1. Baby Extra: “The birth of a baby is a unique moment in the life of parents. It makes parents more capable than they ever thought they would be.”

2. The original model An antenatal preventative intervention for vulnerable families to enhance parent-infant contact and to reduce attachment difficulties Set up by Marij Eliens, national co-ordinator for VIG in hospitals, and a psychologist colleague Took 2 years to gather support and funding A fundamental aim was to offer non-stigmatising support to high risk families: thus based in Sure Start type centres Criteria for referral: at least one parent has a history of drug/alcohol use, being abused, or has a psychiatric diagnosis (including depression and ASD)

3. Aims Prevent attachment difficulties Increase feelings of being a parent Strengthen preventative care To make organisations work together Deliver a targeted intervention to high risk families Increase the expertise of professionals To carry out research

4. Can be referred ante or post-natally by a range of professionals (child health service 29%; adult mental health 17%; hospitals 9%; midwives 4%; others 22%) and through self-referral (19%) If antenatal, one ‘welcome visit’ (in-depth interview focusing on emotional side to pregnancy, relationship with baby, hopes and fears and support in place); one viewing/discussion of DVD to prime parents for early communication; a group session; film in first hour of baby’s life; and review one week later. Parents are then offered another visit, or round of 3 VIG reviews. Support is given from a psychiatrist, drug and alcohol agencies, social worker, psychologist and administrator, as well as the two project leaders (all part time; each organisation gives the time of their professionals) Van Bakel at Tilburg University is the academic lead

5. Initial ‘Welcome’ Discussion 1.How did you come to us? 2.Do you know what you need from Baby Extra? 3.How are you/you two? 4.Pregnancy –How’s your pregnancy going? –What do you think it will be like to be a parent to this child? –What do you think the baby will be like? –What kind of parent do you think you will be? –How do you make contact with your baby now? –How are you preparing for the moment of giving birth? (refocus on emotions if needed) –How are you preparing for the time after you’ve given birth? First day/week/after that. –How about your family – what do they think about your pregnancy? –Was the pregnancy planned? Did you want to have a baby? –Where are you going to give birth? –Who’s looking after your care?

6. 5.How was your childhood? 6.What is your own concern, the reason why you’ve been referred/have referred yourself? 7.What medication are you using? 8.Are you using alcohol or drugs? 9.Have you been abused? 10.Are you in treatment at the moment? 11.What do you want to get out of Baby Extra (reference to the long list of potential referrals, practical help, group meeting, books to read, extra support at home, psychiatric consultancy)? 12.Would you be willing to take part in research? Parents are all given a leaflet about the project. A file is made up for each client, containing the consent form, their demographic information, a contact sheet, a checklist for professionals and a write up of the initial discussion. After the meeting to look at the video and discuss early communication, parents are given their own copy of the film together with a booklet that describes the needs of the infant at each stage of development and what a parent can do to support their initiatives.

7. Assessment and evaluation Pre-intervention: demographics; Edinburgh Depression Scale; State-Trait Anxiety Inventory; Symptom Check List.e344444 Post-intervention: Emotional Availability Scales; the Ages and Stages Questionnaire: Social and Emotional at 6 and 15 months; Attachment Q- Sort at 12 – 18 months. Preliminary results show that 90% of children are securely attached and out of more than 500 families that have been supported by the project, only 2 children have needed child protection procedures.

9. Replicating Baby Extra here: some challenges VIG is not embedded in hospitals VIG is not offered by all HVs and Midwives Getting funding to start up a project is hard at the best of times (although it took Marij 2 years) Would organisations be prepared to give the time of their professionals? Attachment assessment (Strange Situation or Attachment Q Sort) is very time consuming There are very few predictors of attachment

10. A pilot in North Suffolk Educational Psychologist training in VIG and a specialist midwife for women with significant mental health difficulties or/and learning difficulties Criteria is that they meet the midwife’s referral criteria (so same high risk category) Specialist midwife’s ‘care as usual’ (although enhanced to include promotion of contact and mind-mindedness), plus introductory interview (joint) that follows Baby Extra; session with DVD to think about early communication; 3 films post-birth (including one in the first hour – midwife to film) and VIG reviews (EP) Work with other agencies for further support as usual Pre-evaluation will be a stress index (SLEQ) plus other (yet to be determined); midwife uses the Alpha psycho-social tool which has been verified in the Cochrane report as having predictive value (high risk) Post-birth evaluation of project will be use of the CARE-Index on a final, joint visit