Minding the Baby

Summary Minding the Baby is an intensive home-visiting programme for vulnerable, first-time pregnant women and their families. It is jointly delivered by highly skilled nurses and social workers. As well as practical health and social support, the programme draws on parental and infant mental health approaches to promote secure attachment and prevent maltreatment. It runs from the final trimester of pregnancy until the child’s second birthday - a golden time to set the template for good parenting and prevent maltreatment. The programme was rigorously developed at Yale University and has shown promising results. Our programme will run over 5 years in 4 areas across the UK, aiming to reach 320 families. We want to test the efficacy of this programme: –Can the programme achieve its desired impacts? –How best can it be delivered in UK settings?

The case for intervention Babies are highly vulnerable Under 1s are over three times as likely to have child protection plans for physical abuse as the average child. Under 1s are over two times as likely to have a child protection plan for neglect as the average child. Almost half (45%) of serious case reviews involve a child under one. A critical window of opportunity Recent insights from neuroscience and developmental psychology highlight the critical importance of pregnancy and infancy. Opportunity for positive engagement and behaviour change, motivated by desire to do the best for the baby.

“Early adversity casts a long shadow” Prof Sir Michael Rutter Preventing maltreatment before it occurs

An ounce of prevention is worth a pound of cure James Heckman’s analysis of the rates of return from programmes across different stages of childhood suggest the smart investor would focus her attentions on the early years

The need: why intervene at this time Certain risks factors make some families more at risk of maltreating their baby – we need to offer them support before maltreatment happens. There is mounting evidence to support the effectiveness of home visiting interventions like the Family Nurse Partnership in the UK. We want to build on this evidence – Minding the Baby is a new programme that builds on what we know works and adds a strong mental health and social work component.

Minding the Baby

Carefully crafted by Profs Arietta Slade, Lois Sadler and Linda Mayes, Yale University. Minding the Baby (MTB) is an intensive home visiting programme for first time mothers who are aged under 25 with additional or complex needs, such as homelessness, relationship conflict, or experience of care. MTB builds on the learning from evidence based programmes such as the Family Nurse Partnership, but is also distinct from other programmes. Pairs of social workers and nurses jointly work with each family from the third trimester of pregnancy until the baby reaches age 2. Focus is on maternal and infant mental health and as well as delivering practical nursing and family support. Early findings from the US include: –Secure attachment –Quality of parenting and interaction –Positive health outcomes at birth –Positive life trajectories for mothers

Minding the Baby UK Aims To improve infant outcomes including early attachment quality and reported cases of child abuse or neglect. To improve maternal outcomes including the quality of the mother-infant relationship and maternal attachment capacity. Approach Work with 4 trailblazing areas across the UK to test new programme Work in partnership with local health and children’s services. 5 year testing phase. Independent evaluation and guidance from leading international experts Aiming to reach 320 families across 4 areas in the UK.

Roles and common goals Social Worker Nurse Mental health promotion Perinatal depression and anxiety Infant assessment Dyadic play and developmental guidance Family intervention (counselling/relationships) Legal court systems Crisis intervention Case management Assessment Prenatal care and health ed Nutrition; breastfeeding; labour plan etc. Child health and develop Safety and injury prevention Child development Anticipatory guidance and parenting skills Mother’s health Physical and mental health Family planning Smoking, nutrition, exercise Secure Attachment Reflective Parenting Primary Care Giver- Child relationship

Keeping the baby in mind: ‘reflective functioning’ RF refers to a parent’s capacity to make sense of their child’s internal states, emotions, thoughts and intentions. High reflective functioning forms the basis of healthy and secure attachment and effective parenting. Low reflective capacity is associated with poor attachment and is a risk factor for abuse and neglect. Non-reflective parents: Focus on child’s personality & behaviour. Make negative attributions. Tantrum = child is mean, bad, selfish. Try to control behaviour. Others seem incomprehensible.

Keeping the baby in mind: ‘reflective functioning’ MTB staff model reflective behaviours with mother and baby. They make connections and model curiosity and openness about mental states. Techniques: Film Play Speaking for the baby Drawing Parent: “Do babies have feelings?” Non-reflective clinician: “Of course babies have feelings! You have feelings, don’t you?!” Reflective clinician support: “You are wondering if babies have feelings? What do you think from your baby’s reactions?”

Next steps Recruiting nurse practitioners to work in partnership with NSPCC social workers. Engaging partners to get referrals and develop relationships. Setting up evaluation.