Anita Schrader McMillan

Publications (4)1.94 Total impact

• Article: Parenting for mental health: what does the evidence say we need to do? Report of Workpackage 2 of the DataPrev project.

  Sarah L Stewart-Brown, Anita Schrader-McMillan
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  ABSTRACT: The last decade has witnessed increasing interest in the promotion of mental health and well-being because of its importance for health and social functioning at individual level and for the social and economic well-being of societies. Recent research from a range of disciplines (including neurodevelopment, developmental psychology and genetics) has highlighted the importance of childhood, and particularly the first few years of life, for future mental, social and emotional development. The quality of the parent-child relationship and parenting more generally is one of the factors in determining outcomes. The objective of this review was to identify effective interventions to support parents, parenting and the parent-child relationship from the ante-natal period to adolescence. A systematic search of key electronic databases was undertaken to identify systematic reviews evaluating approaches to parenting support; 52 systematic reviews were identified. Results were synthesized qualitatively and reported under the following headings: (i) perinatal programmes; (ii) parenting support programmes in infancy and early years focused on enhancing caregiver sensitivity and attunement; (iii) formal parenting programmes focused on children's behaviour; (iv) parenting support for highest risk groups. The review provides a robust international evidence base of programmes which have been demonstrated to improve parenting and the mental health and well-being of children. Policies and programmes to support parenting offer much scope for improving mental health. Effective provision requires a skilled workforce and careful application of approaches that have been found to work. More research is needed to develop and identify interventions for some of the highest risk groups.
  Health Promotion International 12/2011; 26 Suppl 1:i10-28. · 1.94 Impact Factor
• Article: ‘It was good to learn how to show affection’: Central American men who reject hypermasculinity

  Anita Schrader McMillan, Moli Paul
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  ABSTRACT: To understand why some men ‘reproduce’ socially legitimated violence in their relations with other men, women, children and sub-alterns, and some do not, it is necessary to go beyond structural accounts to an understanding of the dynamics through which cultural demands, environmental constraints and socialisation shape subjectivity. This is an exploratory study of a small sample of men, who reject the use of disciplinary violence towards children and differ from the ‘hegemonic’ hypermasculine norm in other domains. Attention is drawn to the critical role of attachment experiences in enabling men to reject violence as a normative practice. These experiences appear to have galvanised these men's capacity to accurately interpret their own mental states and those of others. Para entender las rezones por las cuales algunos hombres ‘reproducen’ a la violencia legitimada por la sociedad, en sus relaciones con otros hombres, con mujeres, niñ@s y grupos subalternos, es necesario mirar más allá de los factores estructurales, y trazar la manera en la cual la cultura, el entorno, y la socialización afectan a la subjetividad. Este estudio exploratorio de un pequeño numero de hombres que rechazan el machismo hegemónico en sus entorno, y de incluyendo el uso del ‘castigo’ físico como forma de socializar y educar a sus hij@s. Se llama la atención en particular, al apego y a los factores comúnmente asociados con la resiliencia psicológica, en explicar el proceso por los cuales estos hombres llegan a rechazar a la violencia. Los hallazgos de este estudio exploratorio son congruentes con otros, que llaman la atención a la capacidad de los hombres que rechazan a la violencia, de interpretar a sus propios estados mentales y comprender la subjetividad de l@s otr@s.
  Community. 08/2011; Work & Family(Vol. 14):367-382.
• Article: Home and community based parenting support programmes and interventions: report of Workpackage 2 of the DataPrev project

  Sarah L. Stewart-Brown, Anita Schrader McMillan
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  ABSTRACT: The last decade has witnessed an increasing interest in the promotion of mental health and wellbeing because of its importance for health and social functioning at the individual level and for the social and economic wellbeing of societies. Recent research from a range of disciplines has highlighted the importance of the quality of the parent-child relationships and parenting on children‟s emotional and social development, and on adult mental health and wellbeing. Intervention studies involving children of all age groups have shown that if parenting can be influenced for the better outcomes can be changed. The DataPrev project was funded by the 6th Framework of the European Community Research Programme under Policy-Orientated Research with the aim of establishing a database of evidence-based programmes in Europe that promote mental health and wellbeing and prevent mental illness throughout the life course. This is the report of the Workpackage 2 describing the international evidence base on programmes to support parenting, including home and community based programmes.
• Source

  Available from: Sarah Stewart-Brown

  Article: Systematic review of interventions for the secondary prevention and treatment of emotional abuse of children by primary carers

  Anita Schrader McMillan, Jane Barlow, Sarah L. Stewart-Brown, Yvonne Carter, Peter Sidebotham, Moli Paul
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  ABSTRACT: Background Emotional abuse (or psychological maltreatment, as it is more commonly called in the US) is an inadequately researched and poorly understood concept, despite increasing awareness about the harm it can cause to children‟s lives. Although it unifies and underpins all types of maltreatment it also occurs alone and when it does, tends to elude detection and intervention. There have to date been no systematic reviews of the literature on the secondary prevention and treatment involving the parents or primary carers of emotionally abused children. Objective The objective of the review was to identify studies that evaluate the effectiveness of interventions in the secondary prevention and treatment of child emotional abuse involving the parents or primary carers of children aged 0 – 19 years. Methods Studies were included if they involved any intervention which was directed at emotionally abusive parenting and that measured change in (i) emotional unavailability (ii) negative attributions (i.e. that involve the parent attributing negative intentions, beliefs or attitudes toward the child); (iii) developmentally inappropriate interactions; (iv) lack of recognition of children‟s boundaries; (v) inconsistency of parenting role; (vi) missocialisation or consistent failure to promote the child‟s social adaptation. The primary outcomes evaluated involved proxy measures of a range of parent, family and child outcomes including parental psychopathology, parenting attitudes and practices, family functioning and/or child behaviour and the child‟s development and adaptation. . A broad search strategy was developed in order to identify as many relevant studies as possible. An electronic search of a wide range of databases was carried about. No study type was excluded. The search was augmented by direct contact with academics and practitioners known in this field. The search included studies written in English, Spanish, French and German. Studies were included if the intervention was described, and the impact on at least one indicator of emotional abuse was assessed. Included studies were critically appraised by two reviewers using standard criteria. Data were extracted using a standard proforma, and a qualitative synthesis of results was carried out. Results The initial search yielded 4248 publications of potential interest. Of these, 175 were obtained for possible inclusion or as background material. A total of 21 studies of 18 interventions, met all the inclusion criteria. A further 43 studies were relevant, but did not meet all of the inclusion criteria. Studies were organised according to the type of emotional abuse targeted: emotionally abusive parenting; parents of infants with faltering growth; missocialisation: parenting interventions with substance-abusing mothers. Twelve included studies had quantitative designs. Of these, 6 comprised randomised controlled trials; 1 comprised a follow-up of a randomised controlled trial; 2 were controlled studies; and 3 had one-group pre- and post-designs. The remaining 9 were case studies. Included studies involved a wide range of interventions. The 8 studies for parents which address emotionally abusive parenting (rejection, misattribution, parent-child role reversal and anger management) involved evaluations of cognitive-behavioural training (CBT), behavioural training and parent-infant psychotherapy. Two further case studies involved cognitive-behavioural training, mentalisation and family-based therapy. The 9 interventions with parents of infants with faltering growth evaluated CBT, behavioural training, parent infant psychotherapy and interaction guidance; lay home visitors, and a range of therapeutic options based on the diagnostic condition of the parents. The 3 studies of interventions for substance abusing mothers evaluated a relational psychotherapy group for mothers, and a residential treatment for substance abuse with a parenting component. The sample sizes for quantitative studies were small and ranged from 17 to 98 participants. Ten interventions involved mothers alone, while a further 11 included fathers, either at the outset or at a later stage, and in 3 cases extended family members. Interventions for emotionally abusing parents The findings from the 8 included studies evaluating CBT, psychotherapy, and behavioural approaches suggest that group-based CBT may be an effective means of intervening with this group of parents, although it cannot currently be recommended with parents experiencing symptoms of severe psychopathology. While one comparative study showed a psychotherapeutic intervention to be more effective than a CBT focused intervention, the outcomes measured in this study (i.e. parent and child representations) favoured the former. Behavioural case work involving the use of problem-solving techniques may also have a role to play with some parents, although further research is still needed. Interventions to enhance parental sensitivity The findings from a systematic review of 81 interventions that aimed at enhancing parental sensitivity and / or infant attachment found strong evidence that short term (less than 16 sessions) interventions, with a behavioural focus and aimed exclusively at enhancing maternal sensitivity were also most effective in enhancing infant attachment security. This supports the notion of a causal role of sensitivity in shaping attachment. Interventions that included fathers as well as mothers showed higher effect sizes but results are tentative since they are based on a small number of small scale trials. Parental behaviours associated with faltering growth Nine studies evaluated a range of interventions with parents of babies with faltering growth including interaction guidance, home visiting; parent-child psychotherapy, behavioural casework and multi-component interventions. The findings show that interaction guidance and parent-infant psychotherapy may be potentially effective means of working with this group of clients along with behavioural casework, but that further research is needed before these can be recommended. Missocialisation: Parenting interventions for substance-abusing parents 5 studies (one of which was a 6-month follow-up) evaluated interventions for substance abusing mothers, including a relational psychotherapy group and a residential treatment for substance abusing adults with a parenting component. The findings show that initial gains made in the former were not sustained at 6-months and few benefits from residential intervention. Conclusions Emotional abuse is a complex issue resulting in part from learned behaviours, psychopathology and/or unmet emotional needs in the parents, and often compounded by factors in the families‟ immediate and wider social environment. As such, a „one-approach-fits-all‟ is unlikely to lead to sustained change. The evidence base is weak, but suggests that some caregivers respond well to cognitive behavioural therapy. However, the characteristics that define these parents are not clear. There is currently no evidence to support the use of this intervention alone in the treatment of severely emotionally abusive parents. Some of the evidence suggests that a certain form of emotional abuse (for example, highly negative parent affect, which may be expressed as frightened and frightening behaviours in the parent) stemming from unresolved trauma and loss, is less amenable to CBT. There is some evidence that interaction guidance and psychotherapeutic approaches can generate change in parents with more severe psychopathology. Further research is urgently needed to evaluate the benefits of both psychotherapeutic and cognitive behavioural interventions, including those which take the form of family therapy, with parents at the more severe end of the spectrum, with fathers, and with older children. There is also a need to gain further understanding about which forms of emotional abuse respond best to different treatments.