HEALTH LED PARENTING PROJECT –
REVIEW OF HEALTH LED INTERVENTIONS IN PREGNANCY AND EARLY YEARS
Jane Barlow, Anita Schrader McMillan, Sue Kirkpatrick, Deborah Ghate, Jacqueline Barnes, Marjorie Smith
Aim of the review:
To contribute to the development of the Child Health Promotion Programme (CHPP) by
identifying the most effective forms of parenting support from the antenatal period to child age 3.
Methods: Systematic review of parenting support provided through health services from the
antenatal period to child age 3.
Justification: Early parenting is a significant determinant of children’s developmental
outcomes. Parenting mediates other factors, including bereavement or poverty.
Key messages:
Service delivery: Progressive universalism: provision of a universal service within which
assessment of need can be conducted.
Pregnancy
Supporting the transition to pregnancy – using
group antenatal classes in community or healthcare
settings that respond to the priorities of parents
Relationship issues and preparation for new
roles and responsibilities
Emotional changes
Importance of parent-infant relationship
Development of problem-solving skills
Supporting fathers
Identify and intervene with families in need of additional support (self esteem; relationship; to
more severe problems eg drug/ alcohol abuse)
Anxiety/depression, alcohol/drug abuse and domestic violence are significant predictors
of poor outcomes postnatally
Pregnancy a key opportunity to identify families in need of support
Assessment should be taken routinely and on a universal basis
Postnatally
Introducing the Social Baby
Both parents should be introduced to the ‘social baby’ – information about the sensory
and perceptual capabilities of their infant (eg The Social Baby book/video or validated
tools (eg Brazelton NBAS)
Supporting the Parent-Infant relationship
Promoting closeness and sensitive/attuned parenting (eg skin to skin care; use of soft
baby carriers; infant massage)
Individualised coaching by a professional aimed at stimulating attuned interactions –
videofeedback
Invitation to group-based parenting programmes (eg Mellow Parenting)
Father-infant groups that promote opportunities for play and guided observation
Referral to attachment-oriented or parent-infant psychotherapy sessions
Anticipating Problems
Anticipatory guidance, with accompanying booklets/materials, in healthcare
settings: eg practical guidance on managing crying; sleep routines; encouragement
of parent-infant interaction
Supporting Fathers
Need to work with both parents from pregnancy onwards
Methods of supporting mothers also work with fathers! (eg infant massage; NBAS)
Most effective methods of support involve: Active participation with/observation of
their own baby; repeated opportunities to practice new skills; responsive to
individual concerns; important to address parental conflict
Promoting Child Development
Parenting and early environment influence the infants’ developing brain
Encouragement to use books, music and interactive activities to promote parentbaby relationship and hence development
Focusing provision
The focus of support to both mothers and fathers during the perinatal period should be the
parent-infant relationship
There is evidence to suggest that brief interventions can be effective BUT the quality of
services is important and should be matched to the needs of families
Many methods of supporting families with medium-level problems involve helping them
develop problem-solving skills
Resource Issues
Many services can be provided as part of
standard provision – need to focus visits
Many effective methods (eg infant massage;
baby carriers) are some of the cheapest
available with considerable long-term benefits
Scale down investment in activities that are not
well supported by the evidence
Effective targeting of intensive and costly
interventions
Workforce Issues
Midwives and health visitors are key to effective
delivery of CHPP
Further skilling-up of primary care workforce
needed
Staff should have core qualities, skills and
understanding (irrespective of intervention or
service) to enable them to work effectively with
families
These should be provided as part of core training
of professionals - nurses or health visitors.