Health visitor parenting support programme leads to ‘striking’ change in toddlers' behaviour
Nicole Weinstein
Monday, June 14, 2021
A health visitor programme, which involved parents being filmed playing and eating with their children, has led to marked improvements in young children's behaviour, a study by the University of Cambridge and Imperial College London has found.
Health visiting teams across six NHS sites visited 300 families of children showing early signs of challenging behaviour as part of the Healthy Start, Happy Start study, which looks at testing video-feedback in promoting positive parenting.
Over the course of six sessions, health visitors filmed video clips of everyday situations with parents, such as playing together of having a meal with their children, and then analysed the content in depth.
During the next visit, they reviewed specific clips, highlighting often fleeting moments when the parents and child appear to be ‘in tune’. They discussed what made these successful, as well as any incidents in which more challenging issues arose. This helped the parents to identify particular cues and signals from their children and respond in a manner that helped their children feel understood and reinforced positive engagement and behaviours.
Half of the families received the programme alongside routine healthcare support, while the other half received routine support alone.
When assessed five months later, the children whose families had access to the video-feedback approach displayed significantly reduced behavioural problems compared with those whose families had not.
The researchers described the difference as the equivalent to having tantrums every day to having tantrums once or twice a week. Similarly, in the case of destructive behaviours, it represents the disparity between regularly throwing or breaking toys and other items, and barely doing this at all.
The children involved in the trial were aged 12 to 36 months, far younger than the age at which interventions for behaviour problems are normally available.
When families were followed up two years later, when their children were three- and four-years-old, researchers found that not only did the programme improve children’s behaviour problems immediately after delivery, but also two years later.
The results suggest that providing tailored support for parents at this earlier stage, if their children show early signs of challenging behaviour – such as very frequent or intense tantrums, or aggressive behaviour – would significantly reduce the chances of those problems worsening.
Dr Christine O’Farrelly, from the Centre for Play in Education, Development and Learning (PEDAL), Faculty of Education, University of Cambridge, said, ‘Often, as soon as you move a programme like this to a real health service setting, you would expect to see a voltage drop in its effectiveness compared with research conditions. Instead, we saw a clear and striking change in child behaviour.’
Beth Barker, a research assistant at the PEDAL Centre, said, ‘The fact that this programme was effective with children aged just one or two represents a real opportunity to intervene early and protect against enduring mental health problems. The earlier we can support them, the better we can do at improving their outcomes as they progress through childhood and into adult life.’
Paul Ramchandani, professor of Play in Education, Development and Learning at the University of Cambridge, said, ‘To provide this programme in any health service would require investment, but it can realistically be delivered as part of routine care. Doing so would benefit a group of children who are at risk of going on to have problems with their education, behaviour, future wellbeing and mental health. There is a chance here to invest early and alleviate those difficulties now, potentially preventing problems in the longer term that are far worse.’
- The results are reported in JAMA Pediatrics.
