Family-based interventions and developmental care programmes: Rationale, difficulties and effectiveness

Abstract

Family-based interventions and developmental care programmes are becoming more widespread in neonatal units and after discharge. These early family-centred, developmentally oriented interventions are based on theoretical framework that supports the rationale for early intervention, including the following: (a) bonding and attachment processes theory, (b) brain development and synaptogenesis and (c) a family-centred philosophical approach. These interventions are time-consuming and costly, so their impact must be rigorously evaluated. Randomised controlled trials are the gold standard for clinical research but are not always suitable for investigating all aspects of an intervention. Other research methods might be useful, including animal research, qualitative research, observational studies using large cohorts and benchmarking. It is also important to evaluate the implementation of complex interventions. Early interventions can be administered during the neonatal intensive care unit and/or after discharge. Here we evaluate the following programmes: the Newborn Individualized Developmental Care and Assessment Program, Creating Opportunities for Parent Empowerment, Family Nurture Intervention, the Infant Behavioral Assessment and Intervention Program, the Mother-Infant Transaction Program, the Infant Health and Development Program, and the Victorian Infant Brain Studies intervention. The theoretical framework, nature and aims of these early interventions differ, but developmental support for the child, parenting education and parental psychosocial support are common elements. Most of the interventions are “cue-based” rather than “protocol-based” approaches that are designed to support the “sensitive parenting” development process. No programme focuses specifically on the mother’s voice, but all support the mother-child relationship in general, including promoting sensitive communication using vocal, visual and behavioural channels.