Mariska Klein Velderman

Worldwide, parental divorce and separation rates are high. These include impactful experiences to all involved, posing risks on well-being and functioning of parents and their children, and leading to increased professional care seeking. The Dutch ‘Divorce ATLAS’ training aims at informing and empowering parents after divorce or separation. The intervention offers preventive support and psychoeducation in a 2-sessions group program. We aimed to assess the effectiveness of Divorce ATLAS for parents in the Dutch setting. We performed a quasi-experimental study in which we compared parents participating in Divorce ATLAS groups (n = 187) and parents on a waiting list for online support (n = 111). Outcomes included well-being of parents and their children, parental sense of competence and social support, and children’s prosocial behavior. We performed regression analyses to assess differences in outcomes between intervention and control group. Additionally, we measured and reported parental knowledge and trigger to act after the intervention. As compared with routine family support of parents in the control group, the Divorce ATLAS group intervention led to increases in parents’ sense of parenting incompetence (Hedges’ g = 0.19), and in perceived social support (Hedges’ g = 0.23). Moreover, most parents indicated that Divorce ATLAS had increased their knowledge and had triggered them to act accordingly. Hence, the increased sense of parenting incompetence in the intervention group may be due to increased participants’ awareness of their parenting behaviors. In sum, Divorce ATLAS is promising for educating and supporting parents after divorce.

Background: Individual Shantala Infant Massage is an intervention that is offered by several Dutch Preventive Child Healthcare (PCH) organizations as optional preventive support, in addition to basic care as offered to all children. It targets vulnerable families and aims to enhance sensitive parenting and to reduce (effects of) parental stress. The intervention is carried out by a certified nurse. It consists of three structured home visits. Parents learn to massage their infant and receive parenting support. This study aims to investigate the effectiveness and the process of the intervention. The main hypothesis is that Individual Shantala Infant Massage leads to increased parental sensitive responsiveness, lower perceived and physiological parental stress, and improved child growth and development in the intervention group, compared to a control group where this intervention is not offered by PCH. Secondary research questions address effects on parenting confidence and parental concerns regarding the infant, the influence of background characteristics and the intervention process. Methods: The study is a quasi-experimental non-randomized trial. The aim is to include 150 infant-parent dyads in both the intervention and the control group. This takes into account possible attrition and missing data as 105 dyads with complete data per group are sufficient for analysis. All participants complete questionnaires at T0 (pre-test, child age between six-sixteen weeks), T1 (post-intervention, or ± four weeks after T0), and T2 (follow-up at five months). At T2, a hair tuft is cut from the parents’ head to measure hair cortisol levels. Data on infant growth and development is obtained from PCH files. In the intervention group, additional data is collected to evaluate the intervention process: parents complete an evaluation questionnaire at T1, nurses keep semi-structured logbooks of intervention sessions and interviews are conducted with parents and professionals. Discussion: Study results can contribute to the evidence base of infant massage as applied in Dutch PCH, and can inform parents, PCH practitioners, policy makers and researchers both inside and outside the Netherlands on feasibility and effectiveness of the infant massage intervention as applied in this format and setting. Trial registration: ISRCTN registry: ISRCTN16929184. Date (retrospectively) registered: 29/03/2022.

Background: The outbreak of the COVID-19 pandemic required the transition of health-related face-to-face group interventions to an online setting. While it seems that group outcomes can be realized in an online setting, less is known about resulting potential challenges (and advantages) and how these can be overcome. Objective: The aim of this article is to explore what challenges and advantages may arise when providing health-related small group interventions in an online setting and how to overcome these challenges. Methods: Scopus and Google Scholar databases were searched for relevant literature. Effect studies, meta-analyses, literature reviews, theoretical frameworks, and research reports relating to synchronous, face-to-face, health-related small group interventions, online group interventions, and video teleconferencing group interventions were identified and screened. Findings relating to potential challenges and corresponding strategies are described. In addition, potential advantages of online group settings were explored. Relevant insights were gathered until saturation of results relating to the research questions was reached. Results: The literature indicated several aspects that require extra attention and preparation in the online group setting. These include the delivery of nonverbal communication and affect regulation, as well as the build-up of group cohesion and therapeutic alliance, which seem more challenging online. Yet there are strategies to overcome these challenges, such as metacommunication, collecting participant feedback, and providing guidance concerning technical accessibility. In addition, the online setting provides opportunities to reinforce group identity, such as by allowing independence and the ability to create homogeneous groups. Conclusions: While online, health-related small group interventions offer a considerable number of possibilities and benefits compared to face-to-face groups, there are also potential drawbacks to consider, which, if anticipated, can be to a great extent overcome.

The preceding chapters provided an overview of what has happened in the field of attachment-based interventions during the past three decades. The methodological pitfalls were described and the effectiveness of various types of intervention studies presented, with the somewhat unexpected conclusion that the most intensive, broadband interventions do not necessarily lead to the highest gains in sensitivity or attachment security.

The case study of Sarah and her daughter Linda described in this chapter offers an example of the implementation of four sessions of VIPP and VIPP-R in the Leiden intervention study. The intervention aimed at enhancing sensitive parenting and infant security and restructuring maternal insecure mental representations of attachment. Sarah's participation in the intervention resulted in positive effects on her sensitivity as well as on her daughter's attachment security. Overall, meta-analytic results demonstrate that short-term interventions focusing on sensitive parenting are most effective (Bakermans-Kranenburg, Van IJzendoorn, & Juffer, 2003; see Chapter 5). Positive effects on parental sensitivity were accompanied by positive, albeit somewhat smaller effects on attachment security. Because of the diverging outcomes of intervention studies, there is need to look more closely at the processes leading to successes in enhancing sensitive parenting and preventing or altering insecure attachment in young children. By examining the program implementations and process evaluations of more and less successful interventions (e.g., Lambermon, 1991; Lieberman, Weston, & Pawl, 1991), we may gain more insight into effective components of interventions and into the process of intergenerational transmission of attachment.

Conflicten tussen ouders kunnen schadelijke gevolgen hebben voor kinderen, zoals gedragsproblemen, slaapproblemen en slechte schoolprestaties. De manier waarop conflicten tussen ouders benaderd worden lijkt hierin een belangrijke rol te spelen. In de literatuur wordt onderscheid gemaakt tussen destructieve en constructieve conflicthantering. Bij destructieve conflicten gebruiken ouders negatieve conflictstrategieën, zoals dreigend en agressief gedrag of het negeren van de ander. Bij constructieve conflicten gebruiken ouders tactieken gericht op het toewerken naar een oplossing of het versterken van de relatie. Het is de vraag of de negatieve gevolgen van conflicten zich ook manifesteren wanneer ouders een constructieve conflictstrategie hanteren. In deze literatuurstudie is de impact van constructief conflict tussen ouders op de psychosociale problemen en emotionele onveiligheid van kinderen onderzocht. Psychosociale problemen betreffen internaliserende en externaliserende problemen. Emotionele onveiligheid betreft de onveiligheid die kinderen ervaren binnen het gezin. De resultaten van de studies toonden geen of een negatief verband tussen constructief conflict en psychosociale problemen en een negatief verband tussen constructief conflict en emotionele onveiligheid. Als ouders op een constructieve manier met conflict omgaan lijkt dit zodoende niet te leiden tot negatieve gevolgen voor de kinderen. Interparental conflict can have severe consequences for children, including behavioral problems, sleep problems and poor academical performance. The way in which interparental conflicts are managed seem to play an important role in the extent to which the conflicts affect children. The literature on interparental conflict distinguishes different forms of interparental conflict, including destructive and constructive conflicts. During destructive conflicts, parents use negative tactics such as threatening the partner, using aggressive behavior or ignoring the partner. During constructive conflicts, parents use tactics aimed at working towards a solution or strengthening the relationship. The negative consequences of destructive conflict are well established. The question is whether these negative consequences also occur when parents’ conflict is constructive. Therefore, this literature review investigates the influence of constructive conflicts on the psychosocial problems of children and on children’s emotional insecurity. Psychosocial problems include internalizing and externalizing problems. Emotional insecurity is the feeling of security children experience at home. Results revealed no association or found a negative association between constructive conflict and psychosocial problems. Moreover, the studies revealed a negative association between constructive conflict and emotional insecurity. Finally, emotional insecurity was found to mediate the relationship between constructive conflict and internalizing and externalizing problems. Thus, constructive conflicts between parents do not lead to negative consequences for their children.

BACKGROUND The outbreak of the COVID-19 pandemic required the transition of health-related face-to-face group interventions to an online setting. While it seems that group outcomes can be realized in an online setting, less is known about resulting potential challenges (and advantages) and how these can be overcome. OBJECTIVE The aim of this article is to explore what challenges and advantages may arise when providing health-related small group interventions in an online setting and how to overcome these challenges. METHODS Scopus and Google Scholar databases were searched for relevant literature. Effect studies, meta-analyses, literature reviews, theoretical frameworks, and research reports relating to synchronous, face-to-face, health-related small group interventions, online group interventions, and video teleconferencing group interventions were identified and screened. Findings relating to potential challenges and corresponding strategies are described. In addition, potential advantages of online group settings were explored. Relevant insights were gathered until saturation of results relating to the research questions was reached. RESULTS The literature indicated several aspects that require extra attention and preparation in the online group setting. These include the delivery of nonverbal communication and affect regulation, as well as the build-up of group cohesion and therapeutic alliance, which seem more challenging online. Yet there are strategies to overcome these challenges, such as metacommunication, collecting participant feedback, and providing guidance concerning technical accessibility. In addition, the online setting provides opportunities to reinforce group identity, such as by allowing independence and the ability to create homogeneous groups. CONCLUSIONS While online, health-related small group interventions offer a considerable number of possibilities and benefits compared to face-to-face groups, there are also potential drawbacks to consider, which, if anticipated, can be to a great extent overcome.

This study aims to assess the identification rates in a developmental monitoring system (i.e., preventive child healthcare, PCH system) regarding identification of emotional, behavioral (EB) problems, cognitive developmental and family problems in children, and the contribution of such a system to referral to (specialized) mental health and social care services. Over a predetermined period of 6 months, we retrieved data from a random sample of 1370 children aged 0 to 18 years from the registries of two PCH organizations in the Netherlands. We assessed the degree to which PCH professionals identify EB and cognitive developmental and family problems and invite children with these problems for follow-up PCH assessments or refer them to (specialized) mental health and social care services. Among preschool-aged children, we identified 22% with EB problems, cognitive developmental and/or family problems (mainly EB and family problems). Among school-aged children, numbers varied from 10 to 14% (mainly EB). PCH invited 3 to 10%, varying in proportions of child age, for a follow-up assessment, and referred 0 to 4% of the children to external services. Conclusion: A developmental monitoring system with only preventive tasks may help to identify children with EB, cognitive developmental, and/or family problems. This can lead to early support for most of these children, with low referral rates to (more specialized) mental health and social care services. Our findings deserve validation in comparable settings and in other countries. What is Known: • Well-child care requires monitoring of the health and development of children for timely identification of problems and subsequent intervention. • The Dutch Preventive Child Healthcare system is an example of a developmental monitoring system with only preventive tasks. What is New: • A developmental monitoring system with only preventive tasks may help to identify children with problems, resulting in early support for the majority. • This may reduce referral rates to (more specialized) mental/social health services.

Worldwide, many children experience parental separation and divorce. This has a significant impact on their well-being, and emotional and behavioral functioning, and calls for prevention. To assess the effects of the Children of Divorce Intervention Program in the Netherlands (CODIP-NL) on 6- to 8-year-olds, we performed a quasi-experimental effect study. The study compared children receiving CODIP-NL (intervention: I, n = 104), children not receiving CODIP-NL but having divorced parents (divorced control: DC, n = 37), and children belonging to non-divorced families (non-divorced control: NDC, n = 138). Outcomes pertained to children’s positive functioning, emotional and behavioral problems, and well-being. We assessed pre- to post-test differences in change in mother-reported outcomes between the intervention and control groups, and pre- to post-test differences in group leader reports. The intervention led to increases in mother-reported positive functioning (d = 0.97 I vs. DC; d = 1.04 I vs. NDC), and well-being (d = 1.00 I vs. DC; d = 0.84 I vs. NDC). Mother-reported child emotional and behavioral problems decreased after participation (total difficulties, d = 0.73 I vs. DC; d = 0.49 I vs. NDC). Group leader-reported pre- to post-test differences (p ≤ 0.001) pointed in the same directions. Findings support further implementation of CODIP to support children’s positive functioning and well-being, and to decrease emotional and behavioral problems after their parents’ divorce.