Powerful risk and protective factors implicated in early emotional and behavioral development can be found in the relationship between parent and child (see Chapter 3). The parent plays a central role, for example, in teaching the child the critical social and emotional regulation skills that are essential for adjustment to the demands of elementary school and peer relationships. Parents also have an indirect effect on emotional development by the extent to which they buffer the child from the effects of poverty or neighborhood violence.
The quality of parenting practices specifically implicated in the development of emotional and behavioral problems is affected in turn by a myriad of contextual factors associated with poverty and, in many cases, with minority status (see Chapter 3). The effects on parenting and child emotional development of interventions to increase the incomes of poor families have not been evaluated in well-designed, randomized trials. Even among the numerous promising early intervention programs targeted directly at specific aspects of parenting, only about 1 in 20 has been evaluated, and many of these have methodological weaknesses (U.S. Department of Health and Human Services, 2001b).
In the findings summarized below, we emphasize randomized studies with objective or multiagent assessment. Trials without postintervention follow-up are cited for their value in establishing the causal status of antecedents to emotional disturbance.
Early interventions directed at improving the parenting of young mothers appear highly promising for the prevention of emotional problems in children before they emerge at school entry. Importantly, the antecedents identified in developmental studies have been shown to be malleable in these intervention studies.
The most promising and carefully evaluated set of early interventions and randomized trials has been the nurse home visitation program developed by Olds and his colleagues (Olds et al., 1986, 1997, 1998). Beginning in the third trimester of pregnancy, women living in poverty with no previous live births were identified for a public health nurse visitation program that was targeted at specific and well-established early risk factors. Program targets included prenatal care, maternal diet, and reductions in cigarette smoking. The program provided mentoring and strong emotional support for the mother.