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Effects of early intervention

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How helpful is it for parents and babies to participate in a group-based parenting programme? And how do you measure whether it is helpful? A new PhD project at SFI – The Danish National Centre for Social Research seeks to establish more knowledge on the effects of a very early intervention for disadvantaged families with infants aged 0-1 year.

In 2008 2.5 per cent of all 0-17 year olds in Denmark received a preventive intervention under the Consolidation Act on Social Services (Serviceloven). This means that at least 32,000 children lived in families with emotional and behavioural problems. These families might be offered some kind of family therapy.

Research shows that early onset of serious emotional and behavioural problems in children predict an increased risk of a range of poor outcomes later in life, including delinquency, violence, depression, substance abuse, school dropout and subsequent unemployment. There is an increasing interest in early intervention, since studies show that it is possible to mitigate problems at a relative low cost, if high-quality interventions are delivered before the problems get to ingrained in the family. The big question, though, is how early to intervene to get optimal outcomes in families where there might be concerns about the future development of the child(ren)?

In recent years, preventive interventions for infants, such as The Incredible Years Baby Programme (IY Baby), have been implemented in Denmark. The overall goal of the project is to examine the effects of a very early intervention for disadvantaged families with children aged 0-1 on child and parent well-being, development, behaviour, and relations. The project is carried out in three parts.

In the first part the existing international research on the effects of family interventions for parents of 0-1 year olds are synthesised in a Campbell review (systematic review). Studies enter a meta-analysis and effect sizes across studies are calculated.

In the second part, the focus is on assessment. Early intervention programmes aim to improve parent-infant relationships, parental self-esteem and confidence, and infant development. It is difficult, however, to measure concepts like these because both infants and parents go through rapid physical and psychological developments in the first year of a child’s life. In Denmark there is not a strong tradition for using assessment instruments and only a few are available in Danish. High-quality assessment instruments that measure important aspects of infant and parent life and fit into a Danish context are translated into Danish and are validated on a Danish sample of infants and parents.

In the third part of the project, the effects of the Incredible Years Baby Programme (IY Baby) in Denmark are measured in a randomized controlled trial (RCT). The IY series were developed in the 1980s by psychologist Carolyn Webster-Stratton, with the baby programme being the most recent addition in 2008. Although pilot studies are underway in Wales, no RCT has been carried out yet. Therefore this study will be the first to establish the effects of the IY Baby Programme. Furthermore it will be one of the first RCT effectiveness studies of a social intervention in Denmark.

IY Baby is a group-based programme targeting vulnerable parents with infants (0-1 year old). The goals of the programme are to promote parental competencies and strengthen parenting confidence and parent-infant attachment. IY Baby was implemented in Denmark in 2010 and can be used both as a preventive intervention and as treatment for families showing more severe problems. In the ten-week programme, six to eight parents (ideally both mothers and fathers) attend with their babies and participate in hands-on role plays and exercises with their own babies.

About 120 families will be randomised for IY Baby or treatment as usual (TAU), which can be different kinds of support. Assessment instruments translated into Danish in part two of the project are used to assess outcomes. Outcomes are expected to cover parenting confidence, child development, maternal depression, parent-child interaction and attachment. Outcomes are mainly collected at home visits at baseline, 3 months and one year for long-term follow up. Video observation and telephone interviews might also be included in the assessment.

The PhD study is being funded by the Tryg Foundation.

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