Intervention(s)
Supportive Parenting is a targeted preventive intervention in which youth healthcare nurses visit parents at home to support them in raising a child. The intervention was originally developed to prevent parenting problems and child maltreatment and generally improves the living environment of the child. Supportive Parenting is currently offered by 188 out of the 344 municipalities in the Netherlands. Around the 14th day after birth, a nurse who works at a child health clinic (consultatiebureau) visits every family in the Netherlands with a newborn child. During this visit, the nurse explains to all parents in regions that offer Supportive Parenting what the intervention entails and hands out a questionnaire that is used to identify eligible parents. The screening questionnaire tries to identify parents who are at risk of child maltreatment. The items to determine eligibility were carefully selected during the development of the intervention and the choice of variables is explained in detail by Bouwmeester et al. (2006). The questionnaire contains items on the following domains: parents' childhood experiences, parents' perceptions and expectations, parents' mental health, parents' history with substance abuse, parents' relationship with their partner, parents' social support system, parents' age, and the child's health at birth.
After the screening, nurses contact families that are eligible for the intervention by phone. The nurse again explains the intervention, discusses the outcomes of the screening questionnaire, and schedules the first house visit. Supportive Parenting is a voluntary programme, where additional support is offered to parents who could use some extra help. The nurse explains to parents that children benefit when their parent is doing well, when they are comfortable and confident in their parenting, and when they are aware of the effect their own childhood experiences can have on their behaviour. Supportive Parenting helps parents be the best version of themselves, which will in turn benefit the child. Ideally, Supportive Parenting is offered to all parents, but for financial reasons the intervention is targeted. The nurse explains to parents that the questionnaire they filled out helps nurses to find those parents who would possibly benefit most from Supportive Parenting. The intervention is not a way for municipalities to monitor parental behaviour or to check whether child maltreatment takes place within the household.
After eligible parents indicate their interest in the intervention, a youth healthcare nurse visits parents when the child is approximately 6 weeks, 3 months, 6 months, 9 months, 12 months, and 18 months old. This is in addition to care as usual, e.g. the normal visits to the child health clinics. Depending on the family situation, additional visits might be planned, either as house visits or a phone consultation. Visits are generally between 60 and 90 minutes each, depending on parental preferences. For example, some parents prefer to have shorter house visits that occur more often. The nurses who conduct house visits work at a child health clinic (consultatiebureaus) and receive additional training before the start of the intervention. During this training, nurses learn all the practicalities of the intervention, such as the structure of the house visits, the content to be discussed with parents, and the material available. Nurses learn how to explain the intervention to parents and how to discuss the sometimes delicate questionnaire items with them. In Supportive Parenting, nurses focus on the ontogenic system, the microsystem, and the exosystem used by Belsky (1980) and on the concept of parental awareness used by Baartman (1996) to explain child maltreatment. Belsky (1980) argues that there are stress and support factors in the ontogenic system, which regards the individual parent, the microsystem, which includes their immediate family, and the exosystem, which regards the broader social support system. Nurses learn to identify these factors of support and stress. Baartman (1996) explains child abuse by looking at conflicting interests between parents and children. He divides parental awareness into expectations, perceptions, and sensitivity. Nurses help parents to understand their expectations of and perceptions on the development of their child. They also focus on parents' sensitivity, defined as the ability of parents to see, understand, and anticipate what a child needs and to adequately respond to this. The training teaches nurses to identify factors of improvement. For example, for the development of children, healthy bonding with their parent is important. Nurses learn how to recognise attachment styles that are secure, avoidant, ambivalent, or disorganised. They then learn how to respond to the signals they pick up on. The training includes sufficient time for nurses to practice, with an actress playing a mother who is eligible for the intervention. The Supportive Parenting training takes approximately 18 hours.
During the house visits, nurses guide parents by open questions to indicate what their struggles are and where they would like to see improvement. The lengthy house visits give nurses far more time, compared to the regular child health clinic visits, to listen to parents and truly understand where nurses can support them best. The main topics of discussion include the development of the child, the expectations and experiences of the parents, and the social life and support system of the parents. For the development of the child, the nurse and parents focus on the health of the child, their sleeping pattern, and the relation between the child and the parents. For the expectations and experiences of parents, parents get the opportunity to talk about their own childhood. The nurse listens to their stories and helps them reflect on their experiences. This helps parents to understand where certain behaviours come from and whether their expectations are realistic. The nurse and parents use this to improve unhealthy parenting behaviours. For the social life and support system of parents, the nurse helps parents in combining parenthood with having a job, having a social life, and having a partner. It is important for parents to have a balance in their lives and it can be difficult for (new) parents to combine all these obligations. Here, the nurse and parents focus on building a network for practical and social support. The nurse helps parents to realise who they can turn to for support. This support can come from within the parents' network, from new social contacts, or from professional help. If needed, the nurse guides parents into finding further professional support, such as psychological help.