A programme designed to improve attachment and address parental issues as well as developing better parent-child relationships
- Tends to show a positive effect on parental mental health and child behaviour
- Evidence is very low strength as studies are small and methodologically limited
- Tentative support for Mellow Parenting as an intervention for families with additional health and social care needs
Overall effectiveness: 1 (maximum 2)
Strength of evidence: 0 (maximum 3)
Overall effectiveness: 1 (maximum 2)
Strength of evidence: 0 (maximum 3)
What is this?
Mellow Parenting (MP) is a programme designed to promote sensitive parenting. It aims to improve parental-child attachment and address parental mental health as well as developing better relationships between parent and child.
How is it meant to work?
Mellow Parenting is a group-based approach designed to support families who have additional health and social care needs who are experiencing relationship challenges with their young children. The parental risk factors that might lead to these needs include exposure to relational violence, mental ill health, problem drug use, adolescent parenthood or social deprivation.
It is a flexible programme based on principles from attachment theory, adult education and behavioural psychology that also offers practical help (for instance help with transport and childcare). Mellow Parenting has also been modified for different groups, such as fathers (‘Mellow Dads’) and babies (‘Mellow Babies’).
Most studies included focused on the main Mellow Parenting intervention (with children aged 1-4), but two focused on Mellow Babies (for children under one year old).
What are the evaluated outcomes?
- Parental mental health
- Child behaviour
How effective is it?
Parental mental health
Overall, Mellow Parenting tended to show a positive effect on parental mental health. This is based on very low strength evidence.
Overall, Mellow Parenting tended to show a positive effect on child behaviour. This is based on very low strength evidence.
This evidence was considered very low strength as data types were diverse, the studies were not independent of the creators of Mellow Parenting and had very small samples, and there was some methodological bias. It is difficult to draw firm conclusions based on very low strength evidence.
The positive effects should be interpreted as a tentative indication that the intervention may be effective for children and families.
Where has it been studied?
The studies were carried out in Russia, Scotland, New Zealand and Northern Ireland. More evidence from the UK would help us understand how Mellow Parenting works in this context. Existing evidence gives tentative support to the position in the UK that Mellow Parenting meets the NICE guidelines for effective parenting programmes.
Who does it work for?
Specific subgroups have not been identified so far. But the samples for all studies included groups with multiple indicators of developmental risk including social adversity, exposure to interpersonal violence, parental substance misuse, parental mental illness or previous involvement of social services.
One study found that Mellow Parenting was not likely to benefit children with reactive attachment disorder.
The evidence that the benefits of Mellow Parenting are shared between both parents and children is consistent with findings from other attachment-informed programmes such as Incredible Years. It is thought that Mellow Parenting occupies a unique place within these programmes due to its focus on families with substantial difficulties, its time-limited, group-based approach and its flexibility in age range.
When, where and how does it work?
The assumption is that Mellow Parenting has a focus on parental mental health and parental sensitivity and therefore leads to improved psychological development for children.
Current research has shown little explanation to support findings or details of the specific routes to outcomes. Future evaluations of Mellow Parenting and other programmes involving parents and young children would benefit from a clear, standardised set of outcome measures focused on tracking change in parental mental health; indicators of child social, emotional and linguistic development and perhaps parent-infant interaction.
What are the costs and benefits?
There is currently no information on the cost-benefit of Mellow Parenting.
How is it implemented?
There are few details in the systematic review of the specific successes or challenges of implementing Mellow Parenting across different cases.
However, use of video feedback and interactive tasks were identified as key enablers to programme delivery. Also, the fact that Mellow Parenting can be delivered by non-specialists who can then work to accreditation as a practitioner gives the programme greater reach.
The following information about implementation was taken from five of the studies that were included in the systematic review.
How is it delivered?
NEWPIN project intervention: For mothers of under-fives with parenting difficulties (an early version of Mellow Parenting). This intervention lasted for four months and included: a psychotherapeutic group for mothers in the morning while children are cared for in a creche; shared lunch involving staff, mothers and children; an activity (cooking or arts and crafts), followed by an afternoon group session with mothers, while children are again looked after in a creche.
At the afternoon session parenting topics were discussed using worksheets and videos of group members were shown, or examples discussed from the lunchtime activity session. Mothers were also given ‘homework’ to try at home and report back to the group.
Mellow Babies: Referrals were provided by health visitors. Mothers were visited by a group facilitator before the beginning and at the end of the group. This visit included videotaping the mother interacting with her baby during the baby’s mealtime.
The group was then attended by mothers and infants between 10am – 3pm, once a week for 14 weeks. Mothers were supported to attend with taxi transport, lunch and creche facilities. Each group session included a morning psychotherapeutic group for the mothers; lunch and playtime with mothers, babies and staff together, followed by an afternoon parenting workshop which drew on videos of the mothers interacting with their babies.
Fathers were invited to three evening sessions which included information about post-natal depression and activities to support interaction with their babies.
Mellow Parenting: One full day per week for 14 weeks, with between 8-10 mothers in a group. Participants might be referred from a variety of service including health visitors, social services or CAMHS workers. Mothers receive a home visit before the group work begins, in some cases two visits.
At one of these visits a video will be taken of the mother caring for their child. Like the previous interventions, sessions include a personal group for mothers; shared mealtimes; activities with mothers and children and analysis and feedback of videotaped material.
In one study with parents of older children aged 6-9 some adaptations were also explored, including adding a programme for children designed to address emotional literacy and self-regulation of emotions, incorporating an additional 4-6 sessions of video feedback and trialling the intervention in a school setting.
Hoki Ki Te Rito (HKTR): a cultural adaptation of the Mellow Parenting programme for Maori mothers and grandmothers of children aged between 0-5. Studied in New Zealand.
Who can deliver it?
- For the NEWPIN project, group sessions were delivered by a clinical psychologist, a social worker and a care worker. Children were looked after in the creche by care workers
- Mellow Babies sessions were delivered by a counselling psychologist and a health visitor
- In Mellow Parenting (Southern Health and Social Care Trust, Northern Ireland, facilitators came from a range of professional backgrounds including health visiting, CAMHS, parenting workers or Family Intervention Teams
- The HKTR (Maori) adaptation of Mellow Parenting was delivered by Maori facilitators. Their professional backgrounds were not specified.
What are the training and supervision requirements?
- In Mellow Babies, monthly supervision was provided by the programme author
- In Mellow Parenting (Northern Ireland), facilitators were trained by the Mellow Parenting organisation in the core programme over three days. Facilitators also had an additional day of training in the Mellow Babies programme. A facilitators’ group was established to support facilitators in the delivery of the programme
What supports good implementation?
Observations from five Mellow Parenting evaluations on features of programme delivery that support good implementation include:
- Facilitators deliver sessions in pairs or in some cases three facilitators are involved
- Parents are invited to attend Mellow Parenting groups on a voluntary basis. They must be aware of what the programme involves and be committed to attending the whole programme, including participation in home videos and completing homework
- The Southern Health and Social Care Trust developed information leaflets for referrers and parents
- Mothers may require preparation and support to help them engage with the programme
- The Mellow Parenting programme is offered to parents but not mandated
- Video assessments in Mellow Babies are carried out using a structured Mellow Parenting Coding system for identifying positive and negative interactions
- Practical aspects of the Mellow Babies and Mellow Parenting programmes that support mothers’ engagement with the programme include providing a safe environment, a creche, transport to and from sessions, lunch, lunchtime activities and training materials
- Some evaluations noted that it may be beneficial for fathers to also receive a similar programme (Mellow Parenting has since developed a programme called [Mellow Dads]https://www.mellowparenting.org/our-programmes/mellow-dads/)
- Some participants in the HKTR (Maori) adaptation of Mellow Parenting said that they valued having facilitators from their own culture
- The evaluation by the Southern Health and Social Care Trust recommended that supervision should be enhanced, so that facilitators receive line management supervision from within their own professional discipline, meet with other facilitators at least four times per year, receive peer supervision four times per year and clinical supervision twice during the delivery of the 14-week programme.
Walsall Council first implemented Mellow Parenting programmes as part of a four-year Parenting Strategy starting in 2011, which was also partly funded by Public Health. The Mellow Parenting courses are offered as part of the parenting support provided by the Early Help Locality Team.
Mellow Parenting was identified as a specialist parenting offer for families who had social worker involvement and a child aged under five. Initially Walsall only offered Mellow Parenting to mums, but in 2013 they recruited a male practitioner to offer a Mellow Dads group.
It costs between £500-£600 per parent participating in a 14-week Mellow Parenting group programme, most of which is spent on childcare workers and transport for parents. Groups are single sex (either mothers or fathers) and tend to have around 12 participants.
Mellow Parenting practitioners in Walsall attend an intensive three-day training course, and are given a manual about how to deliver the course. Accreditation as a Mellow Practitioner is only given once a practitioner has completed a parent group under supervision, and is given a recommendation by their supervisor. Practitioners are also given three sessions of clinical supervision from a Consultant Clinical Psychologist.
Between November 2013 and July 2014, one Mellow Dads group and four Mellow Mums groups were run in Walsall. All of the participants met one of Walsall’s eligibility criteria – they were affected by substance abuse, poor mental health, domestic abuse, were currently involved with Child Protection services or had a history of having experienced poor parenting themselves.
Walsall Council’s internal evaluation found that between starting and finishing the group, parents reported a reduction in identified problems. 72 per cent of parents experienced a reduction in parenting hassles, 88 per cent experienced reduced depression or stayed in normal ranges, 83 per cent experienced reduced anxiety or stayed in normal ranges, 80 per cent had reduced stress or stayed in normal ranges and 66 per cent reported reduced child problem behaviours. 37 per cent of parents also said they were able to stay calmer and had improved their parenting skills.
This evaluation did not include a comparison group, so it is not possible to make a causal link between these changes and the Mellow Parenting intervention. For the full evaluation please refer to Walsall’s published document.
- Mellow Parenting tends to show a positive effect for families at high risk of adverse outcomes
- This effect applies to both outcomes studied: parental mental health and child behaviour
- The evidence is very low strength as most studies have been small and methodologically limited
- More research is needed on how Mellow Parenting might be implemented and how it achieves its outcomes
- We don’t currently know about the costs and benefits of Mellow Parenting programmes so future studies should examine these
- There is tentative support for Mellow Parenting to continue to be recommended in UK national guidelines as an early years intervention for families who have additional health and social care needs.
This summary comes from an original systematic review called:
Mellow Parenting: systematic review and meta-analysis of an intervention to promote sensitive parenting (Angus Macbeth, James Law, Iain McGowan, John Norrie, Lucy Thompson, Philip Wilson)