Centre For Parent And Child Support Guys Hospital

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Centre For Parent And Child SupportGuys Hospital
Promoting the Mental Health of Young Children
The European Early Promotion Project Professor
Hilton Davis
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European Early Promotion Project
CYPRUS Dr A Paradisiotou, Mrs S Kyriakides, Ms
Y Hadjipanayi, Ms S Vizacou FINLAND Dr K
Puura, Prof T Tamminen, Dr M Turunen SERBIA
MONTENEGRO Prof V Ispanovic, Dr N Rudic, Ms J
Radosovljev, Ms T Miladinavic GREECE Prof J
Tsiantis, Prof T Dragonas, Ms E Layiou-Lignos, Dr
K Papadopolou UK Prof H Davis, Ms R Roberts,
Prof A Cox, Dr C Day
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Plan of Presentation
Background Theoretical Basis Description of EEPP
Service Research Results General Comments
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Further Information
Davis, H. Tsiantis, J. (2005). Special Issue
the European Early Promotion Project (EEPP).
International Journal of Mental Health Promotion,
7, 1, 1-110.
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Justification for Promotional Approach
Highest cause of disability in children. Problems
getting worse. Distressing to all
involved. Impairs all aspects of
development. Highly related to crime. Associated
with adult mental health problems. Expensive to
treat. Services are not meeting the needs.
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Review of Literature
These findings are sobering. In most of the
studies described, programs struggled to enroll,
engage and retain families. When program
benefits were demonstrated, they usually accrued
only to a subset of the families , they rarely
occurred for all of a programs goals, and the
benefits were often quite modest in
magnitude. Gomby, Culross Behrman (1999).
Home visiting recent program evaluations.
Future of Children, 9, 4-26.
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Prevention Effects
Average Effect Sizes 0.1 to 0.2 Indicates
53-56 of random intervention participants better
off than controls. Cohens criteria 0.2
small 0.5 medium 0.8 large Sweet, M.
Appelbaum, M. (2004). Is home visiting an
effective strategy? A meta-analytic review of
home visiting programs for families of young
children. Child Development, 75, 1435-1456.
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Effective Ingredients
  Theory-based Parent-helper partnership
Clear aims and goals Family-centred
Developmental component Parent-infant
relationship Service coordination Comprehensive
response
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Effective Ingredients
Community based Early identification
system Evidence-based methods Staff
selection/training Skilled management Programme
monitoring
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Theoretical Basis of Partnership Model
Davis H, Day C. Bidmead C (2002). Working in
Partnership with Parents The Parent Adviser
Model. London Harcourt Assessment
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Family Partnership Model
Construction Processes
Partnership
Helper Qualities
Helper Skills
Process
Outcomes
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Intended Outcomes of Helping

Do no harm Help parents identify, clarify and
manage problems. Enable parents (including
problem anticipation). Enable development and
well-being of children. Facilitate social support
and community development. Enable service
support. Compensate where necessary. Change the
system.
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The Helping Process

RELATIONSHIP BUILDING EXPLORATION UNDERS
TANDING GOAL SETTING STRATEGY
PLANNING IMPLEMENTATION REVIEW

END
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Partnership

Active participation/involvement Sharing power
with parents leading. Complementary
expertise. Agreeing aims and process. Negotiation.
Mutual trust and respect. Openness and
honesty. Clear communication.
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Essential Qualities Of The Helper
Professional expertise Respect Genuineness Empathy
Humility Quiet enthusiasm Personal integrity
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Communication Skills Of Helpers
Attention/Active listening Prompting and
exploration Empathic responding Summarizing
Enabling change Negotiating Problem solving
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Construing
All build construction system As model to
anticipate and adapt Constructions derive from
previous experience Unique to the individual Not
necessarily conscious or verbal Constant process
of testing, clarification and change Constructions
of others determine interaction
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EEPP Service Structure
Universal promotional interview (4-6 weeks
before birth) Universal promotional interview
(4-6 weeks after birth) Health visitor judgment
about need (using Need Checklist) Continue to
visit those in need using Partnership Model
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Antenatal Promotional Interview 1
Introduction Womans Feelings About
Pregnancy Expected Family Support Anticipated
Changes in Family Life/Relationships Self-percepti
ons of the Mother-to-be

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Antenatal Promotional Interview 2
Anticipations of Unborn Child Anticipation of
Delivery Anticipation of Feeding Finances and
Environment Life Events

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EEPP Indicators of Need 1
THE CHILD Premature/Small for Dates,
Physical Illness/Concern Constant
Crying PREGNANCY Unwanted, Other Concerns
(e.g. young mother) M-C RELATIONSHIP
Lack of Feeling for the Baby, Problems in
Interaction
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EEPP Indicators of Need 2
THE FAMILY Adversity in Mothers Childhood,
Marital Discord, Physical Illness,
Psychological Problems, 4 Children and
Isolation ENVIRONMENT Poverty/Debt,
Unemployment, Housing Problems, Overcrowding,
Environmental threat LIFE EVENTS Recent
Major Life Events
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EEPP Research Detail
Intervention families seen by trained
staff. Comparison families seen by untrained
staff. Evaluation by independent research
teams.   Families assessed at 8 weeks and 2
years. 430 families recruited into Intervention.
390 families in Comparison Group.
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EEPP Families In Need (UK)
HV Research Judgment
Judgment Intervention 62 (55) 77
(68) Comparison 25 (24) 73 (71)
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Frequency of Problems Rated by Trained and
Untrained Health Visitors
  Trained Untrained Mental health problems
(plt 0.001) 19 3   Marital discord (p 0.008)
23 6   Social isolation (plt 0.001) 30
4   Financial problems (plt 0.001) 19
1   Adverse life events (p 0.041) 15 6
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Accuracy Of Specific Need Identification
Intervention Comparison
Cyprus 55 67 Finland 61 68 Greece 78
32 Serbia 53 47 UK 66 32 Total
62 49
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Maternal Depression at 24 months
Inter. Comp. P ES Finland 10
(12.7) 17 (25) 0.03 0.22 Greece 2 (3.2)
6 (11.3) 0.04 0.15 (53-56
better)
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Outcomes Family Grid (Greece) 24mths
Inter. Comp. P ES Self-esteem 0.8
1.06 0.0001 0.69 Partner 0.9 1.29 0.004 0
.5 Child 0.5 0.61 0.02 0.49 (64-
70 better)
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Outcomes PS Index (Greece) 24mths
Inter. Comp. P ES Distress 20 25
0.02 0.51 Other scales in predicted direction
but not significant Overall ES 0.31
(58)
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Outcomes BSQ at 24mths
Inter. Comp. P Greece Eating 6.6
26.4 0.005 Peer 32.8 54.7 0.02 8 of 10
scales in predicted direction with ES
0.46 UK Depend. 17.3 27.1 0.046
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Bayley Scales at 24mths
Inter. Comp. P ES Greece Mental
88 82 0.006 0.58 Motor 96 92 0.24 0.18 Be
haviour 68 54 0.19 0.16 UK (No need
group) Mental 104 96 0.04 0.37 Motor 100 92
0.0009 0.64 Behaviour 80 60 0.09 0.27
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Outcomes HOME Inventory at 24mths
Inter. Comp. P ES Greece (5 of 7 scales
in predicted direction) Organization 5.3 4.6
0.001 0.72 Variety 3.6 3.1 0.02 0.48 UK (6
of 7 scales in predicted direction) Responsiveness
9.8 9.2 0.01 0.34 Play materials 8.5 8.2 0.02
0.28
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Other Interaction Measures at 24mths
Inter. Comp. P UK Quality of
relationship 0.9 1.1 0.06 Control
1.5 1.9 0.03 Involvement 66.5 65.3 0.08 G
reece Quality of relationship 0.7 1.0 0.02 Mater
nal sensitivity 0.8 0.6 0.03
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HOME Scores
More change found in Intervention Group from
perinatal period to 24 months (significant or
trend) Responsiveness (Finland
UK) Avoidance of Punishment (Finland) Organization
(Greece UK) Provision Play
Materials (Finland UK) Total Score (Finland,
Greece UK)
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Mothers Satisfaction with EEPP Service (Medians)
Intervention Comparison
p Cyprus 33 38 0.003 Finland
20.5 21 0.2 Greece 13 20
0.0002 Serbia 16 19 0.08 UK 20 25
0.03 Total 20.5 25 Average effect
size 0.4
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Further Information
www.cpcs.org.uk Centre for Parent and Child
Support, Guys Hospital