Promoting Parental Skills and Enhancing Attachment in Early Childhood (CAPEDP) Trial

The Parental Skills and Attachment in Early Childhood: Reduction of Risks Linked to Mental Health Problems and Promotion of Resilience Project (CAPEDP) was a demonstration project in France, implemented from 2006 to 2011. CAPEDP enrolled pregnant women who were younger than 26 years old and had one or more of the following risk factors: had less than 12 years of education, qualified for free health care based on low-income status, or intended to raise the child in the absence of the father. The model was designed to promote infant mental health by addressing postnatal maternal depression, improving parenting skills, and promoting healthy mother-child attachment. Psychologists provided home visits that were guided by a series of six DVDs, brochures covering a variety of health and mental health topics, and video recordings of the mother-child interactions. CAPEDP offered families 44 home visits from the third trimester of the mother’s pregnancy to the child’s second birthday.

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In response to an increased number of children living in disadvantaged environments being referred for mental health care, the Parental Skills and Attachment in Early Childhood: Reduction of Risks Linked to Mental Health Problems and Promotion of Resilience Project (CAPEDP) was developed to promote infant mental health and reduce the incidence of infant mental health problems. CAPEDP drew on the framework from the Nurse-Family Partnership (NFP) model and Integrated Services for Perinatal Health and Early Childhood, a Canadian adaptation of the NFP. The model was based on Bandura’s self-efficacy theory, Bronfenbrenner’s ecological model of human development, and Bowlby’s attachment theory. CAPEDP was implemented within and designed to supplement the French system of free public mother-child support and prevention services.

CAPEDP was a demonstration project* funded by the French National Ministry of Health, the French National Institute for Prevention and Health Education, the French National Institute for Health and Medical Research, and the French Public Health Research Institute. It was implemented from 2006 to 2011 by Assistance Publique - Hôpitaux de Paris, the main public university hospital in Paris. No ongoing technical assistance is available.

*The information in this profile represents how the model was implemented during the demonstration trial.

The intended population included mothers who were younger than 26 years old, were less than 27 weeks pregnant, and spoke French fluently enough to actively participate in CAPEDP. Eligible participants also had to meet one or more of the following risk factors: had less than 12 years of education, qualified for free health care based on low-income status, or intended to raise the child in the absence of the father.

Psychologists provided home visits that focused on four themes: (1) the family and its social and cultural network, (2) the mother’s needs and health, (3) creating a safe and stimulating environment for the baby, and (4) the baby’s development. The specific content of the visits varied over the course of the intervention period (with different content offered in the prenatal, 0 to 6 months, 6 to 15 months, and 15 to 24 months periods). Home visitors tailored the visits to the varying needs of each family.

The home visitor recorded a video of the mother and child interacting during daily routines, such as bath and meal time. During the following visit, the home visitor and mother discussed the video together and the home visitor helped the mother reflect on her parenting practices.

To guide the visits, the home visitors used (1) a series of six DVDs on topics such as pregnancy, child care, and child development; and (2) a set of 39 brochures covering a variety of health and mental health topics related to promoting parent-child relationships.

CAPEDP was implemented by home visitors from well-baby clinics.

No information was available about ongoing fidelity guidelines that implementing programs or home visitors were required to meet.

The following staff were involved in implementing the model: home visitors, a clinical supervisor, a project manager who monitored implementation fidelity, and the principal investigator.

The home visitors were clinical psychologists. The supervisor was a child psychiatrist with perinatal and home visiting experience. The supervisor had knowledge of attachment theory, early development, and early psychopathology; and clinical expertise in postpartum depression and parental mental health disorders.

A senior clinician provided weekly individual supervision. The principal investigator met with the home visitors as a group every two weeks. The principal investigator also established a hotline for questions. The project manager monitored home visitors’ fidelity to the intervention manual.

CAPEDP required home visitors to participate in a six-day pre-service training. No information was available on the pre-service training requirements for supervisors. Ongoing training and support on how to use the video recordings of parent-child interactions was provided.

Antoine Guédeney
Department of Child & Adolescent Psychiatry
Hôpital Bichat Claude Bernard124 blv NEY
Paris, France 75018

Email: antoine.guedeney@bch.aphp.fr