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This five-year randomised controlled trial explored the impact of the Lifestart home visiting parenting programme, on parent and child development outcomes. The Lifestart Programme is a universal and structured child-centred programme of information and practical activity for parents of children aged from birth to five years of age. In total, 424 parents and children participated, and outcomes were measured at pre-test (child age < 12 months), mid-point (age 3) and post-test (age 5). Compared to the control group, parents who received the Lifestart programme reported reduced parenting related stress, increased knowledge of their child's development and improved confidence in their parenting role. There was no evidence of any change in child development outcomes (i.e. cognitive, behavioural, social or emotional development) and there was no clear evidence of any consistent differential programme effects in relation either to gender, first time motherhood, high pre-test anxiety or low maternal education. The results are commensurate with findings from other evaluations of similar programmes and are aligned to the hypothesised theory of change. The study contributes to the limited knowledge on solely home visiting, universal parenting programmes on parent and child outcomes. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Parenting interventions are effective for improving child conduct problems (CPs), but online self‐directed interventions are required to improve reach and impact. Mothers are the main users of such programmes; fathers show low participation rates despite evidence of increased efficacy when they participate.This randomised controlled trial examined the efficacy of Family Man, a brief, self‐directed online parenting intervention for fathers and mothers of children with CPs. The intervention involves several innovative design features to maximise the engagement of fathers. Families (N = 103; 102 mothers, 78 fathers) seeking help with managing their 2‐ to 8‐year‐old child's CPs were randomly assigned to either the Family Man intervention condition (n = 53) or a 4‐week waitlist control group (n = 50). Primary outcomes were frequency and severity of child CPs and secondary outcomes included dysfunctional parenting, parenting efficacy, parenting stress, parental psychological distress, household disorganisation and interparental conflict.Repeated measures ANOVAs/MANOVAs found that at 4‐week post‐assessment, parents in the intervention group reported significantly lower levels of child CPs than waitlist. Significant effects for the intervention group relative to waitlist were also found across all secondary outcomes examined. Intervention effects were maintained at 2‐month follow‐up for the intervention group. Outcomes did not significantly differ for mothers and fathers.Results support the efficacy of this brief, self‐directed online parenting intervention in improving child CPs and a range of parent and family outcomes, both for fathers and mothers. Implications for improving the reach and impact of parenting interventions and increasing father engagement, are discussed. [ABSTRACT FROM AUTHOR]

Abstract Background Clinicians and researchers should consider the expected benefits and potential harms of an intervention. Parenting programmes are a widely used evidence-based intervention for child behaviour problems. However, few data are available on potential negative effects. The aims of this paper were to increase systematic knowledge of adverse event (AE) assessment in parenting programmes and to provide an AE assessment tool. Methods As part of the RISE project (prevention of child mental health problems in South-eastern Europe—adapt, optimise, test and extend parenting for lifelong health), we developed and tested an AE assessment procedure in three sequential studies for parents of children with child behaviour problems aged 2 to 9 years in North Macedonia, Republic of Moldova, and Romania. This paper reports on the development of the assessment tool in phase 1 (N = 140), phase 2 (N = 835), and the final experiences with using the optimised procedures in phase 3 (multisite randomised controlled trial, N = 823) in which AEs were assessed before, three times during intervention delivery, and at 1 year follow-up. At each time point, the participants completed a 12-item AE checklist. If moderate-to-severe problems of parent or child were reported, a structured follow-up interview was conducted. Results The response rate on the AE assessment tool increased from 6% (phase 1) to 100% (phase 3) indicating improvement in collecting these data based on the experiences of each phase. Results of the RCT (phase 3) showed generally low (S)AE frequencies with the finally optimised procedure: During the intervention, no serious adverse events (SAE) were registered; at least one AE was reported by 10% (after the first session), 7% (after the third session), and 4% (after the last fifth session) of participants. None of the identified (S)AEs was causally related to the study or intervention. Cost–benefit considerations are needed to determine the best way to ensure participant safety in parenting programmes. Conclusion The applied active AE assessment procedure provides a comprehensive AE assessment tool that can be used by others—with adaptations for the specific context, if needed. Based on our experiences, we outline recommendations for future studies. Trial registration ClinicalTrials.gov, registration number phase 1: NCT03552250; phase 2: NCT03865485, phase 3: NCT04721730 . Registered on 13 January 2021.

Background: Clinicians and researchers should consider the expected benefits and potential harms of an intervention. Parenting programmes are a widely used evidence-based intervention for child behaviour problems. However, few data are available on potential negative effects. The aims of this paper were to increase systematic knowledge of adverse event (AE) assessment in parenting programmes and to provide an AE assessment tool. Methods: As part of the RISE project (prevention of child mental health problems in South-eastern Europe—adapt, optimise, test and extend parenting for lifelong health), we developed and tested an AE assessment procedure in three sequential studies for parents of children with child behaviour problems aged 2 to 9 years in North Macedonia, Republic of Moldova, and Romania. This paper reports on the development of the assessment tool in phase 1 (N = 140), phase 2 (N = 835), and the final experiences with using the optimised procedures in phase 3 (multisite randomised controlled trial, N = 823) in which AEs were assessed before, three times during intervention delivery, and at 1 year follow-up. At each time point, the participants completed a 12-item AE checklist. If moderate-to-severe problems of parent or child were reported, a structured follow-up interview was conducted. Results: The response rate on the AE assessment tool increased from 6% (phase 1) to 100% (phase 3) indicating improvement in collecting these data based on the experiences of each phase. Results of the RCT (phase 3) showed generally low (S)AE frequencies with the finally optimised procedure: During the intervention, no serious adverse events (SAE) were registered; at least one AE was reported by 10% (after the first session), 7% (after the third session), and 4% (after the last fifth session) of participants. None of the identified (S)AEs was causally related to the study or intervention. Cost–benefit considerations are needed to determine the best way to ensure participant safety in parenting programmes. Conclusion: The applied active AE assessment procedure provides a comprehensive AE assessment tool that can be used by others—with adaptations for the specific context, if needed. Based on our experiences, we outline recommendations for future studies. Trial registration: ClinicalTrials.gov, registration number phase 1: NCT03552250; phase 2: NCT03865485, phase 3: . Registered on 13 January 2021. [ABSTRACT FROM AUTHOR]

Culturally responsive parenting interventions are crucial for immigrant parents in disadvantaged areas. This qualitative study delves into the experiences of 18 immigrant mothers (Mage = 41.2 years) from Somalia, Syria, Turkey, Eritrea, and Iraq participating in the Swedish Self-Assured Parents programme, targeting immigrant parents who live in social disadvantage with teenage children. Thematic analysis revealed seven main themes (1) the meaning of the programme content and structure, (2) enjoying oneself and being comfortable, (3) putting the adolescent in the centre, (4) mothers' own socioemotional development, (5) changing from being a passive reactor to an active agent, (6) empowered citizenship, and (7) having always been a strong and good mother. Overall, the mothers were positive about both the content and the format of the programme, appreciating the warm and supportive climate. They also perceived themselves as being more attentive to adolescent needs, having improved their own socio-emotional skills, and being empowered both as a citizen and as a mother on account of attending the programme. With the development of culturally responsive programmes that take into account the unique needs and experiences of diverse populations, governments can effectively support parents, promote child positive development, and help cultivate social cohesion among the members of society. [ABSTRACT FROM AUTHOR]

Abstract Background Evaluating the effectiveness of early years parenting interventions provides evidence to improve the development and wellbeing of children. This protocol paper describes a study to explore the feasibility of evaluating the Incredible Years Toddler early life intervention programme, which is offered to parents of 1–3-year-olds via the Better Start Bradford programme. The study aims to use a Trial within a Cohort Study (TwiCS) design that randomly selects individuals participating in a cohort to be offered an intervention. The TwiCS information and consent process is person-centred and aims to replicate real-world practice whereby only those who are offered the intervention are given information about the intervention. The cohort is the Born in Bradford’s Better Start (BiBBS) cohort, an interventional birth cohort recruiting expectant parents in three areas of Bradford, UK. The study will assess the feasibility of TwiCS procedures, staged consent, and intervention take-up. Methods We will conduct a feasibility TwiCS to test study procedures. We aim to establish the following: (1) whether TwiCS methodology can be implemented to create control and intervention arms, whilst documenting any incidences of contamination within the cohort; (2) whether satisfactory rates of intervention uptake are achieved among participants allocated to the intervention; and (3) whether satisfactory rates of retention of participants in the intervention can be achieved. A Red Amber Green (RAG) rating system has been applied to support the feasibility assessment of each objective: to be rated red (not achieved), amber (partly achieved), and green (achieved). Eligible participants in the BiBBS cohort will be individually randomised 1:1 to the intervention or control arms, with stratification by child age (1 or 2 years old at the time of randomisation) and ethnicity (White British, South Asian, or other). BiBBS researchers will seek consent from participants randomised to the intervention to pass their contact details onto Incredible Years’ delivery agents. Discussion This feasibility study will inform the utility of the TwiCs approach within an experimental birth cohort to evaluate interventions for infants, toddlers, and their families. Trial registration The study was prospectively registered on ISRCTN (ISRCTN16150114).

Background: Early childhood is a critical period for child development. Effective approaches to support families in low‐resource settings in the use of responsive and stimulating parenting are needed. Aim: The aim of this study was to examine the effects of the Reach Up early childhood parenting programme on children's development, parenting attitudes and practices, when delivered through early childhood development (ECD) centres in Zimbabwe. Methods: A cluster randomised controlled trial was conducted in Sanyati, a rural district in Zimbabwe. Twenty‐four of 51 available centres were randomised to intervention (n = 12) or control (n = 12) groups. Sixteen mothers with a child aged 12–30 months were recruited from each centre's catchment area (n = 189 intervention; n = 193 control). The intervention comprised two home visits per month delivered by centre teaching assistants over a period of 27 months. Primary outcomes were child Developmental Quotient (DQ), Language, Eye and Hand coordination, Performance and Practical Reasoning subscale scores assessed at follow‐up. Secondary outcomes were mothers' attitudes about child development, parenting practices and maternal depressive symptoms all measured at baseline and follow‐up. Intention to treat analyses was conducted using mixed‐effects regression models with the standard error adjusted for cluster and inverse proportionality weights to adjust for attrition. Significance was set at P < 0.05. Results: A total of 285 (74.6%) of 382 children enrolled were tested, with 97 children lost to follow‐up. The intervention improved the children's DQ by 3.55 points (95% CI 0.82 to 6.28), Eye and Hand by 3.58 (95% CI 0.59 to 6.56) and Practical Reasoning by 4.19 (95% CI 0.96 to 7.42). No significant improvements to Performance or Language scores, parenting attitudes, parenting practices and depressive symptoms were identified. Conclusions: A home visiting intervention delivered by ECD teaching assistants promoted children's development. This suggests that outreach from preschools may be an effective platform for delivery of parenting interventions. [ABSTRACT FROM AUTHOR]

Nurturing care and protection from parents and community in the early years of life are fundamental for a child's development. The article aims to explore what relations parents see as meaningful in their child's upbringing and how these are shaped, and how these perspectives are reflected in MANU. MANU is a universal parenting programme in Greenland. Ten of 40 interviews with parents were selected for the analysis of this article's objective. Five grandparents were interviewed. Grandparents are the child's closest extended family members and provide support to parents. Parents placed between one to 19 extended family members in their child's network. Eating and being in nature together, along with familial and intergenerational connectedness, were deemed valuable and important aspects in child-rearing. Parents' own experiences in childhood can influence and complicate how parents place their new family within the extended family. The MANU materials address aspects in the role of kin that parents and grandparents described in interviews. The format and delivery of MANU aims to be universal and mostly addresses Western epistemologies, but both Western and Inuit epistemologies coexists in Greenland. This article creates a window into the existing context parents navigate in. It is important that initiatives are built within this context to ensure they are relevant to families [ABSTRACT FROM AUTHOR]

The present study aimed to train Traditional Birth Attendants (TBAs) in a parenting program called Learning through Play (LTP) to improve their Knowledge, Attitude, and Practices regarding child development after completion of training, for them to be better able to support parents during their routine practice. Quasi experimental design was used. A total of 330 TBAs meeting study eligibility criteria were included and data was collected in a group setting. LTP training was comprised of weekly sessions delivered over 1 month. LTP includes knowledge about child development for children from 0 to 3 years. The Knowledge, Attitude, and Practices (KAP) questionnaire was used to measure change. Statistical analysis was done through Paired Sample T -test. There was a significant difference between pre-post scores t = -29.36 (p <.05). Capacity building of TBAs in LTP program and integrating LTP into existing health care systems may contribute to reducing the child development gaps in Pakistan. Plain Language Summary: Purpose: This study was designed to train the Traditional Birth Attendants (TBAs) in a parenting intervention programme called Learning through Play (LTP) to improve their Knowledge, Attitudes and Practices regarding children's physical, cognitive, and socioemotional development. This training would give them skills to support parents efficiently as a part of their routine practices. Methods: A total of 330 TBAs participated in this study and data was collected in a group setting. LTP training included weekly sessions given over a period of 1 month. The LTP training programme includes information about child development for children from birth to 3 years. The Knowledge, Attitude and Practices (KAP) questionnaire was used to measure change in knowledge after this training. Results: Results showed that there was significant difference between pre training and post training scores. The TBAs scored higher on KAP questionnaire after completing the LTP training as compared to the KAP scores before attending this programme. Conclusion and implications: Training TBAs in LTP programme and integrating LTP into existing health care systems may contribute to reducing the child development gaps in Pakistan. Limitations: Post assessment was conducted immediately after completion of the training; we would recommend for future studies to conduct a follow up assessment to find out how well they remember the information and to what extent they implement the gained knowledge into their routine practice. [ABSTRACT FROM AUTHOR]

ABSTRACTNurturing care and protection from parents and community in the early years of life are fundamental for a child’s development. The article aims to explore what relations parents see as meaningful in their child’s upbringing and how these are shaped, and how these perspectives are reflected in MANU. MANU is a universal parenting programme in Greenland. Ten of 40 interviews with parents were selected for the analysis of this article’s objective. Five grandparents were interviewed. Grandparents are the child’s closest extended family members and provide support to parents. Parents placed between one to 19 extended family members in their child’s network. Eating and being in nature together, along with familial and intergenerational connectedness, were deemed valuable and important aspects in child-rearing. Parents’ own experiences in childhood can influence and complicate how parents place their new family within the extended family. The MANU materials address aspects in the role of kin that parents and grandparents described in interviews. The format and delivery of MANU aims to be universal and mostly addresses Western epistemologies, but both Western and Inuit epistemologies coexists in Greenland. This article creates a window into the existing context parents navigate in. It is important that initiatives are built within this context to ensure they are relevant to families

Objective: This study evaluated the effectiveness of the Parents Plus Special Needs (PPSN) programme, a seven‐week parenting group intervention for parents of adolescents with intellectual disabilities. Method: In a cluster randomised controlled trial, 24 intellectual disability services supporting families of adolescents with an intellectual disability were assigned to PPSN (12 services; 141 parents) or waitlist control group (12 services; 136 parents). Primary outcomes were parent‐reported parenting practices, family adjustment, problem behaviours, emotional problems, and prosocial behaviours. Secondary outcomes were parental satisfaction, parental self‐efficacy, and goal attainment. Results: Compared to the waitlist group, participants in the PPSN group reported improvements in parenting practices, problem behaviours, parental satisfaction, parental self‐efficacy and goal attainment, which were retained at 3‐month follow‐up. There were additional gains for family adjustment at follow‐up. Conclusion: The PPSN is effective in improving parenting behaviour, family relationships, and problem behaviours in adolescents, but not in improving emotional difficulties. [ABSTRACT FROM AUTHOR]

Papua New Guinea (PNG) is a low-income country experiencing high rates of family violence and child maltreatment. Child protection services are under-developed, and few tertiary-trained social workers are employed by them. A research team was commissioned to develop a parenting programme for implementation in remote provinces. After development and co-design of the programme, a pre- and post-evaluation was conducted in 10 communities to test the programme's potential to facilitate change. Measures of harsh parenting, family well-being and parental attitudes were translated by experienced academics and administered to parents by a team of staff and students from a local university. Responses were subjected to factor analyses. A series of paired-sample t-tests was conducted to ascertain change in parents' reported family well-being and use of harsh disciplinary practices (sample n = 159). Encouraging numbers of caregivers attended the programme in all sites. The analysis of change between pre- and post-programme scores revealed statistically significant reductions in verbal abuse and corporal punishment, and in harsh parenting overall, with reductions in partner violence and family difficulties contributing to improvements in family well-being. The evaluation indicates that with further development, this programme could be implemented as a primary prevention measure to complement child protection services. To consolidate the programme's future implementation by building the pool of trained personnel, links with social work education should be further developed. [ABSTRACT FROM AUTHOR]

Abstract Background Poor perinatal mental health and maternal sensitivity towards a child in the early years can carry a long-term cost to individuals and to society, and result in negative child outcomes such as poor mental health and social emotional issues. Despite the recognition of early intervention and prevention, there is mixed evidence regarding antenatal parenting interventions that aim to enhance perinatal mental health and maternal sensitivity to prevent negative child outcomes. ‘Baby Steps’ is a relationship-based antenatal and postnatal parenting programme. The service evaluated in this study is delivered in a low-income and ethnically diverse community via Better Start Bradford. This study aims to assess whether the universally, and remotely delivered Baby Steps programme is effective in improving postnatal maternal sensitivity (primary outcome) and postnatal maternal mental health (secondary outcome) when compared to services as usual 6–10 weeks post-birth. It will also assess differences in birth outcomes, and differences in the prevalence of poor perinatal mental ill health through routine data. The feasibility of collecting cost and health related resource use data for a future economic evaluation will be explored. Methods The study is a quasi-experimental evaluation in a single centre. All participants are drawn from Born in Bradford’s Better Start (BiBBS) interventional family cohort study. Intervention participants will be matched to a demographically comparable control group using propensity score matching. The required minimum sample is n = 130 (ratio 1:1) to detect a medium effect (± 2.35, d = .50) on the primary outcome—maternal-child sensitivity, using the Mothers Object Relations Scale Short Form (MORS-SF). Secondary outcomes include the Patient Health Questionnaire (PHQ-8), Generalised Anxiety Disorder assessment 7 (GAD-7), identification of poor perinatal mental health through routine data, and birth outcomes (delivery method, gestation period, low birth weight). Service delivery costs and health resource use will be gathered from routine data. Discussion This study will evaluate the effectiveness of Baby Steps for enhancing maternal-child sensitivity and maternal mental health when delivered universally and remotely. The findings regarding programme effectiveness, process, and costs will be relevant for researchers, service commissioners, and service staff. Trial registration This study was prospectively registered with ISRCTN (22/04/2022, ISRCTN12196131).

This study aimed to evaluate the effectiveness of the International Child Development Programme (ICDP), a group‐based parenting programme used internationally and implemented nationally in Norway. We used a cluster randomized controlled trial in which 81 groups were randomly assigned to either the intervention or waitlist control condition after the baseline data collection. A total of 590 parents completed at least one of three questionnaires (administrated before and after ICDP and 4 months after completing the intervention). Primary outcomes included parental self‐efficacy, parental emotion sensitivity and positive involvement with their child. Secondary outcomes included parents' perceptions of their relationship with the child, child‐rearing conflicts and the child's psychosocial health. We found significant effects favouring the intervention arm following the intervention and at follow‐up on two primary outcomes (parental self‐efficacy and emotion sensitivity). For the secondary outcomes, we found a significant reduction in child‐rearing conflict at the 4‐month follow‐up, increased closeness to the child, reduced child internalizing difficulties and increased prosocial behaviour immediately following the intervention. However, ICDP seems to have limited effects on parent‐reported changes in children. We conclude that ICDP as a universal preventive programme offered to parents in groups can be effective in strengthening parental self‐efficacy and improving parental emotion sensitivity. [ABSTRACT FROM AUTHOR]

Background: Pakistan is home to 4.6 million children who have been orphaned. Limited data on caregiving in orphanages suggests that caregivers do not have specialized training and experience heavy workloads and high‐stress levels. Supporting these caregivers to provide responsive and consistent caregiving can improve their well‐being along with the psychological and physical development of children who have been orphaned. This research explored the main caregiving‐related challenges faced by caregivers in orphanage settings, their professional and personal needs and perceived emotional and behavioural problems manifesting in children under their care. Method: This research adopted a qualitative research design with a thematic analysis approach. Semi‐structured interviews were conducted with 14 caregivers who were currently caring for four to 12‐year‐old children in Pakistani orphanages. Results: Five main themes: (1) religiosity, (2) economic relief, (3) caregivers' needs and well‐being, (4) caring for children who have been orphaned and (5) need for context specific training, emerged from the data, which included several subthemes. Findings revealed the presence of positive religious views regarding the upbringing and care of children who have been orphaned. Work‐provided accommodation was an important economic relief. Caregivers' psychological, physiological and personal lives were affected by job‐related stress and demands. Many helpful and unhelpful parenting practices were documented, and challenges such as children's verbal and physical aggression, stealing, non‐cooperation and poor social skills were reported. The main professional issues included low salary, high numbers of children in care and lack of context specific professional caregiving training provided. Conclusion: This study established the need for a tailored programme that suits the context specific caregiving needs in Pakistani orphanages to support the training and professional growth of caregivers and promote their wellbeing along with positive developmental outcomes in the children under their care. [ABSTRACT FROM AUTHOR]

Infancy is a critical period during which major developmental transformations occur. Early parenting is one of the strongest influences on infants' immediate and longer-term outcomes. The transition to parenting can be demanding and stressful for mothers and fathers. This paper reports results from a feasibility study of the Empowering Parents Empowering Communities Baby and Us programme, an 8-week, universal, peer-led parenting programme for new parents living in socially disadvantaged communities. This study is a quasi-experimental, one arm, no control group study, assessing the feasibility and acceptability of Baby and Us. Programme participants (n = 158) completed standardised self-report measures of parent goal attainment, self-efficacy, knowledge about parenting, mental wellbeing, parental confidence, and programme acceptability. We found that recruiting parents from disadvantaged backgrounds was feasible (96% of programmes recruited sufficient parents to proceed, mean = 6.6 parents per programme); parent goals closely matched the aims of the programme; programme completion was high (74%), and self-report measurement completion rates were in line with other large scale community delivered parenting programmes; parents rated the programme as highly satisfactory; and they reported significant improvements in their mental wellbeing, confidence, parenting skills, self-efficacy, and goal attainment. These results provide important data to conduct a full-scale trial of Baby and Us. [ABSTRACT FROM AUTHOR]

This article presents the results of an investigation regarding the perceptions of people participating in a programme on parental competencies for family reunification about the changes achieved through the same. This included the perceptions of children, adolescents, and their parents. A qualitative research was carried out based on thirteen focus groups comprising n  = 59 children and adolescents out of the total 135 programme participants. Contributions of the young persons allowed the identification of changes in (1) parental competency related to foster care measures, visits and contact during foster care; (2) parental competency related to family adjustment and parental role during the return home and (3) personal awareness about foster care and family members' reunification process. Additionally, two other concepts emerged, which are considered cross-sectional to the process of foster care and family reunification: (4) the child-rights approach and (5) resources supporting parental education. The findings indicated the importance of resilience phases, communication skills and emotional competencies and attitude and awareness regarding the process of fostering and reuniting families. [ABSTRACT FROM AUTHOR]

Background: Mental disorders have become a public health crisis. Early prevention is key. Parenting programmes are effective for children aged ≥ 3 years; however, there is a lack of evidence of their effectiveness for children aged ≤ 2 years. Objectives: To establish if the model named Enhancing Social–Emotional Health and Well-being in the Early Years (E-SEE) Steps can (1) enhance child social emotional well-being and establish whether or not it is cost-effective at 20 months of age when compared with services as usual; and (2) be delivered as a proportionate universal model with fidelity. Design: A pragmatic two-arm randomised controlled trial and economic appraisal, with an embedded process evaluation to examine the outcomes, implementation and cost-effectiveness of the intervention, and intervention uptake, compared with services as usual. The study had an external pilot phase (which was originally planned as an internal pilot). Setting: The intervention was delivered in community settings by early years children’s services and/or public health staff in four sites. Participants: A total of 341 parents of infants aged ≤ 8 weeks were randomised in a ratio of 5 : 1 (intervention, n = 285; control, n = 56). The target sample was 606 parents. Intervention: Two Incredible Years® parenting programmes (i.e. infant and toddler) delivered in a proportionate universal model with three levels [one universal (book) and two targeted group-based parenting programmes]. Main outcome measures: Child social and emotional well-being (primary outcome) was assessed using the Ages and Stages Questionnaire: Social and Emotional, 2nd edition, at 2, 9 and 18 months after randomisation. Parent depression (secondary key outcome) was assessed using the Patient Health Questionnaire-9 items. Both questionnaires were eligibility screeners for targeted groups. Results: The primary outcome analysis provided no evidence that the E-SEE Steps model was effective in enhancing child social and emotional well-being. The adjusted mean difference was 3.02 on the original Ages and Stages Questionnaire: Social and Emotional, 2nd edition, in favour of the control [95% confidence interval –0.03 to 6.08; p = 0.052; N = 321 (intervention, n = 268; control, n = 53)]. Analysis of the key secondary outcome (i.e. parent depression levels as assessed by the Patient Health Questionnaire-9 items) provided weak evidence on the Patient Health Questionnaire-9 items in favour of the intervention (adjusted mean difference –0.61, 95% confidence interval –1.34 to 0.12; p = 0.1). Other secondary outcomes did not differ between arms. The economic analysis showed that the E-SEE Steps model was associated with higher costs and was marginally more effective (0.031 quality-adjusted life-years gained from E-SEE Steps compared with SAU, 95% confidence interval –0.008 to 0.071) than services as usual, resulting in an incremental cost-effectiveness ratio of approximately £20,062 per quality-adjusted life-year compared with services as usual. Overall take-up of the targeted parenting programmes was low. Sites, although enthusiastic, identified barriers to delivering the intervention. Limitations: The target sample size was not met and the study was not powered to explore the effectiveness of each level of intervention. Most parents in the sample were well educated and, therefore, the results are unlikely to be generalisable, particularly to those at greatest risk of poor social and emotional well-being. Conclusions: The E-SEE Steps proportionate universal model did not enhance child social and emotional well-being, but generated non-significant improvements in parent health outcomes, resulting in considerable uncertainty around the cost-effectiveness of the intervention. The primary and key secondary outcome gave inconsistent signals. Although, with system changes, increased resources and adaptations to the intervention, the model could be implemented, evidence for positive outcomes from the E-SEE Steps model is poor. Future work: The universal-level E-SEE Step data (i.e. the Incredible Years book) from the external pilot will be pooled with the main trial data for further exploration up to follow-up 1, which is the time point at which most change was seen. Trial registration: This trial is registered as ISRCTN11079129. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 8. See the NIHR Journals Library website for further project information.

Abstract Background Parenting programmes aim to alleviate behavioural problems in children, including conduct disorder. This study was part of a multi-phase mixed-methods project seeking to extend the reach of parenting programmes for the treatment of conduct problems through developing an evidence base to inform a personalised approach. It explored the narratives of parents of children with behavioural and conduct problems about parenting programmes to identify how such programmes could be personalised in order to extend their reach to parents and children who do not currently benefit. Methods Face-to-face semi-structured interviews with a purposive sample of 42 parents, who had different experiences of parenting programmes. Interviews were conversational and informed by a topic guide. Analysis of transcripts of audio-recorded interviews drew on inductive thematic approaches and was framed largely within a phenomenological perspective. Results Parents’ accounts demonstrated three themes: 1) a personalised approach needs to include the child; 2) a supportive school matters; and, 3) the programme needs to feel personal. Parents were more likely to have a positive experience at a parenting programme, and for their child to demonstrate positive behavioural changes, when they felt their concerns were validated within the group and they also felt supported by the child’s teachers. Parents whose children had been assessed prior to undertaking the programme were also more likely to perceive the programme to be beneficial, compared to parents who felt their child’s individual issues were never considered. Conclusions Our findings point to the potential for personalised approaches to extend the reach of parenting programmes to parents and children who do not currently benefit from such programmes. Important in personalising parenting programmes is assessing children before parents are referred, to directly work with children as well as parents, and to work collaboratively with parents and children to identify which families are most suited to group support or one-to-one support and how this may change depending on circumstances.

This study, conducted in a real‐world setting, evaluated the effect of a parenting programme offered to families receiving child protection services (CPS) for child neglect. With a retrospective quasi‐experimental design, the study used administrative data to examine the association between participation in the Incredible Years® (IY) parenting programme and the likelihood that the family's CPS case file would be closed. The intervention group included all children involved with CPS for neglect who had at least one parent who participated in the IY between 2007 and 2015 (n = 299) whereas the comparison group consisted of 299 children with substantiated neglect but who received care as usual in CPS, during the same time period. The children were matched by a propensity score calculated using several variables. A Cox regression comparing intervention and comparison groups revealed that the participation in the programme increased the probability of case closure by 43%. Thus, participation in the programme can contribute to restoring the family's ability to care for the child, thus reducing the time spent in CPS. [ABSTRACT FROM AUTHOR]

Triple P is a parenting programme used in the youth healthcare practice of many Dutch municipalities to support parents in raising their children. According to international research, this Australian intervention is effective for parents with children up to the age of 12. It shows positive effects on parenting skills and on the reduction of both parents' child-rearing stress and their children's behavioural and emotional problems. Our study examined the effectiveness of Teen Triple P level 4: a training programme for parents of teenagers aged 10–16. The programme included five group sessions of 1.5–2 h each, as well as three individual (phone) consultations. Through a matching procedure, 103 parents who participated in Teen Triple P were compared in a quasi-experimental study with 397 parents in a control group. Compared with the control group, parents who received the Teen Triple P training reported a significant improvement in their parental practice. Now, they are more involved with their child, more responsive to the needs of the children, and they report fewer parent–child conflicts. Some positive differences in behavioural problems among adolescents, as reported by their parents, could be found among the experimental group. These findings remained the same at the follow-up. [ABSTRACT FROM AUTHOR]

This paper describes the process of adapting an early childhood development programme, with proven effectiveness in Bangladesh, for integration into government health services in rural Bangladesh. Through a three-stage process, we adapted an evidence-based, home-visiting, programme (Reach-Up and Learn) for delivery in government health clinics by government health staff as part of their regular duties. Stage one involved preparing an initial draft of two parenting interventions for use with: (1) pairs of mother/child dyads, and (2) small groups of mother/child dyads. In stage two, we piloted the adapted interventions in nine clinics with a total of twenty-seven health staff and 357 mother/child dyads. We used data from mothers' attendance, feedback from participating mothers and health staff and observations of parenting sessions by the research team to revise the interventions. Stage three involved piloting the revised interventions in six clinics with eighteen health staff and 162 mother/child dyads. We gathered additional data on mothers' attendance and used observations by the research team to finalize the interventions. Through this three-stage process, adaptations were made to the intervention content, process of delivery, materials, and engagement strategies used. The largest challenges were related to incorporating the parenting programme into health staff's existing workload and promoting mothers' engagement in the programme. We also simplified the content and structure of the curriculum to make it easier for health staff to deliver and to ensure mothers understood the activities introduced. This iterative piloting was used prior to implementing and evaluating the interventions through an effectiveness trial.

The aim of this study was to assess parents' satisfaction and perceived usefulness of the Incredible Years® (IY®) parenting programme in the Child Protection Services (CPS) context, where children's behaviour problems are common. Evidence‐based programmes are rarely offered in CPS, and little is known about how they are perceived by parents. We compared parents (N = 62) with (N = 43) and without (N = 19) CPS contact regarding their satisfaction with the IY® parenting programme, with information gathered from weekly and final evaluation forms. The attendance rate of parents to the weekly sessions (max 19) was also calculated. Comparisons between CPS and non‐CPS clients were analysed using multilevel models. Satisfaction scores ranged between 5.8 and 6.2 (max 7) for all studied domains. Mean attendance rate to the group sessions was 11.5 (SD 5.9), and 74% of participants attended at least nine out of 19 sessions. No group differences emerged in satisfaction or attendance between CPS and non‐CPS parents. Parents in CPS committed well to the programme and found it as useful as parents without CPS contact. IY® appears to be acceptable to parents involved in CPS, and their engagement to the programme can be considered as reasonably good. [ABSTRACT FROM AUTHOR]

Abstract Background In the search for effective interventions aiming to prevent perinatal stress, depression and anxiety, we are evaluating a Mindfulness Based Childbirth and Parenting (MBCP) Program. In this study we explore the participants’ experiences of the program. Method This is a descriptive qualitative study with influences of phenomenology. The participants were expectant couples who participated in the program and the pregnant women had an increased risk of perinatal stress, anxiety and depression. Ten mothers and six fathers were interviewed in depth, at four to six months postpartum. Thematic analysis of the transcripts was conducted. Results The participants’ descriptions show a variety in how motivated they were and how much value they ascribed to MBCP. Those who experienced that they benefitted from the intervention described that they did so at an intra-personal level–with deeper self-knowledge and self-compassion; and on an inter-personal level–being helpful in relationships. Furthermore, they perceived that what they had learned from MBCP was helpful during childbirth and early parenting. Conclusion Our findings demonstrate that most of the parents experienced MBCP as a valuable preparation for the challenges they met when they went through the life-changing events of becoming parents. The phenomenon of participating in the intervention, integrating the teachings and embodying mindfulness seems to develop inner resources that foster the development of wisdom. Trial registration ClinicalTrials.gov ID: NCT02441595, May 4, 2015.

Abstract Background Support to strengthen the early parent-infant relationship is recommended to ensure the infant’s future health and development. Little is known about the universal approaches taken by health visitor to support this early relationship. The aim of this study is to investigate the effects of health visitors’ use of the Newborn Behavioral Observation (NBO) method among new parents. Methods This is a cluster-randomised community-based study implemented in four Danish municipalities. Health visitors will conduct the trial, and the geographical districts they work in will constitute the clusters as units of randomisation. The participants will be approximately 2800 new families, randomised into an intervention or a comparison group according to their health visitor. The families are recruited at the first postpartum home visit. Parents in both groups receive care as usual: parents in the intervention group also receive the standardised NBO method in home visits performed from 3 weeks to 3 months postpartum. Data consist of self-reported parent questionnaires and video recordings of a selected group of vulnerable first-time mothers recorded 4 months postpartum. The self-reported data are obtained: at baseline 1 week postpartum and then at follow-up 3, 9 and 18 months postpartum. Data will be analysed using the intention-to-treat method and the analyses will include comparison of change in the primary variables across time supplemented by multiple regression analysis. The primary study outcomes are measured by the following factors: parental confidence, infants’ socio-emotional development and mother-infant relationship. Other measures include parental mood and stress, breastfeeding duration and utility of the health visitor services. Data collection among the health visitors in both groups will serve to monitor any change in practice regarding the work with early parent-infant interactions. Discussion This protocol describes an evaluation of the NBO method used universally in health visiting practice. The intervention seeks to support early parenting by increasing parents’ understanding of their infants’ cues. The NBO is currently implemented in Denmark even though an evaluation of the NBO has yet to be made in a community setting in Denmark and internationally. The study may contribute to building an increasingly evidence-based practice for health visitors. Trial registration ClinicalTrials.gov ID: NCT03070652. Registered February 22, 2017.

Early-onset behavioural difficulties persisting into the pre-school years, can make young children vulnerable to poor long-term outcomes including the development of conduct disorders, which are linked to significantly higher societal costs. Several parenting interventions have been shown to reduce behavioural difficulties in children and this evaluation presents outcomes from the Psychology of Parenting Project (PoPP), a national implementation programme delivered in early years services in Scotland. This evaluation of service implementation reports on a large cohort of children (2204, age: 2–5 years) whose parents/caregivers participated in PoPP group-based parenting interventions. We explored change in parent-reported Strengths and Difficulties Questionnaire (SDQ) scores following either the Incredible Years Pre-school Basic or the Level 4 Group Triple P interventions. Latent profile analysis (LPA) was used to identify statistically distinct sub-groups of children based on SDQ subscale scores (emotional, conduct, hyperactivity, peer problems and prosocial). Pre- and post-intervention SDQ scores were available for 58% of children. Large intervention effects were reported and analyses showed that 60% of "at-risk" children were no longer scoring in the at-risk range post-interventions. LPA identified four statistically-distinct profiles of children. Children from "low" and "moderate" behavioural problem profiles benefited more from Triple P, whereas "severe" and "hyperactivity-focused" problem profiles displayed better outcomes following Incredible Years. When delivered through a robust implementation scheme, these parenting interventions can be effective in routine service settings and produce clinically important improvements. These findings and the identification of distinct profiles of children who may respond differentially to interventions could guide the planning of future dissemination schemes. Highlights: We examine the Psychology of Parenting Project (PoPP)—a national roll out of evidence-based parenting interventions in Scotland. We calculated intervention effects using data from a sample of 2,264 children enrolled in PoPP interventions in the evaluation period. 60% of children scoring in the high-risk range of the Strengths and Difficulties Questionnaire pre-assessment were no longer scored in the clinical range post-intervention. Overall, we observed similar outcomes when comparing the Incredible Years and Triple P intervention groups. These results suggest that PoPP interventions may offer considerable long-term savings when considering potential long-term costs associated with conduct disorders. [ABSTRACT FROM AUTHOR]

Background: Parenting programmes aim to alleviate behavioural problems in children, including conduct disorder. This study was part of a multi-phase mixed-methods project seeking to extend the reach of parenting programmes for the treatment of conduct problems through developing an evidence base to inform a personalised approach. It explored the narratives of parents of children with behavioural and conduct problems about parenting programmes to identify how such programmes could be personalised in order to extend their reach to parents and children who do not currently benefit. Methods: Face-to-face semi-structured interviews with a purposive sample of 42 parents, who had different experiences of parenting programmes. Interviews were conversational and informed by a topic guide. Analysis of transcripts of audio-recorded interviews drew on inductive thematic approaches and was framed largely within a phenomenological perspective. Results: Parents' accounts demonstrated three themes: 1) a personalised approach needs to include the child; 2) a supportive school matters; and, 3) the programme needs to feel personal. Parents were more likely to have a positive experience at a parenting programme, and for their child to demonstrate positive behavioural changes, when they felt their concerns were validated within the group and they also felt supported by the child's teachers. Parents whose children had been assessed prior to undertaking the programme were also more likely to perceive the programme to be beneficial, compared to parents who felt their child's individual issues were never considered. Conclusions: Our findings point to the potential for personalised approaches to extend the reach of parenting programmes to parents and children who do not currently benefit from such programmes. Important in personalising parenting programmes is assessing children before parents are referred, to directly work with children as well as parents, and to work collaboratively with parents and children to identify which families are most suited to group support or one-to-one support and how this may change depending on circumstances. [ABSTRACT FROM AUTHOR]

Many countries seek evidence-based interventions for children who have been exposed to domestic violence, and they frequently turn to interventions developed in the US and disseminated to Europe as a solution. Societal and cultural differences may, however, pose barriers to successful implementation. Project Support (PS), piloted in this study through social services agencies in Sweden, has shown positive effects in the US for families with children who have been exposed to intimate partner violence (IPV). The aim of this study was to investigate counselors' and caregivers' experiences when giving/receiving PS in Sweden. The study was based on interviews conducted with 11 mothers and 13 counselors with experience in the programme. A thematic analysis showed three themes (Initial doubts, Confidence from positive change, and Flexibility- challenge for the organization) and the study adds information about obstacles for implementation of PS in Sweden. Cultural and organizational differences between Sweden and the US in practice and child-rearing attitudes are highlighted, as well as the importance of making adjustments while maintaining treatment fidelity, and promoting the dissemination of the approach. [ABSTRACT FROM AUTHOR]

Abstract Background Traumatic brain injury (TBI) in children is associated with a range of poor long-term outcomes, including behavioural disturbances. Parents can experience high levels of stress and injury-related burden, and evidence suggests that distressed parents are less likely to adopt positive parenting styles to manage their child’s behaviour. The ‘Signposts for Building Better Behaviour’ program is a parenting programme that was originally developed to assist parents of children with an intellectual disability in managing their child’s behaviour. More recently, it has been adapted to include a TBI module, to assist parents in managing post-TBI behaviour. However, geographical and financial barriers remain, preventing many parents from accessing the programme in the standard face-to-face modality. This project aims to investigate the feasibility and acceptability of the programme when delivered with clinician support via videoconferencing. Methods/design The sample for this feasibility study will be recruited from the Royal Children’s Hospital, Melbourne, and the Victorian Paediatric Rehabilitation Service. Participants will be the parents of a child who sustained a TBI between the ages of 2.0 and 6.11, within the previous 2 years. The parents of 15 children will complete the programme, with clinician support via videoconferencing, while the parents of a further 15 children will form a treatment as usual wait-list control group. Parents complete questionnaires assessing their child’s behaviour, as well as assessing their own mental health, sense of parenting competency, disciplinary style, and family functioning. These will be completed upon enrolment in the study regarding their child’s pre-injury behaviour and then again pre-intervention, immediately post-intervention, and 4 months post-intervention. Parents who complete the intervention will also complete questionnaires assessing their satisfaction with the programme and its delivery. Information will be collected on the feasibility, clinical practicality, and acceptability of the programme when delivered through this medium. Discussion This study is the first to investigate the feasibility of delivering post-child TBI behavioural intervention via videoconferencing in Australia. Preliminary findings from this study may support the development of a larger randomised controlled trial. It is hoped that programme delivery through this medium would facilitate better access to the programme, enabling improved long-term outcomes for families. Trial registration ANZCTR, ACTRN12616001574437

Background: Children with developmental disabilities tend to develop challenging behaviours. Parenting programmes that focus on behaviour management may help parents address these difficult behaviours by increasing parenting self‐efficacy. However, the literature on parenting self‐efficacy is still limited due to measurement variability in conceptualization and operationalization of the construct, and heavy reliance on cross‐sectional data. Method: This study utilized hierarchical linear regression to examine the predictors of parenting self‐efficacy in 284 mothers who attended a parenting programme in a hospital's Department of Child Development in Singapore. Results: Our model was able to explain 37% of variance in parenting self‐efficacy. After controlling for general stress and specific parenting hassles, the programme was still found to be effective in improving mothers' parenting self‐efficacy. Conclusions: Results are discussed in terms of their implications for developing a model for parenting self‐efficacy, and possible improvements to be made on the parenting programme. [ABSTRACT FROM AUTHOR]

Families, parents and caregivers play a central role in child health and development, especially during the first 1000 days of life (from pregnancy to age 3 years), a critical period that lays the foundation for future health, learning and well-being. Many agencies, including the World Bank, the United Nations Children's Fund, and the World Health Organization (WHO), have recognized parenting education programmes as a priority for improving child development outcomes in low- and middle-income countries. In the Lancet series on early childhood development, the concept of nurturing care was introduced, which encompasses health, nutrition, security and safety, responsive caregiving, and early learning (Black et al., 2017). It is a crucial entry point for multisectoral collaborations to support families and reach young children living in marginalized communities, including transitional or refugee contexts. [ABSTRACT FROM AUTHOR]

As a result of the COVID-19 pandemic, Mellow Parenting proposed online strategies for some of their interventions. One such intervention was Mellow Bumps – becoming Online Mellow Bumps. The objective of this study was to evaluate the implementation of antenatal parenting intervention Mellow Bumps in an online format and determine if this can be done safely and without detriment to pregnant women in Turkey. The study used an exploratory study design to investigate routine evaluation data collected pre- and post-intervention. Outcomes were online feasibility, mental health symptoms (depression, anxiety and stress), maternal subjective well-being, perceived quality of relationship with baby, maternal confidence and maternal social connectivity. 128 mums-to-be took part in the intervention between January 2021 and May 2021 from a total of 21 different provinces in Turkey. 57 pre- and post-intervention responses were eligible for analysis. This gives a response rate of 44.5% for evaluation, though the intervention completion rate was high at 89.5%, suggesting the intervention is engaging and accessible. Improvements were found for maternal stress levels, maternal subjective well-being and perceived relationship with baby. Improvements were also found for maternal confidence and maternal social connectivity. This is the first study to evaluate the antenatal parenting intervention Mellow Bumps in an online format, namely Online Mellow Bumps. The online format makes the programme accessible for at-risk mothers and families, with the potential to continue reaching wider audiences beyond the pandemic who otherwise might struggle to access support. The findings show that the online group can be effective in improving mental health symptoms and mental well-being, supporting expectant mothers before the baby is born. Future research using a control group, a larger and more inclusive sample, and assessing the longer-term effects on parent and child would be beneficial. [ABSTRACT FROM AUTHOR]

Parenting programmes are the recommended treatments of conduct disorders (CD) in children, but little is known about their longer term cost-effectiveness. This study aimed to evaluate the population cost-effectiveness of one of the most researched evidence-based parenting programmes, the Triple P—Positive Parenting Programme, delivered in a group and individual format, for the treatment of CD in children. A population-based multiple cohort decision analytic model was developed to estimate the cost per disability-adjusted life year (DALY) averted of Triple P compared with a ‘no intervention’ scenario, using a health sector perspective. The model targeted a cohort of 5-9-year-old children with CD in Australia currently seeking treatment, and followed them until they reached adulthood (i.e., 18 years). Multivariate probabilistic and univariate sensitivity analyses were conducted to incorporate uncertainty in the model parameters. Triple P was cost-effective compared to no intervention at a threshold of AU$50,000 per DALY averted when delivered in a group format [incremental cost-effectiveness ratio (ICER) = $1013 per DALY averted; 95% uncertainty interval (UI) 471-1956] and in an individual format (ICER = $20,498 per DALY averted; 95% UI 11,146-39,470). Evidence-based parenting programmes, such as the Triple P, for the treatment of CD among children appear to represent good value for money, when delivered in a group or an individual face-to-face format, with the group format being the most cost-effective option. The current model can be used for economic evaluations of other interventions targeting CD and in other settings. [ABSTRACT FROM AUTHOR]

The objective of this study is to compare the efficacy and cost of specialised individually delivered parent training (PT) for preschool children with attention-deficit/hyperactivity disorder (ADHD) against generic group-based PT and treatment as usual (TAU). This is a multi-centre three-arm, parallel group randomised controlled trial conducted in National Health Service Trusts. The participants included in this study were preschool children (33-54 months) fulfilling ADHD research diagnostic criteria. New Forest Parenting Programme (NFPP)—12-week individual, home-delivered ADHD PT programme; Incredible Years (IY)—12-week group-based, PT programme initially designed for children with behaviour problems were the interventions. Primary outcome—Parent ratings of child’s ADHD symptoms (Swanson, Nolan & Pelham Questionnaire—SNAP-IV). Secondary outcomes—teacher ratings (SNAP-IV) and direct observations of ADHD symptoms and parent/teacher ratings of conduct problems. NFPP, IY and TAU outcomes were measured at baseline (T1) and post treatment (T2). NFPP and IY outcomes only were measured 6 months post treatment (T3). Researchers, but not therapists or parents, were blind to treatment allocation. Analysis employed mixed effect regression models (multiple imputations). Intervention and other costs were estimated using standardized approaches. NFPP and IY did not differ on parent-rated SNAP-IV, ADHD combined symptoms [mean difference − 0.009 95% CI (− 0.191, 0.173), p = 0.921] or any other measure. Small, non-significant, benefits of NFPP over TAU were seen for parent-rated SNAP-IV, ADHD combined symptoms [− 0.189 95% CI (− 0.380, 0.003), p = 0.053]. NFPP significantly reduced parent-rated conduct problems compared to TAU across scales (p values < 0.05). No significant benefits of IY over TAU were seen for parent-rated SNAP, ADHD symptoms [− 0.16 95% CI (− 0.37, 0.04), p = 0.121] or parent-rated conduct problems (p > 0.05). The cost per family of providing NFPP in the trial was significantly lower than IY (£1591 versus £2103). Although, there were no differences between NFPP and IY with regards clinical effectiveness, individually delivered NFPP cost less. However, this difference may be reduced when implemented in routine clinical practice. Clinical decisions should take into account parental preferences between delivery approaches. [ABSTRACT FROM AUTHOR]