Links 2.4, 2.5, 2.6 and 2.7, 2.8, 2.9 and 2.10
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.
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.
a. Interventions for parents of infants and children in the early years
i. Interventions delivered in the antenatal period
Low birthweight 
Smoking cessation 
ii. Preparation for parenthood
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 
iii. Pregnant women with socially complex needs 
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: 
Domestic abuse 
Maternal mental health and wellbeing 
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
Peer support 
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.
For further discussion and detailed information about specific interventions readers are referred to the source document.
v. Promoting positive relationships with infants and children
There is evidence that: 
There is limited evidence:
vi. Preventing unintentional injuries in the home
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.  These include:
vii. Supporting social and emotional wellbeing
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.  This can potentially reduce the negative impact of their family circumstances.
Evidence shows that: 
viii. Home visiting 
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:
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:
Teenage mothers 
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 
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 
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. 
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 
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).
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.
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.
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.
i. Community-based interventions 
(See also model 1 ‘Supporting parent and family functioning’).
ii. School-based interventions 
iii. Multi-component interventions 
iv. Engaging parents and families (service development and engagement) 
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:
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.
Evidence suggests that:
Evidence suggests that the type of support needed by parents falls into six main categories:
v . Family-centred help-giving approach 
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 
c. Interventions for adolescents and parents of adolescents