It took just one new mother to say out loud that she was “so tired” and within minutes all those around her were in tears.
“It was a really special moment,” says Jessica Staines, a mother of three. “It stuck out in my mind.”
A participant in a parent support programme called UpTo2, in Clondalkin, west Dublin, she recalls how the flood of feelings released by that other mother’s candid comment underlined both the vulnerability and the connectedness of the group.
Public health nurses who facilitate UpTo2 observe that about week six is often an emotional milestone. By then, a sense of trust has developed among those taking part in the Incredible Years parent and baby course, which kickstarts the programme. “We had one group where every single person was crying, including us as facilitators,” says Catherine Hanley, assistant director of public health nursing in Dublin West. “What it did was gel the group, they were so tight.”
Friendships made there are likely to continue long after the course is finished.
However, anecdotal accounts of feel-good factors are not enough to measure the effectiveness of such parenting supports. While, globally, there are many “evidence-based” parenting courses on offer, relatively little research has been done here about what works best – when, why, how and for whom – in an Irish context.
The recent launch of results from a five-year investigation, funded by the Health Research Board, into ways of meeting the health and social needs of young families, was timely. This was acknowledged by Ciara Pidgeon, head of a new parenting support policy unit within the Department of Children and Youth Affairs. "Over the next couple of years, we are going to have very important conversations about parenting supports in Ireland, about what people would like to have and what will deliver results," she said at the launch event in Dublin.
The National Economic and Social Forum has estimated that for every €1 invested in prevention and early intervention to support parents and children, the State will get a return of €4 to €7 in the long term.
A central aim of the study, led by Prof Sinéad McGilloway, the founder/director of the Centre for Mental Health and Community Research at Maynooth University, was to evaluate the effectiveness of UpTo2. (It is also known as the Parent and Baby programme in some centres, but will be referred to by the former name in this article.)
Researchers recruited 106 parents taking part in the programme for the ENRICH study – the title being an acronym contrived from “EvaluatioN of wRaparound in Ireland for CHildren and families” – along with another 84 parents who received services as usual for a comparative group.
UpTo2 is described as a “wraparound-inspired” early parenting support service open to all, currently available in Clondalkin (through Blue Skies) and in Drogheda and Dundalk, Co Louth (through the Genesis Programme).
As the name suggests, it works with parents of children aged 0-2 on a programme that is bookended by two Incredible Years (IY) courses – the parent and baby course in phase one, when the baby is about two months, and phase two from around 18 months, concluding with the IY parent and toddler course. Additional components during both phases include baby massage classes, weaning, first aid and play workshops.
A feature of UpTo2 is close collaboration between statutory services – the public health nurses – and voluntary organisations in designing and delivering the programme. Another strand of the ENRICH research was to evaluate the successes and challenges in putting these supports in place, while assessment of cost-effectiveness is still a work in progress.
Initial interviews showed that many with newborns felt ill-prepared for parenting. Feelings of inadequacy, doubt, anxiety and worry, as well as exhaustion and isolation were common.
These findings, say the researchers, underline “a strong perceived need for universal early parenting supports within primary care and community service settings”.
Hanley says public health nurses see “huge isolation” in the housing estates of Dublin West. “Nobody knows their neighbours and the first time these women are at home is when they have a newborn.” Before that, they were always leaving their house in the morning to go to work and not returning until the evening.
“Social supports may be down the country or the other side of the city. It is not easy – suddenly you are on your own at home, in the house with a baby.”
And public health nurse Mabel Murtagh points out that some new parents are homeless and living in hotels, which compounds the isolation.
Peer support
The peer support in parenting programmes such as this is invaluable, as groups are composed of people with children of similar ages, all dealing with much the same issues. “The power of mothers is phenomenal,” says Murtagh, recalling one participant who came from direct provision, feeling very vulnerable and awkward. “These mothers formed a cocoon around her and things were being swapped – it’s just that maternal support, like the village scenario of years ago that we are missing, the sense of community.”
But, of course, that cannot happen until a new mother walks through the door. “One of the things we underestimate is how big a step it is for a parent to join a group,” Alice Malone of the Genesis Programme told a half-day seminar held in September to launch this research.
A lasting improvement in parental confidence among those taking part in UpTo2, as opposed to those receiving services as usual, was one of the key findings of the ENRICH study. The sustained effect over the first two years of the child’s life illustrates that this group-based early parenting intervention “can strengthen parenting confidence and enhance satisfaction with parenthood in the longer-term”, according to the summary report.
“These findings suggest positive long-run changes in parents’ belief in their ability to cope with the demands of parenthood,” it says. Parents who have a greater sense of efficacy in parenting tend to experience more positive mental health and use more sensitive and responsive strategies with their children.
At the outset, the parents’ sense of competence was higher among the group who were receiving services as usual than those registered for the UpTo2 programme – possibly because 70 per cent of the latter were first-time mothers, whereas only 39 per cent of the comparative group were. But while the confidence of those on the programme steadily increased, that of the other group steadily decreased, and the positions were reversed at the time of the third and final follow-up at two years.
However, there were no other differences between the groups as regard to parent wellbeing or child outcomes – at least in the final follow-up. But at about eight months old, results indicated that the programme had positive impacts on both emotional support and the cognitive stimulation being provided to babies in the home.
Importance of communicating
Mothers reported being more aware of the importance of communicating with their chid, some having initially believed their baby could not understand or benefit from interaction at such a young age. Following the advice given, they began to read and play more with their infants.
Even the best-designed early childhood programmes are not going to have the desired results if they are not rolled out effectively. The ENRICH study found “clear evidence of implementation success”, according to research programme manager Dr Gráinne Hickey.
Parent satisfaction was high, with 95 per cent to 100 per cent reporting that they were “satisfied” or “highly satisfied” with the programme and its various components. And the facilitators said they gained both personally and professionally from their role in the programme.
However, the research also flagged problems such as maintaining parental engagement over the two phases of the programme. On average, lower-risk families attended three to four more sessions than those in the higher-risk category.
In additional analysis of the impact of the programme on these two categories, the ENRICH study concluded that the high-risk families registered for UpTo2 did not differ from those in the “services as usual” group on any parent or child outcome measures, “suggesting that there were no intervention benefits for this sub group”.
What participants say about ‘wraparound’ early parenting support
Parents
The UpTo2 programme gave Jessica Staines “a second chance to parent in a more effective way”, she says.
Her third child, Alex, was just six weeks old when she started the programme at Deansrath Family Centre in Clondalkin, Dublin, in September 2018.
“It gave me an opportunity to think about things – especially having had a small gap between the first two” – Amelia, now aged seven and her sister Olivia (5). “I was only figuring out how to get out the door and I was expecting a second.”
On the Incredible Years course, she learnt more about the importance of building connections between neurons in babies’ rapidly developing brains: “The more you do the more they grow; the more they grow, the more you do.”
It also prompted her to do “a lot of reflection”. Being on her third child, “you do look back at your first and think ‘God, I didn’t quite do that . . .’,” she says with a smile.
Staines believes there is “huge” value in parents supporting each other in organised groups such as these and she was very glad to be able to use her experience of breastfeeding to help others.
With her first child, she had tried a private baby massage course but didn’t have a very happy experience, as she was a very fussy baby. The leader, she says, “suggested that maybe the course wasn’t for us. It took me all my energy to get there that day and to be met by that wasn’t helpful.”
Whereas with Alex, baby massage classes were very rewarding, and she feels very lucky that they could do them free this time as part of the wraparound programme. “We do have a lot of services in Clondalkin and we are very, very lucky,” she adds.
Jeannette Traynor says participating in the programme changed not only the way she interacted with her baby, but also how she parented her two older children. The importance of “parentese” was a revelation, says the mother of three from Clondalkin. “The way you talk to them and name everything. You might say ‘look at that big blue ball’ whereas before I would have said ‘there’s the ball’.”
She also appreciated better the value of reading from an early age. She soon saw how her baby, Paige, loved pop-up, sound and touch-and-feel books.
It inspired the family to join the local library. Paige (now aged three) and her older brothers, Devin (8) and Marcus (6), can all choose their own books, whereas before Traynor would try to interest them all in one book, “but as they’re all different ages this didn’t work”.
Public health nurses
Public health nurses combine with community workers in the delivery of UpTo2 but first they have to persuade new parents to give it a go.
They never sell it as a “parenting” programme, says Mabel Murtagh, a nurse working in the Clondalkin area, because otherwise the first reaction can be: “Am I not a good enough parent?” Instead they explain there is a new, community network of support systems for parents like them.
The nurses usually won’t mention it on their first visit to a home but rather on a follow-up visit, or if a parent rings about an issue. Mentioning that there is a great course covering topics such as “settling your baby” and “why is your baby crying?” is often enough to interest them.
“I think people are desperate for information and desperate to be the best parent,” says Murtagh. She sees how new mothers are under pressure from social media, with all the images of women with their high-end buggies, skinny jeans and looking fabulous out enjoying their skinny lattes at six weeks. “Our role is to say that is not the real world.”
As facilitators of the groups, the nurses must take a step back and encourage the parents to share and support each other.
“We’re not the people giving the answers and that is always very difficult for us as public health nurses,” smiles Catherine Hanley, assistant director of public health nursing in Dublin West. “We want to make everything better.”
“I really had to sit on my hands, zip this,” adds Murtagh as she points to her mouth, “and nod and allow the silence to develop.” When the silence develops, the emotions come . . .
Coordinator
Susan Mulroe, co-ordinator of the UpTo2 programme at Deansrath Family Centre in Clondalkin specialises in involving “hard-to-reach” families.
She works with addiction services, the Traveller community and direct provision centres, trying to get the word out about the supports and to encourage participation.
For example, she was determined to enable a mother with triplets from a direct provision centre to attend, although everybody was telling her it would be “impossible”, that the woman would never come near the programme. Mulroe arranged transport for the mother to attend a session of baby massage “and that had to make a difference”.
Although the participants covered by the ENRICH study were all mothers, she is glad to say there are currently three fathers – a lone dad and two partners – on the programme at Deansrath. “That really is a big development since the research.”
Grandparents are also welcome. Ideally, people caring for babies aged about six weeks are registered for the groups, although some are referred with babies up to four or five months.
While 20 parents are signed up for each group, they can expect attendance of 10-15 at each meeting, Mulroe explains. “Once they come through the door, we do our utmost to keep them.”
The struggles of first-time parenthood are common right across the socio-economic spectrum and UpTo2 is open to all. There are four sessions a year, split between Clondalkin and Balgaddy. Groups are quite diverse, Mulroe says, adding: "We don't judge where you're living or what your occupation is."
