The impact on parenting and the home environment of early support to mothers with new babies
| DOI | https://doi.org/10.1108/17466660200600028 |
| Published date | 01 December 2006 |
| Date | 01 December 2006 |
| Pages | 4-20 |
| Author | Jacqueline Barnes,Kristen MacPherson,Rob Senior |
| Subject Matter | Education,Health & social care,Sociology |
4
1Professor of
Psychology, Institute
for the Study of
Children, Families
and Social Issues,
Birkbeck, University
of London.
2Senior Research
Officer, Institute for
the Study of
Children, Families
and Social Issues,
Birkbeck, University
of London.
3Senior Research
Fellow,Leopold
Muller Centre for
Child and Adolescent
Mental Health, Royal
Free and University
College Medical
School, University
College London and
Honorary Consultant
Child and Adolescent
Psychiatrist,
Tavistock and
Portman NHS Trust.
Journal of Children’s Services
Volume 1 Issue 4 December 2006
©Pavilion Journals (Brighton) Ltd
Abstract
The study reported here aimed to evaluate the impact on parenting and the home environment of
community volunteer home visiting offered during or soon after pregnancy to potentially vulnerable
mothers. A cluster-randomised study allocated Home-Start schemes to intervention or comparison
(existing services) conditions. Mothers were screened at routine health checks. Families in intervention
and comparison areas were assessed at two and 12 months. The results showed that comparing families
receiving supportand those in comparison areas, there werefew differences. Therewas a greater
reduction in parent–child relationship difficulties for supported families, but they offered their children
fewer healthy foods. There was no evidence of enhanced parenting, organisation of the home
environment or moreappropriate use of health services. Comparing families receiving supportwith a
second comparison group,living in intervention areas but not receiving support, no differences were
found. The article concludes that a more structured approach may be required to make changes in
parenting behaviour and the home environment.
Key words
early intervention; home visiting; volunteer support; infancy; parent–child relationships
Introduction
Based on evidence from studies of early brain
development (eg. Perry, 1995; Shore, 1997) and
interventions in the USA such as Early Head Start
(Love et al,2002) there has been an increasing
emphasis in the UK on offering early interventions
designed to increase family well-being and enhance
infant development, especially to disadvantaged
families (Barnes & Freude-Lagevardi, 2003; Glass,
1999). A review of early intervention initiatives
concluded that family support might be particularly
useful when initiated during pregnancy, providing a
means of establishing positiverelationships between
families and service providers in the community in
the eventuality that those families required additional
services (Barnes, 2003).
Multi-faceted programmes for vulnerable
populations incorporating home-based services
focusing on the parents and centre-based services
for children have demonstrated their effectiveness,
particularly when they are offered proactively, either
prenatally or at birth (IHDP, 1990; MacLeod & Nelson,
2000). However, such comprehensive programmes
are too costly to incorporate into existing services.
In addition, it is not clear which aspects of complex
interventions offering support to mothers at home,
aday care place, parenting groups and additional
health checks aremost closely associated with
improved outcomes. Home support may be crucial
The impact on parenting
and the home environment
of early support to mothers
with new babies
Jacqueline Barnes1,Kristen MacPherson2and Rob Senior3
and can be effective without the attendant services
offered in programmes such as the Infant Health and
Development Program (IHDP), at least as a means of
intervening to change parenting behaviour. It has
been demonstrated that effects can be additive. For
instance, the early Head Start intervention randomly
assigned families to receive either home visiting or
child services at a centre, or both of these. Those
families receiving both home visiting and centre child
care showed most improvement, while centre care
alone led to more improvement for children and home
visiting had more impact on parenting and the home
environment (Love et al,2002). Thus, support such as
professional home visiting or early child education
within a centre may be a starting point that could be
offered to a larger proportion of families than those
who receive all aspects of complex interventions.
There has been some debate about support for
parents, questioning whether the impact made
through professional support could also be achieved
by (less expensive) paraprofessionals (Halpern, 1990)
or by community volunteers. Findings from research
arecontradictory (Kendrick et al,2000). A systematic
review of home-based social support provided by
non-professionals for socially disadvantaged mothers
who had recently given birth (Hodnett & Roberts,
2000) concluded that therearebenefits to
capitalising on experienced mothers in the
community,in terms both of cost and cultural
sensitivity,in comparison with purely hospital-based
programmes led by teams of health care
professionals. Hard-to-reach and vulnerable families
in particular may respond better to supportfrom
other parents rather than from professionals (Barnes
&Freude-Lagevardi, 2003). The question of whether
or not visits are structured is also relevant. Structured
support generally requires more training and
supervision. This may appeal to some families but it
has been suggested that mothers respond better to
support that acknowledges their expertise
(Bromwich, 1990; Lojkasek, Cohen & Muir, 1994).
There is a range of evidence that professional
home visitors following structured interventions with
clear guidelines have significantly improved parenting
outcomes. The most rigorously evaluated home
visiting intervention, in the US, involved monthly
visits from pregnancy until 24 months, proving
particularly beneficial for young and/or single women
of low socio-economic status (SES) (Olds et al,1986).
In the UKan intervention comprising social support
from a community midwife during pregnancy,
targeting mothers at risk for low birth weight, had a
beneficial impact on maternal and child health
outcomes (Oakley et al,1990). A combination of visits
from a community volunteer, a nurse and a social
worker has also been the subject of a randomised
trial1,with the professionals giving advice and the
volunteers providing support (Marcenko & Spence,
1994). Mothers reported fewer psychological
symptoms and made greater use of services. The
Bristol Child Development Programme (Barker &
Anderson, 1984) offered support and encouragement
through health visitors visiting monthly postnatally
for one year, exploring issues such as diet, health and
maternal self-esteem, and it has been incorporated
into health visitor practice in some areas, but no
evidence from trials is available.
Community mothers can also be effective in
offering a structured approach, using materials
previously intended for use by professionals. A
randomised trial in Dublin, Ireland, trained
community mothers in the Barker Child Development
Programme. They made monthly visits for the first
year of the child’s life, visiting families with a
newborn infant living in selected areas of
disadvantage. The trial identified benefits for mothers
and children (Johnson, Howell & Molloy, 1993).
Intervention children received more immunisations,
and parents read and played in a more stimulating
manner and wereless tired and miserable.
Currently,however,there is no conclusive evidence
about the impact of unstructured support offered by
community volunteers. Home-Startoffers a service
intended to complement the role of professionals by
improving the support available to families who may
not want to be identified as requiring ongoing
professional help.Emphasising the befriending nature
of the support, volunteers are mainly parents
themselves and aim to remove any stigma attached to
receiving help, responding to families with flexibility,
openness and encouragement so that parents’ capacity
to cope is enhanced. Several uncontrolled studies2of
Home-Start suggest that it has beneficial impacts for
families (Frost et al,1996; Shinman, 1994; van der
Eyken, 1982) but one quasi-experimental study3did not
find a significant difference between those receiving
Home-Start support and those receiving standard local
services either in the outcomes examined or in the
extent to which services other than Home-Start were
used (McAuley et al,2004).
Method
Recruiting Home-Start schemes
The study used a cluster-randomised design, with
stratification by three regions in England: South East
and London; Midlands and East; and North East and
North West. Out of the 237 Home-Start schemes in
The impact on parenting and the home environment of early support to mothers with new babies
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Journal of Children’s Services
Volume 1 Issue 4 December 2006
©Pavilion Journals (Brighton) Ltd
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