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

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