131Are there interventions that improve parenting skills and/or secure attachment & bonding

Grading:1++High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias
RID: 557Reference number 4658
Barlow J;Parsons J;
Group-based parent-training programmes for improving emotional and behavioural adjustment in 0–3 year old children
2003Parsons J.John Wiley & Sonspgs
Study Type:Systematic Review
Patient
Characteristics
Intervention
Comparisons
Study Length
Outcomes
Effect
FundingCochrane Collaboration
ConclusionsThis study aimed to evaluate group based jparenting programmes. Five studies were included in a meta analysis. Parent reports showed a non significant result favouring intervention and independent observations of children’s behaviour showed a significant result favouring the intervention group (ES-0.54, CI −0.84–−0.23).
Quality++
RID: 553Reference number 4665
Coren E;Barlow J;
Individual and group-based parenting programmes for improving psychosocial outcomes for teenage parents and their children
2001Barlow J.John Wiley & Sonspgs
Study Type:Systematic Review
Patient
Characteristics
Intervention
Comparisons
Study Length
Outcomes
Effect
FundingCochrane
ConclusionsThis review is based on the data from four small studies (279 women total). These showed that both infividual and group based parenting programmes favored the intervention group on a range of maternal and infant measures.
Quality++
RID: 548Reference number 1460
Kendrick D;Elkan R;Hewitt M;Dewey M;Blair M;Robinson J;Williams D;Brummell K;
Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis
200082: (6)Arch Dis Childpgs 443 451
Study Type:Systematic Review
Patient
Characteristics
Intervention
Comparisons
Study Length
Outcomes
Effect
FundingHTA
ConclusionsHome visiting programmeswere associated with an improvement in the quality of the home enviornment as measured by the HOME score, p<0.001. Fewstudies used UK health visitors so caution must be exercised in extrapolating the results to the UK.
Quality++
RID: 604Reference number 4688
Wade K;Cava M;Douglas C;Feldman L;Irving H;O;apos;Brien MA;Sims JN;Thomas H;
A systematic review of the effectiveness of peer/paraprofessional 1:1 interventions targeted towards mothers (parents) of 0–6 year old children in promoting positive maternal (parental) and/or child health/developmental outcomes (Structured abstract)
1999Ontario Ministry of Health, Region of Hamilton-Wentworth, Social and Public Health Services Division.pgs
Study Type:Systematic Review
Patient
Characteristics
Intervention
Comparisons
Study Length
Outcomes
Effect
FundingPublic Health Research Education and Development Program, Canada
ConclusionsMost of the studies were US based and most targeted poor/low income mothers/families. Overall there was some positive evidence to support the effectivenessof peer/paraprofessional 1:1 interventions in promoting child development and positive parent child interaction. Almost all of the methodologically sound studies targetted high risk populations.
Quality++
Grading:1+Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias
RID: 573Reference number 974
Anisfeld E;Casper V;Nozyce M;Cunningham N;
Does infant carrying promote attachment? An experimental study of the effects of increased physical contact on the development of attachment
199061: (5)Child Developmentpgs 1617 1627
Study Type:Randomised Controlled Trial
PatientWomen were similar in all demographic characteristics except parity and ethnicity. The control group had more primips and mor Black mothers.
Characteristic
InterventionUse of soft infant carrier versus plastic infant seats.
Comparisonssecurity of attachment; maternal responsivity and sensitivity.
Study Length13 months
OutcomesChi square t test calculations were made
EffectThere were significantly more securely attached infants in the experimental group than in the control group, p=.019. A comparison of high and moderate/low users showed that 15/16 high users had infants who were securely attached and of the seven moderate/low users four were securely attached (NS result).
FundingSnugli Cottge Industries, Ross Labs and several private donors.
ConclusionsIn this study, close physical contact between mother and infant appears to promote secure attachment.
Quality+Small study; no allocation concealment;subjectivity in maternal responses and observers assessments
RID: 587Reference number 4666
Coren E;Barlow J;Stewart-Brown S;
The effectiveness of individual and group-based parenting programmes in improving outcomes for teenage mothers and their children: a systematic review.
200326: (1)Journal of Adolescencepgs 79 103
Study Type:Systematic Review
Patient
Characteristics
Intervention
Comparisons
Study Length
Outcomes
Effect
FundingUnknown
ConclusionsThe findgins of the review are based on 14 studies that used varying study designs and are therefore limited. The results suggest that parenting programmes can be effective in imporving a range of psychosoial and developmental outcomes for teenage mothers and their children.
Quality+This review included one group study designs
RID: 847Reference number 379
Goodman JH;
Becoming an involved father of an infant
200534 2JOGNN - Journal of Obstetric, Gynecologic, & Neonatal Nursingpgs 190 200
Study Type:Metaananalysis
Patient
Characteristics
Intervention
Comparisons
Study Length
Outcomes
Effect
FundingNational Institute of Nursing Research
ConclusionsFathers of infants experienced four phases:
  1. entering with expectations and intentions
  2. confronting reality
  3. creating one’s role of involved father and
  4. reaping rewards.
A crucial step in becoming closer to his child was a father’s development of skills needed to care for the infant. Feeling excluded from providing care to the infant was perceived as inhibiting the development of the father infant relationship. This was particularly true among fathers of breastfed babies.
Quality+This was a metasynthesis of qualitative work and is thus inherently subjective. However, after careful reading a list of metaphors (themes, concepts or phrases) in each report was developed and these were compared and common findings were identified.
RID: 572Reference number 944
Jacobson SW;Frye KF;
Effect of maternal social support on attachment: experimental evidence
199162: (3)Child Developmentpgs 572 582
Study Type:Randomised Controlled Trial
PatientFirst time mothers at least 17 years old participating in WIC in the US.
Characteristics
InterventionWomen were assigned a volunteer coach or usual care
ComparisonsA neonatal assessment, a 13 and 14 month assessment was made. An initial Brazelton Assessment was done and then HOME assessment. Complexity of play was assessed and attachment ratings scores were calculated.
Study Length14 months
OutcomesAttachment ratings scores and criterion sort scores. T tests and pvalues are calculated
EffectAttachment ratings was significant or experimental group, p<0.005.
FundingYoung Scholar’s Award
ConclusionsThis study may provide evidence that maternal social support aids development of secure attachment
Quality+Small study with subjective outcome measures
RID: 551Reference number 861
Johnson Z;Howell F;Molloy B;
Community mothers’ programme: randomised controlled trial of non-professional intervention in parenting
1993306: 6890Brit Med Jpgs 1449 1452
Study Type:Randomised Controlled Trial
PatientThe women were primiparous and lived in a defined deprived area in Dublin
Characteristics
InterventionA community mothers programme using trained volunteer mothers plus standard care v. standard care alone
ComparisonsMother’s self esteenm on child’s first birthday; hospital admissions; diet and developmental milestones.
Study Length1 year
OutcomesRR and p values
EffectThere was NS difference in hospital admissions. For inclusion of all food groups in daily diet the intervention group performed significantly better than controls (p<0.01). By maternal report, with the exception of motor games the differences between the two groups on developmental tasks was highly significant (p<0.01).
FundingBernard van Leer Foundation, The Hague
ConclusionsNon professionals can deliver a health promotion programme on child development effectively. Whether they can do so as effectively as professionals requires further study.
Quality+Data on self esteem, diet and child’s cognitive activities collected by maternal
RID: 602Reference number 4686
Turley MA;
A meta-analysis of informing mothers concerning the sensory and perceptual capabilities of their infants: the effects on maternal-infant interaction
198514: (3)Maternal Child Nursing Journalpgs 183 197
Study Type:Metaananalysis
Patient
Characteristics
Intervention
Comparisons
Study Length
Outcomes
Effect
FundingUnknown
ConclusionsThe major conclusion was that providing information to mothers concerning their infant’s social capabilities significantly increased the overall effect size by 81% in terms of maternal-infant interaction. The effect of location where the information was provided on maternal infant interaction was significant p=.009. The t test differences showed that the home as a setting for providing information was significantly different from the hospital setting. The results should be viewed with caution as the source of information was largely unpublished studies.
Quality+This is an old meta analysis which used 20 experimentally controlled studies, 16 of which were dissertations or master’s theses
Grading:1Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias*
RID: 544Reference number 884
Andresen PA;Telleen SL;
The relationship between social support and maternal behaviors and attitudes: a meta-analytic review
199220: (6)American Journal of Community Psychologypgs 753 774
Study Type:Metaananalysis
Patient
Characteristics
Intervention
Comparisons
Study Length
Outcomes
Effect
FundingUnknown
ConclusionsThis review found significant correlations between both emotional (supportive actions that conveyed empathy, caring, love, and trust) and material support (physical resources needed to cope with the demands of parenting) and maternal behaviours (p<.05). Maternal behaviours included responses to child’s physical and emotional needs, verbal interactions with the child, infant stimulation or play interactions. The results of this analysis must be usedcautiously because of methodological issues sited above.
QualityNon RCT’s included; heterogeneity of outcome measures makes combining data problematic; studies predominately white middle class women; half of the studies were unpublished dissertations
RID: 545Reference number 4656
Armstrong KL;Fraser JA;Dadds MR;Morris J;
Promoting secure attachment, maternal mood and child health in a vulnerable population: a randomized controlled trial.
200036: (6)Journal of Paediatrics & Child Healthpgs 555 562
Study Type:Randomised Controlled Trial
PatientInner city families rated to be at resk due to history of violence or demographic risk factors
Characteristics
InterventionA structured program of child health nurse visits was offered
ComparisonsHome visits were compared to normal care
Study Length4 months
OutcomesT tests and ANOVA used
EffectThe HOME test showed p<0.05 for each subscale.
FundingCommunity Child Health Service, Royal Children’s Hospital and Health Service District, National Health and Medical Research Coucil of Australia, the Abused Child Trust of Queensland, Creswick Foundation of Victoria and Rotary International
ConclusionsEary home based intervation targeted to vulnerable families may promote an environment conducive for infant mental and general health. This study may not be universally generalisable However.
QualityIt is unclear if the investigator was blind at the 4 motnth visit; no allocation concealment; almost 10% droput rate
RID: 581Reference number 4619
Bakermans-Kranenburg MJ;Van Ijzendoorn MH;Juffer F;
Less is more: meta-analyses of sensitivity and attachment interventions in early childhood
2003129: (2)Psychol Bullpgs 195 215
Study Type:Metaananalysis
Patient
Characteristics
Intervention
Comparisons
Study Length
Outcomes
Effect
FundingCenter for Child and Family Studies, the Netherlands
ConclusionsA core set of 51 randomized control group studies was established from the total of 81 studies reviewed. In this set of studies interventions appeared to be significantly effective in enhancing maternal sensitivity, p<0.00. Unexpectedly the four studies that did not use personal contact as a means of intervening showed the largest effect - use of soft baby carriers, kangaroo method, a workbook and a video (p<.05).

Heterogeneity of outcome measures and transformation of sttistics and use of dissertation abstracts should call for cautious interpretation.
QualityNon RCTs included and statistics were recomputed and transformed into Cohen’s d. Dissertation abstracts used.
RID: 564Reference number 348
Clemmens D;
The relationship between social support and adolescent mothers’ interactions with their infants: a meta-analysis
200130: (4)JOGNN - Journal of Obstetric, Gynecologic, & Neonatal Nursingpgs 410 420
Study Type:Metaananalysis
Patient
Characteristics
Intervention
Comparisons
Study Length
Outcomes
Effect
Funding
ConclusionsThe review concludes that there is a significant relationship between social support of adolescent mothers and their interactions with their infants, r=.60 (CI .239–.379). However, they ave used a meta analysis to evaluate non RCTs and the results should be viewed with caution.
QualityThis meta analysis included cross secional studies and used a varies of outcome measures
Grading:4Expert opinion, formal consensus
RID: 1003Reference number 4988
Bolzan N;Gale F;Dudley M;
Time to father
200439 1–2Social Work in Health Carepgs 67 2
Study Type:Qualitative
Patient
Characteristics
Intervention
Comparisons
Study Length
Outcomes
Effect
Funding
ConclusionsThis is a qualitative study which explores men’s postnatal mental health. Themes identified include a desire to be more involved in the direct care and nuturing of their babies than their fathers were. Fathers having least flexibility and autonomy in their work reported experiencing more unhappiness, anxiety and higher levels of stress.
Quality

From: Appendix C, Clinical Evidence Extractions

Cover of Postnatal Care
Postnatal Care: Routine Postnatal Care of Women and Their Babies [Internet].
NICE Clinical Guidelines, No. 37.
National Collaborating Centre for Primary Care (UK).
Copyright © 2006, National Collaborating Centre for Primary Care.

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