Today, the Royal Foundation Centre for Early Childhood announced a new partnership study with the Institute of Health Visiting (iHV) and led by Professor Jane Barlow at the University of Oxford to support health visitors’ work with families to promote infant wellbeing and social development.

Across the world, thanks to advances in neuroscience, there is a growing body of research on the importance of the earliest years of life. During this period, from pregnancy to the age of five – and, in particular, during the “critical first 1001 days” – babies’ brains are developing faster than at any other time of their lives. They are shaped by early experiences as they develop socially, and learn to manage emotions and build relationships, develop resilience against adversity and trust in others.

Spearheaded by Her Royal Highness The Princess of Wales, the work of The Centre for Early Childhood seeks to raise awareness of why early childhood matters and to translate this evidence from neuroscience into practice. We are therefore delighted to have the opportunity to work closely with The Princess and The Centre to shine a light on the vital work of health visitors who have an important role to play in promoting infant wellbeing and social development. This grant from the Royal Foundation will accelerate our work to support health visitors in this area through a small-scale field trial across two sites to assess the acceptability and feasibility of implementing a new tool to support the promotion of infant wellbeing and social development, and by enhancing health visitors’ ability to identify infants at risk.

Alison Morton, iHV CEO says:

“We are delighted to be working with Her Royal Highness The Princess of Wales, The Royal Foundation Centre for Early Childhood, and Professor Jane Barlow on this exciting new programme of work with health visitors. Through working with Her Royal Highness, I know how committed she is to helping all children have a happy and healthy childhood and this can only happen if we have a much greater focus on the earliest years of life – everyone has a part to play to make sure that no child is left behind.

“It has also been an honour and a privilege for the Institute of Health Visiting to work with The Centre for Early Childhood and health visitors across England to arrange shadowing visits for The Princess over the last few months to enable her to see first-hand the important work of health visitors and hear parents speak about the difference that this has made to them. With more families struggling to manage with rising levels of mental health problems, poverty and other issues that can make parenting even harder, it is vital that all families get the support that they need at this time.”

Dr Jane Barlow, Professor of Evidence Based Intervention and Policy, University of Oxford says,

“This is a very exciting opportunity to focus on babies’ behaviour, using the new observation tool, the ADBB. This tool can help health visitors focus on the ways babies communicate, using eye contact, facial expressions and vocalisation etc. We can learn so much by using it and potentially help identify those families where additional support might be needed.”

Justine Rooke, General Manager, Children’s and Learning Disability Services, Humber Teaching NHS Foundation Trust, says,

‘‘We are delighted to be working with The Royal Foundation and hosting the ADBB study. Infant mental health, and the contribution Health Visitors can make to the development of longer-term health outcomes for children, is a key factor in how we transform our 0-19 service for Hull children and families and integral to the best start in a child’s life. The health visitors trained in the ADBB and Humber Teaching Foundation Trust are really proud to support this work.”

Nadine Anderson, Claire Townsend and Eileen O’Sullivan, Specialist Health Visitors for Perinatal and Infant Mental Health at South Warwickshire University NHS Foundation Trust, say,

We are truly honoured to be invited to take part in a research project of this calibre. We have worked alongside the Institute of Health Visiting, striving for excellence in practice, for a number of years. We recognise that strong secure attachments in childhood are the foundations for good physical and emotional health moving into adulthood. Health visitors in Warwickshire, as highly skilled practitioners, are driving forward the Infant mental health agenda and the use of the ADBB as an assessment tool adds an extra layer of sensitivity and support to the families we sit alongside.”

Why it’s needed: ‘Babies can’t talk, but we now know a lot from scientific research that has been done across the world over the last 20 years on the many different ways that they can communicate through their behaviour – we can learn so much by just tuning into it better. Sometimes it is easy to tune into your baby – for example you may recognise that they may be tired, hungry etc… but at other times it can be much harder for parents to connect with their baby and getting help early to make those connections can make a big difference. 

Why is this field trial needed? Babies are born ready to relate and interact with the world around them – the way that they communicate is through their behaviour. Health visitors are skilled in supporting parents to understand what these behaviours mean so that they can respond quickly to meet their baby’s needs, helping them to feel safe, loved and understood. There are lots of reasons why some parents and babies can find this much harder than others and getting help early can make a big difference.

While ‘supporting maternal and family mental health’ is one of the six ‘High Impact Areas’ for health visiting in England, there is wide variation in the approaches used and support offered to families. The National Commissioning Guidance for health visiting does not recommend the use of any specific tool, and this is left to local decision making. Whilst some areas use assessment tools/questions to support their clinical decision making, none of these have been designed specifically for health visitors’ universal work in the area of parent-infant relationships with all families, and tools developed in other countries have not been normed to the UK population.

What the ADBB is: Building on their existing skills, health visitors involved in this study will be trained in the use of the Alarm Distress Baby Scale (ADBB). This tool, developed in France, is well-validated and widely used internationally to promote infant wellbeing and social development with parents. The ADBB aids the observation and interpretation of different aspects of babies’ social behaviours, such as eye contact, facial expression, vocalisation, activity levels and how they connect with the people and world around them. It will be used as part of the health visitor’s routine visit with all families, helping practitioners and parents to better understand the ways babies express their enjoyment as well as the things that they are finding more difficult.

During her visit to Denmark in February 2022, The Princess was particularly interested in how the ADBB tool was being used with positive outcomes by frontline health visitors as part of their routine examinations of babies during home visits and was keen to explore with the iHV whether a similar approach could work within the health visiting service in England. The aim of this study is, therefore, to conduct a small-scale field trial across two sites to assess the acceptability and feasibility of implementing the ADBB into health visitors’ routine home visits with families in England.

The trial will involve health visitors working in the two selected sites of South Warwickshire NHS Foundation Trust and Humber Teaching NHS Foundation Trust who have been trained in the use of the ADBB scale. An Expert Advisory Group comprising senior academics, government officials and key stakeholders will provide expert advice on the study to enrich and enhance the project’s rigour and support dissemination of the learning in line with the national ambitions to ‘give every child the best start in life’.

The findings from this study will provide valuable learning on the implementation of the ADBB with families in England and has the potential to inform implementation in other sites looking to enhance their support to families across the UK.