NHS Health Scotland



B . Evidence for parenting and the early years interventions (Prevention model)


There is highly processed and review-level evidence of effectiveness that parenting support and intervention in the early years can improve long-term health and social outcomes for children (at-risk). Attachment theory and effective interventions further demonstrate the importance of early years support for parents and children. There is highly processed evidence that interventions targeted at vulnerable groups can be effective in reducing substance misuse and improving other positive behavioural outcomes.


There is highly processed evidence from NICE Public Health Guidance on social and emotional wellbeing in the early years (NICE PH40) that supporting the social, emotional and cognitive development of children can improve long-term outcomes. Although limitations in the evidence were noted, the authors concluded that there is potential for interventions with vulnerable preschool children to be cost effective and cost saving.

NICE PH40 recommendations include[1]:

  • all those responsible for planning and commissioning (including joint commissioning) services for children aged under five in local authorities, the NHS (primary, secondary and tertiary healthcare) and the voluntary, community and private sectors should ensure the social and emotional wellbeing of vulnerable children under-five is assessed as part of the joint strategic needs assessment, with integrated commissioning of universal and targeted services for children aged under five. This includes vulnerable children and their families.

  • identifying vulnerable children and assessing their needs (developing a trusting relationship; working with strengths and capabilities of the family; understand and respond to needs and concerns; sensitively discuss risks).

  • antenatal and postnatal home visiting for vulnerable children and their families.

  • early education and childcare.

NHS Health Scotland’s Briefing on attachment [2], describes attachment as the bond from a child towards their parent or primary caregiver. The briefing cites John Bowlby’s theory of attachment (Attachment and Loss: Vol.1 Attachment, 1982) that defines attached as ‘the disposition of the child to seek proximity to and contact with a specific figure and to do so in certain situations, notably when he is frightened, tired or ill.’

The briefing outlines that there are links between an infant’s attachment style and their later social and emotional outcomes. Secure attachment in infancy is associated with positive outcomes including self-esteem, self-confidence, emotional regulation, resilience and more harmonious relationships in childhood and early adulthood. While attachment style may be a risk or protective factor, this association is not deterministic. Other factors, for example,social support or life stress, are likely to mediate this influence (from Sroufe 2006, Prior and Glaser, 2006 cited in ibid).

The briefing details evidence on effective strategies for promoting secure attachment in young children:

  • The most effective interventions specifically focus on improving sensitive maternal behaviour (as opposed to those which are broader in focus).
  • Interventions that are effective in enhancing parental sensitivity are universally effective (including high-risk populations).
  • The most successful interventions are brief (fewer than 5, or 5–16 sessions) and behaviourally focused.
  • The majority use home visiting as the mechanism for delivery.
  • Providing information to new parents on the sensory and perceptual capabilities of their infants appears to enhance maternal responsiveness and parental interaction with their babies.

From an NHS Health Scotland overview of the effectiveness of interventions to support parents, their infants and children in the early years, there is review-level evidence that intensive structured support to vulnerable mothers during the first 18 months of a child’s life, delivered by specialist nurses, is effective and cost-effective, in improving social and emotional development of vulnerable children. [3]

There is limited highly processed evidence from NICE public health guidance 4: Community-based interventions to reduce substance misuse among vulnerable and disadvantaged children and young people. A good deal of the evidence reviewed was insufficient or inconsistent in its findings to enable firm conclusions in relation to the effectiveness of programmes in preventing drug use among vulnerable and disadvantaged young people. However:

  • Among young people with multiple risk factors, evidence suggests that multi-component community-based approaches and family-based interventions are effective in improving substance misuse behavioural outcomes.

  • Among black and minority ethnic populations, most evidence is insufficient or inconsistent. However, evidence from one review does suggest that incorporating refusal skills training in drug prevention programmes improves effectiveness in reducing substance use.

Parenting interventions, in combination with drug treatment are effective in improving parenting skills and reducing parental drug use in families with drug use problems. However, evidence suggests that home visitation makes no difference on a number of child and parental outcomes among families with substance using members.

Among young substance users, there is strong evidence that family therapy following treatment is effective in reducing substance use and improving social behaviours. Skills training for parents is effective in reducing cannabis use among young substance users and in improving parental coping.

Among young people with behavioural and aggressive problems, multi- component parent and child programmes have been found to be effective on a range of child outcomes.

For young offenders, multi-systemic therapy can be effective at reducing soft drug use and reducing reoffending.

Recommendations in the guidance [4, 5] include:

  • the need for local-area based strategies to be developed and implemented to reduce substance misuse among vulnerable and disadvantaged young people aged under 25.

  • the use of screening and assessment tools to improve the identification of this target population.

  • offering a family-based programme of structured support and offering the children group-based behavioural therapy before and during the transition to secondary school.

There is review-level evidence from one systematic review, of the effectiveness of parenting programmes with pre-teen and early adolescent children, notably in the transition from primary to secondary school, to reduce substance misuse in children. Parental engagement and commitment are important to the success of interventions and the focus should not solely be on the issue of substance use, rather on the whole family (relationships, social skills and personal responsibility). [6]


Scottish policy and practice note

NHS Health Scotland’s (2014) Health Inequalities Policy Review for the Scottish Ministerial Task Force on Health Inequalities [7] cites a Scottish Evaluation of Family Nurse Partnerships [8] demonstrating initial learning of the potential to strengthen a range of personal assets, practical skills of young mothers as well as supporting emotional health and wellbeing.



  1. National Institute for Health Care Excellence (NICE, 2012) public health guidance 40 Social and emotional wellbeing: early years. London: NICE. Available from (external link, 364KB) :http://guidance.nice.org.uk/PH40/Guidance/pdf/English

  2. Scott, E.(2011) Briefing on attachment. Edinburgh: NHS Health Scotland. Available from: www.healthscotland.com/documents/5755.aspx

  3. NHS Health Scotland (2012) Evidence summary: Interventions to support parents, their infants and children in the early years (pregnancy to five years). Edinburgh: NHS Health Scotland. Available from : www.healthscotland.com/uploads/documents/19955- ParentingInterventionsPregnancyTo5Years%20amended%20151112.pdf

  4. National Institute for Health and Care Excellence (2007) NICE Public Health Guidance Intervention 4: Community-based interventions to reduce substance misuse among vulnerable and disadvantaged children and young people. London: NICE. Available from (external link, 250KB) :http://guidance.nice.org.uk/PH4

  5. NHS Health Scotland (2007) Commentary on NICE Public Health Intervention Guidance 4: Community based interventions to reduce substance misuse among vulnerable and disadvantaged children and young people. Edinburgh: NHS Health Scotland. Available from : www.healthscotland.com/scotlands-health/evidence/NICE.aspx

  6. Petrie, J. Bunn, F. and Byrne, G.(2007) Parenting programmes for preventing tobacco, alcohol or drugs misuse in children <18: a systematic review. Health Education Research, pages;22(2). Available from (external link,112KB) : http://her.oxfordjournals.org/content/22/2/177.full.pdf+html

  7. NHS Health Scotland (2014) Health Inequalities Policy Review for the Scottish Ministerial Task Force on Health Inequalities. Edinburgh: NHS Health Scotland. Available from: http://www.healthscotland.com/documents/23047.aspx

  8. Ormiston, R. McConville, S. (2012) Evaluation of the Family Nurse Partnership Programme in NHS Lothian, Scotland: 3rd Report – Infancy. ScotCen Social Research.