Families First

This study investigates the impact of childhood experiences, (marital) relationship, parental mentalizing and support among normative first-time parents and among parents at risk on

a) parenting and parental health and wellbeing and
b) the effects of these factors on the development and health of the child.

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Research themes

1. Longitudinal study from pregnancy until the child is two years

The approach of the study is a systemic and transactional approach of development, including health, mental health, demographic and socio-economic considerations. The survey data was collected from 1013 parents expecting their first child. The data set is longitudinal, and starts at the third trimester of pregnancy and until the child 24 months, with an option for later follow-ups (permission obtained from 403 parents). In five measurement waves, we collected data on depression, stress, parental reflective functioning, relationship satisfaction, social support, sense of coherence and major life changes among the parents, and on health and development of the child. The parents were recruited from maternity clinics from around 80 communities all over the country. The study focuses on exploring how reflective functioning in parenting is related to childhood experiences, socioeconomic factors, emotional availability in parenting, mental health, spouse relationship satisfaction and development and health of the child.

2. Impact of use and perception of support on parenting and child development. This research theme focuses on the impact of support from maternity and well-baby clinics (Neuvola); from open groups; and from friends and family on health and well-being, in relation to socio-economic factors and intergenerational transmission of adversity.

3. Families First Intervention Study.  The Impact of Mentalization Based Group Support on parenting, parent-child relationship and child development and health. Case-control study comparing FF-intervention parents  (n=86) with non-intervention parents. In addition, a qualitative follow-up study on parents experiences of FF- parental groups (n=550).

4. Nurture and Play (Hoivaa ja leiki) Intervention Study

In this study project, we evaluated the measuring of maternal emotional availability already during pregnancy with a newly developed observation called the Pre-EA. Secondly, we developed a manualized, short-term parenting intervention called the Nurture and Play (NaP). In NaP the goal is to increase maternal sensitivity and reflective functioning through playful, emotion-focused activities and reflective practices. We showed in an RCT- study that prenatally depressed intervention mothers were higher in sensitivity and parental RF than non-intervention mothers by the infant age of one. The results thus suggest that NaP may be a feasible and promising early intervention starting already during pregnancy.

5. Hold On (Pidä Kiinni) Intervention Study:  The efficacy of the Hold On®  – rehabilitation program for Substance Abusing Parents and their Children

The Hold On®  – rehabilitation program is an intensive, multimethod treatment program including abstinence from substances, parent-child interaction intervention, trauma-focused therapeutic work, family guidance provided by the Federation for Mothers and Child Homes and Shelters) in Finland.  The treatment program has been evaluated as promising in a previous study. The goal of this follow-up study is to extend the previous study by including all (13) operative units all over Finland and focus more thoroughly in following the parental (well-being, early interaction, reflectiveness) and child (socio-emotional development) related variables from the beginning to the end of the 1-year treatment process. The study will enroll 120 parents, and gather information from the study variables using both questionnaires as well as more qualitatively rich interview and video-based measures. The study group leader (PhD Saara Salo) had supervised and worked with the teams providing the treatments for over 15 years. The other members of the study team all have extensive expertise in studying parent-child relational, parent reflective, as well as trauma and attachment related study questions especially among substance abusing parents and their children.

Cooperation and funding


Professor Linda C Mayes and Assistant Professor Helena Rutherford, Yale Child Study Center, Yale University

Professor Raija-Leena Punamäki, Tampere University 

Professor Zeynep Biringen, Colorado State University

Professor Yoshie Yokoyama, University of Osaka, Japan

Adjunct Professor Tuovi Hakulinen, THL, National Institute for Health and Welfare, Helsinki Finland

MA Malin von Koskull, Folkhälsan, Helsinki Finland

Psych Lic. Marie Rautava, Mannerheim League for Child Welfare, Helsinki Finland

Lahti Diacony Foundation, Baby Magic Project.

Ensi- ja turvakotien liitto


Gyllenberg Foundation

Asla Fulbright Foundation

Folkhälsan Research Center

Medicinska föreningen för Liv och Hälsa

Louis and Göran Ehrnrooth Foundation

Niilo Helander Foundation

Research Advisory Board, International Psychoanalytic Association


Organisation and research team

PI Mirjam Kalland, professor in Early Education and Care, University of Helsinki

Marjukka Pajulo, PhD, MD, Adjunct Professor, University of Turku

Saara Salo, PhD, Post Doc researcher, University of Helsinki

Marjo Flykt, PhD, University Lecturer, Faculty of Medicine, University of Helsinki

Johanna Sourander, Doctoral Student, University of Jyväskylä,

Johanna Räbinä, Doctoral Student, University of Helsinki

Jari Lipsanen, University Teacher, supervisor, Doctoral program in Population Health Faculty of Medicine, University of Helsinki

Laszlo Vincze, Adjunct professor, Senior University Lecturer, Swedish School of Social Science, University of Helsinki

Simo Raittila, Doctoral Student, Faculty of Social Sciences, University of Helsinki

Martina Salvén-Bodin, Clinical Psychologist, City of Espoo


29.2-2.6 2016, Prof. Kalland, Yale Child Study Center, Asla Fulbright Research Grant for a Senior Researcher

Conference presentations

Kalland M, Raittila S, Pajulo M, Salvén M, Vincze L. Marital status, relationship satisfaction, depression and infant health among a sample of Finnish First-time parents. World Infant Mental Health Congress, Rome 27.5. 2018

Kalland M, Raittila S, Pajulo M, Salo S, Salvén M, Vincze L. Impact of group support on mental health, marital relationship and parenting among a sample of Finnish First-time Parents. World Infant Mental Health, Rome 27.5. 2018

Kalland, M.1, Pajulo, M.2, Sourander, J.3, Salven, M.4, Von Koskull, M.5 1 Families First. Evaluating the efficacy of a mentalization-based group intervention for first-time parents. World Infant Mental Health, Prague, 29.5-2.6, 2016

Sourander, J.1, Kalland, M.2, Laakso, M.-L.1 1 P202 Mentalization-based Families First intervention for first-time parents: A qualitative study of Parents’ Perspective. World Infant Mental Health, Prague, 29.5-2.6 2016

Sourander, J. (2016). Ensimmäisen lapsensa saaneet isät ja äidit mentalisaatioteoriaan perustuvassa Vahvuutta vanhemmuuteen -perheryhmässä, Kasvatustieteen päivät, Turku 17-18.11.

Sourander, J. (2016). Mentalisaatioteoriaan perustuva vahvuutta vanhemmuuteen perheryhmä vanhemmuuden tukena, Perhetutkimuksen päivät, Helsinki 11-12.4.

Kalland M Fagerlund Å Pajulo M et al.:  Families First: A Mentalization-Based Group Intervention for First-Time Parents to Promote Child Development and Family Health Symposium presentation, WAIMH Congress, Edinburgh, Scotland 2014

Pajulo M, Von Koskull M, Kalland M, Boukydis Z, Castoor C, Pajulo H. “Baby’s mind in mind”: Three Finnish studies evaluating and enhancing pre-and postnatal parental capacity to mentalise about the baby and parenting. Symposium presentation accepted, WAIMH Congress, Cape Town, South Africa, 2012

Kalland M. Plenary: Promoting early attachment by supporting early parenthood. Mentalization based groups for first-time parents. Congress on Early Childhood Intervention, Council of the Baltic Sea States, Berlin 2011


Salo, S.J., Pajulo, M., Vinzce, L. Kalland, M. Parent Relationship Satisfaction and Reflective Functioning as Predictors of Emotional Availability and Infant Behavior. J Child Fam Stud (2021). https://doi.org/10.1007/s10826-021-01934-2

Sourander J, Laakso M & Kalland  M. 2021. Mentalization-based Families First Group Intervention for First-Time Parents: Parents’ Perspective. Journal of Infant, Child and Adolescent Psychotherapy.

Salo, S J, Sourander J, Pajulo M, Lipsanen J & Kalland M. 2021. Isien ja äitien reflektiivinen kyky: seurantatutkimus raskauden ajalta kahteen ikävuoteen. Psykologia. Accepted/In press.

Kalland M & Salo S. 2020. Vanhemmuuden tukeminen vauva- ja lapsiperheissä. (Supporting parenthood in families with infants and small children).  Accepted for publication, Duodecim.

Kalland M 2019: Voiko ryhmä tukea ensikertalaisvanhempien vanhemmuutta ja parisuhdetta?  Families First- tutkimusprojektin tuloksia. Julkaisussa ”Vanhemmuuden ja parisuhteen tuen vahvistaminen – teoriasta käytäntöön” Tuovi Hakulinen & Jukka Mäkelä & Taina Laajasalo (toim.), THL:n työpapereita.

Salo, S. J., Flykt, M. S., Mäkelä, J., Biringen, Z., Kalland, M., Pajulo, M. & Punamäki, R-L., 2019. The effectiveness of Nurture and Play: A mentalisation-based parenting group intervention for prenatally depressed mothers. Primary Health Care Research and Development. 20, p. 1-11 .

Yokoyama Y, Hakulinen T, Sukimoto M, Silventoinen K, Kalland M 2017.  Maternal wellbeing and health care services in Japan and Finland. European Journal of Public Health, published online 19.12.2017.

Kalland M. 2017. Mentalisaatio ja vanhemmuus (Mentalization and Parenting). Kirjassa: Laitinen I & Ollikainen S (ed.) Mentalisaatio. Therapeia-säätiö.

Kalland M, Fagerlund Å, von Koskull M Pajulo M. 2016. Families First: The Development of a New Mentalization-Based Group Intervention for First–Time Parents.  Primary Health Care Research and Development. p. 1-15 15

Sourander, J., Oksanen E., Viinikka A. (2016). Mentalisaatioteoriaan perustuvasta Vahvuutta vanhemmuuteen -perheryhmästä tukea vanhemmuuteen ja lapsen kehitykseen. Oppimisen ja oppimisvaikeuksien erityislehti NMI-Bulletin. 1/2016, s. 52-64.

Kalland M 2014. Vanhemman mentalisaatiokyky.  (Parental Mentalization) In Viinikka A (ed.) Mentalisaatio perheiden kohtaamisessa , s. 26-38. Mannerheimin Lastensuojeluliitto

Kalland M & von Koskull M. 2014. Promotiivinen näkökulma vanhemmuuden tukemiseen. In Viinikka A (ed.) Mentalisaatio perheiden kohtaamisessa, 158-167. Mannerheimin Lastensuojeluliitto

Salo S & Kalland M. 2014. Lapsen mentalisaatiokyky 39-54. In Viinikka A (ed.) Mentalisaatio perheiden kohtaamisessa, 39-54. Mannerheimin Lastensuojeluliitto

Salo, S., & Flykt, M. (2013).  The impact of parental addiction on child development. In: Parenting and substance abuse. N.Suchman, M. Pajulo, & L. Mayes, pp.  Oxford University Press.

Kalland M 2013. Mentalisaation ja reflektiivisen kyvyn vahvistaminen vanhemmuudessa. In Mellenius N & Remsu N. Vuorovaikutus kuvassa. Videoavusteisen ohjauksen eettisyys ja käytäntö. Mannerheimin Lastensuojeluliiton Lasten ja nuorten kuntoutussäätiö.

Pajulo, M., Pyykkönen, N., Kalland, M., Sinkkonen, J., Helenius, H., Punamäki, R. L., & Suchman, N. (2012). Substance‐abusing mothers in residential treatment with their babies: importance of pre- and postnatal maternal reflective functioning. Infant Mental Health Journal, 33, 70-81.

Kalland M. 2012 The importance of social support and reflective functioning for parenthood. In Kekkonen M, Montonen M & Viitala R (ed.)  Family centre in the Nordic countries – a meeting point for children and families. Nordic Council of Ministers, Copenhagen.

Salo, S., Politi, J., Tupola, S., Biringen, Z., Kalland, M., Halmesmäki, E., ... & Kivitie‐Kallio, S. (2010). Early development of opioid‐exposed infants born to mothers in buprenorphine‐replacement therapy. Journal of reproductive and infant psychology, 28(2), 161-179.

Flykt, M., Punamäki, R.L., Belt, R., Biringen, Z., Salo, S., Posa, T., & Pajulo, M. (2012). Maternal representations and emotional availability among drug-abusing and nonusing mothers and their infants. Infant Mental Health Journal, 33(2), 123-138.13.

Pajulo, M., Suchman, N., Kalland, M., & Mayes, L. (2006). Enhancing the effectiveness of residential treatment for substance abusing pregnant and parenting women: Focus on maternal reflective functioning and mother‐child relationship. Infant Mental Health Journal: Official Publication of The World Association for Infant Mental Health27(5), 448-465.

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