Background
Parent-child intervention
Studies on the efficacy of interventions
Cultural considerations
A Swedish example of parent-infant intervention approaches
The work assignment
Elements in the program
Interaction treatment "in video" – Marte Meo
Interaction treatment "in vivo"
Interaction treatment "in verbis" (verbally)
Collaboration with the families' social network
Aims of the current study
Ethical approval
Methods
The four centres for parent-child intervention
Subjects
n | |||
---|---|---|---|
Children's age (n = 118 children; 44 girls & 74 boys)
| ♀ | ♂ | |
Unborn | 0 | 4 | 4 |
0 – 11 months | 10 | 6 | 16 |
1 year | 1 | 6 | 7 |
2 years | 7 | 11 | 18 |
3 years | 6 | 10 | 16 |
4 years | 4 | 10 | 14 |
5 years | 4 | 7 | 11 |
6 years | 1 | 6 | 7 |
7 years | 2 | 4 | 6 |
8 years | 1 | 5 | 6 |
9 years | 2 | 1 | 3 |
10 years | 4 | 1 | 5 |
11 years | 0 | 3 | 3 |
12 years | 2 | 0 | 2 |
Child's residence (n = 101 families)
| |||
Mother & Father | 54 | ||
Single Mother | 26 | ||
Mother & Stepfather | 9 | ||
Alternating residence (at least 10 days a month with each parent) | 6 | ||
Single Father | 4 | ||
Father & Stepmother | 1 | ||
Foster home | 1 | ||
Parents' occupation (n = 154 parents, 94 ♀; 60 ♂) | ♀ | ♂ | |
Employed | 35 | 41 | 76 |
Unemployed/employment measures | 15 | 11 | 26 |
Long-term sick-leave/temporary disability pension/pension | 24 | 2 | 26 |
Student | 13 | 3 | 16 |
Seeking political asylum | 3 | 3 | 6 |
Working in the home | 3 | 0 | 3 |
Information missing | 1 | 0 | 1 |
Initiating contact (≥ 1 per case; 124 contact initiators in 101 families) | |||
Social services | 48 | ||
Parents | 37 | ||
Adult psychiatry | 12 | ||
Child health service | 11 | ||
Paediatric clinic | 4 | ||
Preschool | 3 | ||
Child psychiatry | 3 | ||
Maternity welfare | 2 | ||
Other | 4 |
Contact initiators and contact causes
n | |
---|---|
Interaction between parent/parents – child (174 causes stated in 91 families)
| |
Need for support in the parent role | 58 |
Interaction difficulties | 53 |
Boundary setting problems | 44 |
Attachment difficulties | 14 |
Suspected abuse | 4 |
Other | 1 |
Child (142 causes in 78 children in 75 families)
| |
Externalizing problems | 81 |
Aggressiveness (37), Hyperactivity & concentration problems (31), | |
Cannot/Does not want to listen/obey (7), | |
Troublemaking/Obstinacy/Acting out (6)
| |
Regulation problems | 31 |
Sleeping (17), Feeding (7), Screaming (5), Toilet training (2)
| |
Contact difficulties | 5 |
Interaction difficulties with siblings and/or other children | 5 |
Internalizing problems | 4 |
Delayed development | 6 |
Handicap/illness | 6 |
Trauma | 3 |
Other | 1 |
Parents (89 causes in 70 parents in 55 families)
| |
Mental problems/mental illness | 35 |
Insecurity/low self-esteem/immaturity/very young | 38 |
Worn-out & tired | 6 |
Abuse | 4 |
Feeling of loneliness | 2 |
Somatic illness | 2 |
Assaulted others | 1 |
Other | 1 |
Relationship between the parents/step-parents (47 causes in 35 families)
| |
Conflict or crisis with the partner/the other parent | 18 |
Separation | 17 |
Violence or threat of violence | 3 |
Death | 3 |
Other | 6 |
Social network (32 causes in 27 families)
| |
Insufficient network | 12 |
Conflict filled network | 18 |
Other | 2 |
Social situation (25 causes in 23 families)
| |
Burdened social situation | 17 |
Strains in connection with refugee situation | 5 |
Other | 3 |
Treatment, duration, compliance, and termination
Families | Number of sessions | |||
---|---|---|---|---|
n | Md | Mean | Sd | |
Interaction treatment
|
101
| |||
"In vivo" |
88
| 21.5 | 32.3 | 28.5 |
At a centre – family & therapist in a group setting
|
56
|
33.5
|
39.1
|
28.9
|
At a centre – family & therapist exclusively
|
22
|
9.0
|
12.8
|
12.4
|
At home
|
57
|
4.0
|
6.9
|
7.9
|
"In video" Marte Meo |
83
| 6.0 | 6.1 | 3.6 |
Reviews with one parent
|
67
|
4.0
|
4.7
|
3.2
|
Reviews with two parents
|
44
|
4.0
|
4.5
|
2.7
|
"In verbis" |
95
| 9.0 | 13.0 | 12.3 |
Number of sessions with one parent
|
74
|
6.5
|
8.9
|
8.5
|
Number of sessions with two parents
|
60
|
6.0
|
9.3
|
8.7
|
Combinations of treatment modalities
| ||||
"In vivo" & "In video" & "In verbis" | 72 | |||
"In vivo" & "In verbis" | 13 | |||
"In video" & "In verbis" | 5 | |||
"In vivo" & "In video" | 3 | |||
"In verbis" | 5 | |||
"In video" | 3 | |||
"In vivo" | 0 | |||
Collaboration with the families' social network
|
61
| |||
Child care (24) & School (8) | 32 | |||
Social services | 31 | |||
Relatives | 24 | |||
Psychiatry (adults) | 8 | |||
Child health care | 7 | |||
Child psychiatry | 6 | |||
Friends | 3 | |||
Maternal health care | 1 | |||
Network meeting | 9 |
Families | Number of months | |||
---|---|---|---|---|
n | Md | Mean | Sd | |
Treatment duration
| ||||
Length of treatment for all 101 families | 101 | 10 | ||
Treatment completed
|
72
|
8
|
8.9
|
4.60
|
Interrupted treatment
|
10
|
8
|
9.5
|
6.12
|
Still in treatment at T3
|
19
| |||
Treatment completion at T2 (6 m) & T3 (18 m)
| ||||
Treatment completed at T2 | 24 | |||
Treatment interrupted at T2 | 4 | |||
Treatment completed at T3 (another 48 families) | 72 | |||
Treatment interrupted at T3 (another 6 families) | 10 | |||
Proportion of failure to attend treatment (101 families)
| ||||
≤ 15% of planned treatment sessions | 73 | |||
16 – 25% | 9 | |||
26 – 50% | 14 | |||
51 – 75% | 1 | |||
≥ 76% | 2 | |||
Missing data | 2 | |||
After n months
| ||||
Treatment interruption
|
10
| |||
Families moved from the neighbourhood | 3 |
6; 7; 19 months
| ||
Asylum seeking families expelled from the country | 2 |
1; 11 months
| ||
Investigation by social services | 2 |
4; 9 months
| ||
Staff reasons: sick leave or end of service | 3 |
5; 15; 18 months
|
Measures
The parents' experience of parental stress
The parents' patterns of attachment
The parents' mental health
The parents' present and expected life satisfaction
The parents' social support
The children's strengths and difficulties
Procedure
Statistical analysis
Results
The families' problems at the outset of the treatment (T1)
Scale | Intervention mothers | Community samples ♀ | Clinical samples ♂ | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
n | Mean | sd | n | Mean | sd | P | n | Mean | sd | p | |
SPSQa) (couples) | 66 | 3.11 | .58 | 1081 | 2.52 | .56 | <.001 | 75 | 2.81 | .59 | .003 |
incompetence |
66
|
3.11
|
.78
|
2.27
|
.68
|
<.001
|
2.57
|
.84
| <.001 | ||
role |
66
|
3.84
|
.84
|
3.42
|
.82
|
<.001
|
3.88
|
.75
|
.766
| ||
isolation |
66
|
2.65
|
.84
|
2.05
|
.72
|
<.001
|
2.21
|
.82
|
.002
| ||
spouse |
66
|
2.68
|
1.03
|
2.25
|
.94
|
<.001
|
2.29
|
1.07
|
.030
| ||
health |
66
|
3.17
|
.83
|
2.61
|
.88
|
<.001
|
3.09
|
.88
|
.581
| ||
SPSQ (single) | 24 | 3.36 | .56 | ||||||||
incompetence |
24
|
3.46
|
.60
| ||||||||
role |
24
|
3.72
|
.98
| ||||||||
isolation |
24
|
2.93
|
.92
| ||||||||
health |
23
|
3.22
|
.69
| ||||||||
RQb) (B) | 92 | 3.95 | 1.88 | 211 | 5.02 | 1.50 | <.001 | ||||
RQ (D) | 91 | 3.74 | 2.33 | 209 | 2.40 | 1.70 | <.001 | ||||
LoLc) past | 92 | 4.67 | 2.47 | 103 | 4.4 | 2.3 | .430 | ||||
L-o-L present | 92 | 5.22 | 2.07 | 2032 | 7.30 | 1.48 | <.001 | 103 | 5.2 | 2.0 | .945 |
L-o-L future | 89 | 7.92 | 1.81 | 102 | 7.7 | 2.0 | .429 | ||||
Clinical sample ♀ & ♂ | |||||||||||
ISSId) total | 93 | 16.06 | 7.98 | 103 | 16.3 | 6.2 | .813 | ||||
AVAT |
92
|
4.64
|
1.72
|
103
|
4.4
|
1.6
|
.314
| ||||
ADAT |
92
|
5.08
|
3.20
|
103
|
5.9
|
2.9
|
.062
| ||||
AVSI |
93
|
2.04
|
1.80
|
103
|
2.0
|
1.7
|
.873
| ||||
ADSI |
93
|
4.37
|
2.77
|
103
|
4.4
|
2.5
|
.936
| ||||
SDQe) total | 37 | 19.24 | 5.75 | 260 | 6.15 | 5.24 | <.001 | 62 | 16.71 | 7.23 | .073 |
SDQ impact | 37 | 3.54 | 2.40 | 0.34 | 1.16 | <.001 | 3.14 | 2.76 | .466 | ||
emotional |
37
|
4.00
|
2.15
|
1.60
|
1.84
|
<.001
|
4.50
|
2.60
|
.327
| ||
conduct |
37
|
4.86
|
2.00
|
1.09
|
1.29
|
<.001
|
3.23
|
2.23
|
<.001
| ||
hyperactivity |
37
|
6.65
|
3.09
|
2.38
|
2.18
|
<.001
|
6.00
|
2.83
|
.288
| ||
peer |
37
|
3.73
|
2.12
|
1.15
|
1.90
|
<.001
|
3.03
|
2.40
|
.146
| ||
prosocial |
37
|
6.62
|
2.13
|
8.62
|
1.50
|
<.001
|
7.00
|
2.20
|
.402
| ||
GHQ 12f) Prop. of poor psychol. health | 93 | 78.3% | 8792 | 25.6% |
<.001
|
Scale | Intervention Fathers | Community samples ♂ | Clinical samples ♂ | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
n | Mean | Sd | n | Mean | sd | P | n | Mean | sd | p | |
SPSQ (couple) | 51 | 2.72 | .59 | 65 | 2.39 | .50 | .002 | ||||
incompetence |
51
|
2.53
|
.72
|
2.02
|
.57
| <.001 | |||||
role |
51
|
3.29
|
.81
|
3.23
|
.86
|
.703
| |||||
isolation |
51
|
2.61
|
.66
|
2.18
|
.73
|
.001
| |||||
spouse |
50
|
2.48
|
.81
|
1.98
|
.79
|
.001
| |||||
health |
51
|
2.70
|
.85
|
2.57
|
.81
|
.403
| |||||
SPSQ (single) | 8 | 2.81 | .78 | ||||||||
incompetence |
8
|
2.81
|
.87
| ||||||||
role |
8
|
3.06
|
1.18
| ||||||||
isolation |
8
|
2.85
|
.75
| ||||||||
health |
8
|
2.31
|
.97
| ||||||||
RQ (B) | 60 | 4.13 | 1.71 | 192 | 4.88 | 1.48 | .001 | ||||
RQ (D) | 60 | 2.95 | 2.06 | 188 | 2.57 | 1.67 | .149 | ||||
LoL past | 59 | 5.20 | 2.23 | 47 | 5.2 | 2.1 | 1.000 | ||||
L-o-L present | 59 | 5.95 | 1.92 | 47 | 5.5 | 1.9 | .231 | ||||
L-o-L future | 59 | 7.58 | 1.78 | 46 | 7.4 | 1.8 | .610 | ||||
Clinical sample ♀ & ♂ | |||||||||||
ISSI total | 60 | 18.73 | 7.64 | 103 | 16.3 | 6.2 | .028 | ||||
AVAT |
60
|
4.73
|
1.53
|
83
|
5.1
|
1.4
| .136 |
103
|
4.4
|
1.6
|
.199
|
ADAT |
60
|
6.15
|
3.09
|
83
|
7.6
|
2.6
|
.003
|
103
|
5.9
|
2.9
| .605 |
AVSI |
60
|
2.58
|
1.86
|
83
|
3.0
|
1.7
|
.163
|
103
|
2.0
|
1.7
|
.044
|
ADSI |
60
|
5.27
|
2.64
|
83
|
6.5
|
1.8
|
.199
|
103
|
4.4
|
2.5
|
.038
|
SDQ total | 25 | 17.92 | 6.47 | ||||||||
SDQ impact | 25 | 2.76 | 2.89 | ||||||||
emotional |
25
|
3.56
|
2.36
| ||||||||
conduct |
25
|
4.32
|
1.91
| ||||||||
hyperactivity |
25
|
6.84
|
2.94
| ||||||||
peer |
25
|
3.20
|
1.80
| ||||||||
prosocial |
25
|
6.36
|
2.61
| ||||||||
GHQ 12 Prop. of poor psychol.. health | 60 | 43.3% | 7126 | 18.6% | <.001 |
Long term changes (after 18 months (T3)) and short term changes (after 6 months (T2))
T1 | T2 | T3 | |||||||
---|---|---|---|---|---|---|---|---|---|
Scale
|
n
| Mean |
sd
|
n
| Mean |
sd
|
n
| Mean |
sd
|
SPSQ (couples) total stress | 117 | 2.94 | .61 | 108 | 2.78 | .55 | 103 | 2.67 | .59 |
incompetence |
117
|
2.86
|
.81
|
108
|
2.70
|
.75
|
103
|
2.53
|
.74
|
role restriction |
117
|
3.60
|
.87
|
108
|
3.37
|
.84
|
104
|
3.28
|
.89
|
isolation |
117
|
2.63
|
.77
|
108
|
2.48
|
.74
|
103
|
2.38
|
.79
|
spouse |
116
|
2.60
|
.94
|
109
|
2.52
|
.88
|
94
|
2.53
|
.95
|
health |
117
|
2.97
|
.87
|
109
|
2.81
|
.81
|
103
|
2.64
|
.86
|
SPSQ (single parents) total stress | 32 | 3.22 | .66 | 35 | 2.93 | .68 | 32 | 2.75 | .63 |
incompetence |
32
|
3.29
|
.72
|
35
|
2.99
|
.77
|
32
|
2.79
|
.74
|
role restriction |
32
|
3.56
|
1.05
|
35
|
3.37
|
1.04
|
32
|
3.22
|
.97
|
isolation |
32
|
2.91
|
.87
|
35
|
2.56
|
.88
|
32
|
2.33
|
.92
|
health |
31
|
2.98
|
.86
|
35
|
2.68
|
.76
|
32
|
2.53
|
.90
|
RQ (B) | 152 | 4.02 | 1.81 | 143 | 4.20 | 1.78 | 135 | 4.50 | 1.67 |
RQ (D) | 151 | 3.42 | 2.26 | 143 | 3.01 | 2.09 | 135 | 2.84 | 2.00 |
Cantril's L-o-L present | 151 | 5.50 | 2.04 | 142 | 6.30 | 2.05 | 131 | 6.99 | 1.64 |
Cantril's L-o-L future | 148 | 7.78 | 1.79 | 139 | 7.96 | 1.80 | 131 | 8.28 | 1.33 |
GHQ12 | 153 | 4.46 | 3.37 | 144 | 3.42 | 3.30 | 136 | 2.70 | 3.00 |
ISSI | 153 | 17.11 | 7.93 | 143 | 17.99 | 7.25 | 136 | 19.36 | 7.03 |
AVAT |
152
|
4.68
|
1.64
|
143
|
4.72
|
1.56
|
135
|
5.16
|
1.28
|
ADAT |
152
|
5.50
|
3.19
|
143
|
5.89
|
3.00
|
136
|
6.29
|
2.96
|
AVSI |
153
|
2.25
|
1.84
|
143
|
2.22
|
1.79
|
136
|
2.44
|
1.83
|
ADSI |
153
|
4.72
|
2.75
|
143
|
5.15
|
2.69
|
136
|
5.49
|
2.68
|
SDQ total difficulties | 62 | 18.71 | 6.03 | 59 | 15.92 | 6.74 | 56 | 14.21 | 7.37 |
SDQ impact | 62 | 3.23 | 2.61 | 59 | 1.53 | 2.32 | 56 | 1.50 | 2.54 |
emotional symptoms |
62
|
3.82
|
2.23
|
59
|
3.47
|
2.48
|
56
|
2.71
|
2.10
|
conduct problems |
62
|
4.65
|
1.97
|
59
|
3.78
|
2.04
|
56
|
3.36
|
2.34
|
hyperactivity |
62
|
6.73
|
3.01
|
59
|
5.93
|
2.91
|
56
|
5.43
|
2.96
|
peer problems |
62
|
3.52
|
2.00
|
59
|
2.73
|
2.26
|
56
|
2.71
|
2.08
|
prosocial behaviour |
62
|
6.52
|
2.32
|
59
|
6.69
|
2.19
|
56
|
7.27
|
2.33
|
Long term T1→T3 | Short term T1→T2 | |||||||
---|---|---|---|---|---|---|---|---|
Scale
| d | Z | p | d | Z | p | ||
SPSQ (couples) total stress | .45 | -4.539 | <.001 | *** | .28 | -3.643 | <.001 | *** |
incompetence |
.42
|
-4.678
| <.001 | *** |
.20
|
-2.812
|
.005
|
**
|
role restriction |
.36
|
-3.964
| <.001 | *** |
.27
|
-2.809
|
.005
|
**
|
social isolation |
.33
|
-2.678
|
.007
|
**
|
.20
|
-1.945
|
.052
| |
spouse relationship problems |
.07
|
-.586
|
.558
|
.09
|
-.292
|
.770
| ||
health problems |
.38
|
-3.795
| <.001 | *** |
.19
|
-1.890
|
.059
| |
SPSQ (single) total stress | .73 | -3.375 | .001 | ** | .43 | -3.015 | .003 | ** |
incompetence |
.69
|
-3.084
|
.002
|
**
|
.41
|
-2.440
|
.015
| |
role restriction |
.34
|
-2.469
|
.014
|
.18
|
-.931
|
.352
| ||
social isolation |
.65
|
-2.611
|
.009
|
**
|
.40
|
-2.973
|
.003
|
**
|
health problems |
.51
|
-1.732
|
.083
|
.37
|
-1.948
|
.051
| ||
RQ (B) | .28 | -2.851 | .004 | .10 | -.972 | .331 | ||
RQ (D) | .27 | -3.426 | .001 | ** | .19 | -2.202 | .028 | |
Cantril's L-o-L present | .80 | -6.335 | <.001 | *** | .39 | -4.093 | <.001 | *** |
Cantril's L-o-L future | .31 | -3.090 | .002 | ** | .10 | -1.606 | .108 | |
GHQ12 | .55 | -5.466 | <.001 | *** | .31 | -4.051 | <.001 | *** |
ISSI | .30 | -2.636 | .008 | ** | .12 | -1.271 | .204 | |
AVAT |
.33
|
-2.361
|
.018
|
.03
|
-.522
a)
|
.602
| ||
ADAT |
.26
|
-2.187
|
.029
|
.14
|
-1.166
|
.244
| ||
AVSI |
.10
|
-1.018
|
.308
|
-.02
a)
|
-.585
a)
|
.559
| ||
ADSI |
.28
|
-3.400
|
.001
|
**
|
.16
|
-2.313
|
.021
| |
SDQ total difficulties | .68 | -4.254 | <.001 | *** | .44 | -4.167 | <.001 | *** |
SDQ impact | .67 | -4.342 | <.001 | *** | .69 | -4.790 | <.001 | *** |
emotional symptoms |
.51
|
-2.764
|
.006
|
**
|
.15
|
-1.217
|
.224
| |
conduct problems |
.60
|
-4.466
| <.001 |
***
|
.43
|
-3.578
| <.001 |
***
|
hyperactivity |
.44
|
-3.199
|
.001
|
**
|
.27
|
-3.392
|
.001
|
**
|
peer problems |
.40
|
-2.168
|
.030
|
.37
|
-2.920
|
.004
|
**
| |
prosocial behaviour |
.32
|
-2.718
|
.007
|
**
|
.08
|
-1.164
|
.244
|