Positive Relationships: Parenting Programmes - Strongest link

The journey into parenthood is one that many adults are unprepared for and it can impact harshly on even strong relationships. Family Foundations is a parenting programme that starts working with couples before their first child is born and aims to give them the tools to be supportive partners and raise their children together.

‘The programme focuses on enhancing the collaboration between parents, which relieves stress and increases support. Then they can naturally become the best parents they can be,’ explains Family Foundations founder Mark Feinberg. ‘I found little support as a new dad but lots of support for my wife. As I began to search the literature, it became clear that supporting dads’ engagement with children depends greatly on the relationship with the mother. That relationship, co-parenting, is a central influence on the well-being of everyone in the family.’

Aimed at enhancing both parent and child well-being, Family Foundations received a strength evidence rating of four out of four in an Early Intervention Foundation report (see box, below) and was found to be a low-cost intervention, scoring one out of five. It is found to have significant impacts on:

• postnatal depression
• improving parenting sensitivity and warmth
• decreasing harsh parenting
• fostering positive couple relations
• establishing positive child self-regulation, and
• reducing child behaviour problems.

The programme was brought to the UK by the Fatherhood Institute, which is licensed to offer training to practitioners, ranging from staff working in the early years and family support services to health visitors. ‘Delivering to the couple is the way forward, and most interventions don’t aim to do it,’ says Adrienne Burgess, joint chief executive of the institute. ‘This is a couple-focused programme which gets to parents at the transition to parenthood, which is the most important time.

‘It’s unique because it addresses the parenting team rather than creating a dependency on the mum and the children’s centre, which means change is sustained in the longer term. This is not gained from a programme delivered to a mum or dad alone. It’s better than ten courses for mums, so there’s more bang for your buck for commissioners.’

FIRST BABY

Family Foundations is aimed at couples who are expecting their first baby and are between 20 and 30 weeks pregnant at the start of the course. It consists of four 90-minute sessions before the birth then, after the birth, three further sessions.

The programme uses a ‘within-the-couple approach’ where parents develop solutions that work for them, rather than having group discussions. Sessions feature a variety of exercises, information and video clips about different approaches to co-parenting.

During the course, couples:

• take part in discussions and activities with their partner
• learn to understand themselves, their partner and their baby
• explore desires and goals for their parenting partnership
• manage the stress of being a new parent
• take part in problem-solving and learning how to develop solutions together
• learn how to support their babies’ early development together.

Lambeth Early Action Partnership, in south London, delivered the Family Foundations programme, supported by the Big Lottery Fund, to five couples last year at the Liz Atkinson Children’s Centre. Deputy operational manager Helen Wroe says one of its appeals is that it targets parents before their child is born.

‘As a children’s centre, we aim to provide services from pregnancy to age five, but our services are predominantly from birth to five. Children’s centres are all about early interactions, so any work with people before the birth is amazing because it’s a time of great change,’ she says. ‘At that point parents are open to new things and know that they’ve got a lot to learn. It gives us the opportunity to engage with them and build relationships.’

Unfortunately, recruiting parents for the course was challenging, with problems of information-sharing with the local midwifery team. They are continuing discussions on how this can be done effectively.

Ms Wroe likes that the programme focuses on couples discussing key topics, which can be very personal, among themselves, with no-one forced to share with the wider group.

‘We found that the couples would naturally continue the discussions between sessions. Parents commented that before the course they were so preoccupied by the pregnancy that they had not thought about discussing what they actually wanted for the baby,’ she says.

‘Having a baby can put a relationship through the toughest test. This course gives parents a safe space to explore the darker corners before having the baby, think how they will handle issues together and come up with strategies.

‘Many couples said that it helped them to pre-empt what might be difficult, such as tiredness and being short-tempered.’

After the birth, the parents resume the course and revisit many of the same topics, but from the perspective of being new parents. A positive by-product of the course is that many of the parents swap contact details and stay in touch, forming an unofficial support network. ‘It was good that dads were also able to meet other dads-to-be,’ says Ms Wroe. ‘We all found it incredibly emotional when everyone came back with their babies and met each other.’

A review of the programme found that all parents following participation reported feeling ‘very well equipped to manage and resolve differences and provide their partner with support’. This included helping each other to get enough sleep.

With sleep deprivation being strongly associated with poor mental health and well-being in parents post-partum, this could prove to be particularly important.

FOUNDATIONS FOR LIFE

Foundations for Life: What Works to Support Parent Child Interaction in the Early Years by the Early Intervention Foundation assesses programmes to improve child outcomes through positive parent-child interaction.

The 75 programmes, all available to UK commissioners, were identified in the Best Start at Home review and are rated out of four according to an assessment of the evaluation evidence, with four being strong; and out of five for the relative input costs, with five being high. It focuses on programmes to promote attachment, behaviour and early cognitive and language development.

The report found that if commissioned, targeted and implemented carefully, many of the programmes have the potential to enhance development and tackle problems identified in the early years, such as improving behaviour and achievement and preventing mental health problems.

OTHER ATTACHMENT PROGRAMMES

CHILD FIRST

Child First believes that to help a child it is necessary to also help their family, because when parents face multiple stresses it is difficult for them to focus on the emotional and developmental needs of their children.

The programme targets young children at risk of emotional problems, developmental delay, abuse and neglect, and works with families in their own homes.

The approach combines comprehensive co-ordinated services, psychotherapeutic intervention for child and caregivers, and increasing adult self-regulation and executive functioning in a single model. It is delivered by two practitioners – one who links families to community-based services, and a qualified psychologist. They provide a package of support tailored to each family’s needs.

Once a family has agreed a plan they receive weekly home visits for six to 12 months, lasting between 45 and 90 minutes. Typically the family receives child-parent psychotherapy during these sessions to repair the impact of trauma on the child and strengthen their relationship. An aim is to help parents reflect on and understand the feelings and motivations underlying their child’s behaviour. It is hoped that through intervention, the parent’s capacity to provide sensitive, age-appropriate care and protection is enhanced.

The Early Intervention Foundation (EIF) rated this programme a three for the strength of evidence of child outcomes, stating that it did not receive a four because it has not yet replicated its results in a high-quality study suggesting long-term impact. It was estimated to be high-cost to set up and deliver.

FAMILY NURSE PARTNERSHIP

Family Nurse Partnership is a home visiting programme for young mothers expecting their first child. They receive visits from a family nurse on a weekly basis just before and after the birth of their child and then fortnightly until their child’s second birthday. The mothers learn about their young child’s health and development, and receive support for their own well-being.

It has established evidence of providing long-term benefits for young mothers and their children, including improved children’s school readiness and a greater likelihood of mothers finding work and completing their education, and scored an EIF rating of four-plus. Programme costs were rated five (high).

MORE INFORMATION

Child First, www.childfirst.org

Early Intervention Foundation, www.eif.org.uk

Family Foundations, http://famfound.net

Family Nurse Partnership, http://fnp.nhs.uk

Download the PDF