What is Nurture and Play?
What is known about the NaP intervention?
What is known about the NaP intervention?
What is known about the NaP intervention?
NaP is based on mentalization theory (supporting parents' mentalization abilities), emotional availability theory, and Theraplay ® interaction therapy. NaP’s developers are psychotherapists with extensive training and experience in various interaction-based work formats and mentalization therapies.
NaP is a practical, preventive, short-ter
NaP is based on mentalization theory (supporting parents' mentalization abilities), emotional availability theory, and Theraplay ® interaction therapy. NaP’s developers are psychotherapists with extensive training and experience in various interaction-based work formats and mentalization therapies.
NaP is a practical, preventive, short-term, and manualized working method for strengthening interaction. NaP is based on direct work with the parent-child relationship, i.e., the child is strongly involved in the treatment from the time of pregnancy onwards. Direct, experience-based, and emotional attunement to sensitivity is a central feature of NaP. Many forms of parenting support are based on guidance through discussion or working with a parent's images and experiences. NaP aims to combine interactive play and reflective work that supports mentalization in a systematic way.
Background Theories and Practices
What is known about the NaP intervention?
What is known about the NaP intervention?
NaP is based on the Emotional Availability Theory ( www.emotionalavailability.com ) of interaction (Salo & Flykt, 2013). This theory emphasizes sensitivity, guidance, non-hostility, and non-intrusiveness as components of effective interaction on the parent's side. Responsiveness and initiative are examined on the child's side. A functioni
NaP is based on the Emotional Availability Theory ( www.emotionalavailability.com ) of interaction (Salo & Flykt, 2013). This theory emphasizes sensitivity, guidance, non-hostility, and non-intrusiveness as components of effective interaction on the parent's side. Responsiveness and initiative are examined on the child's side. A functioning emotional connection is the foundation of interaction.
There are hundreds of studies on the importance of emotional availability; how it is connected to a child's safe development and effective emotional regulation (see www.emotionalavailability.com ). Saara Salo, one of the developers of NaP, has been conducting research on Emotional Availability since 2009 (Salo et al., 2009, 2010, 2021, 2022) with both ordinary and clinical materials (see research list ). Saara Salo has also developed the Emotional Availability Observation Method during Pregnancy (Pre-EA; Salo et al., 2019) . The developer of the theory, Prof. Zeynep Biringen, is in continuous collaboration with Salo and has given permission for her materials to be used as part of the NaP intervention.
In practice, the implementation of Hoilei also applies the principles of Theraplay therapy, which is a model for nurturing the child-parent relationship ( www.theraplay.org ).
Theraplay is an adult-led, active play-based therapy. Theraplay requires longer training and is longer and more intensive in nature. Based on Theraplay, NaP includes active games that are intended to evoke positive emotions and help parents guide and regulate their child. Both of HoiLei's developers, Saara Salo and Hanna Lampi, have long been Theraplay trainers and supervisors.
NaP is also based on the mentalization theory of parenting (Pajulo et al. 2015). Mentalization refers to the parent's ability to reflect on the child's experiences behind their behavior, feelings, thoughts, desires, etc. It is also an understanding of their own feelings as a parent in relation to their child. How they relate to their own childhood, for example, and on the other hand, how much the child senses the parent's experiences, including nonverbal ones.
Aims of NaP
What is known about the NaP intervention?
Aims of NaP
NaP aims to support parents in observing their child as a separate person who has their own experiences from the beginning. Various tasks have been selected from mentalization interventions, the purpose of which is to help the parent observe and wonder about the child's experiences in the here and now. Increasing mentalization ability is
NaP aims to support parents in observing their child as a separate person who has their own experiences from the beginning. Various tasks have been selected from mentalization interventions, the purpose of which is to help the parent observe and wonder about the child's experiences in the here and now. Increasing mentalization ability is considered central to various early interaction interventions (Kalland & Salo, 2020).
NaP developers have training and experience in strengthening mentalization as part of psychotherapeutic work. Saara Salo is also an Anna Freud Center-approved family mentalization intervention trainer and is in continuous international cooperation with mentalization therapeutic trainer communities.
Parental emotional regulation plays a special role in the development of a functioning emotional and mentalizing relationship. It can be affected by, for example, different sensory sensitivities, life stress, or mood problems. One of the developers of Hoilei, Hanna Lampi, is currently working on her doctoral dissertation at the University of Helsinki on the importance of parental sensory regulation in a child's early development.
Research on NaP
NaP Research Studies
A randomized controlled trial (RCT) of the effectiveness of group-based NaP in mothers with depression during pregnancy was conducted. The results showed that both interaction sensitivity and reflective ability were better in the mothers in the experimental group. This demonstrates the effectiveness of group-based NaP.
A new randomized controlled trial (RCT) on the effectiveness of working with infants is currently underway in Buffalo. Data is currently being collected from babies aged 3-6 months.
Helsinki Pre-Home Care (HEK) has collected a feasibility study measuring the implementation experiences of employees, the results of which will be preliminarily reported at the World Infant Mental Health Congress in the summer of 2023. The results showed that Hoilei is an easy-to-implement and effective form of treatment also in the Pre-Home Care environment. A larger effectiveness study is planned.
An interview study was conducted at the University of Jyväskylä on the Care and Play for Foster Families intervention, which mapped the meanings, thoughts and feelings given to the group by foster parents (Tuomi & Ala-Ruona, 2022). According to the study, the intervention helps to deepen the connection between parent and child and strengthen the formation of an attachment relationship. The functionality of the group and peer support are also seen as significant. The results of the study communicate well with attachment theory, which supports the assumption of the importance of a family-centered intervention when working with foster families.
References
Kalland, M., & Salo, S. (2014). The child's mentalization ability. In Mentalization in family encounters (pp. 39-54). Mannerheimin Child Welfare League.
Kalland, M., & Salo, S. (2020). Supporting parenting in families with babies and children. Duodecim .
Pajulo, M., Salo, S., & Pyykkönen, N. (2015). Mentalization as a protective factor for humans. Duodecim , 131 (11), 1050-1057
Pajulo, M., Salo, S., & Pyykkönen, N. (2016). The mentalization core area in child protection work. Family Therapy , 32 (1), 34-44.
Peltokorpi, S., Salo, S., Nafstad, A., Hart, P., Tuomikoski, E., & Laakso, M. (2023). Bodily-tactile early intervention for a mother and her child with visual impairment and additional disabilities: a case study. Disability and Rehabilitation , 45 (12), 2057-2072.
Salo, S., Tuomi, K., & Isoniemi, E. (2008). HoiLei: baby-parent interaction . Psykologien kustantus.
Salo, S., Kivistö, K., Korja, R., Biringen, Z., Tupola, S., Kahila, H., & Kivitie-Kallio, S. (2009). Emotional availability, parental self-efficacy beliefs, and child development in caregiver-child relationships with buprenorphine-exposed 3-year-olds. Parenting: Science and Practice , 9 (3-4), 244-259.
Salo, S., & Flykt, M. (2013). The importance of emotional availability between child and parent in child development and well-being. Psychology , 48 (5-6), 402-416.
Salo, S., & Pajulo, M. (2018). Supporting early interaction between mothers and babies with drug problems. In Drug and drug addiction (pp. 280-283). Duodecim.
Salo, SJ, Flykt, M., Isosävi, S., Punamäki, RL, Kalland, M., Biringen, Z., & Pajulo, M. (2019). Validating an observational measure of prenatal emotional availability among mothers with depressive symptoms. Journal of Prenatal & Perinatal Psychology & Health .
Salo, SJ, Flykt, M., Mäkelä, J., Biringen, Z., Kalland, M., Pajulo, M., & Punamäki, RL (2019). The effectiveness of Nurture and Play: a mentalisation-based parenting group intervention for prenatally depressed mothers. Primary Health Care Research & Development , 20 , e157.
Salo, SJ, Pajulo, M., Vinzce, L., Raittila, S., Sourander, J., & Kalland, M. (2021). Parent relationship Satisfaction and reflective functioning as predictors of emotional availability and infant behavior. Journal of Child and Family Studies , 30 , 1214-1228
Salo, SJ, Sourander, J., Lipsanen, J., Pajulo, M., & Kalland, M. (2021). Reflective ability of fathers and mothers: a follow-up study from pregnancy to two years of age. Psychology , 56 (5), 472-495.
Salo, S., Widenius, L., & Kalland, M. (2021). Mentalization-based child-centered family intervention - how to help families understand each other?. Journal of Family and Couple Therapy , 37 (2).
Tuomi, K. (2018). Intervention for Foster families with young children. Imagine – Early Childhood Music Therapy Online Magazine , 9 (1), 66–68. https://doi.org/ISSN : 2153-7879.
Tuomi, K. (2022). Potentials of music therapy with children and families . University of Jyväskylä. Retrieved from http://urn.fi/URN:ISBN:978-951-39-9258-3
Tuomi, K., & Ala-Ruona, E. (2022). Nurture and play for Foster families with young children: Foster-parents' reflections on attachment-focused group intervention. Approaches: An Interdisciplinary Journal of Music Therapy , First view .
