Family foundations

Although the family is the crucial proximal environment influencing early child development, achieving public health impact through universal, family-focused interventions has been difficult. The transition to parenthood is a critical phase in family development, fraught with strain and stress, and it can influence the course of family relationships and parent and child adjustment. Indicated and selected prevention programs targeting those families at elevated levels of risk during this phase have been developed, shown to be effective, and-in recent years-begun to be disseminated. The “public health paradox” is that the majority of new parents who experience relationship, adjustment, and mental health problems emerge from the lower-and moderate-risk strata that comprise the majority of the population (Rose, 1981). To date, no universal preventive programs designed to reach all parents expecting a first child have been tested in rigorous research, found to be effective, and disseminated widely.