***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Children displaying psychosocial problems are at an increased risk of negative developmental outcomes . Parenting practice s are closely linked with child development and behaviour , and parenting programmes have been recommended in the treatment of child psychosocial problems . However , parental mental health also needs to be addressed when delivering parenting programmes as it is linked with parenting practice s , child outcomes , and treatment outcomes of parenting programmes . This paper describes the protocol of a study examining the effects of a combined intervention of a parenting programme and a cognitive behavioural intervention for mental health problems . Methods / design The effects of a combined intervention of Triple P Discussion Groups and Stress Control will be examined using a r and omised controlled trial design . Parents with a child aged 3–8 years will be recruited to take part in the study . After obtaining informed consent and pre-intervention measures , participants will be r and omly assigned to either an intervention or a waitlist condition . The two primary outcomes for this study are change in dysfunctional/ineffective parenting practice s and change in symptoms of depression , anxiety , and stress . Secondary outcomes are child behaviour problems , parenting experiences , parental self-efficacy , family relationships , and positive parental mental health . Demographic information , participant satisfaction with the intervention , and treatment fidelity data will also be collected . Data will be collected at pre-intervention , mid-intervention , post-intervention , and 3-month follow-up . Discussion The aim of this paper is to describe the study protocol of a r and omised controlled trial evaluating the effects of a combined intervention of Triple P Discussion Groups and Stress Control in comparison to a waitlist condition . This study is important because it will provide evidence about the effects of this combined intervention for parents with 3–8 year old children . The results of the study could be used to inform policy about parenting support and support for parents with mental health problems . Trial registration Clinical Trial.gov : NCT01777724 , UTN : U1111 - 1137 - 1053 AIMS To determine whether home intervention by a specialist health visitor affects the outcome of children with failure to thrive . METHODS Children referred for failure to thrive were r and omised to receive conventional care , or conventional care and additional specialist home visiting for 12 months . Outcomes measured were growth , diet , use of health care re sources , and Bayley , HAD ( hospital anxiety and depression ) , and behavioural scales . RESULTS Eighty three children , aged 4–30 months , were enrolled , 42 received specialist health visitor intervention .  Children in both groups showed good weight gain ( mean ( SD ) increase in weight SD score for the specialist health visitor intervention group 0.59 ( 0.63 ) v0.42 ( 0.62 ) for the control group ) . Children < 12 months in the intervention group showed a higher mean ( SD ) increase in weight SD score than the control group ( 0.82 ( 0.86 ) v0.42 ( 0.79 ) ) . Both groups improved in developmental score and energy intake . No significant differences were found for the primary outcome measures , but controls had significantly more dietary referrals , social service involvement , and hospital admissions , and were less compliant with appointments . CONCLUSIONS The study failed to show that specialist health visitor intervention conferred additional benefits for the child . However , the specialist health visitor did provide a more coordinated approach , with significant savings in terms of health service use . Problems inherent to health service research are discussed Objective To evaluate the effectiveness of a parenting programme as a preventive intervention with parents of preschool children considered to be at risk of developing conduct disorder . Design Pragmatic r and omised controlled trial using a block design with allocation by area . Setting Eleven Sure Start areas in north and mid-Wales . Participants 153 parents from socially disadvantaged areas , with children aged 36 - 59 months at risk of conduct disorder defined by scoring over the clinical cut off on the Eyberg child behaviour inventory . Participants were r and omised on a 2:1 basis , 104 to intervention and 49 to remaining on the  wait  listing ( control ) . Twenty ( 13 % ) were lost to follow-up six months later , 18 from the intervention group . Intervention The Webster-Stratton Incredible Years basic parenting programme , a 12 week group based intervention . Main outcome measures Problem behaviour in children and parenting skills assessed by self reports from parents and by direct observation in the home . Parents ' self reported parenting competence , stress , and depression . St and ardised and well vali date d instruments were used throughout . Results At follow-up , most of the measures of parenting and problem behaviour in children showed significant improvement in the intervention group . The intention to treat analysis for the primary outcome measure , the Eyberg child behaviour inventory , showed a mean difference between groups of 4.4 points ( 95 % confidence interval 2.0 to 6.9 , P<0.001 ) on the problem scale with an effect size of 0.63 , and a mean difference of 25.1 ( 14.9 to 35.2 , P<0.001 ) on the intensity scale with an effect size of 0.89 . Conclusion This community based study showed the effectiveness of an evidence based parenting intervention delivered with fidelity by regular Sure Start staff . It has influenced policy within Wales and provides lessons for Engl and where , to date , Sure Start programmes have not been effective . Trial registration IS RCT Summary .The aim of the present study was to test the effectiveness of the Prevention Program for Externalizing Problem Behaviour ( PEP ) .  PEP has already been evaluated as an efficacy study , i.e. , with high internal validity . The main concern of the current study was to test the effects of PEP under conditions of high external validity.58 child therapists of 37 local institutions of the public health system held  PEP trainings . The intervention was evaluated by a within-subject control group design with three assessment points , two before ( pre1 and pre2 ) and one immediately after ( post ) the PEP training . Depending on the type of analysis , 198 up to 277 families with children aged 3–10 years were included . Data were collected by question naires and comprised symptomatology of the child and the mother as well as parenting . For parenting and child behaviour problems , changes after treatment were greater than changes during the waiting period . PEP produced effect sizes in the small to moderate range . The results suggest that PEP can be delivered under routine care setting s without loss of positive treatment effects . As worse results are often obtained in effectiveness trials , these findings have to be regarded as particularly promising Thirty preschoolers from low-income families participated in a 12-month intervention programme , funded by Sure Start , which engaged them in scaffolded educational activities delivered at home by their mothers . Immediately following the programme , the intervention group outperformed matched controls in tests of academic knowledge , receptive vocabulary , and inhibitory control , but not short-term memory or theory of mind . Teachers ' ratings of children 's capabilities upon school entry favoured the intervention group , especially in terms of listening , responding , writing , mathematics , and personal/social skills . Superior inhibitory control , short-term memory , and numerical skills were associated with higher ratings whereas theory of mind made a unique , negative contribution to responding . We discuss the implication s of these findings for efforts to nurture the development of cognitive self-regulation and school readiness during early childhood OBJECTIVES To determine whether increased postnatal support could influence  maternal and child health outcomes . DESIGN This was a r and omised controlled trial comparing maternal and child health outcomes for women offered either of the support interventions with those for control women receiving st and ard services only . Outcome data were collected through question naires distributed 12 and 18 months postr and omisation . Process data were also collected . There was also an integral economic evaluation . SETTING AND PARTICIPANTS Women living in deprived enumeration districts in selected London boroughs were eligible for the trial if they gave birth between 1 January and 30 September 1999 . RESULTS The 731 participants were found to be well matched in terms of socio-economic characteristics and health and support variables ( 14 % of the participants were non-English speaking ) . Response rates at the two follow-up points were 90 % and 82 % . At both points there were no differences that could not be attributed to chance on the primary outcomes of maternal depression , child injury or maternal smoking . At the first follow-up , there was reduced use of general practitioners by support health visitor ( SHV ) children , but increased use of NHS health visitors and social workers by mothers . At the second follow-up , both community group support ( CGS ) and SHV mothers had less use of midwifery services ( fewer were pregnant ) , and SHV mothers were less worried about their child 's health and development . Uptake of the CGS intervention was low : 19 % , compared with 94 % for the SHV intervention . Satisfaction with the intervention among women in the SHV group was high . Based on the assumptions and conditions of the costing methods , the economic evaluation found no net economic cost or benefit of choosing either of the two interventions . CONCLUSIONS There was no evidence of impact on the primary outcomes of either intervention . The SHV intervention was popular with women , and was associated with improvement in some of the secondary outcomes . This suggests that greater emphasis on the social support role of health visitors could improve some measures of family well-being . Possible areas for future research include a systematic review of social support and its effect on health ; developing and testing other postnatal models of support that match more closely the age of the baby and the changing patterns of mothers ' needs ; evaluating other strategies for mobilising ' non-professional ' support ; developing and testing more culturally specific support interventions ; developing more culturally appropriate st and ardised measures of health outcomes ; providing longer term follow-up of social support interventions ; and exploring the role of social support on the delay in subsequent pregnancy AIM This paper describes a process evaluation that was conducted alongside a r and omized controlled trial of out-of-home pre-school day care . The evaluation aim ed to : ( 1 ) describe the intervention ; ( 2 ) document the day care received by participating families ; ( 3 ) describe the social context of the trial ; and ( 4 ) provide data to assist in the interpretation of trial outcomes . METHODS The setting for the trial was an out-of-home day care Centre in Hackney , East London . Process data were collected through the use of question naires , interviews , and research er field-notes .  Data from question naires were collected from 120 mothers and included data on 143 children . Interviews were undertaken with 21 participating mothers . Staff also completed question naires and the Head of the Centre was interviewed . The quality of care provided was assessed using the Early Childhood Environment Rating Scale . RESULTS Process data collected during the trial suggest that the day care provided was education-led , flexible in catering to families ' needs , and was of a very high quality . The social context of the trial result ed in financial pressures , which may well have influenced the intervention provided . Data collected through in-depth interviews suggested that it may be the flexibility of day care that is particularly important in allowing women to return to paid employment , but that the loss of benefits when starting work may have meant no increase in household income . CONCLUSION The paper illustrates the value of conducting a process evaluation alongside a r and omized trial , particularly where complex interventions are involved . In this case , where the intervention was not provided by the research team , the evaluation allowed an insight into the content of a multifaceted intervention , which is useful in interpreting the trial 's results , and in explaining the possible effects of the social context on the intervention The effectiveness of a parenting program with 394 Head Start mothers was examined . Nine Head Start centers were r and omly assigned to either an experimental condition in which parents , teachers , and family service workers participated in the intervention or a control condition in which the regular Head Start program was offered . Mothers in the intervention group were observed at home to have significantly fewer critical remarks and comm and s , to use less harsh discipline , and to be more positive and competent in their parenting when compared with control mothers . Teachers reported that intervention mothers were more involved in their children 's education and that their children were more socially competent . Intervention children were observed to exhibit significantly fewer conduct problems , less noncompliance , less negative affect , and more positive affect than control children . One year later most of the improvements were maintained Data from the 1958 National Child Development Study ( 1958 - 2004 ) were used in a prospect i ve study of the relation of  financial adversity in childhood to lung function in midlife . It was hypothesized that such a relation would be found and would be mediated partly by early housing deprivation , partly by continuities in social disadvantage , and partly by smoking . These hypotheses were confirmed . The mediating variables explained nearly two-thirds of the observed relation . The strongest individual pathway from early financial hardship to adult lung function was through poor housing in childhood . Poor housing increased the risk of educational failure , which in turn was strongly related to less-advantaged social class . Lack of educational qualifications and less-advantaged social class independently increased the risk of higher levels of smoking . Mediating variables therefore acted in part as indicators of environmental exposures and in part through their links to adult smoking . Early financial adversity is associated with adult lung function partly through poor housing and partly through pathways involving continuities in social disadvantage and the associated environmental exposures and behaviors 
    Output:
    
Programmes offering intensive support , information and home visits using a psycho-educational approach and aim ed at developing parent ’s and children ’s skills showed more favourable outcomes .
These were parenting behaviours , overall children ’s health and higher level of fine motor skills and cognitive functioning .
Child injuries and abuse were also reduced .
Conclusions Interventions with better outcomes and a higher level of evidence combined workshops and educational programmes for both parents and children beginning during early pregnancy and included home visits by specialised staff .