Positive Health Online

Parenting was celebrated and respected as an honourable profession in its own right because of its importance for the future of all society.

Behind every young parent were one or several older relatives in the extended family, watching, monitoring, supporting, guiding where necessary. A vast store of inherited knowledge of health care and healthy eating was passed on from the extended family, and from other 'wise women' in the neighbourhood. This knowledge was not always correct; some of it was based on superstition, but much of it was founded on centuries of trial and error and the kinds of in-built cultural knowledge of how herbs, foods, basic health care, counselling and a wealth of other common sense practices could overcome or limit health problems and provide the nutritional basis for survival.

There were problems with this age-old structure. Poverty was unrelieved by State welfare, although churches and other benevolent organisations did help the most deprived. While women as mothers were honoured, men tended to play only a limited part in the housework and child-rearing. There was often no escape for a woman living in an impossible position with a violent or neglectful husband. The community demanded far more from her than from her male partner, by way of compliance and virtue. But however unfair gender relations were, at least the family and the parenting role were recognised as a fundamental part of societal functioning.

In India babies are massaged with scented oils, especially when they are ill.

Touching and Holding help physical and emotional development.

In China massage is used to relax upset children by touching acupuncture points.

All babies need a lot of touch and holding, even when they are asleep.

The contrast with much parenting today is stark.

Many a young mother is likely to find herself and her child isolated in a flat, often with a partner but sometimes on her own. Her own mother, aunts and older sisters may live in the same town, but are unlikely to be close by. In place of the steady and continuous support provided by the extended family, she will be dependent on instant advice from other young neighbours who are equally unsure of themselves, and will be watching the unrealistic role models provided by most TV programmes.

Whatever health problems arise, parents can and do turn to the GPs or National Health Service hospitals. However, the idea of resolving minor health problems from ones own and the extended family's inherited knowledge is no longer an option that she is likely to consider.

Everything is done by the book because to do otherwise could be 'dangerous'. On nutritional matters the situation is even more serious. Lacking basic knowledge about what is a good diet for herself or her child, she is likely to rely largely on fast foods, high sugar and high fat meals, with squashes, pies, crisps and other minimally nutritious foods forming a major rather than a minor 'fun' part of the diet.

Depending on which area she lives in, she may have a health visitor visit her in the early weeks and months after the birth, but there is normally no long-term support from that source. It is only when she runs into serious problems with her parenting that she can expect intervention, rather than support, from health visitors or social workers.

In essence the State services and local community are not geared to supporting families until they run into difficulty, and what then occurs is usually intervention rather than support. This is in direct contrast to the previous situation in which young families were routinely supported and protected by their extended family networks, the level of support increasing if or when problems arose.

A new form of peer support

The need for some form of effective parent support for the modern parent led to the development, at the end of the 1970s, of what became known as the Child Development Programme. Initially based on specially trained health visitors, it provided regular monthly home visits to first-time parents as well as to other parents who were facing problems in coping with their parenting responsibilities.

There are, of course, already a multitude of 'parent education' programmes in existence, many of them providing courses to teach parents the basics of child-rearing. Unfortunately most of these programmes are founded on a belief that the professionals who devise them have a superior understanding of parenting basics, which need to be conveyed to the parents if they are to become competent. Because it is easier to get across didactic messages in groups, nearly all those programmes take place in group settings, headed by people who are experts in behavioural, language, health or nutritional fields.

The Child Development Programme approached the question of parent support on the assumption that parents, even young people with limited education or experience, have a basic instinct about their role which needs to be encouraged and developed. A key word in the programme ethos is empowerment, helping the parents to gain control over their lives and their children's development. In training the home visitors much emphasis is placed on helping the parents to identify areas of development about which they may be concerned, and where they need to set their own targets.

The home visitor acts as an equal in encouraging the parents' own ideas, but also uses her own knowledge and experience to question the parents' proposed strategies, if needed, so as to help the parents adapt their strategies and plans more constructively. It has been shown that this approach helps to raise the parents' self-esteem and leads to many improvements in parenting. Those improvements in turn contribute to increased development of their children's language, social and cognitive skills, and improved nutrition and better health.

While the home visitor does not herself make suggestions as to what the parents could do, she is expected to ask the parents what new ideas have they found to be successful, and pass on these ideas to other parents whom she visits. The main informational input from the home visitor takes the form of illustrated cartoon sequences and illustrated recipes. There are nearly 200 cartoon sequences, each occupying a full page in which parenting behaviours are illustrated, presenting serious messages in a light-hearted fashion. On each visit three selected cartoons and a recipe will be brought for discussion and left with the parents.

Thus, in addition to using strategies to empower parents, the programme has a strong informational input, without any attempt to become didactic or tell the parents that they are expected to conform. Indeed, parents are encouraged to make up their own minds on all substantive issues, other than basic problems of child safety.

The value of peer support

Health visitors who have been trained to do support visits in this programme are encouraged to see themselves as the equals of the parents they are visiting, rather than as professionals with superior knowledge or higher status.

A more specific form of peer support has arisen from the development of the Community Mothers Programme, based on the same principles as the Child Development Programme, but making use of more experienced mothers to provide the support visits. This is a most interesting development, as the women chosen for the work are drawn from the same housing estates as the parents they visit, to emphasise the equality of status.

The women are paid a modest amount by way of expenses, but in the more advanced programmes one or two individuals are selected as part-time salaried assistant coordinators, working alongside a professional who has been specially chosen to lead and train the community mothers.

This programme has been very well accepted, even in seriously disadvantaged settings. One problem has been that a number of those trained as community mothers have gained such confidence in themselves that they succeed in getting and holding down jobs. Although in one sense this is a loss to the programme, it is a significant contribution to the community.

The most important effect of this programme is to show parents that the skills of parenting are basic to everyone, rather than something special requiring psychological or other professional insights if one is to be a competent parent. People come to realise their strengths and find out that with encouragement and information they can develop their skills and overcome most of their parenting problems.

Programme achievements

A considerable amount of research and other studies on the effectiveness of this programme have been produced during the past 18 years.

A major research study, based on over 1,000 families in six health authorities across England, Wales and Ireland, was undertaken in the early years, with areas, families and health visitors randomly divided into intervention and control samples. One of the interesting findings from that study was that the improvement in maternal self-esteem contributed to the improvement in child behaviours over the two years of the programme support. Another interesting finding (confirmed in a subsequent field study) was that in one of the programme areas there had been an increase of about a centimetre in the height of programme children, compared with non-programme children in the same area. It was believed that this was due to an improvement in the intervention children's diets.

A number of field studies were undertaken subsequently, using a specially devised Early Health and Development Monitor which recorded health visiting outcomes both in Programme families and in families which had not been involved in the Programme. Among the many findings was the evidence on very high levels of immunisation in programme children – this was prior to the introduction of special incentives for attaining such levels. In a number of authorities it was found that programme children had lower levels of hospitalisation in the first year; this did not always occur, but where it did it suggested that parents were more confident in their understanding of their children and more capable of judging whether or not they needed to be brought to hospital. Again it was shown in a number of studies that the qualitative nutritional intake of programme children improved over that of control children.

Perhaps the most important study was one in which over 30,000 children whose parents had previously been involved in the programme were followed up. It was found that there was a 50% decline in physical abuse, compared to physical abuse levels in the surrounding authority areas, and a 40% reduction in placement on the Child Protection Register.

In Dublin a major controlled study was undertaken by medical and other staff on the effectiveness of the Community Mothers Programme. The findings offered impressive evidence on dietary improvements and changes in a number of parent educational behaviours, in programme children compared with control children.

At a more local level there have been numerous studies of how parents view this programme. In every case the parents speak in the highest praise of an approach which values what they have to contribute, respects their views and asks their opinions.

National and international spread

Over the past 18 years the programmes have spread widely, although cutbacks in National Health Service funding have badly affected or even destroyed some programmes, with health visitors in certain areas being taken off the programme to carry out more medicalised procedures as nurses rather than as public health workers.

There are both urban and rural models of the programme, spread across all four countries of the United Kingdom.

The Community Mothers Programme, which was started in Dublin and is now a very large initiative in that city, has been developed in various parts of the UK and in other parts of the Republic of Ireland. It has also been set up in Western Australia. Similar programmes have been developed in the Netherlands and the USA.

Implications of the peer support approach

The implications of this approach to parent support are quite profound.

The idea of training professionals to guide and teach parents is superficially attractive, given the world-wide problems of inadequate parenting – following on the virtual demise of the close-knit extended family. However, such an approach implies that a gap of status, education and insight is a bar to effective parenting. In fact, effective parenting can develop with any parents given a modicum of understanding and goodwill; what is needed is not didactic teaching but rather an encouragement and development of the inborn skills which can be found in most people, provided they get the right kind of empowering support.

Peer support of parents is likely to be the way forward in the decades ahead, with professionals having a backroom role in monitoring the quality of the support and offering ideas as to how that support by community mothers (and community fathers!) may be improved.

There are major implications for health and health care. This is partly through improved nutrition of the children; the programme focuses equally strongly on helping parents improve their own nutrition – both forms of nutrition contribute enormously to lifetime health. Health and health care are also achieved by helping parents become aware that their own instincts and insights should be taken into account, firstly in becoming more aware of their children's health problems, and secondly in participating alongside the medical profession in deciding what should be done to overcome those problems.

It will be a different world in which parents rather than professionals are seen as the key agents in the development of their children. The current focus on child poverty, children's rights, child development and much else all too often marginalises the role of the parents. Parents and their peer supporters have a great potential if society is prepared to accept that ordinary people have a capacity far beyond what we think possible today. The Child Development Programme has identified this capacity and hopes to develop it further in the years to come.

These and other associated programmes, have been developed by the Early Childhood Development Centre, an independent charity with informal links with the University of Bristol, which housed the Centre throughout most of its years until recently.

Further Information

Further information can be obtained from:
The Director
Early Childhood Development Centre
82a Gloucester Road
Bristol BS7 8BN Tel. 0117–914 7720