There is evidence of an association between this range of actions for parents and families and one or more of the short-term outcomes in model 2 . This is based on the rationale that providing (a) universal support for all parents and families, and (b) additional/enhanced tailored support for parents and families with additional needs, will provide them with the knowledge, understanding and skills to enable them to support the holistic development of children and young people.

While the specified actions are intended to support all parents and families, it is important that local areas consider the needs of different groups including those with additional support needs when planning specific actions (see Box 8 :Supporting parents and families with a progressive universal approach). Evidence suggests that a progressive universal model of care is the mechanism by which families with additional needs/risks may be identified and appropriately supported.[1]

Some of the individual reach groups are considered in the sections below. However, as noted in section 11.3 of the full outcomes framework, there remains a lack of robust evidence in relation to key vulnerable groups.

Rationale

a. Interventions for parents of infants and children in the early years

i. Interventions delivered in the antenatal period
Antenatal classes[2]
Overall, there is a lack of evidence regarding the best mechanism for delivering antenatal education, with further research required to establish the most effective means of supporting the delivery of antenatal classes. There is some evidence that group-based prenatal care may improve birth outcomes at no additional cost.

Breastfeeding promotion[2]
Antenatally, the evidence supports the use of:

• antenatal group work (with an interactive component)

• peer support schemes that involve local, experienced breastfeeders as volunteers to prepare parents for breastfeeding

• multi-modal education/social support programmes combined with media campaigns

• 1:1 tailored education sessions, which may be more effective for low-income women who had planned to bottle feed and group support for women who had planned to breastfeed.

Low birthweight [2]
There is moderate review-level evidence on the modest effect of psychosocial interventions on the reduction of low birthweight, indicating that smoking cessation programmes were the only interventions that were effective in reducing low birthweight.

Smoking cessation [2]
Evidence suggests that effective smoking cessation interventions have a behavioural focus, aim to change beliefs about smoking, and address stress management. Combining behavioural interventions with rewards for smoking cessation and social support may enhance the effectiveness of these interventions.

ii. Preparation for parenthood
Transition to parenthood [2]
Evidence about the effectiveness of antenatal group-based training programmes to prepare parents for their transition to parenthood (that focus on issues such as emotional changes, bonding and attachment) is extremely limited. Further evidence is needed to conclusively establish the effectiveness of these interventions.

There is some evidence from two trials suggests that group-based parenting programmes (some of which extend beyond birth) have the potential to improve a range of parent and child outcomes postnatally, including couple adjustment and relationship satisfaction, satisfaction with the parent–infant relationship and maternal mental health.

Preparation for fatherhood [2]
There is limited evidence that suggests:

• antenatal classes can help to prepare men for fatherhood and enhance their support of their partners both ante- and postnatally.

• a standard six-session antenatal programme enhanced by additional sessions about postnatal psychosocial problems and play was associated with increased maternal satisfaction with their partner’s support in relation to practical tasks, (e.g. domestic chores and childcare).

iii. Pregnant women with socially complex needs [1]
Interventions that are aimed at reducing the impact of socially complex needs in pregnancy focus on the role of maternity care services and specifically on improving a woman’s access (physical and cognitive) to and maintenance of contact with services (see model 3 ‘Delivering antenatal interventions’). Women who have socially complex needs in pregnancy do not necessarily attend their first antenatal (‘booking’) appointment later than women who do not have such needs. However, they may require greater support in order to be able to establish and maintain contact with antenatal services.

However, the evidence that enhanced antenatal care provision, (i.e. services that are provided over and above routine universal care) improves specific outcomes for vulnerable pregnant women and their babies remains unclear.

An ongoing relationship that includes both continuity of care and of carer(s) facilitates effective communication and enhances the antenatal experience of specific groups of women with socially complex needs in the following ways: [1]

• For women who misuse substances (alcohol and/or drugs), a named carer with specialist knowledge/experience improves their engagement.
• For women who are recent immigrants/who do not speak or understand written English easily, continuity of care helps staff to understand religious, cultural and social differences and can help these women to navigate their way around the NHS systems.
• For women under the age of 20, continuity of care may help to maintain their ongoing contact with antenatal services.
• For women experiencing domestic abuse who may not disclose their situation during initial appointments, an ongoing relationship can facilitate disclosure and referral to specialist support services.

Domestic abuse [1]
There is limited evidence of effectiveness to support the impact of specific interventions in response to, or to prevent, domestic abuse in pregnant women.

Maternal mental health and wellbeing [1]
In addition to the risk factors related to complex needs in pregnancy outlined above, maternal mental health and wellbeing is recognised as a key influence on a child’s development during their early years of life.

The high-level evidence outlining the risk factors for developing postnatal depression is strong. In contrast, the evidence about the risk factors and treatments in relation to other mental health problems and the promotion and maintenance of mental wellbeing is relatively weak.

iv. Interventions delivered in the postnatal period
Breastfeeding promotion:
Postnatal hospital stay [2]
There is strong evidence that skilled breastfeeding support, offered by trained peers or professionals to women who want to breastfeed can promote breastfeeding. Unrestricted feeding and unrestricted kangaroo/skin-to-skin care from birth also promote breastfeeding. Likewise regular breast drainage/treatment of mastitis, including the provision of antibiotics for infective mastitis can also promote breastfeeding.

Peer support [2]
Evidence suggests that this is effective as a stand-alone intervention in women who want to breastfeed, but not in those who had already decided to bottle feed. Women who have decided to bottle feed may benefit from tailored 1:1 breastfeeding education that commences antenatally and continues postnatally. However, there is evidence that multifaceted interventions may be effective in its promotion. Effective interventions tend to include a peer support programme combined with health education programmes, media programmes, and legislative and structural changes to the healthcare system. The key messages about peer support for breastfeeding are outlined in Box 3 below.

Box 3: Peer support for breastfeeding [3]

Evidence-informed guidance about peer support for breastfeeding mothers was developed to inform professionals in Health Boards and voluntary sector agencies with responsibility for local breastfeeding support about the most up-to-date policies and evidence related to breastfeeding peer support.

Key messages:

1. Providing breastfeeding peer support was a key recommendation in NICE public health guidance 11: Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households.[4]

2. Peer support is the focus of two activities in Improving Maternal and Infant Nutrition: A Framework for Action [5]. These activities were based on the best available evidence at the time of its publication.

3. Providing peer support aligns with community development endeavours and asset-based approaches.

4. Health Boards’ peer-support-related activities contribute to the achievement of the key Quality Ambitions in The Healthcare Quality Strategy for NHSScotland [6] and is relevant to the ethos of the Commission on the Future Delivery of Public Services.[7]

5. Breastfeeding peer support is popular among health practitioners and voluntary sector agencies in Scotland.

6. Current thinking, beyond the evidence, suggests that breastfeeding peer support activity needs to take full account of the context in which it is delivered and the needs of the local population.

7. The provision of breastfeeding peer support is complex. It needs to be fully integrated with local service planning and delivery regarding the recruitment, training and ongoing supervision of the peer supporter.

8. Breastfeeding peer support may be intensive, involving one-to-one and/or group-based support.

9. Overall, recent review-level evidence indicates that peer support is an effective intervention for breastfeeding.

10. Breastfeeding peer support needs to be appropriately evaluated with due reference to the accepted principles of good evaluation practice.

11. The benefits of peer support need to be evaluated more broadly than exclusively focusing on breastfeeding duration. Context is important, as is taking full account of other measurable benefits at both an individual and community level.

12. As local evidence indicates that peer support is a transactional activity, evaluation of its effectiveness needs to consider both the experiences of the peer supporter and the breastfeeding mother.

13. Future activity related to breastfeeding peer support in Scotland needs to be explicitly defined and guided by well-established ethical principles, especially equity.

For further discussion and detailed information about specific interventions readers are referred to the source document.

v. Promoting positive relationships with infants and children
Evidence shows that a child’s attachment style develops from birth in response to their multiple experiences of their caregiver’s sensitivity to their need for safety and protection. [1] Secure attachment is increasingly recognised as vital to the healthy development of infants and children. Providing information about attachment to parents can increase their knowledge about attachment and parenting. [1] This may improve parent–child interaction and promote the development of secure infant attachment.

There is evidence that: [1]

• interventions that focus exclusively on and effectively enhance maternal/caregiver sensitivity towards the child are universally effective.

• information about parenting can be effectively provided through a variety of approaches, including group-based training, videos and one-to-one interventions.

• encouraging close physical contact through interventions such as the use of soft baby carriers or kangaroo care, (i.e. holding the infant close to their parent’s chest) may enhance the development of secure attachment.

There is limited evidence:[2]

• that infant massage may have a beneficial impact on hormones that influence stress, sleep, crying and the mother–infant interaction. However, these findings are based on limited evidence and thus have limited potential in relation to making recommendations for practice.

• that interventions including father–toddler groups, the use of the NBAS and infant massage and parenting groups with enhanced sessions for men may be effective as means of support for fathers. Further research is therefore needed to explore the optimal duration, long-term and differential impact of effective interventions for fathers.

• of an association between interventions to promote early childhood cognitive development (e.g. book-sharing programmes and community-based early intervention programmes) and maternal and child outcomes.

• of an association between anticipatory guidance to prevent or address early infant/toddler problems for a range of issues (sleep, a child’s temperament, promoting time out and reducing TV viewing, behavioural interventions to improve maternal sensitivity and/or infant attachment, interaction guidance, and parent–infant psychotherapy), and improving outcomes in a number of areas, but requires further research.

vi. Preventing unintentional injuries in the home
There is evidence to show that children under the age of 5 are more likely to experience injuries in the home, (e.g. falls, burns and scalds) than in other locations compared to older children. [1] Efforts to prevent unintentional injuries should balance the potential risks against the benefits that children experience, particularly in outdoor play and leisure activities. Families may lack both the information to enable them to identify and manage risks in their home and the means by which to purchase and install home safety equipment.

There is evidence that effective interventions that may reduce unintentional injuries, related to socio-economic inequalities, combine the provision of home safety equipment and education. [1] These include:

• the provision of home safety advice and free or discounted appropriate safety equipment that is supplied and fitted, (e.g. smoke alarms, stair gates) to families at high risk of unintentional injury

• education and information about general child development.

vii. Supporting social and emotional wellbeing
There is evidence that to ensure all children have the best start in life, a life course approach to the early years should be recommended. [1]

This emphasises that focusing on the social and emotional wellbeing of vulnerable children under the age of 5 who are at risk of, or who are already experiencing, problems is the foundation for their healthy development. [1] This can potentially reduce the negative impact of their family circumstances.

Evidence shows that: [1]

• providing support to parents, children and families who have different levels of need requires input from a range of services. The evidence suggests that home visiting interventions, early year’s education/childcare and enhanced specialist early intervention programmes effectively promote child development and wellbeing in the early years. These can reduce the risk of poor outcomes for economically disadvantaged children in both the short and longer term.

• these interventions can be delivered as part of progressive universal provision. Universal services are those that are available to all families, e.g. health and education services. Enhanced services describe those that are provided in addition to, or involve the adaptation/increase of universal services, in response to the specific needs of families who have been identified as vulnerable.

• universal provision enables the identification and progression of vulnerable/at-risk families (who are most likely to benefit from such interventions) to enhanced interventions, (e.g. intensive home visiting, Incredible Years).

• the skills and experience of practitioners, coupled with their relationship with a family is essential to assessing/addressing a family’s vulnerability.

viii. Home visiting [1]
Evidence shows that home visiting programmes can effectively improve a range of health and wellbeing outcomes for both children and their parents. Factors including the intensity and duration of home visiting and the skill of those providing it have been demonstrated to impact on its overall effectiveness.

There is good evidence that home visiting during pregnancy and in the first year and beyond is effective for those identified as being at risk of poorer outcomes, e.g. deprived families or those with low birthweight babies. Home visiting has been linked to:

• improvement in the home environment

• improvement in family wellbeing, parent–child interactions and maternal sensitivity

• improvement in maternal wellbeing, quality of life and contraception use

• improvement in the social, emotional and cognitive development of children, including pre-term infants

• increased infant attachment security.

Both parents and children may benefit most from intensive home visiting interventions. However, the effectiveness of home visiting in response to the support needs of families at risk of significant dysfunction or child abuse remains inconclusive.

There is evidence of an association between action to provide home visiting programmes and:

• higher levels of mother–infant interaction, breastfeeding initiation, parenting and medical knowledge, parenting satisfaction, and a sense of being supported

• a reduction in the symptoms of maternal depression and anxiety

• improvement in some child cognitive outcomes

• improvement in positive health behaviours and the prevention of injury.

Teenage mothers [1]
There is evidence of an association between enhanced home visiting of teenage mothers delivered by specialist nurses during pregnancy and the first 18 months of a child’s life, and a positive impact upon the social and emotional development of vulnerable children and their mothers, (e.g. Family Nurse Partnership – see Box 4). The best outcomes are seen in children of mothers with low emotional intelligence and/or poor mental health.

Home visiting interventions delivered to teenage mothers, with the specific aim of increasing maternal–infant attachment have not shown clear benefits. However, other targeted nurse-led home visiting programmes have been shown to be effective in helping young mothers to understand their infant’s behaviour and cues.

Substance misuse [1]
Although postnatal home visits may increase the engagement of substance misusing mothers with drug treatment services, there is no clear evidence that such engagement improves maternal or infant outcomes. While this would seem to be counter-intuitive, it may well be that the complexity of substance misuse is such that it cannot be ameliorated by a single intervention.

Smoking cessation [1]
Smoking cessation during pregnancy can reduce the level of low birthweight babies. The provision of home visits and social supports aimed at reducing the stress of pregnant women can effectively increase smoking cessation.

Interventions delivered postnatally in the home by nurses or other health practitioners that aim to increase parental self-efficacy may reduce maternal smoking and children’s exposure to tobacco.

Providing written information/details of cessation services alone is ineffective as an intervention to support smoking cessation.

ix. Early childhood education/children’s centres [1]
Preschool education and interventions delivered in day care or educational settings, (e.g. Sure Start) can help to reduce the poor outcomes of vulnerable children that are linked to their disadvantage. Such interventions can result in sustained improvements in their social, emotional and cognitive development. Services should be run by well trained, qualified staff, (including graduates and teachers) and focus on social, emotional and educational development, delivered within well maintained and pleasant environments.

Full-day programmes have been shown to be effective for improving the cognitive development of children who are particularly disadvantaged. These children gain more from intensive preschool interventions and do not show any negative behavioural consequences associated with the additional hours spent in early education. However, half-day programmes may be sufficient for children of middle or higher socioeconomic status or income for whom more than 30 hours shows a tapering off of cognitive benefits and intensification of negative social-emotional effects. [13]

The home learning environment is also important to the child’s social and cognitive development. High-quality early years education beginning in infancy, combined with home visits to improve the home- learning environment that is targeted at high risk groups can result in improved cognitive and academic achievement that lasts into adulthood.

Evidence suggests that the quality of the preschool is important (see model 3 links 3.6, 3.7–3.12 for further detail).

See also model 1 (links 1.2–1.5) for details of the potential impact long-term outcomes.

x. Enhanced specialist programmes – Group-based parenting programmes [1]
The evidence provides support for the effectiveness of group-based/media-based parenting programmes, (e.g. Incredible Years) in improving emotional and behavioural problems in children aged 3 and under. However, it is still not clear whether group-based parenting programmes are effective as primary prevention interventions delivered to all parents, (i.e. preventing the onset of problems) rather than secondary/tertiary prevention, (i.e. the treatment of early mental health problems). Incredible Years and Triple P have been shown to effectively reduce behavioural problems in children over the age of 3.

Further information and evidence relating to three parenting programmes is presented in Box 4, Box 5 and Box 6.

NHS Health Scotland does not endorse the use of any specific parenting programme over another. Decisions to use a particular programme should consider the effectiveness of the programme and the local delivery context. Local considerations include cost, need, resources and workforce implications (including ongoing training and supervision).

Box 4: Family Nurse Partnership [8]

The programme provides intensive, structured home visiting by specialist nurses from early pregnancy (before 28 weeks) until the child is 2 years old. It is based on the principles of self-efficacy, human ecology and the promotion of infant attachment security. It aims to improve pregnancy outcomes, child health and developmental outcomes and families’ economic self-sufficiency.

Key messages:

• The FNP is a licensed preventive programme delivered to first-time teenage mothers. The goals of FNP are to:

• improve outcomes of pregnancy by helping women improve their prenatal health

• improve child health and development by helping parents to provide more sensitive and competent care to their child

• improve parent’s life course and self-sufficiency by helping them to plan their own future, plan future pregnancies, complete education and find work.

• Evaluation by the Commissioning Toolkit indicates that there is strong evidence from the USA that Family Nurse Partnership (based on studies of the Nurse–Family Partnership) provides both long- and short-term benefits for young mothers and their children.

• Evidence from the USA suggests that FNP provides a good return on investment.

Box 5: Incredible Years (IY) [9]

The parent, child and teacher programmes are separate but interlocking training programmes targeted at children up to the age of 12 that exhibit, or are at risk of, behavioural problems.

Key messages:

• IY aims to strengthen parent–child relationships, promote children’s social and emotional skills and prevent and reduce aggressive and oppositional behaviour.

• IY offers separate but interlocking training programmes for parents, children and teachers.

• In relation to the IY parent training programme:

• Evaluation by the Commissioning Toolkit indicates that there is strong evidence that IY Pre-School/Early Childhood (2–6 years), promising evidence that the IY Toddler (1–3 years) and preliminary evidence that the IY School Age (6–12 years) programmes effectively improve child and parent outcomes.

• It is important that the programme is delivered as designed by the developer, who provides detailed implementation guidance.

• Evidence from Ireland suggests that Incredible Years may provide a good return on investment.

Box 6: Triple P [10]

triple P aims to prevent and treat behavioural, emotional and developmental problems in children by enhancing the knowledge, skills and confidence of their parents. The system includes five levels of intervention for parents of children aged 0–16.

Key messages:

• The triple P - Positive Parenting Program (Triple P) is delivered to parents and carers of children up to 12 years, with Teen Triple P for parents and carers of 12- to 16-year-olds.

• It is a multilevel programme that aims to prevent and treat behavioural, emotional and developmental problems in children and teenagers.
  

• The five levels of Triple P intervention increase in intensity from a universal population-based approach to intensive, targeted interventions for children with more severe difficulties.

• Families can enter Triple P at any level.

• Evaluation by the Commissioning Toolkit indicates that the evidence for the effectiveness of Triple P interventions ranges from preliminary to strong.

• Evidence from Australia suggests that Triple P may provide a good return on investment.

b.  Interventions for parents of older children

i.    Community-based interventions [11]
There is review level evidence of an association between community- based interventions with families, parents and carers of children and young people aged between the ages of 7 and 19 and some improvements in attainment, behaviour and emotional outcomes. The findings suggest that community-based programmes have the potential to improve child behaviour, welfare, and reduce the amount of time spent in care and levels of juvenile crime. Successful programmes focus on parenting skills programmes or support to manage housing, employment or education.

(See also model 1 ‘Supporting parent and family functioning’).

For further discussion of community-based interventions the reader is referred to Box 4, Box 5 and Box 6 ,which outline evidence relating to a number of specific parenting programmes.

ii. School-based interventions [11]
There is review-level evidence of an association between school-based interventions with families, parents and carers of children and young people aged between 7 and 19 years and some improvements in attainment, behaviour and emotional outcomes. School-based interventions that involve parents and carers can improve child behaviour, school attendance, and relationships, as well as prevent or reduce substance misuse and potentially increase educational attainment. Offering support through full service extended schools or through a single point of contact for parents can improve both parental engagement and child outcomes.

iii.  Multi-component interventions [11]
There is limited review level evidence of an association between multi-component interventions with families, parents and carers of children and young people aged between 7 and 19 years and some improvements in attainment, behaviour and emotional outcomes. Multi- component or mixed interventions can have a positive impact on children and family functioning. However, as a consequence of the limitations of the current evidence, the comparative benefits of multi- component versus single interventions are unclear.

iv. Engaging parents and families (service development and engagement) [11]

See also model 3 ‘Interventions for parents of older children’ .

There is qualitative evidence that the key factors for positively engaging parents in parenting programmes are as follows:

• Parents acknowledge that there is a problem.

• The seriousness of consequences of conduct disorder is understood.

• Increased knowledge and skills in handling children’s behaviour to be gained by participation are emphasised.

• Control and confidence in one’s ability to parent effectively.

• Provision of non-judgemental support from professionals throughout process of gaining new knowledge, skills and understanding and implementing parenting skills.

• Parents need peer support.

• Parents’ need for their own needs to be recognised.

• Mothers’ need for support from their spouse/partner.

Evidence from a review of interventions with families, parents and carers of children and young people aged between 7 and 19 years that improve attainment, behaviour and emotional outcomes (UK and North America), identified that the support needs of parents are often not sufficiently addressed in designing services. Parents and children’s views should be taken into account through means such as surveys and focus groups or consultation. Parents seek certain types of support from friends and family and other types from professionals. This preference should also be taken into account when developing support services (see Box 7: Types of support for parents). Parents require support in the form of advice and practical skill development, emotional support, personal and social skills support, family relationship building skills, opportunities to learn, education and training and financial support. Support can be preventative or treatment; some families may require both forms of support.

Box 7: Types of support for parents [11]

Evidence suggests that:

• families and friends are the main sources of support for child rearing

• family, friends and health practitioners are accessed for support on child health issues

• social services are accessed for support on financial help, and ethnic minority parents are more likely to turn to other family members for financial support.

Evidence suggests that the type of support needed by parents falls into six main categories:

1. Information, advice and practical skills: support on a range of information and practical skills.

2. Emotional support: parents want an empathic person to support them. This is reported as a strong parental need when their child had characteristics that increased their risk of poor outcomes; e.g. children with conduct disorders.

3. Personal and social skills: support to improve the personal and social skills of parents through confidence and communication skills training

4. Family relationship-building skills: studies conclude that family relationship building is important in improving child outcomes.

5. Opportunities to learn, education, training and employment: interventions designed to improve parental learning, access to education and employability and their impact on child outcomes are considered. The direct effect on child outcomes within the timeframe measured is minimal; however supporting these needs is likely to have a longer-term indirect impact on child outcomes.

6. Financial support; housing provision: the evidence is inconclusive about any direct benefits to children during the time frame of studies and the outcomes measured. However, such interventions may relieve basic pressures on families and have long-term benefits.

v . Family-centred help-giving approach [11]
There is evidence that:

• the use of a family-centred help-giving approach (primarily US- based), is associated with more positive and less negative parent, family and child behaviour and functioning.

• family-centred helping was significantly associated with participant satisfaction, self-efficacy beliefs, social support, child behaviour, wellbeing, and parenting behaviour. The outcomes most strongly related were satisfaction (with programme practitioners and services), self-efficacy and social support.

• the more family-centred the approach used, the more families were satisfied with the approach, experienced increased self-efficacy beliefs and the more helpful they perceived the support and/or resources provided by the help-giver. Child behaviour and functioning, wellbeing and parenting behaviour were also significantly associated but effect sizes were smaller.

These findings suggest that the method of interaction between a help- giver and the family has an influence on family functioning.

vi. Parents’ experiences and perceptions of parenting programmes [11]
Analysis of parents perceptions of taking part in parenting programmes (mainly Incredible Years) suggest that perceptions of control and parental confidence in ability to parent, guilt, social influences, knowledge and skills and mothers needs are key themes. Acquiring knowledge, skills and understanding along with feelings of acceptance and support from other parents may enable parents to regain control and feel more able to cope with their parenting role. In turn, this reduces feelings of guilt and social isolation and increases empathy with their children and confidence in managing their children’s behaviour.

c. Interventions for adolescents and parents of adolescents
There is good quality review-level evidence (primarily US-based) relating to the impact of interventions aimed at reducing substance, tobacco and alcohol use in adolescents (see also model 1 ‘Interventions for parents of adolescents’): [12]

• Substance use:[12] Although there is insufficient evidence to draw conclusions about the impact of interventions to prevent or reduce drug use by young people in non-school settings, some interventions appear to have a potential benefit e.g. the Strengthening Families Programme and Preparing for the Drug Free Years. There is, however, a need for trials to test their applicability within the UK/Scottish setting, and a need for independent evaluation. Interventions were designed to improve family functioning and effective interventions were those that used techniques and activities to promote authoritative parenting (e.g. communication, parental rule-setting/boundaries/expectations-setting, etc), and included opportunities for skill rehearsal.

• Tobacco use:[12] Some family-based programmes to help family members strengthen non-smoking attitudes and promote non-smoking children or adolescents or their family members, appear to have potential benefit. Strengthening Families appeared to be the intervention with the longest post-intervention impact. Intensity of training and fidelity of implementation seemed to be associated with more positive outcomes. Effective interventions focused upon the promotion of authoritative parenting.

• Alcohol use:[12] There is some evidence of effectiveness of family-based psychological and educational prevention programmes in preventing alcohol misuse compared to other types of intervention or no intervention. The Strengthening Families Programme and Preparing for the Drug Free Years demonstrated post-intervention impact at eight years. There is also some evidence that gender-specific interventions are effective, specifically those that target mothers and daughters. Effective interventions focused upon the promotion of authoritative parenting.

• Sexual health:[12] There is some evidence of effectiveness from interventions focused on improving parent–child communication about sex in order to change adolescent sexual behaviour, although the parenting component was limited in most interventions. The evidence for the effectiveness of parenting interventions in relation to the sexual behaviour of their children is less pronounced than for alcohol, tobacco and substance use. However, there are some promising interventions. Again, these promote authoritative parenting. Effective interventions focused upon the promotion of authoritative parenting.

References:

1. Scott E, Woodman K. Guidance about Effective Interventions to Support Parents, Their Infants and Children in the Early Years. A paper to the Scottish Government Early Years Taskforce; 2012. Available from (external link, 232KB): www.scotland.gov.uk/Resource/0041/00413580.pdf

2. [15] Scott E, Woodman K. Evidence summary: Interventions to support parents, their infants and children in the early years (pregnancy to 5 years). NHS Health Scotland; 2012. Available from: www.healthscotland.com/documents/6089.aspx

3. Scott E, Woodman K. Guidance about Effective Interventions to Support Parents, Their Infants and Children in the Early Years. A paper to the Scottish Government Early Years Taskforce; 2012. Available from: www.scotland.gov.uk/Resource/0041/00413580.pdf

4. Woodman K. Peer support for breastfeeding: Guidance for Scotland. NHS Health Scotland; 2013. Available from: www.healthscotland.com/documents/22529.aspx

5. Scottish Government. Improving Maternal and Infant Nutrition: A Framework for Action. Edinburgh: Scottish Government; 2011.

6. Scottish Government. The Healthcare Quality Strategy for NHSScotland. Edinburgh: Scottish Government; 2010.

7. Scottish Government. Commission on the Future Delivery of Public Services. Edinburgh: Scottish Government; 2011.

8. Scott E. Briefing on the Family Nurse Partnership. NHS Health Scotland; 2013. Available from: http:\\www.healthscotland.com/documents/21625.aspx

9. Scott E. Briefing on the Incredible Years Parenting Programme. NHS Health Scotland; 2013. Available from: http:\\www.healthscotland.com/documents/21625.aspx

10. Scott E. Briefing on the Triple P Positive Parenting Programme. NHS Health Scotland; 2013. Available from:http:\\www.healthscotland.com/documents/21625.aspx

11. Scott E, Woodman K. Evidence summary: Public health interventions to support parents of older children and adolescents. NHS Health Scotland, 2014. Available from: http://www.healthscotland.com/documents/5755.aspx .

12. McAteer J, Jepson R, Wight D, Jackson C. Characteristics of effective and ineffective adolescent health interventions with a parental component. Scottish Collaboration for Public Health Research and Policy, University of Edinburgh and MRC Social and Public Health Sciences Unit, University of Glasgow. Available from (external link, 570KB): http://www.scphrp.ac.uk/characteristics-of-effective-ineffective-adolescent-health-interventions-with-a-parental-component/

13. Geddes R, Haw S, Frank J. Interventions for promoting early childhood development for health. An environmental scan with special reference to Scotland. A report for the Early Life Working Group of the Scottish Collaboration for Public Health Research and Poliy. Edinburgh: Scottish Collaboration for Public Health Research and Policy; 2010.