Early home visit programmes have been developed to help parents build an adequate relationship with their baby and to prevent child developmental delays and affective disorders. The “Appui Parental” ...programme is an intervention carried out by nursery nurses to provide intensive parental support to vulnerable families. Before extending this programme, it seemed necessary to evaluate its impact objectively.
The main aim is to determine the impact of the “Appui Parental” programme on the change in the child's symptoms. The secondary objectives are to evaluate its effects on mother-child interactions, self-assessed parental competence, perception of social support, primary caregiver's anxiety-depression symptoms, alliance with the nursery nurse, frequency of out-of-home placements, and nursery nurses’ stress.
This non-randomized prospective multicentre study would include 44 families who receive the “Appui Parental” intervention for a one to 20-month-old child (intervention group) and 44 families with the same vulnerability criteria who receive care as usual by the maternal and child protection services (control group). The child, parents, mother-child interaction, nursery nurse-mother alliance, and nursery nurse's stress will be assessed at month one and month 18 after inclusion. Comparisons between groups will be performed.
This study should provide the public authorities with objective data on this programme's impact and allow them to pursue its generalization. For professionals, the study should confirm the interest in close early parental support through home visits or should lead to rethinking some aspects of the programme.
Afin de prévenir les troubles psychoaffectifs, les retards de développement et les troubles somatiques associés, plusieurs programmes de soutien parental précoce sous forme de visites à domicile ont été élaborés, notamment pour les familles dites à risque multiple. Ils ont pour objectif de soutenir la mise en place d’un environnement familial et de relations parent-enfant adaptés. En France, ce soutien parental précoce est pratiqué essentiellement par les services territorialisés de protection maternelle et infantile (STPMI). On observe cependant peu de programmes structurés ou d’interventions thérapeutiques à domicile spécifiques, et peu d’études ayant évalué leur efficacité. L’Appui Parental, action de soutien parental renforcé réalisée par des puéricultrices dans des familles vulnérables avec un enfant de moins de 3ans, vise à soutenir de façon intense et prolongée les compétences parentales et la mise en place d’une relation d’attachement sécure. Après environ quinze ans d’existence, et avant d’étendre cette action à d’autres territoires, une évaluation objective de son impact a été décidée.
L’objectif principal est de déterminer l’impact de l’Appui Parental sur la symptomatologie de l’enfant 18 mois après le début de l’intervention. Les objectifs secondaires sont d’évaluer les effets de l’intervention sur le développement de l’enfant, les interactions mère-enfant, le sentiment de compétence parentale, la perception du soutien social, l’état anxiodépressif de la mère ou du soignant principal, l’alliance entre la mère et la puéricultrice, la fréquence de la judiciarisation des situations et enfin sur le stress des puéricultrices.
Cette étude prospective multicentrique inclut 44 familles bénéficiant d’un appui parental pour un enfant âgé de 1 à 20 mois (groupe intervention) et 44 familles répondant à des critères de vulnérabilité équivalents et qui bénéficient de la prise en charge habituelle proposée par le STPMI (groupe contrôle). Une évaluation du développement de l’enfant, de l’état psychologique des parents, de l’interaction mère-enfant, de l’alliance puéricultrice-mère et du stress du professionnel a lieu dans le mois suivant l’inclusion et 18 mois plus tard, à l’aide de questionnaires et d’un enregistrement vidéo d’un épisode de jeu mère-enfant. Les résultats à 18 mois seront comparés dans les deux groupes après ajustement sur l’état initial à l’aide d’une régression linéaire incluant tous les facteurs de confusion identifiés dans les analyses univariées comparant les deux groupes.
Nous formulons l’hypothèse que les symptômes de l’enfant après 18 mois de suivi seront significativement moins importants chez les sujets ayant bénéficié de l’Appui parental (groupe intervention) en comparaison des sujets avec une prise en charge classique (groupe contrôle). De même, il est attendu que les autres tests aient des meilleurs résultats dans le groupe intervention que dans le groupe contrôle. Cette étude devrait apporter aux pouvoirs publics une meilleure visibilité sur les résultats que l’on peut attendre de ce dispositif et le cas échéant, en poursuivre la généralisation. Aux professionnels, l’étude devrait confirmer l’intérêt d’un soutien rapproché à domicile ou conduire à repenser certains aspects du dispositif.
Communities can play an important role in protecting children and supporting vulnerable families. However, there is currently a lack of understanding of what communities actually think and do ...regarding these groups. The purpose of this study was to review and synthesize evidence on community attitudes and behaviors toward vulnerable families. A rapid systematic literature review was conducted, supplemented by 6 semistructured interviews with experienced practitioners. Four databases were searched using key words related to community attitudes and behaviors, parents and families, and family and child protection services. Database searches returned 10 135 unique records, of which 23 met the inclusion criteria. The identified articles investigated a range of attitudes and behaviors, including reporting abuse and neglect; assisting victims of intimate partner violence; attitudes toward parenting practices; and participating in activities that build social support and social capital. Correlates of these attitudes and behaviors included sociodemographic characteristics, individual differences, community characteristics, and incident characteristics. A number of interventions to change community attitudes and behaviors were also identified. Practitioners indicated that success factors for interventions included facilitating active participation from community members; using multifaceted approaches; and increasing empathy toward vulnerable families. Despite increasing evidence around how community members think and act toward vulnerable families, more (particularly review-level) research is needed to determine how to effectively change these attitudes and behaviors.
•Provides evidence of a significant cohort of young kinship carers.•Describes the characteristics and challenges of kinship care by young carers.•Describes an advocacy initiative for recognition & ...support that was codesigned with young kinship carers.
This article describes Australian research that broke new ground in identifying the prevalence and life experiences of young kinship carers, and an advocacy initiative to promote recognition and support for this group. Prevalence and demographic data were derived from census analysis, and interviews with young kinship carers and young people in their care provided an in-depth picture of their life experiences. While the young people were generally doing well, the carers described significant compromises to their life circumstances, including poverty, social isolation, and opportunity costs with regard to education and employment. The advocacy initiative was codesigned with a group of young kinship carers who participated in conference presentations, media interviews and a delegation to the Australian Parliament.
Målet med denne studien var å generere mer kunnskap om hjelpebehov i et utvalg potensielt sårbare familier i perioden hvor skole og barnehage var stengt våren 2020. Vi ønsket å undersøke hvilke ...relevante hjelpetjenester familiene hadde behov for, hvilke tjenester som dekket disse behovene, og hvorvidt psykiske vansker, familiebelastninger og sosial støtte hang sammen med familienes hjelpebehov og hjelpesøkende atferd. Utvalget bestod av foreldre fra 689 familier som hadde blitt rekruttert til FamilieForSK-studien i forbindelse med at de var i kontakt med Familieverntjenesten. Familiene deltok i en ekstra spørreskjemaundersøkelse om hjelpebehov, trivsel, familie og hverdagsliv i forbindelse med covid-19 pandemien. I tillegg til beskrivende statistikk ble logistisk regresjon benyttet for å undersøke relevante sammenhenger. Resultatene viste at foreldrene som rapporterte om høyere nivå av psykiske vansker og mer destruktive foreldrekonflikter, også hadde mer behov for hjelp. Videre var det større sannsynlighet for at familiene med mer destruktive konflikter, mindre sosial støtte og mindre positivt samspill i familien ikke tok kontakt med hjelpeinstansene, selv om de hadde behov for disse. Vi diskuterer resultatene i sammenheng med relevant teori og empiri og drøfter kliniske implikasjoner.
Introduction (comprising background and problem statement): Pregnancy Family Conferencing (PFC) is a program offered to pregnant women at two maternity hospitals in Sydney, Australia when statutory ...child protection are involved due to concerns for the welfare of the unborn baby. The program promotes early engagement and interagency planning by bringing together the family, hospital social workers, child protection caseworkers and other professionals into a series of meetings facilitated by an independent person. In this model, pregnant women and their families are empowered to participate in decisions about the welfare of their baby and where possible reach an agreement in collaboration with professionals about the safest place for the baby once born. The women and families who participate in the program require integrated care across the multiagency service system to meet complex health and social needs which typically include problematic drug and alcohol use, mental health difficulties and domestic violence. Program evaluations previously had not included the voice of the clients and their families and we wanted their input for future program development. Theory/Methods: We conducted a small quantitative study comprising of face to face interviews with ten families who participated in the PFC program from 2015-2017. We asked families about their experience of the meetings and whether they felt heard, respected and empowered during the conferencing process. The data was thematically analysed and coded which assisted in selecting four broad themes of interest. Results, Discussions, and Conclusions (comprising key findings): Families told us that the way meetings are structured and facilitated can help or hinder them to have a voice in the process and the positive impact of hearing professionals recognise their strengths and work with them towards positive solutions. Their responses also highlighted that the way child protection workers exercise their statutory power has an enormous impact on families’ attitudes towards engagement and their perception of the conferencing process. Families talked to us about their fear of statutory intervention, and how the support of health workers and other family members gave them confidence to engage in the process, talk honestly about the support they needed and to engage with the multiagency service system. Lessons learned: We learned that families often experience their interactions with statutory child protection as unjust and as professionals we can make the process fairer, more supportive and positive by listening to families and working in partnership with them. We will report on our progress in developing a “parents as mentors” system which builds on the feedback families gave us and works towards addressing the power imbalance between families and professionals. Limitations and Suggestions for future research: One of the limitations of our study was that only those families who were able to keep their baby in their care agreed to participate. We will talk about our ideas for hearing from those families who were not able to care for their babies and how we can engage and support them through our program.
Objective
To close the chasm between theory about families containing a parent with an eating disorders (EDs) history and lack of selective or indicated prevention programming for such families with ...an older child or adolescent who is, genetically, at high risk.
Method
A search of four major databases for January 2000 through September 2022 yielded no publications that (a) identified genetically high‐risk families with offspring ages 10 through 18; (b) devised a prevention program for the family; and (c) evaluated program effects on risk/protective factors. To rectify this gap, research on three lines of family‐based prevention is reviewed: (1) programs for adolescents at genetic risk for depression or anxiety; (2) the Stanford‐Dresden project for adolescents at high risk for anorexia nervosa; and (3) Sadeh‐Sharvit et al.'s work concerning the Parent‐Based Prevention program for mothers with an EDs history and a child under age 5.
Results
The significant challenges for innovative prevention programming should be addressed by experts in effective EDs, depression, and anxiety prevention, and in family‐based treatment (FBT) for EDs, collaborating with people from genetically vulnerable families. Innovative programming should focus on robust risk factors for EDs, adaptive expression of non‐specific risk factors (e.g., temperament), and strengthening family functioning.
Discussion
The field is overdue for development of prevention programs designed for older children or adolescents who are at risk because a parent has an ED. Evidence‐based prevention programs for EDs and for depression and anxiety, as well as parent‐based prevention informed by FBT, provide a springboard for addressing this gap.
Public Significance
The foundation of theory and research is available for stakeholders to develop prevention programming that closes the huge gap between theory and research about families that are genetically vulnerable for eating disorders versus the complete lack of prevention programming for such families that have an older child or adolescent at high risk.
Maternal vulnerability challenges parenthood and represents a critical task for health professionals working in postnatal care. Being born to a vulnerable mother may have wide-ranging effects on ...child development and carry the risks of impairment in cognitive performance, behavioural disturbances and mental problems which may persist into late childhood and adolescence. It is vital to explore the perspectives of healthcare professionals who have experience of caring for vulnerable families at the obstetric department and in the transition to the primary healthcare sector to identify and describe potential barriers, challenges and the potential for any improvements in postnatal care.
The aim of this study was to describe healthcare professionals' experience of vulnerable families and their extended stay at the obstetric department, and to describe the collaboration between the primary and the secondary healthcare sectors concerning postnatal care.
A qualitative inductive descriptive design with focus group interviews was used for data collection. Two two-hour focus group interviews were conducted at a university hospital in the Capital Region of Denmark in February 2019.
In total, 16 health professionals from the obstetric department and primary healthcare sectors participated.
The overall theme found was Engaging in partnership across sectors and with families can improve postnatal care for vulnerable families. It emerged from three categories: 1) vulnerability as an individual perception, 2) communication and trust as essential competencies and 3) collaboration in a partnership.
This study demonstrates the complexity and challenges of postnatal care provided to vulnerable families. It highlights the possibilities and benefits of engaging in partnership across sectors and families to improve postnatal care for vulnerable families. Engaging in partnerships improves the quality of the extended stay at the obstetric department and the transition to the primary healthcare sector.
Objective
The aim of this study was to increase the knowledge about how the initial Covid‐19 lockdown influenced parental functioning in vulnerable families.
Background
The Covid‐19 pandemic has ...caused major changes to family life. Using a natural experiment design can potentially adjudicate on former inconclusive findings about the effects of lockdown on parental functioning in vulnerable families.
Method
Responses from parents in a sample of potentially vulnerable families in Norway were divided into a lockdown group if participating at baseline and during the initial Covid‐19 lockdown (n = 820 responses) or into a control group if participating at baseline and before lockdown (n = 1368 responses). Mixed model regression analyses were used to mimic a wait‐list design investigating direct lockdown effects on mental health, parenting stress, and three aspects of interparental conflicts, as well as moderation effects.
Results
The lockdown group showed significantly higher levels of parenting stress compared with the control group, but no aversive lockdown effect on mental health or destructive conflicts were found. In fact, decreased levels of verbal aggression and child involvement in conflict were found during lockdown among parents living apart. Pre‐existing financial problems and conflict levels, age of youngest child, and parent gender did not moderate the lockdown effects.
Conclusion
The initial lockdown did not seem to adversely affect parental functioning, beyond increased parenting stress. Caution should be taken when generalizing the findings as child effects and long‐term lockdown effects were not investigated.
Purpose
Hong Kong has experienced four waves of COVID-19 since the first case was confirmed in January 2020. Several studies have highlighted the psychological impacts of the outbreak in Hong Kong ...but have largely ignored the protective factors that contribute to resilience among vulnerable families. This study adopted an ecological resilience framework to explore the impact of this epidemic on members of families with youth with a delinquent tendency/mental health concerns and the ecological protective factors for these vulnerable families.
Methods
Random sampling based on a sampling frame provided by one of the largest local social service organizations in Hong Kong led to the recruitment of 407 respondents who were interviewed using a battery of standardized questionnaires.
Results
The results showed that 30.6% and 11.5% of respondents reported a moderate and a severe level of psychological distress, respectively, almost double the percentages reported in a previous study conducted in Hong Kong before the COVID-19 outbreak. Around 36.6% of respondents indicated they had encountered financial problems and almost 40% indicated aggravated financial circumstances since the outbreak. Hierarchical regression analysis revealed that financial stress was the strongest predictor of psychological distress. Structural equation modeling indicated that family support, indoor leisure activities and community resources significantly mediated the negative influence of COVID-19-related stressors on psychological distress of family members.
Conclusion
Family leisure activities, family support, community spirit and mutual help within the context of social-distancing restrictions may need to be promoted to benefit vulnerable families in Hong Kong under the COVID-19 epidemic.
The consequences of the coronavirus crisis are considerable for everyone in the Netherlands. Although there were concerns about the many vulnerable families who were forced to stay at home because of ...the measures taken by the government to contain the coronavirus in the Netherlands, there has been no increase in the number of reports of domestic violence or child abuse.
To gain insight by a mixed method study on what has happened during the lockdown within families who were already known to social services.
A quantitative study was performed among 159 families recruited before the coronavirus crisis, and 87 families recruited during the lockdown in the Netherlands through child protection services. Family members (parents, children) completed questionnaires about interparental violence, (historical) child abuse and neglect, and emotional security. In a qualitative study 39 of these respondents and 13 professionals were interviewed.
No difference was found in violence between families who participated before and after the lockdown. The level of violence is still high in most families. The absence of assistance promoted the self-reliance of children and parents to deal with this difficult period. Professionals found new ways of connecting to families at risk. Every form of support is important to these families because it made children feel seen and heard. Isolation of families where domestic violence and child abuse occurred, remains a risk factor, even outside the coronavirus crisis.
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