Dialogues with parents: a parental support and empowerment program based on the Touchpoints Model

“Dialogues with Parents-welcoming, listening, and empowering” aimed to understand the impact of an innovative approach supporting parents with identified social/emotional vulnerabilities. Program goals included the promotion of positive parenting, the expansion of parents' knowledge and skills, and the enhancement of parent–child interactions. Based on the Brazelton Touchpoints Developmental-Relational Frameworks, the program applied strength-based assumptions and relationship-based practices to underpin empathic and collaborative relationships with families, seeking to strengthen their confidence in parenting. Two modalities were offered with a modular structure from prenatal–newborn to 6 years. Both included 10 modules, one in which the same group of parents carried out the complete sequence of sessions (Continuous Group) and a second in which parents selected one Touchpoint according to their needs and “drop in” to the session(s) of their choice (Touchpoints 1 by 1 Group). Data were gathered through satisfaction questionnaires at the end of each encounter. A focus group was also held with parents from the Continuous Group. The difference between applications (248) and total participation (99) indicates that parent's interest in participating is high but only a third managed to join the groups. Nevertheless, the results were very positive, highlighting the quality of the Touchpoints approach and program implementation, namely its impact on improving parents' understanding of children's development and of their own role in parenting. Parents particularly valued the opportunity to actively participate in the encounters and, in the Continuous Group, the usefulness of the encounters for themselves as a person and as parents.

1. Introduction

Life opportunities for each individual are fundamental in early childhood, with life-long implications for health and wellbeing (UNICEF, 2017). The care that families can provide for their children is core to the quality of those life opportunities. Therefore, the support provided to families is essential to enhancing parenting competencies, particularly if adjusted to their identified strengths and needs (Doyle et al., 2023). The current knowledge about the relevance of the early years of life (Fox et al., 2010; Shonkoff et al., 2012) offers us the opportunity to promote new theories of change and innovative strategies that support the wellbeing and development of children, families, professionals, and communities. There is a very robust scientific basis for the importance of healthy family relationships as critical to parent and child wellbeing inherent to caring for and being cared for. The Center on the Developing Child at Harvard University (2017) and the National Scientific Council on the Developing Child (2020) highlight the power that caring reciprocal relationships, which promote emotionally positive early life experiences, have in building strong brain architecture in children through “serve and return” interactions between young children and their parents.

The Brazelton Gomes-Pedro Foundation intervention program, “Dialogues with Parents-welcoming, listening, and empowering”, is based on this developmental science and provides relational and developmental guidance for positive parenting. It is a parental support program aimed at enhancing the relationship between parents and children and promoting the optimal emotional development of children, based on the Touchpoints Model. This developmental and relational model, created by Brazelton (1992), describes Touchpoints as periods throughout the first years of life “during which children's spurts in development result in disruption in the family system” emphasizing that “the succession of touchpoints in a child's development is like a map that can be identified and anticipated. They are centered on caregiving themes that matter to parents (e.g., feeding and discipline), rather than traditional milestones” (Brazelton and Sparrow, 2003, p. 1). The Touchpoints approach has an established evidence base showing improved developmental knowledge by parents and providers, improved parent–provider relationships, and reduced parental stress (Swartz and Easterbrooks, 2014; Ayoub and Vele-Tabaddor, 2018), proposing a shift of paradigm in the intervention with families: from prescription to collaboration; from objectivity to empathy; from a linear to multi-dimensional and systemic understanding of development; from inflexible professional boundaries to flexible ones.

The goals of this parenting program are embedded in the Touchpoints approach: to scaffold parents in practicing positive parenting, support them and widen their knowledge and skills about their children's development and their own development as parents, and enhance the sensitivity and attunement of their interactions with their child. The Touchpoints strength-based parent assumptions and guiding principles (Brazelton and Sparrow, 2003, p. 3) underpin the relational strategies with families to build strong provider partnerships with parents, improve parental wellbeing, and support development and learning in a systemic and lasting way.

This innovative model of parenting program based on anticipating known periods (touchpoints) of increased stress associated with children's expectable and necessary developmental process builds upon family strengths, regarding parents as the experts of their children especially when parents might be doubting themselves and/or others are doubting the parents. Expected program results for the direct beneficiaries included increased parental wellbeing and confidence, self-perceived empowerment, sense of self-efficacy, and increased understanding about children's development.

This research report briefly presents the initial findings regarding parents' satisfaction with the program and its impact on parental confidence, understanding of child development, and usefulness as parents and individuals.

2. Methods

2.1. Program description

The modular structure and sequence of group encounters are based on anticipating the Touchpoints periods of disorganization and increased parental stress inherent to developmental progress (prenatal–newborn; 3–8 weeks; 4, 7–9, 12, 15, and 18–24 months; 3, 4–5, and 6 years), delivered in two modalities: (a) the Continuous Group, in which the same group of parents participates in all 10 modules, following the whole child developmental process from prenatal to 6 years; or (b) the Touchpoints 1 by 1 Group, in which parents select the Touchpoint according to their needs, namely the age of their children.

Beneficiaries of the program were parents with children from pregnancy to the age of 6 years, with identified simultaneous risk factors across environmental, cultural, social, and emotional domains. Families were invited to apply based on eligibility for family allowance support and/or other social support programs such as Early Childhood Intervention.

The program had a coordinator who closely accompanied its stages. Each group had a responsible facilitator in charge assisted by a second member of the Brazelton Gomes-Pedro Foundation's team of Touchpoints trainers.

All the encounters had the support of two volunteers to ensure that parents who needed to bring their children had this possibility.

2.2. Preparation for “dialogues with parents”

The preparation and engagement period were crucial for strengthening the program and for the establishment of a solid affiliation with the Growing Better Platform in Cascais (Plataforma Crescer Melhor em Cascais) in which the Brazelton Gomes-Pedro Foundation is a partner and consultant. This community-based platform actively contributed to the program by engaging more than 40 children's institutions (from children birth to 6 years) integrated within its systems such as nurseries and kindergartens. Dialogues with Parents was fully integrated with the strategic vision for the development of early childhood in the Municipality of Cascais in which 200 early childhood professionals (educators and assistants) were fully trained in the Touchpoints approach. Just 33 km away from Lisbon, Cascais is the fifth most populous town in Portugal with 214,000 residents (INE, 2021).

Twenty representatives of the Growing Better Platform's entities/institutions participated in an initial strategic planning meeting, allowing (i) the presentation of the program's aims and target groups, (ii) the identification of the actions and daily contact among partners with multiple challenged families in situations of greater vulnerability (Melo and Alarcão, 2011), and (iii) reflection on the best places and time to implement the parent group encounters. This resulted in a collaborative reflection on the consequences of the pandemic, such as new vulnerability circumstances that had become particularly visible to the Growing Better Platform representatives in their daily interactions with families. In particular, they identified a high number of families with increasing financial and mental health vulnerabilities who did not benefit from public social support. The local early childhood intervention team also stressed their recommendation for parents with children with developmental disorders to have the opportunity to participate in these encounters.

The strategic planning also resulted in the scheduling of venues and dates according to the host organization's availability and motivation for engaging in the program. The area with the largest number of institutions that supported families in more vulnerable conditions was chosen to host the Continuous Group, and all encounters were hosted by the Cooperativa TorreGuia nursery (March 2022 to April 2023).

For the Touchpoints 1 by 1 Parents Group, each of the 10 encounters was allocated to diverse entities/institutions for Children in the Municipality of Cascais. The intention was to distribute the encounters to 10 diverse places in the municipality. The Cascais Municipal Council Team broadened the possibilities with suggestions for cultural/artistic places beyond the Growing Better Platform. These proposals identified host institutions across nurseries/kindergartens and the facilities of a museum, deeply reaching into the community to meet families where they are.

The Brazelton Touchpoints Center (Boston, USA) assisted in validating documents and support instruments, namely the Touchpoints Parenting Program training manual for parents/families, which was completely translated into Portuguese.

2.3. Dissemination and participants' recruitment

Promotional materials to generate parent group participants were displayed in all the Growing Better Platforms in Cascais institutions. Families with children from 0 to 6 years old could express their interest through an online application system, sharing socio-demographic information used for application approval for eligibility associated with risk factors.

At the same time, applications for volunteer caregivers were opened. Concerning parents' applications, in the Continuous Group, the number of participants was limited to 20. The aim was to create a sense of cohesion and belonging among parents to allow an open dialogue based on the commonality or complementarity among parental experiences and life circumstances, strengths, and needs. The goal of cultivating in-depth knowledge across early childhood development required a Continuous Group experiencing the process together. For each encounter of the Touchpoints 1 by 1 Group, the number was limited to 25 parents to enhance involvement and equal opportunity for participation.

2.4. Encounters' organization

All encounters were carefully organized. Facilitators engaged in a reflective process involving the preparation and evaluation of each encounter. The encounters followed an organization supporting an active dialogue with parents, leveraging their participation. Table 1 presents the organization of the encounters for both group conditions.

TABLE 1

Table 1. Dialogues with parents—encounters agenda.

Institutional directors and/or educational teams were present at the encounters to provide logistical support (opening the institution on Saturday; preparing the space; offering a mid-morning snack; and preparing the room to welcome the children). The host organization teams did not implement the group facilitation processes inherent to the intervention.

2.5. Data collection and analysis

Data were gathered through a final satisfaction questionnaire for both groups in each encounter. The satisfaction questionnaire asked about how the encounters met the parents' initial expectations; the length, time, and place of the encounters; the organization and importance of the shared themes; the opportunity for parents to actively participate; the relationship with the facilitators and other parents; and the usefulness of the encounter for themselves as a person and as parents, as well as the impact of the encounters on their understanding of child development (Likert type questionnaire). It ended with open questions: “what I liked most was…,” “what I liked least was…,” “this meeting was important for me because…,” and “other comments and suggestions”.

A focus group was also held with parents from the Continuous Group using a semi-structured script exploring the impact of the training, namely on parental confidence and satisfaction, understanding of child development, and usefulness as a mother/father and person. It was conducted by the program coordinator, with the support of a facilitator, after the last encounter, and lasted 40 min. Four mothers and one father volunteered to participate giving their informed consent.

Frequency distribution (descriptive analysis) was used to describe and summarize the quantitative data. Open-ended questions and focus group data were qualitatively analyzed. Coding was done using a combined deductive (inspired by open-ended questions and a focus group script) and inductive (data-driven) approach to explore the participants' experiences and views from their own perspectives.

3. Results

3.1. Continuous touchpoints parent group

3.1.1. Socio-demographic data

Of the 20 accepted applications, 11 parents completed higher education, 5 finished secondary education, 3 parents finished lower secondary education, and 1 parent did not answer. Regarding work status, 1 mother was on maternity leave, 14 parents were employed, and 5 were unemployed. All were Portuguese except for one Brazilian mother; four were male participants and 16 were female participants. Three were married couples consisting of a father and mother. The group of participants included families with a mother, father, and children, as well as four single-parent families with a mother and children.

Regarding the number of children, the group had 34 children in total. Eight families had one child, seven families had two children, and four families had three children. At the beginning of the encounters, one of the families included a pregnant mother. In the encounters, some parents brought their children, and one child came to all the encounters with her mother. Eighteen children attended daycare and kindergarten.

Most children lived with their mother and father; one with mother and father alternately, two with their mother, and one with mother, grandparents, and cousins.

With regard to public support, 17 families benefited from public family allowance, and the local early intervention team supported 5 children and families.

3.1.2. Parents satisfaction

The attendance was irregular—some of the parents with accepted applications and confirmed attendance ended up coming to only one encounter. Therefore, only 11 parents were considered effective participants in the Continuous Group, having taken part in more than 5 meetings.

The results show high percentages of parents' positive opinions about their opportunity to actively participate, as well as their strong relationship with the facilitators and other parents. Furthermore, the usefulness of the encounter for them as a person and as a mother/father was highly valued. Only three items—duration, time, and place of the encounter, and organization and importance of the themes—had 2–4% of answers rated as satisfactory. The remaining items were all valued as “good” and mostly as “very good” (Table 2).

TABLE 2

Table 2. Continuous touchpoints parent group—satisfaction questionnaires results^*.

Considering the open-ended questions, we underline the high number of parents' responses that expanded and deepened their reports of the positive impact that the first items indicate. Replies highlighted the value perceived from shared experiences, the interactions among parents and between parents and facilitators, the benefit of a feeling of wellbeing, appreciation for the authentic, non-judgmental setting, and the importance of sharing information and knowledge about children's development with openness and respect. Parents expressed specific appreciation for the emphasis on their strengths.

Regarding satisfaction questionnaire feedback on the importance of the encounters for each of them as a mother or father, parents reported their feeling of belonging and being welcomed with respect, the importance of listening and being listened to, the positive interactions among all, and the expansion of their knowledge concerning the stages of development.

Very few questionnaire responses raised what mothers/fathers “least valued”. In those answers, parents reported that time ran too “quickly” or that the encounters only took place once a month, revealing their appreciation for the time spent in the encounters. Delays in the arrival of the families and the dispersion of the themes “because there is a lot to share” were briefly highlighted too.

Finally, in “other comments and suggestions”, parents left generous words of gratitude and recognition, suggesting the continuity of the program and the opportunity to offer it to more families in the community in general. Parents also suggested holding the encounters in other locations and better time management with even more focus on the themes/development phases.

3.1.3. Focus group outcomes

Parents described what they experienced in the encounters, namely the unity that was established among the participants, the discovery of strengths that allowed them to overcome challenges, their transformation as parents but also as individuals, the safe place of belonging and participation felt during the meetings, and the wish that the meetings would continue.

As participant parents underscored:

“We shared knowledge, techniques, and awareness, but above all, we also allowed ourselves to be human and bring a set of fragilities (...) That first day, we made our group contract, which gave us a security (...) confidence and a very big union, a feeling of belonging, and I think that whatever happens in our lives, we will never forget these sessions.” (Mother 1)

“I had so many worries, I thought my son had so many problems, that when I arrived here (…) it reassured me in relation to his development and the delay (…) helping to understand my son better, understanding better how I have to deal with him and realising that this problem was not only mine. Many times, I thought it was only mine and in the end it wasn't.” (Mother 2)

“This bridge between facilitators and parents, many of whom have already passed through these ages and others who have not yet passed through the ages we spoke about, was really very enriching. I came with no expectations at all because I had never taken part in anything of this kind, and it surprised me.” (Mother 3)

“I started this group a bit disorganised (…) I was going through a very difficult phase, very unconfident as a mother and the difference really is huge! I know that there are several factors, it's not just the group, but it's also very much the group. It's a lot about sharing and of course this whole framework too, isn't it? Of the Touchpoints and of listening to you. Listening to facilitators who have always been human and have always brought their stories and human side. I think this also unites, doesn't it, it also warms you up, it also brings you closer.” (Mother 4)

“Brazelton's vision and what he brings, (...) that development also brings apparent regressions, right? That this is natural, that this can be part of it and that it is ok! It is not a problem (…) He is learning to walk! He is learning to walk and, maybe, there are other things that are a little further behind. It is not possible to learn everything at the same time. I think that's very reassuring!” (Mother 3)

“We can know many things, can't we? Cognitively knowing (…) But another thing is what we shared here! It's really very different. I think that's what makes all this so rich (…) I know that I may fail! To be able to say it out loud and receiving this acceptance from the group. (…) Here, I can fail. Not that I want to, but I can! And I can look at that failure as a learning experience. How can it be different next time?” (Mother 3)

“I don't know what cycles are coming, I don't know what will happen, but I am sure that I will always treasure this group.” (Mother 3)

“I think it has made me a better person.” (Father)

“I think that here we have learned that what we do with love, we do well. And I think that only in a space like this could happen. So, I think repeating this, countless times, for other parents to have these opportunities, would be incredible.” (Mother 1)

3.2. Touchpoints 1 by 1 parent group

3.2.1. Socio-demographic data

A total of 223 applications were accepted for the 10 encounters. However, despite the high number of applications, the number of engaged participants remained mostly between 5 and 18 parents per encounter for a total of 78 participants.

Of the 78 effective participants: 5 parents completed studies up to the third cycle of basic education, 16 parents concluded secondary education, and 48 parents completed higher education. Nine participants did not answer. Regarding work status, 1 mother was on maternity leave, 60 parents were employed, and 9 parents were unemployed. Eight participants did not answer. Participants were of Portuguese nationality except for three Brazilian mothers, one Colombian mother, and one Guinean mother. Participants were mostly mothers (71), and seven were fathers.

Regarding the number of children, 53 families had 1 child, 21 families had 2 children, and 5 families had 3 children, making a total of 110 children. In 4 of the 10 encounters, parents brought their children.

The majority of the children under the age of 6 children were in daycare and kindergarten. Few families had the support of nannies or grandparents. The majority of children lived with their parents; one with mother and father alternately, six with the mother, and one with the grandmother. The composition of the families included seven single-parent families.

With regard to family allowance, 23 families were receiving public benefits, and 2 families had special social integration income. Two children and their families received support from the local early intervention team.

3.2.2. Parents' satisfaction

The results also highlight the high percentages of parents' positive opinions about their opportunity to actively participate and the strong relationship with the facilitators. The results also underline the importance of the topics covered. Only two items—duration, time, and place of the encounter—had 8% of answers rated as satisfactory. The remaining items were all valued as “good” and mostly as “very good” (Table 3).

TABLE 3

Table 3. Touchpoints 1 by 1 parent group—satisfaction questionnaires results^*.

Considering the open-ended questions, there were a high number of written responses in which parents underlined the positive impact of the encounters, emphasizing the positive interaction between parents, sharing parenthood experiences, the quality of the facilitators, the atmosphere of non-judgment and empathy, as well as the understanding of the development of the children and the parents themselves in the construction of their parenthood.

With regard to what parents liked least, the few answers highlighted that they would have liked each encounter to last longer but also the disappointment that there were not more participants and the delays in the arrival of the families.

Regarding the importance of each encounter for each mother/father, parents reported the effectiveness of the group process to pause and listen, the new knowledge acquired about themselves and their children, and their motivation and greater confidence to educate their children.

In other comments and suggestions, words of thanks and encouragement were shared.

4. Discussion

The Brazelton Gomes-Pedro Foundation intervention program, “Dialogues with Parents-welcoming, listening, and empowering”, aimed to provide relational and developmental guidance for positive parenting. The goals are embedded in the Touchpoints approach, namely, to scaffold parents in practicing positive parenting, support them and widen their knowledge and skills about their children's development and their own development as parents, and enhance the sensitivity and attunement of their interactions with their child.

The very positive impact that participants highlighted confirmed that these aims and objectives were successfully met. The program Dialogues with Parents, embraced by the Touchpoints approach, incorporated their experience and knowledge with dignity and respect into a shared reflection. Based on the stages of development of their children and the development of their parenting, participants in both groups were fully involved, as the evaluation results indicate. Other programs based on the Touchpoints approach also describe increased parental wellbeing and confidence, as well as feelings of support (Swartz and Easterbrooks, 2014; Ayoub and Vele-Tabaddor, 2018).

On the other hand, despite the involvement and commitment of the various entities that hosted the meetings, the effective number of participants proved to be less than expected. It became clear that when there was more involvement by the nursery and/or kindergarten teams that hosted the encounters, parents' participation was higher.

Continuous efforts were made to ensure that the accepted applicants participated in the encounters. In some cases, parents were informed that they could not be present; however, it was only on the day of the meeting that most of their attendance and absences were confirmed. Similar challenges were described in a recent systematic review (Jukes et al., 2022).

This lesson is powerful and should be the object of reflection and renewed strategy in the next edition that we wish to implement. As we have shared and evaluated with the Growing Better Platform in Cascais, with more mobilization of each partner institution, the gap between applications and participation would probably be reduced. However, it was very relevant to see how professionals responsible for each meeting location and the team from the Social Division of the Municipality of Cascais were involved and valued the innovative dynamics carried out, reinforcing the value of the program and the desire for more families to benefit from it. In a future edition, with the lessons learned, a renewed sense of commitment to the effective participation of parents should be enhanced.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

Ethical approval was not required for the studies involving humans because participants gave their informed consent to participate in this program. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.

Author contributions

ATB, MRX, NA, and JS contributed to conception, design of the study, and wrote sections of the manuscript. LT organized the database. ATB wrote the first draft of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.

Funding

The Parental Program Dialogues with Parents was funded by Prémio BPI Fundação “la Caixa” Infância award number IN21-00108. This publication is funded by CIE—ISPA projects UIDP/04853/2020 and UIDB/04853/2020, through national funds of FCT/MCTES-PT.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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