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New Research: Health Visitor delivered programme reduces behaviour problems in young children

25th May 2021

A Voices blog sharing the research of Beth Barker and Paul Ramchandani from the Play in Education, Development & Learning (PEDAL) Research Centre, University of Cambridge.


A brief, home-based parenting programme delivered largely by health visiting teams has been found to reduce behaviour problems in young children up to two years after programme delivery.

Behaviour problems are common, affecting about 5-10% of children. We know that the earlier we can support families the better. But we are currently lacking evidence-based interventions that can be offered to families at the earliest signs of these difficulties when children are still in toddlerhood. Even programmes that have been found to be helpful have rarely been tested in ‘real-world’ NHS settings with health professionals delivering the programme as part of their wider caseload.

In the Healthy Start, Happy Start study, we aimed to support families who reported difficulties with their children’s behaviour by testing a six-session, home-based, attachment-focused parenting programme called Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (or VIPP-SD). The study was a randomised controlled trial run by Imperial College London and the University of Cambridge in partnership with health visiting teams across six NHS sites, and funded by the NIHR HTA programme. This was the first study in the UK to trial the delivery of this programme in NHS settings.


The VIPP-SD programme adopts a sensitive, strengths-based approach by really focusing in on positive moments shared between caregivers and their children. To bring this to life for families, video clips of them interacting with their children during everyday moments are used by the programme’s health professionals to highlight the important role that parents play in their children’s lives. The goal of the programme is to support caregivers to become more ‘in tune’ with their child, to notice their child’s subtle behavioural cues and signals, to empathise, and to provide sensitive and responsive parenting. Previous research has shown that this parenting style can have positive impacts on the parent-child relationship and children’s overall development.

During the Healthy Start, Happy Start study, 300 families with one- and two-year olds were followed up for two years until their children were three- and four-years-old. Half of the families received the programme alongside routine healthcare support, while the other half received routine support alone. We found that the programme improved children’s behaviour problems immediately after families finished the programme but also when we followed them up again two years later.

This clear and striking long-term change in child behaviour tells us that providing tailored supports to families in the 0-3 year period represents a powerful opportunity to intervene early and alleviate these difficulties before they worsen and become embedded.

The findings of this study provide important evidence of the power of health visitors delivering early intervention. We know that improving outcomes for all children and families, in amongst inequalities and disparities that have only been amplified during the pandemic, is going to need more than any one single programme can provide. Instead, to best serve families, health services need investment, funding, and capacity to draw upon an evidence-based menu of supports that can be offered to parents and children as they move through the family life course.

Beth Barker & Paul Ramchandani, PEDAL Research Centre, University of Cambridge.

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