements significantly influencing actual practices, though additional research is needed. A comprehensive framework for implementation is needed to bridge the gap between recommendation practices and the use of these practices. [ABSTRACT FROM AUTHOR]

Background: Early childhood development (ECD) is a critical stage in children's lives, influencing future development and social integration. ECD research among children with disability and developmental delay in low‐ and middle‐income countries is limited but crucial to inform planning and delivery of inclusive services. This study is the first to measure and compare the prevalence of disability and developmental delay among children attending preschool centres in rural Malawi. Methods: A cross‐sectional survey was conducted in 48 preschool centres in Thyolo district, Malawi. Data were collected from parents or guardians of 20 children per centre. Disability was ascertained using the Washington Group/UNICEF Child Functioning Module. Child development was measured using the language and social domains of the Malawi Development Assessment Tool. Results: A total of 960 children were enrolled; 935 (97.4%) children were assessed for disability and 933 (97.2%) for developmental delay; 100 (10.7%) children were identified as having a disability. The prevalence of disability was higher among children 5+ years (n = 60; 29.3%) than children 2–4 years (n = 40; 5.5%); 109 of 933 (11.7%) children were classified as having developmental delay, 41 (4.4%) in "language" and 77 (8·3%) in "social" domains. Conclusions: This study found that disability and developmental delays are common among preschool children in Malawi. It is one of the first to measure disability and delay among children in a preschool setting in Africa. [ABSTRACT FROM AUTHOR]

Background: Families of children with hearing loss must make a number of decisions during the transition from diagnosis of hearing loss to enrolment in early intervention and thus require a wealth of information and support. This study aimed to investigate families' needs during this period and explore how these needs might differ for families of children with hearing loss who have additional disabilities. Methods: An exploratory qualitative study incorporating semistructured in‐depth interviews and thematic analysis was used. A total of 28 participants from two groups were involved: (a) family members of children with hearing loss (n = 17) and (b) professionals who support these families during the transition period from diagnosis of hearing loss to enrolment in early intervention (n = 11). Results: Analysis of qualitative data revealed four major themes: (a) families require information that meet their specific needs; (b) families require supportive professionals to "walk the journey" with them; (c) some families want to connect with other families who "are in the same boat"; and (d) professional support needs differ for children with hearing loss who have additional disabilities. Conclusions: Families and professionals in this study identified a wide range of family needs during the transition to early intervention. The results highlighted the importance of providing individualized services and considering families' needs when providing family‐centred services. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Physical and psychological challenges can arise from paediatric injury, which can impact child health outcomes. Evidence‐based resources to promote recovery are limited. The low cost, portable Cellie Coping Kit for Children with Injury provides evidence‐based strategies to help children manage injury‐related challenges. This study aimed to describe intervention feasibility and explore initial outcomes (learning, quality of life [QOL], and trauma symptoms). Methods: Three independent pilot studies were conducted. Child–parent dyads (n = 61) participated in the intervention; ~36% completed a 4‐week follow‐up assessment. Results: Results suggested that the intervention was feasible (e.g., 95% of parents would recommend the intervention; >85% reported that it was easy to use). Over 70% of participants reported learning new skills. No statistically significant differences were detected for children's QOL or trauma symptoms preintervention to postintervention. Conclusion: Preliminary research suggests that the Cellie Coping Kit for Children with Injuries is a feasible, low‐cost, preventive intervention, which may provide families with strategies to promote recovery from paediatric injury. Future research, including a randomized controlled trial, ought to further examine targeted long‐term intervention outcomes. [ABSTRACT FROM AUTHOR]

Background Playgroups are a relatively unique form of family support programme that is common in Australia which has high community acceptance and significant government investment. However, limited evidence exists regarding the effectiveness of playgroups to achieve better outcomes for children and their parents. This study describes patterns of playgroup participation for Aboriginal and Torres Strait Islander families with young children and examines the extent to which participation from birth to three years is associated with subsequent child, parent and community outcomes. Methods This study uses three years of longitudinal data for 622 Aboriginal and Torres Strait Islander children who were participants in the Longitudinal Study of Indigenous Children (LSIC). Longitudinal associations between playgroup attendance when children were age 2 and 3 years and outcome measures for child vocabulary, motor skills, behaviour problems, prosocial development, parent home learning engagement, resilience, advice-seeking and health service use, and community trustworthiness were examined using path analysis. Results Rates of playgroup participation in this sample group were generally lower than for Australian children overall. Playgroup attendance when children were age 2 to 3 years was associated with higher parental engagement in home learning activities when children were aged 4 years which, in turn, was associated with stronger expressive vocabulary scores for children. Conclusion The findings from this study suggest that playgroup participation can enhance the home learning environments for Aboriginal and Torres Strait Islander children. Playgroups as a parent support programme hold strong potential to reach and engage families, particularly in areas of high geographic isolation, which can realize improved outcomes for children, parents and communities. [ABSTRACT FROM AUTHOR]

Background There is strong evidence that early intervention (EI) can improve outcomes for children with autism spectrum disorder (ASD), and consequently, the importance of EI has been widely promoted to families of children with ASD. However, the perspectives of parents of children with ASD regarding the EI message have not been widely examined. Methods This study used qualitative methods to explore parental perspectives on the EI message. Semi-structured interviews were undertaken with 14 participants from 12 family units to explore the perspectives of parents of children with ASD on the EI message. Thematic analysis was undertaken on the data. Results Three central themes were constructed following data analysis: (i) parents' initial perceptions of EI following their child's diagnosis with ASD; (ii) the consequences (both positive and negative) of the EI message; and (iii) parents' perspectives on life after EI. The results of this study indicated that parents were acutely aware of the importance of EI, and although this provided parents with hope immediately post-diagnosis, it also placed pressure on parental decision-making regarding which intervention approaches to access for their children with ASD. Conclusions The results of this study highlight the importance of carefully considering how health messages, specifically the importance of EI, are communicated to families of children with ASD. Furthermore, the findings of this study also highlight the need for allied health professionals to communicate openly with parents about the anticipated outcomes of EI programmes. [ABSTRACT FROM AUTHOR]

Background Resource constraints may inhibit the provision of appropriate interventions for children with neurodisabilities presenting with behavioural sleep problems. Telephone calls (TC), as opposed to home visits (HV), may be a more resource efficient means of supporting these families. Objective To conduct a preliminary investigation exploring the feasibility and acceptability of replacing HV with TC to support parents implementing sleep management strategies and to gather evidence to inform the design and methods of a full trial. Methods Parents referred to a sleep management intervention routinely delivered by a community paediatric team were alternately allocated to receive implementation support via HV (n = 7) or TC (n = 8). Activity logs recorded the frequency, duration and mode of support. Parents and practitioners were interviewed about their experiences of receiving/delivering the intervention. Results Intervention drop-out was low, the frequency, number of contacts and intervention duration appeared comparable. Parents allocated TC received less contact time. Parents valued implementation support irrespective of delivery mode and practitioners reported that despite initial reservations, implementation support via TC appeared to work well. Conclusions TC appears an acceptable and convenient mode of delivering sleep support, valued by both parents and practitioners. We recommend a full-scale trial to investigate effectiveness. [ABSTRACT FROM AUTHOR]

Background The importance of early intervention approaches for the treatment of attention-deficit hyperactivity disorder ( ADHD) has been increasingly acknowledged. Parenting programmes ( PPs) are recommended for use with preschool children with ADHD. However, low 'take-up' and high 'drop-out' rates compromise the effectiveness of such programmes within the community. Methods This qualitative study examined the views of 25 parents and 18 practitioners regarding currently available PPs for preschool children with ADHD-type problems in the UK. Semi-structured interviews were undertaken to identify both barriers and facilitators associated with programme access, programme effectiveness, and continued engagement. Results and conclusions Many of the themes mirrored previous accounts relating to generic PPs for disruptive behaviour problems. There were also a number of ADHD-specific themes. Enhancing parental motivation to change parenting practice and providing an intervention that addresses the parents' own needs (e.g. in relation to self-confidence, depression or parental ADHD), in addition to those of the child, were considered of particular importance. Comparisons between the views of parents and practitioners highlighted a need to increase awareness of parental psychological barriers among practitioners and for better programme advertising generally. Clinical implications and specific recommendations drawn from these findings are discussed and presented. [ABSTRACT FROM AUTHOR]

Objectives To understand the barriers to programme success among high-needs families in Kids First, an early childhood intervention programme. Methods Using a qualitative approach, a secondary analysis was performed using the qualitative data set (111 interviews and focus groups with 242 participants) from the Kids First programme evaluation. Data analysis was conducted to identify common experiences among high-needs families in the programme and barriers to programme success. Results Participants identified housing insecurity as a major factor impeding programme delivery, retention and successful outcomes. Housing insecurity was shown to create or exacerbate ongoing crises among high-needs families. Only after housing insecurity was addressed were families able to benefit from the Kids First programme. Conclusions The findings of this research suggest that until baseline material security is established for high-needs families, early childhood development ( ECD) interventions will be limited in meeting their objectives. In order to have the most effect for those living in poverty, helping families to achieve basic material security, including secure housing, should precede the targeted provision of psychosocial ECD supports. This finding has implications for how ECD intervention programmes could more effectively be designed and whom they should target. [ABSTRACT FROM AUTHOR]

Background Infants and toddlers with developmental difficulties represent a heterogeneous group who often receives early intervention ( EI). Notable population heterogeneity exists and complicates unmet need and effectiveness research. However, a mix of relatively homogeneous clinically policy relevant 'subgroups' may create the apparent heterogeneity. To date, methodological challenges have impeded identifying these potential groups and their policy-relevance. Methods From the 2005-2006 National Survey of Children with Special Health Care Needs, we derived a sample ( n = 965) of infants and toddlers with parent-reported developmental difficulties. We used latent class analysis ( LCA) to identify subgroups of developmental vulnerability based upon functional, social and biological characteristics that would make children eligible for EI. Mixture modelling estimated the likelihood of each subgroup receiving parent-reported EI, controlling for race/ethnicity, child's age, and state of residence. Results LCA identified four distinct subgroups of developmental vulnerability: developmental disability (Group 1), mild developmental delay (Group 2), socially at risk with behaviour problems (Group 3), and socially at risk with functional vision difficulties (Group 4). Black, non- Hispanic children are significantly more likely than their white counterparts to be in Group 3 ( β = 1.52, P = 0.001) or group 4 ( β = 1.83, P < 0.001). Compared with children with a mild developmental delay (Group 2), children in group 1 ( β = −0.61, P < 0.001), group 3 ( β = −0.47, P = 0.001) and group 4 ( β = −0.38, P = 0.009) are significantly less likely to receive EI. Conclusions Racial and ethnic differences exist with regard to membership in developmental vulnerability subgroups. Observed inconsistencies in access to EI suggest the need for improved surveillance, referral and outreach. [ABSTRACT FROM AUTHOR]

Background Following early identification of deafness attention has now turned to early intervention of deaf children and their families. Improved outcomes associated with early identification and quality early intervention have been long predicated. However, the effectiveness of early intervention is mediated by parents' values, beliefs and preferences. How these mediate the nature of intervention is key to understand how early intervention impacts on outcomes. Methods Eighty-two parents of early identified deaf children participated in a longitudinal study (UK). Data from parents were collected through postal questionnaires. Parents provided repeated data on My Views on Services questionnaire (at 6-month interval). They also filled in once the Trait Emotional Intelligence questionnaire and a socio-demographic questionnaire. Statistical analyses were carried out to investigate parents' preferences and satisfaction with content of early intervention. Results Families had contact with a median of five professionals and 45 h of early intervention (on a 6-month basis). Parents view all content of early intervention as important. Content that supported parents to support their child was a priority for them. Length of involvement in early intervention and mothers' personal disposition did not have an effect on ratings of importance. However, mothers' educational background did influence ratings on the Supporting Parents subscale ( F= 3.41; d.f. = 3 and 66; P= 0.023). Parents' satisfaction scores with content of early intervention were neutral (mean: 0.2; SD 0.8). Parents were more satisfied with contents that supported them to support their deaf child, than with those aimed to support themselves. Parents' satisfaction with content that supported themselves did increase with length of involvement in early intervention ( t=−3.435; P= 0.004). Significant correlations ( r= 0.221; r= 0.230; r= 0.252) between mothers' well-being and satisfaction scores were identified. Conclusion These findings underscore the importance of understanding how parents' beliefs, values and perceived need impact on their experience of early intervention. [ABSTRACT FROM AUTHOR]

Introduction Government early intervention services for children with intellectual disability (ID) in Western Australia have adopted the model of family-centred care. The aim of this study was to evaluate how well it was being practised, to describe the pattern of service utilization and to identify factors influencing parental perceptions of family-centred care. Methods The study included children aged 0–6 years with ID, who were registered clients of Disability Services Commission, Western Australia. Parents completed a postal survey questionnaire about the frequency and type of services received and their perceptions of services using the Measure of Processes of Care (MPOC-56) questionnaire. Mean scores for the five MPOC domains were compared using anova against the independent variables of child age group, child diagnostic group, service type and frequency, place of residence, family and demographic variables. Significant variables in each domain were then entered into multivariate analyses. Results Of 292 eligible families, 165 (59%) returned a completed questionnaire. While over 50% of children had contact with occupational, speech and physical therapists at least once per month, less than 20% of children had at least annual contact with either psychology or dental services. Families rated their satisfaction highest for ‘respectful and supportive care’ and lowest for ‘providing general information’. Individual item analyses indicated less satisfaction with ‘co-ordinated and comprehensive care’. Higher means were associated with more frequent contact with occupational therapy. Conclusion Overall respondents reported early intervention services for young children with ID in Western Australia provided satisfactory family-centred care by means of the 56-item MPOC. The frequency of contact with allied health professionals was positively associated with parental ratings of family-centred care. The study indicates under-servicing in dental care and psychology services. [ABSTRACT FROM AUTHOR]

Background Women with low incomes are at higher risk to have low-birthweight (LBW) babies and less likely to participate in prenatal support programmes than women with higher incomes. This study examined birth outcomes among participants in the Newfoundland and Labrador Mother-Baby Nutrition Supplement (MBNS), a prenatal programme for women with low incomes that provides a monthly financial supplement and printed information on infant health and development, along with a referral to public health nursing services. Methods Application data (e.g. mother's age, education) for those who applied between August 2002 and December 2004 were obtained from the Provincial Government. Birth outcomes (e.g. birthweight, weeks of gestation) were available for 1599 women. Of these, 862 were parity zero and subsequently delivered full-term infants. Comparisons were made on demographics, timeliness of enrolment and rates of full-term LBW. Results Participants were more often single, younger and less educated than the average woman who gave birth in the Province or Canada in 2004. Women enrolled early were less likely to have a full-term LBW baby than those enrolled late (χ2(1)= 4.03, P= 0.045). Mothers enrolled late had a higher rate of full-term LBW than was the case in the Province [risk ratio (RR) = 2.76, 95% confidence interval (CI) = 1.61−4.74] and Canada (RR = 2.53, 95% CI = 1.55−4.21) whereas those enrolled earlier, despite increased risk due to low income, age and education, single status and zero parity, had rates of full-term LBW on par with the Province (RR = 1.29, 95% CI = 0.71−2.32) and Canada (RR = 1.19, 95% CI = 0.68−2.08). Conclusion The MBNS is an effective intervention for improving birth outcomes in women considered at risk. The challenge is to enrol pregnant women as early as possible. Future research will examine what programme component or combination of components (e.g. financial, information, referral) affects birth outcomes. [ABSTRACT FROM AUTHOR]

Background This study addressed the need for studies of the efficacy of the Born to Learn (BTL) curriculum. Methods Based on random assignment, 227 families of infants received the BTL curriculum conducted in monthly home visits, and 237 families received general child development education only. Results The BTL curriculum resulted in higher mastery motivation (task competence) at 36 months (P < 0.05) and greater effects for children from low (P < 0.01) versus high socio-economic status on mastery motivation and cognitive development at 24 months. No effects were found on a wide range of other developmental outcomes. Conclusion Future studies should document the BTL curriculum effectiveness in diverse settings and samples. [ABSTRACT FROM AUTHOR]

Background Programmes that promote early psychological development of children in the developed world have been found to be beneficial. However, such programmes are rare in underprivileged parts of the developing world. We adapted one such parent-based programme (Learning Through Play) for a rural Pakistani population and aimed to study if: (1) it was acceptable to community health workers; (2) the programme led to an improvement, after a period of 6 months, in mothers' knowledge and attitudes about early infant development; (3) it led to a reduction in the levels of maternal mental distress in the post-natal period. Methods Using a cluster randomized design with villages as unit of randomization, 163 mothers from 24 villages in a rural sub-district of Rawalpindi, Pakistan, received the ‘Learning Through Play’ programme, whereas 146 mothers from 24 villages acted as controls. Twenty-four community health workers were trained to carry out the programme. Assessments were conducted using a specially developed 15-item Infant Development Questionnaire and the 20-item Self-Reporting Questionnaire (SRQ). Results Over 80% of the community health workers trained found the programme to be relevant and were able to integrate it into their routine work. There was a significant increase in mothers' knowledge and positive attitudes about infant development in the intervention group, compared with the control group. Women in the intervention group answered correctly 4.3 (95% CI 3.7–14.9, P < 0.001) more questions than the control group. There was no difference in levels of mental distress measured by the SRQ. Conclusions The ‘Learning Through Play’ programme was successfully integrated into the existing health system and accepted by community health workers. The programme succeeded in improving the knowledge and attitudes of mothers about infant development. [ABSTRACT FROM AUTHOR]

Background The UK Government introduced a large-scale early childhood intervention programme, Sure Start, in 1999. Sure Start is to be further expanded, to achieve national coverage. US experience is highly relevant for anticipating challenges that this expansion will raise. Methods This is a focused, narrative review. We examine the impact, funding, quality-improvement and programme objectives of Head Start and Early Head Start programmes. Results (1) Early childhood interventions can make a significant difference to children’s life chances; (2) expansion without adequate funding threatens quality; (3) narrower objectives, which are easier to measure, can crowd out broader objectives, which are difficult to measure; (4) programmes must balance fidelity to the model and flexibility to local conditions; (5) multiple objectives may conflict; and (6) programmes may have differential impacts. We consider the implications of these findings for Sure Start, focusing on funding, quality control and parental involvement. We also consider that the potential Sure Start should offer for tackling health inequalities in early childhood and suggest ways in which this aspect of the Programme could be enhanced. Conclusion Head Start has been dogged by concerns about quality and effectiveness. Many of these problems stemmed from an over-hasty expansion, which locked the Programme into inadequate funding and uneven project- and staff-quality. These issues have been addressed through large funding increases and more rigorous performance measures. Nevertheless, concerns about the aims of the Programme and the extent of parental involvement in management remain. Current funding for Sure Start appears to be adequate, while systematic evaluation procedures have been built in from its inception. Concerns have been raised about the implications of expansion for funding, quality and for parental involvement in management of local programmes. US experience shows that these are centrally important issues and that, if they are not addressed early on, they can take many years to rectify. [ABSTRACT FROM AUTHOR]

In this article, the current climate of early intervention is considered, advocating the necessity for it to remain a cutting-edge service that attends to the changing needs profiles of children and their families. The article reviews the difficulties experienced by families in the UK, where, as the government acknowledges, life chances are still unequal. It emphasises that early interventions can increase the likelihood of the family being able to engage or re-engage with mainstream societal services, thus reducing the long-term costs to society. It discusses the past and present UK policy context from 2004, when Sohns reported that the UK was the only country without a national policy of infrastructure in relation to early childhood intervention, until the present when, a raft of legislation is in place acknowledging its importance and the need for priority. Central to many effective early intervention programmes is the goal of establishing shared communication in the infant–key carer dyad, using alternative communication and therapy-based interventions. The article discusses parent-inclusive programmes which meet the needs of both parents and children, and receive endorsement from parents. Finally, the article considers evaluation of early childhood services, and the necessity of increasing the centrality of the family in service delivery in order to provide services which are integrated, relevant and efficacious. [ABSTRACT FROM AUTHOR]

Attention deficit hyperactivity disorder (ADHD) is a complex disorder, where both genetic and environmental influences make a substantial contribution to the risk for the disorder. One of the challenges facing clinicians is to simplify for parents the multifaceted reasons why their child may have developed ADHD, explain the associated symptoms, and encourage parents to participate in intervention. Increasing parents understanding about ADHD should make them better informed about the disorder, more likely to consent to intervention, and increase adherence to both psychosocial and pharmacological treatment. The aim of this review is to provide clinicians with a brief synopsis of our current understanding about the aetiology of ADHD, co-morbidity and associated problems, developmental course and intervention options. [ABSTRACT FROM AUTHOR]

Background Early intervention is known to improve outcomes for babies at risk for growth and developmental problems. Such programmes usually have a prolonged course and require frequent contacts with the service providers. As a consequence of poverty, illiteracy and lack of communication facilities in developing countries, treatment adherence can suffer. Methods The present study is an analysis of a clinic-based early intervention programme for high-risk babies in a developing society in Goa, India. A sample of 152 neonates and their parents were offered an early intervention programme and followed up until their first birthday. The primary outcome under study was the uptake of the programme. Various socio-demographic, programmatic and infant-related variables that could affect compliance were examined. Results Compliance with the intervention programme was only moderate, with 59.2% of infants brought for three or more sessions. Higher maternal educational levels and proximity of the place of residence of the family to the early intervention clinic were significantly associated with better compliance. Conclusions Early intervention programmes that go into homes have a greater chance of reaching high-risk infants, compared with those provided at a distant centre. Better-educated mothers are more likely to be convinced about the benefits of such inputs. The authors conclude with recommendations for future practice and research. [ABSTRACT FROM AUTHOR]

Abstract Background Although international interest in intensive home-based early behavioural intervention for children with autism is increasing, there is little or no published research on the experiences of families conducting these programmes. Methods One hundred and forty-one UK parents conducting Lovaas-style interventions with their young child with autism were asked to identify factors that acted as facilitative factors and barriers to the implementation of these programmes. Parents responded to written questions contained within a questionnaire survey, and their responses were subjected to a content analysis procedure. Results Several of the facilitative factors and barriers were found to be similar. For example, a supportive therapy team was the most frequently cited facilitative factor, and problems recruiting and maintaining a suitable team was the most frequently reported barrier. Other factors seemed to be more independent constructs. For example, an important barrier was the lack of time and personal energy, but plenty of time and energy was not cited as a facilitative factor. Conclusions The practical implications of these results for families and for services supporting families engaged in intensive early behavioural intervention are discussed. In addition, more general implications for the designers of behavioural intervention programmes are identified. [ABSTRACT FROM AUTHOR]