Archives: Intervention

Summary

Introduction

The Strategy intervention is a psychosocial support intervention aimed at supporting the parents or guardians of children and adolescents diagnosed with ADHD. The intervention aims to reduce the child’s ADHD symptoms by strengthening parenting skills and improving the executive function of the parents and the child. The objective of the Strategy intervention is to increase the parents’ understanding and knowledge of ADHD so that they recognise the limitations to executive function caused by the symptom profile and their impacts on the family. The intervention also supports the parents’ adaptation to their child’s ADHD diagnosis.

Objective and research question

This systematic literature review assesses the effectiveness of the Strategy intervention on the basis of research literature. The review answers the following questions: In how much detail is the Strategy intervention described? Does the Strategy intervention have evidence-based effectiveness, applicable to Finland, in increasing the ADHD knowledge of the parent, strengthening parenting skills and improving the executive function of the child and the parent?

Data and research methods

This study used the Population, Concept and Context (PCC) strategy to search for literature, which is a typical strategy in exploratory literature reviews. The search targeted the following question: What research has been done on the Strategy intervention?  The following keywords were used: P = children, adolescents, parents, C = Strategy intervention, Strategi-programmet. Context was omitted to avoid an excessive restriction of the results of the search. The primary area of interest in the search was effectiveness studies carried out on the method, although studies carried out by using different frameworks were also included. A systematic search was carried out for the following six reference databases: MEDLINE, APA PsycInfo, CINAHL, ERIC, Web of Science and Scopus. In addition, a search for publications in Finnish was performed on the Finna.fi service, and the search was supplemented by a manual search.

Results

Based on the literature search, only one effectiveness study was selected for a systematic review. In addition, one Swedish peer-reviewed study and one Swedish non-peer-reviewed report were reported at the end of this review and did not affect the methodology evaluation of the intervention. The selected Swedish study was conducted without a control group using a pre-post design, where the effectiveness of the Strategy intervention was examined in terms of the parents’ increased knowledge of ADHD. The secondary response variables examined were the intervention’s effect on the child’s behavioural symptoms and characteristics (Strengths and Difficulties Questionnaire (SDQ)), parental stress (The Parental Stress Scale (PSS)) and parenting attributions (modified Written Analog Questionnaire). Parents (n=549) were divided into three groups based on the severity of their ADHD symptoms. The severity of the parents’ ADHD symptoms had no effect on the response variables: the parents’ knowledge of ADHD increased in allof the groups.

Methodology evaluation

As the Strategy intervention is well-described and there is promising evidence of its effectiveness, it receives a methodology evaluation score of 3/5. There is research evidence of increased knowledge of ADHD among parents of children diagnosed with ADHD. More research is needed to support the intervention’s strengthening of parenting skills and the improvement of the child’s and parent’s executive function.

Summary

Introduction

As mental health challenges increase among children in various age groups, there is a need for preventive measures and low-threshold support to alleviate symptoms. The purpose of the Friends programme is to support mental wellbeing and strengthen resilience. Different versions designed to suit the needs of different age groups utilise peer learning and activity-based exercises. The programme suits a wide range of target groups and is easy to implement. It can be used either in the child’s developmental environment, such as school, or as part of health and social services, in which case it is targeted at children who exhibit symptoms. The Friends for Life version of the Friends programme is intended for children aged 9–12 years to prevent anxiety and depressive symptoms.

Objective and research question

This systematic literature review assesses the effectiveness of the Friends for Life version of the Friends suite of interventions on the basis of research literature. The review answers the following questions: In how much detail is the Friends programme described? Does the Friends for Life version of the Friends programme have evidence-based effectiveness, applicable to Finland, on the mental wellbeing of children aged 9–12, especially with regard to anxiety and depressive symptoms?

Data and research methods

This study used the Population, Concept and Context (PCC) strategy to search for literature, which is a typical strategy in exploratory literature reviews. The search targeted the following question: What research has been done on the Friends programme? The following keywords were used: P = children and adolescents, C = Friends. Context (C) was omitted to avoid an excessive restriction of the results of the search. The primary area of interest in the search was effectiveness studies carried out on the Friends for Life version of the intervention, although other types of studies were also included. A systematic search was carried out for the following six reference databases: MEDLINE, APA PsycInfo, CINAHL, ERIC, Web of Science and Scopus. In addition, a search for publications in Finnish was performed via the Finna.fi service. The search was supplemented with a manual search.

Results

A total of 19 effectiveness study articles were included in the assessment. One of the studies was Finnish, three were Nordic and the rest were studies that met the inclusion criteria and had been carried out in high-income countries in accordance with the World Bank’s country classification. In addition, the literature searches identified two Finnish studies that are reported in the reflection section. Two systematic literature reviews, four meta-analyses and one study that was both a systematic review and a meta-analysis could not be assessed as such because they also included studies concerning countries other than high-income countries. Two of the studies also included other interventions besides Friends. Evidence of effectiveness has been obtained from Nordic studies as well as studies concerning other high-income countries. The quality of the studies was varied. The studies were focused on assessing the effectiveness of Friends for Life, which is the version of the Friends programme aimed at school-aged children. The studies were divided in terms of whether the intervention was assessed as 1) a universal intervention implemented for everyone in a particular school, or 2) a targeted intervention for children or adolescents with anxiety symptoms, either a) in school or b) in the context of a service providing psychosocial care. Effectiveness with regard to the wellbeing of children and adolescents was primarily measured in terms of the reduction of anxiety symptoms and, in certain studies, also changes in depressive symptoms and social skills. According to the assessment, the intervention was observed to have positive effects on the mental wellbeing of children and adolescents through the reduction of anxiety symptoms (d=0.008–0.70) and the reduction of depressive symptoms (d=0.04–0.63). No negative effects were observed. In particular, the programme appears to be beneficial for children who are already exhibiting symptoms. The studies provided indications that, in the school environment, especially interventions implemented by external professionals produced positive effects. The verification of preventive and long-term effects was made more difficult by the research design that is typical of intervention studies, where the control group was on a waiting list for participating in the programme. Support for the implementation of the intervention was assessed to be moderate. The intervention and its theoretical foundation are well-described, and the link between the core elements and the theory is satisfactorily explained.

Methodology evaluation

The Friends for Life version of the Friends suite of interventions receives a methodology evaluation score of 4/5. There is evidence of effectiveness with regard to improved mental wellbeing among children and adolescents in the 9–12 age group, particularly in terms of reduced anxiety and depressive symptoms. In several studies, the programme is compared with another intervention, a waiting list or standard care or support. The results provide indications of the usefulness of the intervention as part of communal activities in a child’s developmental environment. More research is needed on the effectiveness of universal interventions focused on the prevention of anxiety symptoms.

Summary 

Phenomena

Behavioural problems, emotions and emotional regulation, parenting skills and knowledge, and neuropsychiatric challenges 

Introduction

The ENGAGE intervention has been developed for the prevention and treatment of difficulties in self-regulation and executive function among children below school age. At the core of the intervention are shared sessions of play, where parents are guided to support the child’s executive function skills through positive interaction. The ENGAGE intervention is intended for children aged three to six who have challenges related to hyperactivity, inattention and behavioural regulation. The group intervention comprises six meetings with the parents and six meetings with the children over an eight-week period, as well as two telephone or video conversations with the parents. Challenges in self-regulation and executive function are among the most common reasons for seeking support for a child’s development. For a child below school age, the challenges may manifest in the form of hyperactivity, difficulties with waiting and listening to instructions, and deficiencies in emotional regulation in exciting or frustrating situations, for example. Early self-regulation has been found to have a strong connection to executive function and psychological wellbeing that extends well into adulthood. In childhood, the development of executive function is strongly shaped through daily activities and interaction. In guided practice, the child can be supported and encouraged so that they dare to try things even when they are difficult, thereby strengthening their nascent self-regulation and executive function skills. 

Objective and research question

This systematic literature review assesses the effectiveness of the ENGAGE intervention on the basis of research literature. The review answers the following question: Does the ENGAGE intervention have evidence-based effectiveness, applicable to Finland, in the prevention and treatment of difficulties in self-regulation and executive function among children below school age?

Data and methods

This study used the Population, Concept and Context (PCC) strategy to search for literature, which is a typical strategy in exploratory literature reviews. The search targeted the following question: What research has been done on the ENGAGE intervention? The following keywords were used: P = children and parents, C = Leikitään ja keskitytään -menetelmä (the English equivalents) and concepts related to executive function and play-based interventions. Context was omitted to avoid an excessive restriction of the results of the search. The primary area of interest in the search was effectiveness studies carried out on the method, although studies carried out by using different frameworks were also included. A systematic search was carried out for the following six intervention databases: MEDLINE, APA PsycInfo, CINAHL, ERIC, Web of Science and Scopus. In addition, a search for publications in Finnish was performed via the Finna.fi service.

Results

Based on the literature search, three effectiveness studies were selected for a systematic review. Two studies that affected the assessment were conducted in New Zealand on the ENGAGE intervention, on the basis of which the Finnish Leikitään ja keskitytään perheille intervention has been developed. In addition to the studies conducted in New Zealand, a Finnish effectiveness study on the LeKe perheille intervention was assessed. The quality of the effectiveness studies was good. The intervention has been shown to have positive effects on self-regulation and executive function at home. Based on the assessment, the intervention has a robust theoretical foundation and description. The intervention is comprehensively described in the instructor’s manual, and implementation support offered by the intervention is fulfilled in six out of seven areas. There are good opportunities for the successful implementation of the ENGAGE intervention.

Methodology evaluation

The methodology evaluation score for the Finnish Strongest Families Parent Training Programme is 5/5, which means that there is strong evidence of the intervention’s effectiveness in the Finnish context. There is evidence of the effectiveness of using the intervention for children aged three to six who have difficulties with self-regulation and executive function.

Abstract

Delivery of the intervention

Child families

Aim of the intervention

Family Group Conference aims to improve the children’s wellbeing in child protection by enhancing the participatory role of the child, family and the child’s closest networks. The Family Group Conference strengthens the initiatives by the child and the family during the child protection process.

Description of the intervention

Family Group Conference is a structured intervention for the child families in the Finnish child protection. It may be used at different stages of the child protection process, and for children at different ages. Theoretical frameword lies on the problem solving theory, which focuses on resources and solution-focused brief therapy. In addition, dialogue, principle of restorative social work (Frost et al. 2012) and child’s information (Heino 2005) are important background factors.  Family Group Conference is voluntary for the client. Client family, impartial conference inviter, social worker and the closest network related to the child’s case participate in the Family Group Conference. In addition, the child has an assistant. Intervention proceeds from preparations to Family Group Conference, where contact, communication and a plan for the child’s case are agreed on. The plan and its realization are followed and evaluated. Duration of the intervention varies depending on the child’s case from a year to a couple of years. Intervention has also been used in cases of young criminals, custody disputes and in disability, mental health and elderly services.

Availability of the intervention in Finland

The actors who deliver the intervention organize the training for the Family Group Conference, and there are no criteria for the participation in the training. Content and structure of the trainings vary between instructors. Exact information on the availability and quantity of trainings is not readily available. Family Group Conference has been developed in New Zealand as a legitimate working model in custody situations and cases of young criminals. In Finland, Family Group Conference has been developed in a multiactor project run by Stakes, and the intervention is used in the child protection. Exact information on national availability and implementation are not readily available.

Research- and evidence-based efficacy of the intervention

There is moderate research-based evidence for the intervention, including an international meta-analysis (Dijkstra et al. 2016), two RCTs (Asscher et al. 2014; Hollingshead et al. 2017), a prospective quasi-experimental study (Sundell & Vinnerljung 2004) and some qualitative studies. There is no research-based evidence of efficacy for the Family Group Conference.

Literature

Asscher, J., Dijkstram S., Stams G., Decovic, M. & Creemers, H. (2014). Family group conferencing in youth care: characteristics of the decision making model, implementation and effectiveness of the Family Group (FG) plans. BMC Public Health, 14, 154.

Dijkstra, S., Creemers, H., Asscher, J., Decovic, M. & Stams, G. (2016). The effectiveness of family group conferencing in youth care: A meta-analysis. Child Abuse & Neglect, 62, 100–110.

Frost, N. Abram, F. & Burgess, H. (2012). Family group conferences: context, process and ways forward. Child and Family Social Work, 19, 480–490.

Heino, T. (2005). Lapsen tieto – sen paikka tutkimuksessa ja käytännössä. Teoksessa Hänninen, S. & Karjalainen, J. & Lahti, T. (toim.): Toinen tieto – kirjoituksia huono-osaisuuden tunnistamisesta. Stakes.

Hollingshead, D. M., Corwin, T. W., Maher E. J., Merkel-Holguina, L., Allan, H. & Fluke, J. (2017). Effectiveness of family group conferencing in preventing repeat referrals to child protective services and out-of-home placements. Child Abuse & Neglect, 69, 285–294.

Sundell, K. & Vinnerljung, B. (2004). Outcomes of family group conferencing in Sweden: A 3-year follow-up. Child Abuse Neglegt, 28, 267–287.

Abstract

Delivery of the intervention

Group-based / individually

Aim of the intervention

The aim of the intervention is to promote anxiety management skills among 7–17 year-old children and adolescents, to teach how to identify situations causing anxiety and to reduce worrying in the target group. The Cool Kids –intervention teaches parents how to respond and react to child’s anxiety in a supportive manner.

Description of the intervention

Cool Kids is targeted at child families where the child or the adolescent has anxiety symptoms, which affect everyday life. Cool Kids is delivered either in a group or individually. In the intervention, parents participate actively, supporting and reacting to the child’s anxiety. The intervention is based on psychoeducation and comprises cognitive exercises, step-by-step exposure exercises and learning to identify emotions. The intervention lies on the cognitive-behavior therapy. (Lyneham et al. 2003; Rapee et al. 2006a; 2006b.) A group-based intervention is delivered to 4–8 child families and it contains ten meetings, weekly at first and every fortnight towards the end. In the meetings, the focus is on learning new strategies to manage anxiety through discussions, games and playing. In the group meetings, the families are given homework to practice new skills at home. A workbook suitable for the age of the child or the adolescents, is used in the intervention. Cool Kids is provided both as a treatment program and preventive method.

Availability of the intervention in Finland

Cool Kids –training is targeted at social and healthcare professionals who have experience in cognitive-behavior therapy and in mental health work with children and adolescents. Method training is organized by the Future health and social services centres –initiative (Viva) and the Mielen tila (engl. State of mind) -project run by Kummit ry. of the clinic of child psychiatry and the children’ clinic, the HUS Helsinki University Hospital. The Cool Kids has been developed in the University of Macquire in Australia (Lyneham et al. 2003; Rapee et al. 2006a; 2006b) and intervention has been adopted in USA and Europe also. In Finland, Cool Kids is applied in the clinic of child and adolescent psychiatry in HUS.

Research- and evidence-based efficacy of the intervention

The Cool Kids –intervention has been investigated in several randomized controlled trials (e.g. Arend et al. 2006; Chavira et al. 2014; Hudson et al. 2009; Rapee et al. 2006a). RCT studies on Cool Kids have been conducted in school environment from the perspectives of early support and prevention (Haugland et al. 2020; Mifsund & Rapee, 2005). Group-based Cool Kids at school reduced anxiety symptoms among 8–11 years old children compared to the children in the waiting list (Mifsund & Rapee, 2005). In a Norwegian study, the effectiveness of Cool Kids on anxiety, reported by the children and parents, was found to be moderate compared to the control group (Haugland et al. 2020).

Literature

Haugland B, Haaland ÅT, Bast V, Bjaastad J, Hoffart A, Rapee RM, Raknes S, Himle JA, Husabø E & Wergeland GJ (2020) Effectiveness of brief and standard school-based cognitive-behavioral interventions for adolescents with anxiety: A randomized noninferiority study. Journal of the American Academy of Child & Adolescent Psychiatry, 59(4), 552–564.

Lyneham H J, Abbott M J, Wignall A & Rapee R M (2003) The Cool Kids Anxiety Treatment Program. Sydney: MUARU, Macquarie University.

Mifsud C & Rapee R M (2005) Early intervention for childhood anxiety in a school setting: Outcomes for an economically disadvantaged population. Journal of the American Academy of Child Adolescent Psychiatry, 44(10), 996–1004.

Rapee R M, Abbot M J & Lyneham H J (2006a) Bibliotherapy for children with anxiety disorders using written materials for parents: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(3), 436–444.

Rapee R M, Lyneham H J, Schniering C ym. (2006b) The Cool Kids child and adolescents anxiety program – therapist manual. Sydney, NSW: Centre for Emotional Health, Macquire University.

Abstract

Delivery of the intervention

 Individual- / group-based

Aim of the intervention

The aim of the intervention is to help 3–12 years old children to learn the skills they need for psychosocial problem solving in everyday life. The Kids’ skills aims to improve the child’s ability to observe and control the symptoms related to a given problem.

Description of the intervention

The Kids’ skills is a structured intervention, which consists of 15 levels, and it is developed to support children with psychosocial problems. The intervention is based on solution-focused therapy, brief therapy, and partly on Milton Erickson’s psychotherapy tradition (Furman 2016). Intervention influences indirectly on reasons behind the child’s problems and interactions within the family. It focuses on the psychosocial problem perceived by the child in everyday situations, such as difficulties in emotion regulation, behavioral problems and defiance. Intervention can be delivered on the condition that the child’s problem can be solved or alleviated. The fifteen steps of the intervention focus on the child’s skills and enhancing the skills but systematic conduct of each step is not strictly required (Bentner 2014).  The Kids’ skills may be used at home with the child, in a group of children, and is applicable to youth and adults.

Availability of the intervention in Finland

The Kids’ skills is developed by Ben Furman, who is a psychiatrist at the Helsinki Brief Therapy Institute and social psychologist Tapani Ahola. The Kids’s skills training is available as online studies and face-to-face studies organized by the Brief Therapy Institute, which maintains instructor certification. The intervention is also available as a mobile application. The intervention has been used to some extent in the child and family services and in child psychiatry. The intervention has been adopted as a part of South Carelian program to address reform in the child and family services.

Research- and evidence-based efficacy of the intervention

The intervention has been tested in a Finnish study based on multivariate methods (Hautakangas, Kumpulainen & Uusitalo 2021). It demonstrated that the self-regulation skills of 4 to 7 years old children in the daycare improved in the Kids’ skills intervention group compared with the control group. In addition, the intervention increased the commitment of the early educators to promote children’ self-regulation skills. The intervention has satisfactory research-based evidence of efficacy.

Literature

Bentner, A. (2014). Muksuoppi tutkimuksen kohteena. Saksalaisia selvityksiä suomalaisesta lasten ongelmien ratkaisumenetelmästä.

Furman, B. (2016). Muksuopin lumous. Luova tapa auttaa lapsia voittamaan psyykkiset ongelmat. Lyhytterapiainstituutti.

Hautakangas, M., Kumpulainen, K. & Uusitalo, L. (2021). Children developing self-regulation skills in a Kids’ Skills intervention programme in Finnish Early Childhood Education and Care. Early Child Development and Care.

Summary

Introduction

The Family School is aimed at children aged 3 to 6 years and their parents. It consists of a group of parents and a group of children. The aim of the programme is to provide tools and support for families struggling with a child’s challenging behaviour. Challenging behaviour can manifest as defiance, impulsivity, aggression or hyperactivity.

Objective and research question

This systematic literature review assesses the effectiveness of the Family School intervention on the basis of research literature. The review answers the following question: is the Family School effective in addressing behavioural problems in children under school age, aged 3 to 6 years, and contributing to positive parenting?

Data and methods

This study used the Population, Concept and Context (PCC) strategy to search for literature, which is a typical strategy in exploratory literature reviews. The search targeted the following question: what research has been done on the Family School?  The following keywords were used: P = parents and young children, C = Family School. Context was omitted to avoid an excessive restriction of the results of the search. The primary area of interest in the search was effectiveness studies carried out on the intervention, although studies carried out using different frameworks were also included. A systematic search was carried out for the following six databases: MEDLINE, APA PsycInfo, CINAHL, ERIC, Web of Science and Scopus. In addition, a search for Finnish publications was performed on the Finna.fi service, and the search was supplemented by a manual search.

Results

The literature search found a Finnish monograph dissertation that examines the results and effectiveness of the Family School programme. The intervention has also been the subject of a licentiate thesis, which was highlighted in the review. The Family School is well-described, and its mechanisms of action are based on the principles of cognitive-therapeutic and behavioural-therapeutic interventions and social learning theory. According to the dissertation, progress was observed in the parenting skills of the parents who participated in the Family School and in the behaviour of the participating children, but no differences compared to the control group were found. The results were maintained during a one-year follow-up. The quality of the study was good, although the group sizes were small. The implementation support provided by the intervention is satisfactory. There is room for improvement particularly in the provision of tools for monitoring, maintenance and repeatability for those who implement the intervention.

Methodology evaluation

The Family School is a well-described and promising intervention that has a theoretical foundation and preliminary research on its effectiveness. The evaluation score for the intervention is 3/5.

Abstract

Delivery of the intervention

Group-based

Aim of the intervention

The intervention aims to promote the positive interaction between child and parent, strengthen the parent’s mentalization ability, suppot the parents relationships as well as enable peer support in everyday life of families with babies. The intervention improves wellbeing of the entire family.

Description of the intervention

Families first is a peer group -based intervention and continues the support that the family coaching provides for the parents who have received their first child. The intervention is founded on attachement theory, mentalization theory and the concept of reflexiveness (Fonagy ym. 1991; Slade ym. 2005; Kalland ym. 2015). Peer groups gather 8-12 times every other week in thematic and structures meetings. The meetings are lead by two municipal professionals in the field of child and family work, who have been trained as intervention instructors. Families first -groups are best suited for parents, whose babies are 3-4 months old. The intervention suits also for other families with newborns, not only those having their first child.

Availability of the intervention in Finland

In Finland, the training for Families first -group instructors is targeted for the municipal professionals in social and health care and in education.  Previous experience in instructing groups and work experience with parents and families is required. Mannerheim League for Child Welfare and Folkhälsan organize instructor training. The intervention has been developed from the Yale University’s Parents first program and adapted to suit the child health clinic system, and the child and family services in Finland. Families first –groups are provided for families with babies through family coaching and other services provided by the child health clinics and child and family services. There is no accurate information on regional availability of the intervention in Finland.

Research- and evidence-based efficacy of the intervention

There are ongoing qualitative (Sourander ym. 2016) and effectiveness (Kalland ym. 2015) studies on the intervention.

Literature

Fonagy, P., Steele, H., Moran, G., Steele, M. & Higgitt, A. (1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 13, 200–217.

Kalland, M., Fagerlund, Å., von Koskull, M. & Pajulo, M. (2015). Families First: the development of a new mentalization-based group intervention for first-time parents to promote child development and family health. Primary Health Care Research & Development, 17, 3–17.

Slade, A., Sadler, L., DeDios-Kenn, C., Webb, D., Currier-Ezepchick, J. & Mayes, L. (2005). Minding the baby: a reflective parenting programme. Psychoanal Study of the Child, 60, 74–100.

Sourander, J., Kalland, M., & Laakso, M-L. (2016). Mentalization-based Families First intervention for first-time parents. A qualitative study of parents’ perspective. Käsikirjoitus valmisteilla.

Abstract

Delivery of the intervention

Individual-/family-based

Aim of the intervention

The intervention aims to increase awareness of the child-parent interaction and strengthen the mentalization ability of the parent. The intervention targets the impact on the attachment relationship between the child and the parent and the emotional presence of the parent.

Description of the intervention

VIGis a video-reflexive intervention for child families. The framework for the intervention is provided by the theories of the intersubjectivity (Trevarthen 1979) and mediated learning experience (MLE) (Feuerstein & Feuerstein 1991), the concept of mentalization as well as research-based knowledge on video-reflexive methods. In the beginning of the intervention parents, together with a VIG instructor set goals, followed by a working period of 3-5 cycles. One cycle means a video recording of any given everyday situation such as going out, getting dressed etc. and a subsequent video-reflexive instructive discussion. During the discussion, the parent and the VIG instructor conduct a microanalysis based on the video, in order for the parent to view the interaction between him-/herself and the child from both child and adult perspectives. The child may participate in the discussion as is appropriate for his or her age. At the end of the intervention the instructor and the family evaluate whether the set goals were reached. The intervention is used as a method in work supervision of social and healthcare professionals and students.

Availability of the intervention in Finland

VIG–instructor training is targeted at education, social and healthcare professionals. The training is organized by the Foundation for the Rehabilitation of Children and Young People, which is a sub-organization of the Mannerheim League for Child Welfare. The Foundation provides training also for the trainers and work supervisors. Video Interaction Guidance was originally developed in Netherlands but in Finland, the Foundation for the Rehabilitation of Children and Young People of the Mannerheim League for Child Welfare has been responsible for its development. The Foundation co-operates with a British organization, the AVIG, regarding training, certification and method co-operation in order to ensure fidelity. The intervention is used in the fields of education and social and healthcare. There is no exact information for the regional availability of the intervention in Finland.

Research- and evidence-based efficacy of the intervention

Two international RCT-studies on the use of VIG in families with premature babies have been conducted. In their RCT, Hoffenkamp et al. (2015) found an increase sensitivity and decrease in withdrawal among the participants in the intervention group (n=75) compared to the control group (n=75). In addition, sensitivity and co-operation between the parent and child was found to increase in the intervention group (n=31) compared to the control group (n=31) in another RCT (Barlow ym. 2016). There is modest evidence of effectiveness for the intervention in terms of stronger interaction between babies and parents in the VIG intervention group, as compared to control group who received treatment as usual. There is no peer reviewed study on VIGin Finland.

Literature

Barlow, J., Sembi, S. & Underdown A. (2016). Pilot RCT of the use of video interactive guidance with preterm babies. Journal of Reproductive and Infant Psychology, 34, 511–524.

Feuerstein, R. & Feuerstein, S. (1991). Mediated learning experience: a theoretical review, teoksessa Feuerstein, R. Klein P. & Tannenbaum, A. (toim) Mediated learning experience (MLE): Theoretical, Psychosocial and Learning Implications, 3–51. London: Freund.

Hoffenkamp, H. N., Tooten, A., Hall, R. A. S., Braeken, J., Eliëns, M. P. J., Vingerhoets, A. J. J. M. & van Bakel, H. J. A. (2015). Effectiveness of hospital-based video interaction guidance on parental interactive behavior, bonding, and stress after preterm birth: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83, 416–429.

Trevarthen, C. (1979). Communication and cooperation in early infancy: A description of primary intersubjectivity. Teoksessa M.M. Bullowa (toim.): Before speech. Cambridge University Press, New York, 321–347.

Abstract

Delivery of the intervention

Group-based

Aim of the intervention

The aim of the Nyytti Group is to alleviate the fear of childbirth in pregnant mothers and prevent the adverse effects of the fear. The intervention strengthens and reinforces the preparedness for the childbirth and the parenthood.

Description of the intervention

The Nyytti Group is a semi-structured peer group-based intervention, targeted for pregnant mothers expecting their first child. The intervention is based on strengthening the body awareness and self-regulation, peer groups as well as instructive and educative ways of working (psychoeducation). The peer groups gather six times during pregnancy and once after childbirth. The groups are led by a trained Nyytti instructor. Each meeting has its own psychoeducative content and exercise for body awareness (Salmela-Aro et al. 2011). The aim of the group discussions is to share peer support and increase own emotions, body awareness and mentalization. Families are prescribed to Nyytti Groups by the child health clinics.

Availability of the intervention in Finland

Method training is organized by the developers of the intervention, if needed. The training is targeted for psychologists and psychotherapists. The intervention has been developed by the psychologists Riikko Airo and Maiju Tokola. Nyytti Groups are organized at the Women’s Hospital (Helsinki University Hospital, HUS) and Oulu University Hospital.

Research- and evidence-based efficacy of the intervention

The effectiveness of the Nyytti Groups has been studied in a randomized controlled trial (Rouhe et al. 2013; Rouhe et al. 2015; Salmela-Aro et al. 2011). The scope of the study was to investigate the effect of the Nyytti Group on the method of childbirth and positive childbirth experiences (Rouhe et al. 2015), preparedness for the childbirth and strengthening of the motherhood (Salmela-Aro et al. 2011), as well as adaptation to the motherhood and postnatal depressive symptoms (Rouhe et al. 2013). The preparedness for the childbirth increased among mothers who gave birth to their first child in the intervention group. With reduced fear of childbirth, the motherhood strengthened in mothers who participated in the Nyytti Group (Salmela-Aro et al. 2011.) The Nyytti Group also had an effect on the method of childbirth (vaginal delivery), positive childbirth experience (Rouhe et al. 2013) and adaptation to motherhood (Rouhe ym. 2015).

Literature

Rouhe, H., Salmela-Aro, K., Toivanen, R., Tokola, M., Halmesmäki, E., Ryding, E-L. & Saisto, T. (2015). Group psychoeducation with relaxation for severe fear of childbirth improves maternal adjustment and childbirth experience – a randomized controlled trial. The Journal of Psychosomatic Obstetrics & Gynecology, 36(1), 1–9.

Rouhe, H., Salmela-Aro, K., Toivanen, R., Tokola, M., Halmesmäki, E. & Taisto, T. (2013). Obstetric outcome after intervention for severe fear of childbirth in nulliparous women – randomized trial. An International Journal of Obstetrics & Gynaecology, 120, 75–84.

Salmela-Aro K., Read, S., Rouhe, H., Halmesmäki, E., Toivanen R. M., Tokola, M. I. & Saisto, T. (2012). Promoting positive motherhood among nullparious pregnant women with an intense fear of childbirth: RCT intervention. Journal of Health Psychology, 17(4), 520–534.

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