Mellow Babies and Mellow Toddlers: Effects on maternal mental health of a group-based parenting intervention for at-risk families with young children

Highlights

• Mellow Parenting (MP) was acceptable to parent-child dyads with complex needs.

• MP was associated with improved maternal mental health and parenting confidence.

• This is the first study to explore national MP participation across multiple sites.

• These results warrant controlled studies that incorporate follow-up data.

Abstract

Background

Parental risk factors can have a significant detrimental impact on child development, yet most parenting interventions do not address parental mental health. There is also a dearth of evidence regarding parenting interventions for families with children under two years old. Mellow Parenting (MP) is a suite of parenting interventions targeting at-risk families with complex needs, including those with very young children. Preliminary studies suggest that MP can improve both parent and child outcomes, but no evaluation has been conducted in routine practice.

Methods

Using a real-world design we analysed routine data from a UK cohort of n = 183 mother-child dyads, collected over a 21-month period. Data were gathered immediately pre- and post-intervention. Outcomes included maternal mental health, parenting confidence, daily parenting stress, and child behaviour. Intention-to-treat and ‘completer’ analyses were performed. Associations between attendance, participant demographics, and pre-post change in outcomes were modelled.

Results

MP participation was associated with improvements in maternal mental health (d = 0.36), parenting confidence (d = 0.42), and a component of child psychosocial behaviour (conduct problems; d = 0.36), but not overall child difficulties, or daily parenting stress. Mothers with a partner experienced larger benefits in mental health and parenting confidence compared to single mothers. Younger mothers, and those with a history of mental health problems, attended more intervention sessions.

Limitations

The study used real-world data and was thus uncontrolled, limiting causal interpretations.

Conclusions

This is the first study to explore MP participation on a multi-site national level and suggests that group-based parenting interventions may be effective for at-risk families. These results should be expanded upon via controlled studies that incorporate follow-up data.

Introduction

Early childhood is a critical period of development which is highly susceptible to a multitude of environmental risk factors (Walker et al., 2011). Sensitive and attuned parenting has been shown to have a significant positive influence over the extent to which such risks impact child outcomes (Lengua et al., 2007, Trentacosta et al., 2008). This is particularly important in the case of families exposed to multiple co-occurring contextual risk factors e.g. low socioeconomic status, psychiatric disorder and parental experience of trauma (Masten et al., 1995), who are at higher risk of future problems (France et al., 2010, Lanza et al., 2010, Rutter, 1979). Consequently, there has been significant growth in the development of group-based parenting programmes that aim to improve parenting skills during early stages of child development (Barlow et al., 2016).

Parenting interventions such as ‘Incredible Years’ (Webster-Stratton and Herbert, 1994) and ‘Triple P’ (Sanders and Dadds, 1993) are effective in improving child behavioural outcomes in school-aged and pre-school children (Dretzke et al., 2009, NICE 2006). However, evidence supporting group-based parenting interventions for parent-child dyads with children under two years old remains particularly limited (Barlow et al., 2016, Jones et al., 2016) despite public health initiatives to support families through improved parenting skills in the first 2 years of children's lives (Allen, 2011, Commons, 2015). Methodological limitations of the current evidence base include lack of consistent reporting of drop-out rates, analysis of data from ‘completers’ only (Barlow et al., 2010), inclusion of self-selected parents (Jones et al., 2016, Wilson et al., 2012), lack of sufficient analysis power, and a failure of authors to declare financial conflicts of interest (Coyne and Kwakkenbos, 2013, Eisner et al., 2015, Wilson et al., 2012). Several reviews and meta-analyses suggest that children of disadvantaged parents show poorer intervention outcomes (Lundahl et al., 2006, Reyno and McGrath, 2006). Furthermore, few studies have considered maternal mental health as a primary outcome (Barlow et al., 2014), despite evidence for the detrimental impact of maternal depressive symptoms on early child development and quality of parenting (Walker et al., 2011). This is of importance given that measurement of change in parental mental health may act as a barometer for the effect of the intervention on the child further downstream.

From an implementation science perspective, widely evaluated and implemented parenting programmes have been limited by poor engagement of families who are at high risk of adverse developmental outcomes (Utting et al., 2007). It is also unclear whether specific programmes may be more successful in groups with higher levels of risk factors (Gardner et al., 2010). Thus, the evidence-base and implementation of parenting programmes for families with additional social/health needs substantially lags behind more general implementation (Evans et al., 2015, Olds et al., 2007).

In this context, Mellow Parenting represents a suite of parenting programmes targeted for vulnerable families of children from the antenatal period up to age five – with Mellow Babies (MB) targeting infants aged 0–18 months and Mellow Toddlers (MT) for children aged 19 months through to pre-school (aged 4–5 years). MP programmes are multi-modal, guided by attachment theory, social learning and cognitive behaviour-theory, and diverge from other evaluated programmes through their explicit targeting of parents who often have trouble engaging in services due to complex needs such as child protection concerns, severe depression, anxiety disorders, or domestic violence (Department of Education, 2013). The evidence-base for the efficacy of MP is increasing, with a meta-analysis suggesting moderate effect sizes on parental mental health and child outcomes (MacBeth et al., 2015). These are supported by qualitative studies of its effectiveness (Birtwell et al., 2015, Puckering et al., 2011). However, little is known about the effectiveness of MP programmes in routine practice.

The current study aimed to investigate the association between MP participation (either MT or MB) and improvements in maternal and child outcomes. Our primary focus/interest was maternal mental health, (depression, anxiety and irritability). Secondary outcomes included parenting confidence, parenting daily stress and child problem behaviour. We hypothesized that MP would be associated with positive improvements in all four outcomes. We also conducted exploratory analyses to assess whether any baseline characteristics were predictive of change across any outcomes.