Parenting for mental health: what does the evidence say we need to do? Report of Workpackage 2 of the DataPrev project

The last decade has witnessed increasing interest in the promotion of mental health and well-being because of its importance for health and social functioning at individual level and for the social and economic well-being of societies. Recent research from a range of disciplines (including neurodevelopment, developmental psychology and genetics) has highlighted the importance of childhood, and particularly the first few years of life, for future mental, social and emotional development. The quality of the parent-child relationship and parenting more generally is one of the factors in determining outcomes. The objective of this review was to identify effective interventions to support parents, parenting and the parent-child relationship from the ante-natal period to adolescence. A systematic search of key electronic databases was undertaken to identify systematic reviews evaluating approaches to parenting support; 52 systematic reviews were identified. Results were synthesized qualitatively and reported under the following headings: (i) perinatal programmes; (ii) parenting support programmes in infancy and early years focused on enhancing caregiver sensitivity and attunement; (iii) formal parenting programmes focused on children's behaviour; (iv) parenting support for highest risk groups. The review provides a robust international evidence base of programmes which have been demonstrated to improve parenting and the mental health and well-being of children. Policies and programmes to support parenting offer much scope for improving mental health. Effective provision requires a skilled workforce and careful application of approaches that have been found to work. More research is needed to develop and identify interventions for some of the highest risk groups.     

Mental health and global well-being

A range of evidence-based, cost-effective interventions can be implemented in parenting, at schools, at the workplace and in older age to promote mental health and well-being. Such programmes need to be supplemented with actions to build mental health capital and promote resilience to manage and cope with the global risks that face humankind over the coming years. Actions need to connect mental and physical health and individuals need to be connected through health-promoting social networks; living environments need to be designed to support mental health and well-being; well-being indicators that include material living conditions, quality of life and sustainability can help drive healthy public policy. There is an urgent need to invest in skills training in decision-making, social interactions, building trust and cooperative behaviour that support the family of humanity as a whole as it faces the unprecedented stressors resulting from climate change.     

Mapping interventions that promote mental health in the general population: A scoping review of reviews

Health policies and programs promoting mental health or preventing mental illness in the general public are under-recognized facets of primary prevention. Increasing awareness and adoption of such strategies could reduce the burden of mental illness in individuals, families, communities, and society as whole. We conducted a scoping review of reviews of interventions to promote mental health or prevent mental illness. We searched PubMed, PsycINFO, Scopus, Cochrane CENTRAL, CINAHL and ERIC from 2004 to 2014. Reviews were included if the authors indicated a systematic approach in their literature searches, and if they comprised interventions in Westernized countries targeting the general population. We identified 39 reviews that met the inclusion criteria. Mental health intervention approaches and outcomes varied across age groups and settings, and included functional, social, and cognitive measures. Most interventions aimed to prevent a specific mental illness or symptoms (depression, anxiety, burnout, or stress). Cognitive-behavioral therapy and educational components were common. School-based programs focused on outcomes involving social and academic development. Interventions for families, especially for young or disadvantaged parents, taught parenting skills to help improve the well-being of children and their care-givers. In the workplace, the focus was on managing stress, while programs for the elderly emphasized quality of life determinants. This review summarizes a wide variety of interventions to promote mental health or prevent mental illness, but the literature is primarily focused on the individual or family unit. More information is required about interventions at the community and societal levels.     

Investing in mental health and well-being: findings from the DataPrev project

A systematic review was conducted to determine the extent to which an economic case has been made in high-income countries for investment in interventions to promote mental health and well-being. We focused on areas of interest to the DataPrev project: early years and parenting interventions, actions set in schools and workplaces and measures targeted at older people. Economic evaluations had to have some focus on promotion of mental health and well-being and/or primary prevention of poor mental health through health-related means. Studies preventing exacerbations in existing mental health problems were excluded, with the exception of support for parents with mental health problems, which might indirectly affect the mental health of their children. Overall 47 studies were identified. There was considerable variability in their quality, with a variety of outcome measures and different perspectives: societal, public purse, employer or health system used, making policy comparisons difficult. Caution must therefore be exercised in interpreting results, but the case for investment in parenting and health visitor-related programmes appears most strong, especially when impacts beyond the health sector are taken into account. In the workplace an economic return on investment in a number of comprehensive workplace health promotion programmes and stress management projects (largely in the USA) was reported, while group-based exercise and psychosocial interventions are of potential benefit to older people. Many gaps remain; a key first step would be to make more use of the existence evidence base on effectiveness and model mid- to long-term costs and benefits of action in different contexts and settings.     

Developing policy in the provision of parenting programmes: integrating a review of reviews with the perspectives of both parents and professionals

Background   Parenting programmes are a key component of the delivery of children's services, but evidence-based policy has often proved difficult to implement.
Methods   The present review addressed this issue by integrating a review of systematic reviews of parenting programmes and a series of focus groups with parents and professionals involved in parenting across three agencies in a regional area (health, education and social work). The review summarizes parenting interventions targeting infant mental health, emotional and behavioural difficulties, autism spectrum disorder and attention deficit hyperactivity disorder, abuse/neglect, alcohol/substance abuse and 'vulnerable' parents. The focus groups discussed topics such as the range of parenting services across the three agencies, accessibility, gaps in the service and future directions.
Results and conclusions   Twenty systematic reviews were summarized. These reviews demonstrated that there is a wide range of parenting programmes available that have the potential to benefit families who are affected by problems ranging from emotional and behavioural difficulties to adolescent substance abuse. However, the findings of the focus groups reveal that the success of these programmes will depend in part on how they can be tailored to meet the social context of the families targeted. These integrated findings are discussed in terms of their implications for policy and practice.     

What role can child-care settings play in obesity prevention? A review of the evidence and call for research efforts

Given the widespread use of out-of-home child care and an all-time high prevalence of obesity among US preschool-aged children, it is imperative to consider the opportunities that child-care facilities may provide to reduce childhood obesity. This review examines the scientific literature on state regulations, practices and policies, and interventions for promoting healthy eating and physical activity, and for preventing obesity in preschool-aged children attending child care. Research published between January 2000 and July 2010 was identified by searching PubMed and MEDLINE databases, and by examining the bibliographies of relevant studies. Although the review focused on US child-care settings, interventions implemented in international settings were also included. In total, 42 studies were identified for inclusion in this review: four reviews of state regulations, 18 studies of child-care practices and policies that may influence eating or physical activity behaviors, two studies of parental perceptions and practices relevant to obesity prevention, and 18 evaluated interventions. Findings from this review reveal that most states lack strong regulations for child-care settings related to healthy eating and physical activity. Recent assessments of child-care settings suggest opportunities for improving the nutritional quality of food provided to children, the time children are engaged in physical activity, and caregivers' promotion of children's health behaviors and use of health education resources. A limited number of interventions have been designed to address these concerns, and only two interventions have successfully demonstrated an effect on child weight status. Recommendations are provided for future research addressing opportunities to prevent obesity in child-care settings.     

Is parenting style related to children's healthy eating and physical activity in Latino families?

Parenting styles influence a child's risk for obesity. The goals of this study are to evaluate the influence of (i) parenting style on children's health behaviors (physical activity and dietary intake), (ii) children's sociodemographic characteristics on parenting style and on children's health behaviors and (iii) parents' sociodemographic characteristics on their use of controlling styles to promote a healthy home environment. Survey and anthropometric data were collected from a community sample of Latino parents (n = 812) and their children in kindergarten through second grade. Parental use of positive reinforcement and monitoring was associated with children's healthy eating and exercise. Also, parents' use of appropriate disciplining styles was associated with healthier eating, while parental use of control styles was associated with unhealthy eating. The daughters of parents who used controlling styles ate more unhealthy foods than did the sons. Older, employed and more acculturated parents used less controlling styles than their counterparts. Parenting interventions targeting children's dietary intake and physical activity should encourage parents to use more positive reinforcement and monitor their children's health behaviors as these parenting styles are associated with healthier behaviors. Moreover, intervention researchers may want to encourage Latino parents to use less controlling styles with girls as this parenting style increased girls' risk for unhealthy eating.     

Practice,Knowledge and Needs of Occupational Therapy Practitioners Providing Services to Parents with Physical Impairments: A Pilot Study

Abstract

This survey study describes practice patterns, knowledge, skills, resources, and needs of occupational therapy practitioners providing services to parents with physical impairments. Participants (n?=?51) primarily worked in outpatient rehabilitation (30%), inpatient rehabilitation (21%), and acute care (15%) settings. Participants reported evaluating and providing interventions for nine role-focused parenting activities. All participants agreed addressing the instrumental activities of daily living (IADL) of parenting should be part of occupational therapy practice. Adaptive equipment and techniques were utilized to increase participation of parents with physical impairments in child rearing. Lack of resources for childcare equipment and need for more training were barriers. Ninety-eight percent of participants agreed advancing the role of occupational therapy for parents with physical impairments is needed.     

Prevalence of Children’s Mental Health Problems and the Effectiveness of Population-Level Family Interventions

The prevalence of mental health problems among children and adolescents is of growing importance. Intervening in children’s mental health early in life has been shown to be more effective than trying to resolve these problems when children are older. With respect to prevention activities in community settings, the prevalence of problems should be estimated, and the required level of services should be delivered. The prevalence of children’s mental health disorders has been reported for many countries. Preventive intervention has emphasized optimizing the environment. Because parents are the primary influence on their children’s development, considerable attention has been placed on the development of parent training to strengthen parenting skills. However, a public-health approach is necessary to confirm that the benefits of parent-training interventions lead to an impact at the societal level. This literature review clarifies that the prevalence of mental health problems is measured at the national level in many countries and that population-level parenting interventions can lower the prevalence of mental health problems among children in the community.Key words: child, mental health, prevalence, family intervention, evaluation     

The health-promoting family: a conceptual framework for future research

There has so far only been little research attention given to how families actively engage in promoting their health in everyday life. In this paper a theoretical framework is proposed for studies of the 'health-promoting family' with particular focus on children's health and well-being. This paper sets out a conceptual model for understanding how the family can play a part in promoting both the health of children and children's capacities as health-promoting actors. It draws on contemporary social science approaches to health, the family and children, suggesting a new emphasis on the family's ecocultural pathway, family practices and the child as a health-promoting actor.     

Brief,Rapid Response,Parenting Interventions Within Primary Care Settings

Opportunities created by the Patient Protection and Affordable Care Act along with the increased prevalence of pediatric behavioral and mental health concerns provide new challenges for pediatric health care providers. To address these matters, providers need to change the manner by which they provide health care to families. A novel approach is providing brief, rapid response, evidence-based parenting interventions within the pediatric primary care setting. Family-focused parenting programs support the American Academy of Pediatrics recommendations of improving mental health via supports in pediatric primary care to maximize the social and psychological well-being of families. A considerable body of research indicates that parenting interventions reduce the severity and frequency of disruptive behavior disorders in children and provide support to parent by bolstering parental resilience and improving overall family functioning. Providing these services within the pediatric primary care setting addresses the need for fully integrated health services that are family-centered and easily accessible.     

The population's insurance protection as a mechanism responsible for provision of sanitary and epidemiological well-being

The paper describes a principal scheme of insurance protection organization due to the negative human influences of environmental factors and industrial risks as one of the most effective mechanisms responsible for controlling sanitary-and-epidemiological well-being and human health. It also considers how a voluntary medical collective insurance program and a civil responsibility insurance one are being implemented due to unforeseen damages done to the population's health and how the quality and safety of goods (work, services) are controlled. Organizational, methodic, and normative legal approaches are proposed to developing the population's insurance protection system.     

Toward environments and policies that promote injury-free active living--it wouldn't hurt

Although being active is vital to the health and well-being of children, increases in physical activity can lead to an elevated risk of injury, which is a leading cause of childhood mortality globally. This article provides an overview of the evidence base concerning unintentional injuries associated with popular forms of physical activities for youth, and describes how injury prevention and child obesity professionals can work together to prevent injuries while promoting active lifestyles. Policy and environmental interventions that are beneficial to both outcomes are highlighted and recommendations for future research for these complementary areas are also provided.     

Prescribing happiness: positive psychology and family medicine

Although mental health promotion is consistent with the philosophy of family medicine, it is largely unclear what behaviors or interventions comprise mental health promotion in practice. A recent effort in psychology, known as "positive psychology," has endeavored to better understand happiness, meaning in life, character strengths, and how these all can be developed. Because happiness is associated with multiple benefits, including better health, it behooves family physicians to become familiar with and incorporate positive psychology into their practices. This article reviews examples of the work in positive psychology, including gratitude, capitalization, "satisficing," character strengths, and learned optimism. Potential applications of each area in medical education, physician well-being, and patient care are described.     

Responsive parenting: interventions and outcomes

In addition to food, sanitation and access to health facilities children require adequate care at home for survival and optimal development. Responsiveness, a mother's/caregiver's prompt, contingent and appropriate interaction with the child, is a vital parenting tool with wide-ranging benefits for the child, from better cognitive and psychosocial development to protection from disease and mortality. We examined two facets of responsive parenting -- its role in child health and development and the effectiveness of interventions to enhance it -- by conducting a systematic review of literature from both developed and developing countries. Our results revealed that interventions are effective in enhancing maternal responsiveness, resulting in better child health and development, especially for the neediest populations. Since these interventions were feasible even in poor settings, they have great potential in helping us achieve the Millennium Development Goals. We suggest that responsiveness interventions be integrated into child survival strategies.     

Parenting: A Group Programme for Abusive Parents

Treatment programmes for sexual offenders constitute a new area of practice for occupational therapy. Role dysfunction is evident in the way the offenders perform within their family, work and social settings. This article describes a parenting group which was established in order to assist the offenders to examine their parenting roles and to develop new and appropriate parenting skills.     

Landscape and well-being: a scoping study on the health-promoting impact of outdoor environments

Objectives

The present literature review conceptualises landscape as a health resource that promotes physical, mental, and social well-being. Different health-promoting landscape characteristics are discussed.

Methods

This article is based on a scoping study which represents a special kind of qualitative literature review. Over 120 studies have been reviewed in a five-step-procedure, resulting in a heuristic device.

Results

A set of meaningful pathways that link landscape and health have been identified. Landscapes have the potential to promote mental well-being through attention restoration, stress reduction, and the evocation of positive emotions; physical well-being through the promotion of physical activity in daily life as well as leisure time and through walkable environments; and social well-being through social integration, social engagement and participation, and through social support and security.

Conclusion

This scoping study allows us to systematically describe the potential of landscape as a resource for physical, mental and social well-being. A heuristic framework is presented that can be applied in future studies, facilitating systematic and focused research approaches and informing practical public health interventions.     

Marketing animal facilitated therapy

Animal Facilitated Therapy (AFT) is the therapeutic use of the human-animal bond to improve a patient's physical and emotional health. It is an emerging treatment modality that is gaining acceptance among medical practitioners and healthcare administrators. Medical care has traditionally focused on the clinical well-being of the patient. But it is now widely recognized that emotional health is an integral part of physical health. Many patients have unmet psychological and emotional needs that affect their ability to heal and to maintain health. Because some animals have the capacity for interrelationships with people, companion animals can provide an adjunct to traditional therapies. For many patients, particularly those having long-term disabilities, the interaction with an animal fills important emotional needs which can improve mental and physical health. AFT often works when other therapeutic modalities have failed. It gives health professionals an alternative method for reaching patients who are depressed or who have withdrawn from social intercourse. AFT can be used in a variety of situations and settings. Programs are often staffed by trained volunteers and can be implemented and maintained at a relatively low cost. Marketing Animal Facilitated Therapy must focus on creating awareness about the health benefits derived from the human-animal bond, stimulating demand for animal therapy programs in healthcare settings, and generating funding for operating expenses and replication of services.     

Starting early: promoting the mental health of women and girls throughout the life span

The importance of mental health in the promotion of lifelong health among men and women alike cannot be overstated. However, mental health remains under-addressed within general public health and community health programs. In this report, we focus primarily on the mental health of women and discuss risk factors that can affect the well-being of women throughout the life span. The literature reviewed demonstrates a strong relationship between social and environmental risk factors, such as abuse and family dysfunction in childhood, to health risk behaviors and poor mental health in adulthood. We concluded that adverse childhood experiences (ACEs) and poor adult mental health could contribute to cycles of intergenerational transmission of risks leading to poor mental and physical health in children of ACEexposed parents. Also, we argue that public health communities can make a difference in women's lifelong health by improving early recognition and treatment of mental health concerns, seeking opportunities to prevent exposures to known risk factors in childhood, and developing targeted parenting interventions. Promoting healthy psychological states and coping mechanisms before, during, and after exposure to adverse events throughout life is also critical. Perhaps such efforts will help to reduce or even break cycles of risk exposure specifically for women and their children. Finally, existing prevention activities and opportunities for promoting the mental health of girls and women are discussed. Ultimately, this report challenges the women's health and public health communities to take action because mental health can have a serious impact on lifelong well-being.