Prevention of mental health problems: rationale for a universal approach

Bayer, Jordana K.; Hiscock, Harriet; Morton-Allen, E; Ukoumunne, Obioha C; Wake, Melissa

doi:10.1136/adc.2006.100776

Cited by 34 publications

(30 citation statements)

References 19 publications

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“…Firstly, a 69% uptake on the basis of eligible birth records is high for population trials. 5 Non-participants' index of disadvantage scores were only marginally lower than those of participants, indicating that our results could be generalised to a wide socioeconomic spectrum, although perhaps not the lowest end. Secondly, we used well validated parent reported outcome measures appropriate to this age group.…”

Section: Strengthsmentioning

confidence: 50%

“…Nevertheless, we successfully recruited many families with known risk factors for behavioural problems; 39% of the final sample were exposed to clinical levels of maternal depression, anxiety, and stress symptoms; substance misuse; partner conflict; social isolation; or financial problems. 5 Thirdly, although almost all families received some of the programme, only 49% received the full programme, underscoring the difficulty of implementing a true population prevention programme. If the parenting programme became part of routine primary care, the dosage received by families could conceivably increase (owing to streamlining and promotion of local sessions) but equally could further decrease.…”

Section: Limitationsmentioning

confidence: 99%

“…2 Possible approaches to reducing childhood mental health problems include management of established problems, secondary prevention targeting children with either family/social risk factors or early signs of disorder, and universal prevention offered to all children. 5 Management approaches include drug treatment, individual psychotherapy, and parenting programmes, the last of which have the strongest evidence of efficacy to date. 2 6-8 Parenting programmes share the goals of modifying the key aspects of parenting known to contribute to behavioural problems in children, by reducing harsh or abusive parenting, increasing warm parenting, and informing parental knowledge of normal development.…”

Section: Introductionmentioning

confidence: 99%

“…5 However, no high quality evidence showing the effectiveness of universal prevention has been published. 2 6 Here, we report intermediate trial outcomes of the first truly universal parenting programme aiming to prevent early childhood externalising behaviours before onset.…”

Section: Introductionmentioning

confidence: 99%

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Universal parenting programme to prevent early childhood behavioural problems: cluster randomised trial

Hiscock

Bayer

Price

et al. 2008

BMJ

129

181

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Objective To determine whether a parenting programme, offered universally in primary care, can prevent behavioural problems in children and improve parenting and maternal mental health.Design Cluster randomised trial.Setting 40 primary care nursing centres (clusters) in Victoria, Australia.Participants 733 English speaking mothers of 8 month old children sequentially recruited from well child appointments; 656 retained at 24 months.Intervention Structured three session programme at age 8-15 months, co-led by well child providers and a parenting expert. The programme covered normal development and behaviour, strategies to increase desired behaviour, and strategies to reduce unwanted behaviour.Main outcome measures Maternal report of child externalising behaviour (child behavior checklist 1½ -5 year old), parenting (parent behavior checklist), and maternal mental health (depression anxiety stress scales) at 18 and 24 months.Results At 18 months, child behaviour and parenting scores were similar in the two groups. At 24 months, externalising scores in the intervention and control groups were similar (mean 11.9 (SD 7.2) v 12.9 (7.4)); however, on the parent behavior checklist subscale scores, intervention group parents were less likely to report harsh/abusive parenting (mean 38.9 (SD 7.7) v 40.5 (8.8); adjusted mean difference −1.83, 95% confidence interval −3.12 to −0.55) and unreasonable expectations of child development (40.9 (9.9) v 42.7 (9.6); −2.18, −3.74 to −0.62). Mean scores for nurturing parenting and maternal mental health were similar in the two groups at both times.Conclusions A universal parenting programme resulted in modest improvement in parenting factors that predict behavioural problems in children but did not reduce externalising behavioural problems or affect maternal mental health at 2 years.

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Section: Strengthsmentioning

confidence: 50%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Universal parenting programme to prevent early childhood behavioural problems: cluster randomised trial

Hiscock

Bayer

Price

et al. 2008

BMJ

129

181

View full text Add to dashboard Cite

show abstract

“…68,69 While reaching families at higher risk of alcohol misuse problems is important, accurate identification of such families is often challenging, and programmes targeted at families on the basis of risk may stigmatise attendance, thus affecting take-up. 70,71 Universal programmes are less likely than targeted interventions to deter parents, and, ideally, will reach families at higher risk from alcohol misuse while avoiding stigmatisation. Because alcohol consumption is a part of everyday life in the UK, a universal programme is relevant to everyone because they either drink alcohol themselves or are exposed to the effects of others' alcohol consumption.…”

Section: Community and Family Involvementmentioning

confidence: 99%

Preventing alcohol misuse in young people: an exploratory cluster randomised controlled trial of the Kids, Adults Together (KAT) programme

et al. 2015

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BackgroundInvolvement of parents/carers may increase the effectiveness of primary school-based alcohol-misuse prevention projects. However, few interventions have been designed for pre-adolescent children, or specifically involve parents/carers. The Kids, Adults Together (KAT) programme in primary schools aimed to reduce alcohol misuse through such an approach.ObjectiveTo determine the value and feasibility of conducting an effectiveness trial of KAT.DesignParallel-group cluster randomised exploratory trial with an embedded process evaluation. Schools were the unit of randomisation.SettingPrimary schools (n = 9) in south Wales, UK.ParticipantsPupils in Year 5/6 (aged 9–11 years) and their parents/carers; school staff.InterventionThe Kids, Adults Together programme consisted of (1) classwork addressing the effects of alcohol; (2) a family event for children and parents/carers; and (3) a ‘goody bag’ containing fun items, including a digital versatile disc (DVD) for families to watch together. The intervention comprised KAT plus existing alcohol-related activities and lessons. Control-group schools continued with existing alcohol-related lessons and activities.Main outcome measuresKey outcomes related to the progression criteria for a potential future effectiveness trial. These included the acceptability, participation equity, feasibility and implementation of KAT; the recruitment and retention of research participants; and the acceptability and feasibility of research processes, including data collection methods and outcome measures.ResultsNine schools (free school meal entitlement ranging from 1% to 37.2%) participated. Two of five intervention schools withdrew but all four control schools were retained, and these seven schools facilitated all research data collections. Programme acceptability and participation rates were high in all three intervention schools (parent/carer participation rates ranged from 45.1% to 65.7%), although implementation quality varied. At baseline, approximately 75% of eligible children (n = 418) provided data, of whom 257 also provided data at follow-up. Only 27 parents/carers (estimated response rate 6.5%) completed interviews. Most children were willing to complete questionnaires but measures were not appropriate for this age group. Measures of alcohol consumption produced inconsistent responses. Intermediate outcomes on family communication showed no evidence of intervention effectiveness.ConclusionsIn the three schools that received the KAT intervention, it was found to be acceptable to schools and pupils and there were good levels of participation from parents/carers from across a range of socioeconomic groups. However, two intervention schools withdrew from the trial. Findings from intermediate outcomes on family communication did not support programme theory. In addition, the study highlighted challenges in identifying suitable outcome measures for children aged 9–11 years and the feasibility of long-term follow-up via secondary schools.Future workIt would not be appropriate to proceed to an effectiveness trial of KAT. There are doubts/uncertainties about the potential effects of KAT; suitability of measures; the large number of schools which would be required for an effectiveness trial of KAT, and the cost of this; feasibility of follow-up in secondary schools; and programme implementation and theory. There is a need to develop and validate measures for children aged 9–11 years; to test the feasibility of follow-up data collection methods in secondary schools; and to further consider sample size requirements and feasibility.Trial registrationCurrent Controlled Trials ISRCTN80672127.FundingThe exploratory trial of this project was funded by the National Institute for Health Research Public Health Research programme and the process evaluation was funded by the Economic and Social Research Council. The work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. This project will be published in full inPublic Health Research; Vol. 3, No. 15. See the NIHR Journals Library website for further project information.

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Translational research to prevent internalizing problems early in childhood

et al. 2010

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This article discusses the importance of and one approach to translational research to prevent internalizing problems very early in life. The World Health Organisation (WHO) predicts that by 2,030 internalizing problems will be second only to HIV/AIDS in the international burden of disease. Internalizing problems affect one in every seven school age children, with negative impacts on peer relations, school engagement, and later mental health, adult relationships, and employment. There is persuasive evidence that intervention in the preschool years can have a cost-effective impact on general developmental outcomes, compared to later school or adult intervention. However, the development of early childhood prevention for internalizing problems is in its infancy. Two significant risk factors for child internalizing problems are temperamental inhibition (characterized by fearfulness and withdrawal) and overinvolved/protective parenting practices. Rapee et al. have conducted two randomized "efficacy" trials with inhibited preschoolers in which a parenting group intervention reduced internalizing disorders up to 3 years later. Translational "effectiveness" research is now underway at the population level, to determine the balance of benefits and harms of systematically screening preschoolers for inhibition and subsequent intervention for all those affected. This rigorous public health research, followed by effective dissemination, addresses gaps identified in the WHO Prevention of Mental Disorders report.

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Prevention of mental health problems: rationale for a universal approach

Cited by 34 publications

References 19 publications

Universal parenting programme to prevent early childhood behavioural problems: cluster randomised trial

Universal parenting programme to prevent early childhood behavioural problems: cluster randomised trial

Preventing alcohol misuse in young people: an exploratory cluster randomised controlled trial of the Kids, Adults Together (KAT) programme

Translational research to prevent internalizing problems early in childhood

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