Promotion of mental health is an important topic and early interventions may be the most
cost-effective investment for the society. The Child Health Care (CHC) in Sweden reaches 99%
of parents with infants and is the society's major promotive support during the first years
of life. All Children in Focus (ACF) [in Swedish: Alla Barn i Centrum (ABC)] is a universal
program aiming to support positive parental strategies and promote child well-being. ACF has
shown positive effects for parental efficacy and strategies and for child well-being at age
3-12 years. In this 3-year project the investigators aim to gain knowledge about how ACF
given to parents with children 1-2 years (Little ACF) may influence parenting and child
well-being. Specific research questions are how Little ACF in comparison to care as usual
(CAU) within CHC can:
strengthen strategies of emotional regulation in parents,
promote parenting practices,
promote child well-being
lead to reduction of child behavior problems (externalizing/internalizing),
engage and retain parents in groups?
Parents with infants of 12-24 months that are registered at any of the included CHC centers
in Stockholm, Gotland and mid-Sweden will be asked for participation. Recruitment will be
performed at the ordinary 10-, 12- or 18-months visits of the child. The CHC nurse will ask
parent/s for participation verbally and parents will be provided the information and consent
form and a pamphlet about the study. Parents who are interested in participating will be sent
a link via email with the same information and consent form that can be signed digitally.
Thereafter they will be sent the questionnaire. When the CHC nurse has recruited twice as
many parents as a full Little ACF group, the researchers will randomize the parents into the
two groups, one receiving the intervention Little ACF and the other a control group receiving
CAU and digital lectures. The CHC nurse will notify the parents about which group they have
been randomized to and a description on how the study will proceed.
A previous randomized study of ACF (aimed at parents with children 3-12 years) showed an
effect size (Cohen's d) of 0.30 for parental self-efficacy. Since this study compares Little
ACF with CAU including lectures (instead of waiting list), a marginally smaller effect (d =
0.25) between the groups is expected. With a significance level of 95% (p-value 0.05) and a
power of 80%, it would thus be needed 251 participants in each group. A drop-out rate of 25%
is expected, which means that a total of 670 families would need to be included.
Each Little ACF group will consist of parents of 5-7 children, which means that about 60-70
groups will be needed and thus a total of 25 group leader pairs if each pair leads three
groups. The pair of group leaders consist of one CHC nurse and one social worker or other
profession with experience of working with parents of young children. Group leaders will be
provided a training containing theory, practical exercises, and supervision. The training is
spread out over three occasions taking place every other week to allow for the possibility to
start Little ACF groups in between the training sessions. After the training, the group
leaders will be offered monthly group supervision.
Effects of Little ACF on positive parenting and strategies are assessed through parental
questionnaires distributed digitally to be completed independently by the parents. Child
well-being is measured through parental questionnaires and data in CHC records. CHC nurses
will be invited to semi-structured interviews to gain a better knowledge in how the
experience of Little ACF affect daily work at CHC. Quantitative data will be analyzed
statistically with linear regression models and qualitative data will be analyzed using
thematic analysis.
This study adds to the evidence of promotion during infancy and give information if Little
ACF is effective for parents and young children. It may also reduce needs of future
interventions of mental health problems.