Impact of a Brief Group Intervention to Enhance Parenting and the Home Learning Environment for Children Aged 6–36 Months: a Cluster Randomised Controlled Trial

Prev Sci DOI 10.1007/s11121-017-0753-9 Impact of a Brief Group Intervention to Enhance Parenting and the Home Learning Environment for Children Aged 6–36 Months: a Cluster Randomised Controlled Trial N. J. Hackworth 1,2,3 & D. Berthelsen 4 & J. Matthews 1 & E. M. Westrupp 1,2,3 & W. Cann 1 & O. C. Ukoumunne 5 & S. K. Bennetts 1,2,3,6 & T. Phan 1 & A. Scicluna 1 & M. Trajanovska 1 & M. Yu 1,7 & J. M. Nicholson 1,2,3,4 # The Author(s) 2017. This article is published with open access at Springerlink.com Abstract This study evaluated the effectiveness of a group parenting intervention designed to strengthen the home learning environment of children from disadvantaged families. Two cluster randomised controlled superiority trials were conducted in parallel and delivered within existing services: a 6-week parenting group (51 locations randomised; 986 parents) for parents of infants (aged 6–12 months), and a 10-week facilitated playgroup (58 locations randomised; 1200 parents) for parents of toddlers (aged 12–36 months). Each trial had three conditions: intervention (smalltalk group-only); enhanced intervention with home coaching (smalltalk plus); and ‘standard’/usual practice controls. Parent-report and observational measures were collected at baseline, 12 and 32 weeks follow-up. Primary outcomes were parent verbal responsivity and home learning activities at 32 weeks. In the infant trial, there were no differences by trial arm for the primary outcomes at 32 weeks. In the toddler trial at 32-weeks, Electronic supplementary material The online version of this article (doi:10.1007/s11121-017-0753-9) contains supplementary material, which is available to authorized users. * N. J. Hackworth M. Yu J. M. Nicholson D. Berthelsen J. Matthews 1 Parenting Research Centre, Level 5, 232 Victoria Parade, East Melbourne 3002, Victoria, Australia E. M. Westrupp 2 Judith Lumley Centre, La Trobe University, Level 3, 215 Franklin St., Melbourne 3000, Victoria, Australia W. Cann 3 Murdoch Childrens Research Institute, 50 Flemington Rd, Parkville 3052, Victoria, Australia O. C. Ukoumunne 4 School of Early Childhood, Queensland University of Technology, Level 4, B Block, Victoria Park Road, Kelvin Grove 4059, Queensland, Australia 5 National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, South West Peninsula (PenCLAHRC), University of Exeter, Exeter EX1 2LU, UK 6 Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville 3052, Victoria, Australia 7 Australian Institute of Family Studies, 485 La Trobe St., Melbourne 3000, Victoria, Australia S. K. Bennetts T. Phan A. Scicluna M. Trajanovska Prev Sci participants in the smalltalk group-only trial showed improvement compared to the standard program for parent verbal responsivity (effect size (ES) = 0.16; 95% CI 0.01, 0.36) and home learning activities (ES = 0.17; 95% CI 0.01, 0.38) but smalltalk plus did not. For the secondary outcomes in the infant trial, several initial differences favouring smalltalk plus were evident at 12 weeks, but not maintained to 32 weeks. For the toddler trial, differences in secondary outcomes favouring smalltalk plus were evident at 12 weeks and maintained to 32 weeks. These trials provide some evidence of the benefits of a parenting intervention focused on the home learning environment for parents of toddlers but not infants. Trial Registration: 8 September 2011; ACTRN12611000965909. Keywords Early childhood intervention . Home learning environment . Cluster randomised controlled trial . Parenting . Parent–child interactions Policy attention is increasingly focused on early childhood intervention to ensure that all children commence school with the skills required for successful academic participation (Council of Economic Advisors 2014). From a young age, children raised in socially or economically disadvantaged families are at higher risk for poor cognitive, language, and socio-emotional development (Fernald et al. 2013; Nicholson et al. 2012). While early childhood initiatives to foster the development of young children from disadvantaged families can provide long-term societal benefits (Heckman et al. 2010), there is limited evidence on how to achieve this within existing services. The current research addresses this gap by evaluating the effectiveness of a parenting program, smalltalk, delivered within two Australian early childhood service sectors (Nicholson et al. 2016). Socio-economic inequalities in children’s development are evident from a young age. By the time children commence school, those from more disadvantaged backgrounds lag behind their peers on the language, learning and socio-emotional skills they require for academic success (Nicholson et al. 2012). These early differences are maintained or widen with age, resulting in substantially poorer life-course outcomes (Kaplan et al. 2001; Poulton et al. 2002). Several modifiable characteristics of early childhood that contribute to inequalities in child development have been identified, offering the opportunity for early preventive interventions. Central to this are children’s early and repeated exposure to a home environment in which parents have a direct impact on the level and rate of children’s linguistic, cognitive and social/emotional development (Dreyer et al. 1996; Landry et al. 2006). In particular, parent–child interactions have been shown to play an important role in the link between socio-economic disadvantage and child development (Bradley et al. 2001; Miller et al. 2014; Yeung et al. 2002). Role of the Home Learning Environment in Supporting Children’s Development In homes that are rich in literacy resources and where adults converse and read to children regularly, young children develop cognitive, communicative and social skills earlier than children whose homes do not provide such opportunities (Farver et al. 2006; Landry et al. 2006; Tamis‐LeMonda et al. 2004). Specific parenting behaviours associated with the development of these skills include warm, sensitive and responsive interactions, and engagement in cognitively stimulating activities (Landry et al. 2006; Tamis‐LeMonda et al. 2004). For example, parental warmth and expressions of affection and respect promote the acquisition of children’s sense of mastery, autonomy and self-efficacy. Parent interactions that respond to and build on a child’s interests result in sustained engagement and attention and create optimal conditions for learning (Farrant and Zubrick 2012). Parent verbal responsiveness during these interactions, increases children’s verbal expressions and their exposure to complex language (Hoff 2006). Frequent shared book reading provides an interactive context for acquiring and practicing verbal and conceptual skills. The poorer development of children from socially and economically disadvantaged families has been attributed, (...truncated)