1. The best start at home: what does the evidence say?

2. Focus and method of the review 1. What works to improve parent-child interaction in order to improve (a) attachment, (b) social-emotional and behavioural development and (c) language and communication skills? 2. Interventions could be universal or targeted prevention, and needed to focus on children from conception to age 5 years. 3. In terms of evidence, studies could lie on a spectrum from formative (e.g. pre-post) to those with multiple randomised controlled trials. 4. We looked at 100 interventions, identified through (a) searches of programme databases and other reviews, (b) a questionnaire to EIF Places and (c) expert consultation. 5. We reviewed the evidence in terms of: (a) what the intervention comprises, (b) evaluation quality, (c) impact and (d) implementation issues.

3. Analytical framework 1. 3 outcomes: (a) attachment and parental sensitivity, (b) social-emotional and behavioural development, and (c) language and communication skills. 2. 3 levels of prevention: (a) universal, (b) selective and (c) indicated. 3. 8 types of intervention: (a) media-based (b) individually delivered (c) live demonstration (d) group-based (e) group-based with adjunctive components (f) home visiting (g) self-administered (h) multicomponent

4. (1) Attachment and parental sensitivity 1. There is some evidence to support the use of parent-infant psychotherapy to improve secure attachments in infants who may have experienced traumatic events such as abuse, and who consequently display attachment, or emotional and behavioural problems. 2. The evidence for techniques involving live demonstration, such as through infant massage and video feedback, where there is elevated risk (i.e. selective prevention), is stronger for impact on parents than it is for impact on attachment. 3. The evidence for home visiting interventions is mixed, with comparison group study and formative evidence of an impact on the parent-child relationship (including sensitivity and responsiveness) but less evidence of an impact on attachment. 4. The evidence is limited for universal media-based and universal and selective group- based interventions, in large part because of the relatively small number of studies.

5. (2) Social, emotional and behavioural development 1. The strongest evidence is for indicated group-based parenting programmes (i.e. where children have early signs of developmental problems), which show an impact on parenting and child behaviour. This is supported by strong systematic review level evidence. 2. The evidence for universal and selective group-based programmes, or for group-based interventions with adjunctive components, is more limited and mixed. 3. The evidence is also strong for individually delivered interventions for families with complex problems and/or with children displaying behaviour problems in terms of improving parenting and reducing child abuse potential and child behaviour problems. 4. Although few universal media-based and universal and indicated self-administered programmes were identified, there is comparison group level evidence of an impact on child behaviour, and systematic review level evidence supports the use of self-administered programmes at the indicated level.

6. (3) Language and communication skills 1. There is reasonably strong evidence for home visiting programmes (largely selective), most of which have comparison group studies demonstrating effectiveness in areas such as parent responsiveness and aspects of children’s development (e.g. pre-reading skills) 2. Evidence from comparison group studies of multicomponent interventions (also largely selective, and involving home and community-based elements) is mixed but on balance can be seen to help parents support their children’s learning and improve some child outcomes (including language and reading). 3. There is formative and to a lesser extent comparison group evidence to support the use of book- sharing interventions in which dialogic reading/booktalk is encouraged, although the impact on parenting behaviours is measured more than the impact on children’s language. 4. Finally, the evidence reviewed suggests that baby signing applied at a universal level does not have an impact on children’s language development, and that group-based behavioural parenting programmes may need additional subject-specific content if they are to have a positive impact on parents’ use of language in interactions with their children.

7. Reference Axford, N., Barlow, J., Coad, J., Schrader-McMillan, A., Sonthalia, S., Toft, A., Wrigley, Z., Goodwin, A., Ohlson, C. & Bjornstad, G. (2015) The Best Start at Home: What Works to Improve the Quality of Parent-Child Interactions from Conception to Age 5 Years? A Rapid Review of Interventions. London: Early Intervention Foundation. http://www.eif.org.uk/publication/the-best-start-at-home/

8. Contact details nick.axford@dartington.org.uk www.dartington.org.uk