"By providing early support, we want to enhance children's opportunities"

Eveline von Arx: What does “early childhood support” mean to you?

Andrea Lanfranchi: It’s about providing support for parents so that they are able to offer their children the stimulation they need for healthy development. Roughly 10 percent of families in Switzerland need additional help because they are struggling with a variety of complex challenges.

EvA: What does that mean?

AL: It means that children in these families are growing up in situations of neglect, since their parents face challenges that limit their ability to meet their parenting responsibilities. It may mean that they are affected by poverty, unemployment, psychological problems or trauma. When the issues of poverty or migration are coupled with unfavorable living conditions and a lack of social networks, this results in a confluence of stressors that can pose a risk to a child’s development and later school success. This is the focus of our Swiss longitudinal study known as ZEPPELIN (Zürcher Equity Präventionsprojekt Elternbeteiligung und Integration), a Zurich-based research and prevention project that promotes parent participation and integration.

EvA: What kinds of families are included in the ZEPPELIN study?

AL: Families that have been exposed to cumulative psychosocial stressors. We conducted a randomized controlled trial (RCT), with families randomly assigned to either the intervention or the control group. Several times a month, over a period of three years, families in the intervention group received support from trained parenting coaches. At various points, we examined the effects of these interventions.

EvA: What factors were measured?

AL: We used video recordings to measure maternal sensitivity in interactions with children, and we also measured child development – the latter with the help of various tests. The study’s interventions to promote healthy development began during pregnancy, but focused particularly on the first three months after the child’s birth.

EvA: What were the goals of the ZEPPELIN study?

AL: The study seeks to determine whether the early-childhood program known as Parents as Teachers (PAT) does in fact have a positive effect on children’s intelligence, language, behavior and social integration. We are also looking at whether it improves parenting skills.

“There is a gap between children who have and have not benefited from language support in the first few years of life.”

EvA: What have the results shown so far?

AL: Findings from the first three years suggest that the program has positive effects on a number of different levels. Thanks to the study design and controls for a number of variables, we can confidently conclude that the observed effects are due to the specific strengths of the PAT program, which is not true of other early childhood programs. We found significant effects in the areas of cognition, language and behavior among children in the intervention group, relative to the control group.

The health questionnaires showed, among other things, that children in the intervention group were less anxious and slept better than their counterparts in the control group. We found no significant effects on motor skills. With respect to parenting skills, mothers who participated in the PAT program showed greater sensitivity to their children.

Collaborating with Ulrike Ehlert of the Department of Psychology at the University of Zurich, we were even able to find biological correlates for these psychological/parenting mechanisms. With more sensitive mothers, children in the PAT program are less stressed. We demonstrated this by measuring the level of cortisol in their fingernails and DNA methylation in their saliva.

EvA: How were parenting skills defined?

AL: One factor was the level of stimulation found in the child’s environment, including the home. Does the child have access to appropriate toys and puzzles? Do the parents encourage their children, for example by helping them name objects or colors while at play? Or – to give a negative example – is the television set always switched on?

EvA: What other effects did you find?

AL: In the intervention group, we found an expansion of social networks. This might mean, for example, that mothers attended German classes or visited a library or community center. Mothers (or parents) were accompanied on their first visits by their parenting coaches as a way of helping them become familiar with the available infrastructure resources.

EvA: Have other countries found similar effects?

AL: The PAT program originated in the United States and was later adapted for use in Germany. Model projects in the US have shown larger effects in that country. This is related to the fact that in Switzerland and Germany, in contrast to the US, the level of basic services for young children and parents is already quite high. Such services include counselling for mothers, playgroups, child care centers and comprehensive pediatric care. Even small effect sizes should therefore be viewed positively. It is also important to note that ZEPPELIN is the only study of early childhood interventions in Switzerland that uses an RCT design.

EvA: Can you tell us more about the interventions? And about the parenting coaches?

AL: In most cases the parenting coaches are maternal consultants who have undergone additional training. They pay home visits to the families at specified times, approximately twice a month. Schedules are adapted to meet the needs of each family on a case-by-case basis; sometimes visits will be more frequent, sometimes less. The important thing is continuity.

The parenting coach helps the mothers/parents improve their parenting skills and supports the child’s development. Coaches must always be careful, however, not to make parents feel that they are doing something “wrong.” They should not lecture the parents or make them feel insecure.

EvA: Do you monitor what the coaches are doing?

AL: Once a year, home visits are videotaped and analyzed in the interest of quality control. For one-third of the families, we used interpreters at the beginning of the program.

EvA: Why is it important to intervene at such an early age?

AL: It is clear from the literature that the first few years of life are enormously important for a child’s development and for educational and learning opportunities. Some studies have shown that interventions during the preschool or primary school years come too late, particularly for language development. At that point, it may well be impossible to correct deficits in this area.

There is a gap between children who have and have not benefited from language support in the first few years of life, and that gap may widen after they enter school. That’s why it’s so important to begin providing intensive, professional support at the earliest possible stage.

EvA: What’s next for ZEPPELIN?

AL: The children in the study will enter preschool in August 2016. We now want to measure the long-term effects of the program to determine whether they are sustainable. We will be conducting a follow-up study during the preschool year, first grade and third grade. The families in the study will continue to have the opportunity for group meetings with other parents as a way of ensuring ongoing support. In cooperation with the Department of Education of the canton of Zurich (Office of Youth and Career Services), we are launching a related program called “Lernort Familie 5+”.

The first part of ZEPPELIN is now finished. In the interest of achieving a long-term impact, however, the Parents as Teachers (PAT) program will continue – in the canton of Zurich under the sponsorship of “zeppelin-familien startklar” and in Frauenfeld. St. Gallen and Ticino have recently adopted the program as well.