nfhk2011 sven bremberg_plenary4
DESCRIPTION
Universal programmes for parenting support - a Swedish national strategy for promoting public health. Sven Bremberg, Statens folkhälsoinstitut.TRANSCRIPT
Universal programmes for parenting support - a Swedish national strategy for promoting public health
Sven Bremberg MD PhD
Formal and informal expenditures for children 0-17 years of age, Sweden 1995
Swedish family support
• Fully paid parental leave 13 months, partly paid for additional 3 months
• Subsidised pre-schools with child centred pedagogy
• Universal child health services
• Child poverty rate 4%
Health promotion by improving parenting skills during childrens early years
• Behaviour problems
• Depression and anxiety
• Smoking
• Alcohol and illegal drugs
• Obesity and food habits
• Cardiovascular disease
Source: Stewart-Brown, S. (2008). Improving parenting: the why and the how. Arch Dis Child, 93(2), 102-104.
Diana Baumrind - parenting styles
Warm/accepting
Hostile/negative
Restrictive Authoritative Authoritarian
Accepting Yielding Neglecting
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Universal health promotion
Parental support: the potential
• Counselling by a nurse - RCT – Counselling at home, once a month, 0-5 yrs
– At age 20: 40 % reduction of depression.
– Aronen et al, Finland, Am J Orthopsych, 2000
• Counselling by a GP - RCT – 10 visits, 20 minutes, 0-6 yrs
– Follow up at age 6: less anxiety, sleep, aggression
– At age 27-29: less depression, smoking, obesity. Better education.
– Cullen et al, Australia, J Pediatr, 1996
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To develop parenting competences
• Role models – Own childhood
– Other adults
• Media
• Professionnels
• Courses
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The parent couple - communication
Attachment enhancing programmes
• In high income countries - 40% insecure attachment by age 18 months
• Structured programmes are effective - 70 RCTs
• Interpretation of infant signals use of photos or video clips
New attachment promoting programmes (ICDP) introduced into established CHC parent groups
• Child health nurses have been trained as facilitators for ICDP
• Photos rather that video clips
• Interpretation of infant signals
• ICDP is used also after infancy
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Child age 3-10 yrs
COPE
Structured methods for parents of children age 3-9 years, based on methods like PMT, COPE
etc. adapted for universal use in Sweden…
• Parental groups
• Starting with videotaped problem situations
• Modelling
• Role play
Systematic review of 77 RCT - Analysis of componets in effective programmes
• Consistent reduction of behaviour problems, anxiety and depression
• Emphasis on a positive interplay
• Learing by practice - “home work”
• Models for handling “bad behaviour”
Source: Kaminski,et al. (2008). J Abnorm Child Psychol, 36(4), 567-589.
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Fraction of all first child parents who have participated in a parental group, child age 3-10 yrs, Sweden 2004 - 2008
National parental programme launched in Sweden 2009
• Child age 0-18 yrs
• Different actors
• Health services Municipalities, NGOs
• Different methods
• In 2009-2010 €7 million for development and €8 million for research
Research themes
• Swedish RCT:s of internationally established programmes
• New Swedish programmes
• Social and gender equality
• Systems for delivery: multiple actors with municipalital coordination