Transcript Minding the baby - Scottish Personality Disorder Network

Minding the Baby
Summary
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Minding the Baby is an intensive home-visiting programme for
vulnerable, first-time pregnant women and their families.
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It is jointly delivered by highly skilled nurses and social workers.
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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.
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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.
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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.
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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
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Under 1s are over three times as likely to have child
protection plans for physical abuse as the average
child.
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Under 1s are over two times as likely to have a child
protection plan for neglect as the average child.
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Almost half (45%) of serious case reviews involve a
child under one.
A critical window of opportunity
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Recent insights from neuroscience and developmental
psychology highlight the critical importance of
pregnancy and infancy.
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Opportunity for positive engagement and behaviour
change, motivated by desire to do the best for the
baby.
Preventing maltreatment before it occurs
“Early adversity casts a long shadow”
Prof Sir Michael Rutter
Early
childhood
Middle
childhood
Adolescence
Conception
Adulthood
Early adversity
Maltreatment
Trauma
Disrupted neurodevelopment
Social, emotional and
cognitive impairment
Adoption of risky
health behaviours
Disease disability
and social problems
Toxic stress
Cumulative burden over time
Increased risks
for the next
generation
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
Minding the Baby
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Carefully crafted by Profs Arietta Slade, Lois Sadler and Linda Mayes, Yale
University.
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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.
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MTB builds on the learning from evidence based programmes such as the Family
Nurse Partnership, but is also distinct from other programmes.
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Pairs of social workers and nurses jointly work with each family from the third
trimester of pregnancy until the baby reaches age 2.
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Focus is on maternal and infant mental health and as well as delivering practical
nursing and family support.
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Early findings from the US include:
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Secure attachment
Quality of parenting and interaction
Positive health outcomes at birth
Positive life trajectories for mothers
Minding the Baby UK
Aims
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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
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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
Prenatal care and health ed
Nutrition; breastfeeding; labour
plan etc.
Mental health promotion
Secure Attachment
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
Perinatal depression and
anxiety
Infant assessment
Reflective Parenting
Dyadic play and
developmental guidance
Family intervention
(counselling/relationships)
Primary Care GiverChild relationship
Legal court systems
Crisis intervention
Case management
Assessment
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.
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?”
Techniques:
• Film
• Play
• Speaking for the baby
• Drawing
Next steps
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Recruiting nurse practitioners to work in partnership with NSPCC social
workers.
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Engaging partners to get referrals and develop relationships.
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Setting up evaluation.