The Leksand Parenting Approach
The Leksand approach is a unique form of parenting support, in which the same group of parents meet from pregnancy for a number of years as children proceed from birth to up to 5 years of age, and sometimes beyond.
Over the last 16 years the Swedish Leksand approach has spread across Sweden and to other Baltic countries. In 2002 it migrated to Finland, where 300 districts have adopted it. It has also been adapted in 11 Russian districts, and is growing in Denmark. Although the programme began as one for a small rural community, it has been implemented in many cities in Sweden, Finland and Denmark. In communities with many different cultures interpreters are used.
The original Leksand model was a partnership between county council, municipality, religious communities, adult education and the third sector. Its goals were to equip parents to handle their family situation, and to reinforce social networks. Special support was offered to parents with ‘difficult to manage’ children. The structure was based on extended and reinforced parental education in groups, where the groups learn skills and establish supportive community contacts. Staff have shared goals and cooperate around a clear remit. The groups develop a sense of social togetherness and their level of knowledge and awareness of the child’s needs are increased.
Over time the group is gradually developed to assume responsibility for itself. In many respects the model is designed to replace the lost ‘extended family’ around a new-born.
Midwives are responsible for the pre-birth meetings. The process begins, typically around week 25 of the pregnancy, when the midwife meets the future parents – both mum and dad - at the first antenatal appointment. The midwife greets the parents and welcomes them to the parent group. Ideally 12-20 parents are invited and attend. Each parent is given the opportunity to be seen and heard. The aim at the initial meeting is for the parents to feel secure and to want to continue in the group. To create an identity parents choose a name for their group, such as ‘Millennium Group’, ‘Rising Stars’, ‘Spring Flowers’ or ‘Untouchables’.
The parents meet in their groups around eight or nine times before the birth. Presenters include team members such as a midwife, nurses from the child healthcare unit, a psychologist, pre-school teacher, family counsellor, family therapist, social worker, benefits advisor and ‘Dad’s mentor’. A couple who are recent parents also participate.
Meetings often start with a short talk or presentation by an invited guest (professional or voluntary). After perhaps a half-hour talk, the day’s topic is discussed, with mums and dads in separate groups. The dads’ mentor usually leads the dads’ discussion. The meeting is closed with the mums and dads discussing the day’s topic together over a cup of coffee.
After the birth – the first year
Parents again meet eight or nine times in the year after the birth, right up until the child’s first birthday.
When all the children in the group have been born, all the parents are invited to a postnatal meeting which reinforces the group’s sense of solidarity. Nurses from the paediatric healthcare unit are responsible for the meetings until the first birthday. In addition to those involved pre-birth, new professionals also now participate, including family law experts, nursery head teachers and dental hygienists. The parents also make visits to a library, where they hear about children’s literature.
During this year the parents have plenty of time to get to know each other and the various professional groups in the team, as well as to take part in other activities within the community. Representatives of local authorities, adult education, religious communities and businesses may visit the group.
Beyond the first year
After the first year, three out of four groups choose to continue meeting in their groups. Some groups have been meeting for 10 years. At this stage the responsibility for activities rests with the group itself. Groups typically meet six to eight times a year at this stage.
When a problem arises within a family, it is easy to obtain advice, support and treatment, as the parents already know many of the relevant professionals through their visits and talks to the parent group. Parents remain with their original group when further children are born.
Dads’ mentors normally take part in 2-4 meetings before and 2-4 meetings after the birth, until the child’s first birthday. The group then agrees how often he will be needed. A dads’ mentor is a normal, slightly more experienced dad with two or more children. He attends a short course before participating and receives a small fee from the county council. The role of the dads’ mentor is to support the dads and answer their questions. Evaluations indicate that the dads’ mentor is appreciated by the dads in general and the mums in particular.
An important role is played by the adult education associations, especially during the early years. The Swedish Study Promotion Association is extremely important. When the child is older, other adult education associations will also take part. Voluntary organisations give guest lectures and talk to the parent groups; or the parents make study visits. Participating voluntary organisations include the municipal bodies, Civil Defence Association, Red Cross, parents’ associations, Kids & Dads and the local sports teams. There are also visits to or from commercial companies such as insurance companies or banks. After the child’s first birthday, the role of voluntary organisations increases, as activities are customised to meet the needs and wishes of the parents and the children.
Themes prior to the birth and during the first year of parental education include emotional ups and downs; safe and secure bonding; the loving relationship; task delegation and new roles; the child’s needs and development; male-female language; breastfeeding; children’s food; accident risks; fairy tales; songs, music and visits to libraries; dental health; family law; parental leave; household finances and insurance; child safety; maturity and self-esteem; balancing family and work; information on medicines, alcohol and other drugs; and siblings and step-siblings.
In an evaluation of the programme, average attendance amongst mums at the eight to nine pre-birth meetings was around 95%, with 90% for dads. During the subsequent eight to nine meetings through to the child’s first birthday, mum’s attendance was just under 90%, just under 70% for dads. Comparison control groups receiving more traditional parent training had much lower attendance, particularly amongst dads. After the first birthday, attendance amongst mums averaged around 60%, for dads around 30%.
Success factors for the Swedish Leksand model
- Continuity: Continuity is supported by not breaking up the original group, and by having the same leaders for the meetings (a) before and (b) after the birth until the first birthday. Other factors which encourage participation are the collaborative decision-making structure and the ‘overlapping’ of the various stages through which the group passes.
- Early start: The model starts ‘early’ with the first antenatal appointment and a high level of attendance. The emphasis on parents feeling secure in their environment means they are more likely to seek help for a problem. Help given at this stage is often more effective and far less expensive from every perspective than if it needs to be provided a few years later.
- Support for the dad: Dads are welcomed to the first antenatal appointment and receive their own invitation to join the parent group. They have their own dads’ mentor at many meetings of the parent group. There is open provision for dads on Saturdays, with a special ‘Kids & Dads’ club for all dads with children. These dads’ initiatives have resulted in more dads participating in nurseries and spending more time with their children.
- Identity: Two reasons for the popularity of the Leksand approach among both parents and staff are the created sense of identity, and the formation of networks. A lot of time and care has been put into creating well-being and a sense of solidarity. Parents meet over a common and important goal – the good of the child.
- Feedback: During the early years of the programme, ‘diary sheets’ were distributed after each meeting to each parent and member of staff asking what the person thought was good, what they thought was bad and how it could be changed. These feedback sheets were collated and formed the basis for possible changes and improvements. They are now used more sparingly.
Suitability for teenage or dysfunctional parents
In many locations the model has dysfunctional parents integrated within the groups. They also have had teenage parents with difficult backgrounds. These may require special preparations before the meetings and additional activities, and smaller groups may be required. Engagement can be a problem, but once the stage is reached where they feel safe, secure and confident they usually choose to come to the meetings.
Economist Ingvar Nilsson has calculated the profitability of the Leksand model from both a social and individual perspective. The approach is low cost, estimated at £36 per year per child (£237 per child to age 5). Nilsson calculated the benefits of the preventive effects of the approach at well over £10,000 per participating child, through reduced rates of dysfunction.