In general, with multi-risk families, when parents have a history of trauma or loss, programs need to provide interventions of high intensity and over a long period of time in which the development of a parent-interventionist relationship is key. Brief, focused interventions have been shown to be effective in bringing about <br>change in a particular aspect of functioning, however, or to provide parents with understanding and strategies to change the parent-child interaction and attachment and certain behavioral patterns. Nonetheless, these need to be embedded within a framework of the long-term availability of service providers. Infact, families do not necessarily have to be seen at the same intensity throughout the intervention and can leave the program tor a period of time or be seen less frequently, with the under- standing that they can come back if they are concerned about their child or if circumstances change for the family. <br>Families at highest risk may need a mental health approach that is less didactic and that follows the parent's lead and considers the parent's goals for the intervention. This kind of approach puts the parent as an active participant in the intervention and avoids parents' perception of being in a hierarchical relationship in which they feel a sense of powerlessness. Providing a sense of partnership between parents and interventionist needs to be a focus of the intervention. This is particularly important when the parents have experienced loss and trauma. <br>Families at highest risk need to have interventions provided by professionals or highly trained, well-supported paraprofessionals. Nurses may be particularly important during pregnancy and immediately postpartum because of the health questions and breast- feeding issues frequently raised by parents at these times. When parents have psychological issues or psychiatric difficulties, mental health professionals may be critical.
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