CARO: Child and Adult Relationship Observation

CARO: Child and Adult Relationship Observation


01/06/2016 to 31/01/2019


The quality of parent-child relationships is a strong predictor of physical and mental wellbeing in adulthood, and interventions to improve relationships between parents and their children are acknowledged to be an important contributor to the construction of a healthier and fairer society.

In the UK, health visitors (HVs) play a key role in the identification of difficulties in parent-infant interaction and in the provision of support where these difficulties exist. One of the biggest challenges that HVs have to address is how to match provision of care to need, and accurate identification of problems in parent-child relationships is one key area of difficulty.

There is some evidence that use of questionnaires to assess maternal mental health can help in the matching of need to provision but maternal mental health is less important as a predictor of child outcomes than the quality of parent-child interaction. The difficulties that HVs have in accurate identification of problems in the parent-child interaction have ramifications beyond the work they do with individual families: communicating with other agencies about these difficulties becomes difficult without the language to describe them.

The Mellow Parenting Observational System (MPOS) is an event-sampled observational system that can be used to describe the interaction between a parent or carer and a child. The observer records every instance of certain key interactional behaviours usually seen in a normal care-taking routine, such as a mealtime. The coding system has been used as a clinical, forensic and research tool. It samples six dimensions, each of which has a positive and a negative pole. Positives and negatives are scored separately and have been shown to be statistically independent.

The dimensions assessed by MPOS are: Anticipation; Autonomy; Responsiveness; Co-operation; Distress and containment; and Control.  MPOS is a powerful tool for the detection of later problems for children: in a recently published paper we were able to show that MPOS scores accurately predicted later psychiatric disorders in children.

The problem with MPOS is that to date it has only been used reliably by psychologists. We have simplified MPOS and it should now be straightforward to train health visitors to use the tool to improve their practice.  


We plan to:

  • Develop a two-day training course in MPOS
  • Train a group of health visitors to use MPOS
  • Assess how well they agree on the scores, using videos of parent-child interaction
  • Check how consistent the HVs are in their ratings, over time
  • Interview the HVs to find out how they have used MPOS and how the new observational skills they have acquired has changed their practice as well as communication with colleagues and other agencies


A Research award from the William Grant Foundation.


Thompson L, King G, Taylor E, Puckering C, Wilson P. Streamling of the Mellow Parenting Observation System for research and non-specialist clinical use,, Community Practitioner 2019, Oct, 45-47. Full version online: 


Contact information:

Gerry King | +44 (0) 1463 255895 |