• School-based programmes
• Screening, prevention and management of pre and post natal mental health problems
• Home visiting and parenting programmes
• Training of carers

School-based programmes

Universal approaches to social and emotional wellbeing in schools aim to promote a range of the aspects of positive mental health and wellbeing including: aspects of psychological wellbeing (self efficacy, locus of control), confidence (self concept, self esteem) emotional wellbeing (anxiety stress and depression, coping skills) and social wellbeing (good relations with others, emotional literacy, antisocial and pro-social behaviour, social skills) and address parenting and parent child relations. It is therefore suggested that school-based interventions will impact on good relationships and increased social networks through the development of knowledge, skills and improved psychological social and emotional functioning amongst children; and, through the acquisition of knowledge, skills and confidence for parents/carers which will enable them to develop better relationships with their children.[1]

Informed by reviews of effectiveness evidence, NICE has produced public health guidance on promoting social and emotional wellbeing in primary and secondary education. Public health guidance 12 Promoting social and emotional wellbeing in primary education made three action recommendations: comprehensive programmes, universal approaches and targeted approaches. TheNHS Health Scotland Commentary on this guidance supported the action point’s subject, where appropriate, to adaptation to fit Scottish organisational arrangements.[2, 3]
NICE Public Health Guidance 20 Promoting social and emotional wellbeing in secondary education made six action recommendations: a strategic framework to enable all secondary education establishments to adopt an organisation-wide approach to promoting the social and emotional wellbeing of young people; key principles and conditions concerned with, for example, demonstrating a commitment from head teachers and staff to promoting the social and emotional wellbeing of young people and providing an ethos that promotes learning, mutual respect and successful relationships among young people and staff; providing curriculum approaches that promote positive behaviours and successful relationships, and help reduce disruptive behaviour and bullying; working with parents and families to promote the social and emotional wellbeing of young people and help parents and carers develop their parenting skills; working in partnership with young people to ensure that young people can contribute to decisions that may impact on their social and emotional wellbeing; and, integrating social and emotional wellbeing within the training and continuing professional development of practitioners and relevant others involved in secondary education. TheNHS Health Scotland Commentary on this guidance supported the action point’s subject, where appropriate, to adaptation to fit Scottish organisational arrangements.[2, 3]

Screening, prevention and management of pre and post natal mental health problems
SIGN60 Post Natal Depression and Puerperal Psychosis: A national clinical guideline recommended routine antenatal assessment for a history of depression and, screening during pregnancy for personal and family history of psychopathology. It recommended screening, using the Edinburgh Post-natal Depression Scale (EPDS), postnatally for Post Natal Depression. The current research base for preventive interventions in low risk women is extremely limited. SIGN makes a good practice point that in women who are at high risk of experiencing post natal depression it may be effective to have post natal visits, interpersonal therapy and/or antenatal preparation. It recommended that post natal depression and puerperal psychosis should be managed in the same way as outwith pregnancy with due regard to the use of medication and breastfeeding/pregnancy and that due consideration should be given to psychosocial interventions.[4]

There is some evidence for a positive effect of home visiting on the detection and management of postnatal depression. However, issues of measurement and report bias need to be careful consideration in future trials.[5]

Home visiting and parenting programmes
Early years interventions such as home visiting and parenting can contribute to better relationships between the carer and infant. Short-term outcomes include increased parental knowledge, skills and confidence, improved psychological health, detection and management of maternal mental health problems.

There is some good review level evidence to suggest that home visiting can produce positive effects on various dimensions of parenting or mother–child interaction. Further work is needed to evaluate which types of programme, or which programme components, are likely to replicate these impacts and to develop measures which limit bias in results.[5]

Many home visiting programmes have been developed for vulnerable families. Intensive home visiting programmes such as the Prenatal and Infancy Home visitation by Nurses Programme have been extensively evaluated in the US context and found to improve maternal and child functioning in early life. The Family Nurse Partnership programme in the UK and the Lothian Family Nurse Partnership are currently applying and evaluating this model in the UK context. The initial evaluation of the Family Nurse Partnerships (FNP) showed short-term outcomes in terms of improved confidence as parents, better coping skills, better breast feeding rates and reduced smoking in pregnancy.6 Evidence from the full evaluation and the evaluation of the Lothian Family Nurse Partnership could be considered in due course.

There is review level evidence that parenting programmes can have an impact on maternal and infant mental health outcomes.

• Individual and group parenting for teenage mothers has a positive impact on mother-infant interaction, maternal mealtime communication and language development.[7, 8]

• Parenting programmes can have a positive impact on aspects of parental psychological health including, for example, self-esteem, guilt and self-blame, parental efficacy and reduces automatic negative thoughts9 and maternal depression and anxiety/stress.[10]

• Individual and group parenting interventions for teenagers have a positive impact on parental attitudes, parental knowledge, maternal self-confidence and maternal identify [8] parenting programmes can have an impact on maternal psychological health (depression, anxiety/stress and self esteem) and on improving relationships with spouse/marital adjustment.[10]

Training of carers
Foresight makes a number of suggestions on interventions based on a review of the evidence by experts. These include improved training and support for care workers and social workers in childcare, education and mental health; and, local authorities providing the same standard of love, care, education and discipline as might be expected in a family – or even to provide a more enriched experience, in order to counter the effects of negative early environments.[11]

Source:

1. Adi Y, Killoran A, Janmohamed K, Stewart-Brown S (2007). Systematic review of the effectiveness of interventions to promote mental wellbeing in children in primary education: Report 1: Universal Approaches Non-violence related outcomes. NICE: London.

2. NHS Health Scotland (2008). Health Scotland Commentary on NICE Public Health Guidance 12: Promoting social and emotional wellbeing in primary education. NHS Health Scotland: Edinburgh.

3. NHS Health Scotland (2010). Scottish Perspective on NICE public health guidance 20: Promoting social and emotional wellbeing in secondary education. NHS Health Scotland: Edinburgh.

4. SIGN (2002). SIGN 60: Post natal depression and puerperal psychosis. National clinical guidelines. SIGN: Edinburgh.

5. Bull J, McCormick G, Swann, C & Mulvihull C (2004). Ante- and post-natal home-visiting programmes: a review of reviews: Evidence briefing. Health Development Agency: London.

6. Barnes J, Ball, M, Meadows, P, McLeish J, Belsky J & the FNP Implementation Research Team Nurse-Family Partnership Programme: First Year Pilot Sites Implementation in England Pregnancy and the Post-partum Period. Department for Children, Schools & Families: London.

7. Barlow J, & Parsons J. (2003). Group-based parent-training programmes for improving emotional and behavioural adjustment in 0-3 year old children. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD003680. DOI: 10.1002/14651858.CD003680.

8. Coren E & Barlow J. (2001). Individual and group-based parenting programmes for improving psychosocial outcomes for teenage parents and their children. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD002964. DOI: 10.1002/14651858.CD002964.

9. Taylor L, Taske N, Swann C & Waller S (2006). Public health interventions to promote positive mental health and prevent mental health disorders among adults: Evidence briefing. NICE: London..

10. Barlow J, & Parsons J. (2003). Group-based parent-training programmes for improving emotional and behavioural adjustment in 0-3 year old children. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD003680. DOI: 10.1002/14651858.CD003680.

11. Foresight Mental Capital and Wellbeing Project (2008). Final Report. The Government Office for Science, London.