EIF PROGRAMME REPORT TODDLER-PARENT PSYCHOTHERAPY JULY 2016
2 How to read an EIF Programme Report This Programme Report should be read in conjunction with our guidance on How to read an EIF Programme Report, which provides an explanation of the contents of the summary material. This can be found on the EIF website. Scope This assessment is based on information gathered through the EIF s review of What Works to support parentchild interaction in the period from conception to age 5 years in order to improve child development. The child outcomes reviewed were limited to impacts on attachment and/or parent sensitivity; behaviour and social and emotional skills; and cognitive development, in particular early literacy and use of language. The rating included represents an assessment in relation to these outcomes only. Disclaimer The information in this report and the rating of impact is designed to provide information for those developing early intervention programmes and systems. The evidence can be used to inform and assist professional judgement, but it is not a substitute for it. This Report does not purport to contain all the information that may be required by third parties in order to exercise their judgement. Evidence about what has worked in the past offers no guarantee that an approach will work in all circumstances. Every effort has been made to ensure the accuracy of the information, but no legal responsibility is accepted for (i) any errors or omissions (negligent or otherwise); and (ii) any consequences resulting from the use of or reliance on this Report. The Report includes reference to research and publications of third parties: the Early Intervention Foundation is not responsible for, and does not guarantee the accuracy, completeness, timeliness or availability of, those third party materials or any related material. The Early Intervention Foundation does not perform an audit and undertakes no duty of due diligence or independent verification of any information (including, but expressly not limited to, information about costs of the programmes) it receives from third parties including the programme providers. The rating is an independent judgement based on the facts reported to EIF as of the date expressed. It is not a recommendation or a statement of fact. This Report is provided on an as is basis without warranty of any kind, either express or implied.
3 Summary: Toddler-Parent Psychotherapy Programme Description Brief Description Based on the version of the programme evaluated in its best evidence. Primary Outcome Domain: Attachment Delivery Model: Individual Therapy Child Age: Toddlerhood Level of Need: Targeted - Indicated Full Description - Based on information agreed with the programme developer, this section describes the programme more generally in terms of recommended or typical implementation. Toddler-Parent Psychotherapy (TPP) is a psychoanalytic intervention targeting mother-infant dyads that may be at risk of an insecure attachment. Specifically, it aims to prevent or shift an insecure to a secure attachment, as measured by Ainsworth s Strange Situation. Mothers identified as being depressed, anxious, traumatised or at risk of maltreating their child attend weekly sessions with their infant (approximately 20-months old at the beginning of the programme). The sessions are delivered by practitioners with a Master s (or higher) qualification in psychology or social work. During each session, the practitioner helps the mother reflect on her own childhood experiences and differentiate them from her current relationship with her child through empathic, non-didactic support. The practitioner also engages jointly with the mother and infant, so that he/she can model sensitive responding and suggest positive explanations for the child s behaviour. As the therapeutic relationship develops, the mother learns to dissociate negative feelings informed by her own childhood from her interactions with her infant, and appropriately interpret her infant s behaviours. Ratings Summary Strength of Evidence of Child Outcomes Toddler-Parent Psychotherapy (TPP) has preliminary evidence from an RCT. 2+ This study identified statistically significant positive impacts on a number of child and parent outcomes. The conclusions which can be drawn from this study are limited by methodological issues pertaining to high levels of attrition precluding use of intention-to-treat analyses. Programme Costs Unavailable EIF has attempted to estimate the relative cost of programmes per family or child on the basis of information about resource requirements submitted by the provider. In this case, the required information has not been provided. Impact Toddler-Parent Psychotherapy has evidence suggesting impact on a number of child and parent outcomes. We do not report effect sizes from studies which do not satisfy the criteria for an EIF Level 3 rating, as estimates of effect are likely to be biased (potentially to the extent that they indicate a programme is effective when it has no effect). Some key examples of statistically significant impacts include: Child attachment outcomes. Reduction in toddlers with disorganised attachment classification coded observation.
4 The evidence for Toddler-Parent Psychotherapy also demonstrates a range of impacts for the parent, including improved scores on the Dyadic Adjustment Scale (of relationship satisfaction). Implementation Summary Based on information provided by the programme developer, this section describes the programme more generally in terms of recommended or typical implementation. TPP is delivered in 32 sessions of approximately 1 to 1.5 hours duration each by one clinical practitioner with QCF-7/8 qualifications (and 92 hours of programme training). Booster training for practitioners is recommended. It is recommended that practitioners are supervised by one host-agency supervisor (qualified to QCF-7/8 level) with 92 hours of programme training. There is no licensing requirement to run this programme. In Detail Level of need Low need X Moderate need High need Classification Universal X Targeted: Selective Targeted: Indicated Specialist Programme requirements Highly Specialist X Format Sessions Number of practitioners required to deliver it Delivered to individuals 32 sessions of 1 to 1.5 hours duration 1 Practitioner requirements Job Title or Profession of Practitioner 1st Master s level clinical practitioner Qualification Level 1st Recommended QCF 7/8 Hours of programme training 1st Accreditation/certificati on required? 92 hours (7 days face-to-face training with 36 hours of phone consultation). No Booster training? Yes Supervision requirements Number of supervisors 1
5 Type of supervisor Host-agency supervisor providing clinical, skills and case-management supervision Qualification level Recommended QCF 7/8 Training 92 hours Host agency requirements Licensing fee No Evidence Details Toddler-Parent Psychotherapy has evidence from one RCT conducted in the USA. Summary of impact evaluation informing the EIF evidence assessment Study Design Country of Origin Sample Child Outcomes Parent Outcomes 1. Cicchetti et al. (1999). RCT USA 201 mothers at risk of depression with a 20-month infant Attachment security No changes Toth et al. (2006). Attachment security (recoded) Not measured Peltz et al. (2015). Increased relationship satisfaction References References of main studies informing the EIF evidence assessment Cicchetti, D., Toth, S.L. & Rogosch, F.A. (1999). The efficacy of toddler-parent psychotherapy to increase attachment security in off-spring of depressed mothers. Attachment and Human Development, 1, 34-66. Toth, S.L., Rogosch, F.A., Manly, J.T., & Cicchetti, D. (2006). The efficacy of toddler-parent psychotherapy to reorganize attachment in the young offspring of mothers with major depressive disorder: A randomised preventive trial. Journal of Consulting and Clinical Psychology, 74, 1006-1016. Peltz, J.S., Rogge, R.D., Rogosch, F.A., Cicchetti, D. & Toth, S.L. (2015). The benefits of child-parent psychotherapy to marital satisfaction. Families, Systems and Health, Advanced on-line publication: http://dx.doi.org/10.1037/fish00000149.