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Specialist Health Visitors in Perinatal and Infant Mental Health

Specialist Health Visitors in Perinatal and Infant Mental Health: where they are and what they’re doing.

Maternal Mental Health Awareness Week 2023 (#MMHAW23) focuses on being ‘together in a changing world’. Today’s theme, Tuesday 2 May, offers an opportunity to ‘shine the spotlight on support’ – so what better time for the iHV to shine the spotlight on the unique role of Specialist Health Visitors in Perinatal and Infant Mental Health across all UK nations by giving a snapshot of where they are and what they are doing.

Seven years on from the seminal publication on the role of Specialist Health Visitors in Perinatal and Infant Mental health (Sp HV PIMH) by Health Education England1 and one year since the follow-on report by Homonchuk and Barlow2 made further specific recommendations for these practitioners, the Institute of Health Visiting (iHV) has compiled a snapshot of provision and practice across the UK – Specialist Health Visitors in Perinatal and Infant Mental Health: where they are and what they’re doing.

The good news is that there are now Sp HV PIMH in each UK nation, providing strategic leadership, undertaking pivotal training, education and supervisory functions, influencing service redesign and pathway development, and ensuring robust quality assurance through accurate data collection, analysis and audit. We regularly hear examples from Sp HV PIMH of how they continue to advocate for families and use their position and voice to influence local decision makers to ensure perinatal and infant mental health remains prominent in local policies and the political agenda.

A deeper dive at a regional level, however, reveals patchy provision and inconsistent commissioning arrangements for these specialists, with variations in:

  • job descriptions
  • clinical case-loading expectations
  • training and supervision for the practitioner
  • where the role sits – within universal health visiting or specialist perinatal and infant mental health services

In addition, the dire shortages in the health visiting workforce need to be urgently addressed by national government to enable Sp HV PIMH and the wider health visiting workforce to deliver clinically and cost-effective perinatal and infant mental health care.

Melita Graham, Head of Mental Health, says:

All families want and deserve high-quality and joined-up care for PIMH problems. This report highlights the unique leadership role that Specialist Health Visitors in Perinatal and Infant Mental Health have contribute to achieving this.  Furthermore, it shines a light on how specialist provision within health visiting services offers the opportunity to drive clinically and cost-effective high-quality evidence-based PIMH care across the whole system.

There is still work to be done but much to be celebrated. The leadership and commitment of these pioneering specialist health visitors ensures that families at risk of, and those impacted by, mental health problems have the best chance of receiving timely, high-quality, cost-effective care within health visiting services and beyond, helping to give all babies and young children the very best start in life.

Recommendations

Recommendations from previous reports on Sp HV PIMH still stand2, particularly that:

  • Sp HV PIMH should continue to be commissioned by every Local Authority in England, every Health Board in Wales and Scotland, and every Health and Social Care Trust in Northern Ireland. Such commissioning should include the provision of necessary resources to enable them to work both strategically and clinically
  • A national set of Perinatal and Infant Mental Health quality standards for Sp HV PIMH, health visiting and health visiting services are needed
  • The contribution and recognition of the Sp HV PIMH role would be strengthened by the development of credentials for Advanced Clinical Practice (ACP-health visiting)

In addition, this report recommends that:

  • All services should ensure there is a robust offer of reflective clinical supervision for Sp HV PIMH
  • Demand-driven workforce modelling with further exploration of workload weighting for Sp HV PIMH is needed to provide a benchmark for safer staffing and ensure equity of provision
  • Further research into the role of Sp HV PIMH within universal health visiting services compared to specialist services is needed to build a strong evidence base for the NHS and Local Authorities to make the best decisions in designing, commissioning and delivering services in the interests of local people
  • Further research is needed to support the translation of the evidence from the UK Confidential Enquiries into practice, focusing on public health aspects, inequalities and the Sp HV PIMH role
  • The health visiting service should be strengthened by national government through sufficient funding, a demand-driven, well-resourced national workforce strategy to ensure that all families receive high-quality, evidence-based support, regardless of where they live
Download report - Specialist Health Visitors in Perinatal and Infant Mental Health: where they are and what they’re doing

References

  1. Health Education England. Specialist Health Visitors in Perinatal & Infant Mental Health. What they do and why they matter. 2016. Available from: https://www.hee.nhs.uk/sites/default/files/documents/Specialist%20Health%20Visitors%20in%20Perinatal%20and%20Mental%20Health%20FINAL%20low%20res.pdf [Accessed 19th April 2023]
  2. Homonchuk, O. and Barlow, J. Specialist Health Visitors in Perinatal and Infant Mental Health. 2022. Department of Social Policy and Intervention, University of Oxford. Available from: https://spi.web.ox.ac.uk/sites/default/files/spi/documents/media/specialist_health_visitors_in_perinatal_and_infant_mental_health_-_january_2022.pdf [Accessed 19th April 2023]

Promoting safer sleeping for babies in England: new report

At the start of Safer Sleep Week 2023, a new report is published today on promoting safer sleeping for babies. Health visitors have an important role to play in promoting safer sleep and ensuring that these important messages reach all families.

Change is needed to the way safer sleep information is communicated, if risks to babies from unsafe sleeping practices are to be reduced, according to a new report from Oxford, UCL, Bristol and Newcastle Universities. This was prompted by government, in the wake of sudden death in infancy data, in an attempt to identify what type of support was needed to reduce the incidence in all families.

The new report on promoting safer sleep for babies particularly focuses on families facing significant adversity, who may be receiving support from Children’s Social Care Services. While rates of sudden unexpected death in infancy (SUDI) declined steeply in the 1990s and continued to decline until 2014, families living in the most deprived neighbourhoods continue to experience a disproportionately higher rate; the National Child Mortality Database found that 42% of SUDIs occurred in deprived neighbourhoods, compared with 8% in the least deprived.

Researchers interviewed parents, talked to local professional services and studied data on decision-making and safer sleep interventions.

According to the report, a range of motivational factors play a key role in influencing decision-making about the infant sleep environment, including parents’ own needs for adequate sleep, and the need to bond with their babies. Research also suggests professionals responsible for conversations about infant sleep safety have concerns about providing personalised and tailored support and managing risks in families with a social worker.

The researchers recommend:

  • Open conversations between parents and professionals could be used to support safer sleep for babies who have a social worker.
  • These open conversations would need to acknowledge and discuss the reality of people’s lives in order to understand and address the motivation behind parental decisions and actions.
  • Conversations should include credible, trusted sources and sound evidence to explain how and why safer sleep practices aim to protect infants. Social pressures with regard to “good parenting” may act as barriers to open and frank conversations between parents and professionals.

The research finds in-depth conversations about safer sleep might best be delivered to families in receipt of social care by a practitioner, such as a Health Visitor, who can provide continuity of care and who has established a trusting relationship with them. Peer and family support networks are also important to reinforce messages and provide practical advice.

The report suggests professionals could engage parents to identify motivations and provide personalised support that is still consistent with national guidance, but that is based on the needs of individual families.

Such conversations need to be consistent with guidelines from NICE and The Lullaby Trust whilst also being sensitive to the needs and context of individual families. iHV supports the Safer Sleep campaign led by the Lullaby Trust which shines a spotlight on this important public health issue.

Read the report: Promoting safer sleeping for babies in high-risk groups in England

Celebrating iHV’s achievements in family mental health and looking ahead

Just before the end of 2022, the iHV celebrated its 10th birthday and, reflecting on those years, we feel incredibly privileged to have worked alongside so many inspiring people. Year on year, the iHV Mental Health Team has been part of some phenomenal partnerships, delivering a difference for families – and this last year is no exception. Thank you to you all.

Our Mental Health Team report, published today, looks back and celebrates what we have collectively achieved from January 2022 to January 2023 – despite the challenges. We hope you enjoy it – and we hope that during 2023, as part of enabling your own wellbeing and future successes, you also take the time to celebrate your achievements.

Reflecting on the last 10 years, Melita Graham, iHV Head of Mental Health Dept, said:

I came into the iHV because I believed it was the organisation that would offer me the most opportunity to make the biggest difference, in my lifetime, to the lives of babies and their families. After 10 years, my conviction is even stronger, and without exception, each member of the iHV Mental Health Team shares this belief.

Such a lot has happened in the world in the last year and with the pivot to online working, beside the increased need of mental health support for families because of the pandemic, the cost-of-living crisis and widening inequalities, the professional pace of life is staggering.

Throughout 2022, we have stayed close to health visitors and iHV Champions on the ground, parents with lived experience and our partner organisations. We know how tough it is for families and for health visitors and our partners across the mental health system supporting families. The iHV Survey 2022 makes for sobering reading and the 2022 MBRRACE report yet again showed that suicide is still the leading cause of death for women when looking across the perinatal period. Both reports add weight to the mounting evidence of the unacceptable and preventable widening inequalities across the UK.

The iHV has worked hard alongside you in 2022 to drive change and, going into 2023, we are deeply committed to making sure that the voices of babies and their families are heard. Alongside our partners, we won’t stop until every family, irrespective of where they live, has access to a health visitor who has the right qualities, competence, and capacity to deliver high-quality, personalised, and compassionate family mental health care.

To achieve this, we must make self-care for ourselves and each other a priority. All too often, we move on to the next thing without stopping to acknowledge and consider the challenges overcome, the distance travelled, the differences we have made, and what we need to sustain our energy and our hope for the future. At our final iHV Perinatal and Infant Mental Health Forum in December 2022, iHV PIMH Champions came together and celebrated what they had achieved – despite the challenges. Each one of us went away feeling more supported, buoyed, re-energised and inspired! We are all looking forward to building our connections in 2023 and beyond.

Alison Morton, Executive Director iHV, said:

“I am delighted to see today’s report published which sets out the phenomenal achievements of the iHV’s Mental Health team in the last 12 months. Supporting families’ mental health  is a priority for the Institute and for the nation – we are privileged to have such a highly skilled team leading this work. Congratulations to each member of the iHV’s mental health team for their achievements and Melita Graham for her inspiring leadership.

“I hope that you will enjoy reading today’s report which showcases the numerous award-winning and innovative PIMH programmes that are being delivered across the UK by the iHV, and in partnership with others, to support practitioners in their work with families and better mental health across the lifecourse.”

Download iHV Mental Health Report 2022/23

Casting Long Shadows Report

The ongoing impact of the COVID-19 pandemic on babies, their families and the services that support them.

A brand-new report by the First 1001 Days Movement and the Institute of Health Visiting has been published today – ‘Casting Long Shadows: The ongoing impact of the COVID-19 pandemic on babies, their families and the services that support them.’

The report reveals worrying new statistics about babies and young children born or growing up through the COVID-19 pandemic, highlighting how more young children are at risk of harm, have delayed social skills, and have been affected by poor parental mental health.

The report findings were synthesised from evidence in recently published reports, research and national data, as well as analysis from a national survey of 555 professionals and volunteers who work with babies and their families in health visiting, mental health, maternity, early education, and other services.

The findings are compelling and are consistent with a whole raft of studies from multiple sources across the children’s sector, which all indicate that the wide-reaching impacts of the pandemic are far from over for our youngest members of society:

  • An alarming 94.8% of professionals say the pandemic has an ongoing negative or very negative impact on the personal and social skills of children who were living in the pandemic. 92.4% of professionals say the same for communication, speech, and language skills and for emotional wellbeing and development.
  • Almost half (42.7%) of respondents surveyed stated that “many” babies they work with are affected by parental anxiety, stress, or depression due to the pandemic, which is affecting bonding and responsive care.
  • More than 4 in 10 (44.1%) of respondents said that “many” of the babies they work with are currently affected by increased exposure to domestic conflict, child abuse and neglect.
  • 4 in 10 (40.4%) survey respondents reported “many” babies they worked with had been affected by the loss of family income or increased risk of food poverty.

The report also highlights how:

  • Services have not returned to normal, and this could impact future generations – Whilst there has been innovation in service provision, nearly 6 in 10 respondents (59.5%) who reported that their service was operating differently, told us that the changes were not beneficial for families.
  • Services are in ‘crisis’ – The pandemic exacerbated existing strains on services. A significant number of survey respondents raised issues relating to low staffing numbers and poor staff wellbeing, with some professionals talking about services being in “crisis”.
  • The majority of respondents (90.5% in England) did not feel that national or local governments had taken sufficient action to ensure that babies under two and their families receive the support they need to recover from the impact of the pandemic.

With so much compelling evidence, The First 1001 Days Movement and Institute of Health Visiting are calling for:

  1. National Government to take concerted action to address the impacts of the pandemic on our youngest children.
  2. Integrated local strategies are needed to ensure that all children have the best start in life.
  3. National Governments must have long-term child health and development strategies, supported by workforce plans.
  4. Clear leadership within the UK Government is needed to ensure policy decisions include a cross-government focus on the needs of babies and young children. To ensure that this does not fall in the gaps between departments, a cabinet member should be appointed to drive this forward and act now to mitigate the impacts of the pandemic on our youngest citizens.

Alison Morton, iHV Executive Director, said:

“This report helpfully pulls together the unequivocal evidence that the pandemic’s impacts on our babies and young children have been significant and demand much greater attention from policy makers. What happens during these critical earliest years of life really does matter as they lay the foundations for future health and wellbeing. Yet, the report paints a bleak picture for babies in the UK. Too many are missing out on vital early support that can make such a difference. Ignoring this growing problem of unmet need and avoidable harms is short-sighted and will prove more costly in the long run.”

Georgina Mayes, Policy and Quality Lead at the Institute of Health Visiting, said:

“This new report clearly shows that the pandemic is having a lasting impact on many children’s health, wellbeing and development, and on the ability of services to meet their needs. More children are falling behind, inequalities are widening, and some services are reaching a crisis point. Whilst many professionals are working hard to support the families that they work with, this report clearly shows that demand is outstripping the workforce’s capacity to meet the scale of need.

“We call on national and local governments across the UK to take the findings of this research seriously and act now to mitigate the impact of the pandemic on our youngest children’s lives and life chances.”

Read the full report here

 

 

 

MBRRACE-UK publishes their latest Confidential Enquiry

Today, MBRRACE-UK published their latest Confidential Enquiry: MBRRACE-UK Saving Lives Improving Mothers’ Care – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2018-20. For many years suicide has been the leading cause of direct deaths in the year after pregnancy. We are deeply concerned that this has not changed, indeed, the latest report shows that mental ill-health is an increasing cause of maternal death.

Key perinatal mental health findings:

  • 1 in 9 mothers who died experienced severe and multiple disadvantages, such as mental illness, domestic abuse and substance use
  • More women from deprived areas are dying and this continues to increase
  • 40% of deaths within the year after pregnancy were from mental health-related causes
  • Suicide remains the leading cause of direct maternal death in the first postnatal year
  • Suicide during pregnancy or up to six weeks after is increasing – in 2020, women were three times more likely to die by suicide during this period compared to 2017-19
  • Very few women who died by suicide in 2020 had formal mental health diagnoses, but significant numbers had a history of trauma
  • Women living in the most deprived areas are more than twice as likely to die as women living in the wealthiest areas
  • Concerning trend of increasing teenage suicides
  • Roughly doubling of domestic abuse rates in suicide and substance misuse deaths, compared to 2017-2019.

There remain gaps in mortality rates between women from deprived and affluent areas, women of different ages and women from different ethnic groups. Although there has been some positive improvement, this year’s report still shows a continued gap between the mortality rates for women from Black, Asian, mixed and white ethnic groups, with:

  • a more than three-fold difference in maternal mortality rates among women from Black ethnic backgrounds, compared to white women
  • an almost two-fold difference amongst women from Asian ethnic backgrounds, compared to white women.

Responding to the report and its recommendations, Melita Walker, Head of Mental Health at the Institute of Health Visiting, said:

“We are again deeply saddened by the latest MBRRACE report and offer our heartfelt sympathy and deepest condolences to all the families who represent the ‘human face’ of these stark statistics.

“It is worrying to hear, yet again, that suicide is still the leading cause of direct maternal deaths in the year after pregnancy and of the continuing impact of health inequalities on the lives of so many. If we are to save lives, we must work together to make sure that all families have access to the same high-quality mental and physical healthcare. This requires putting families at the centre of a whole system approach with fully integrated systems of care working well together.”

We would like to acknowledge the importance of these powerful reports in facilitating change and enabling systems to work together to address inequalities and the unacceptable tragic outcomes for families. The sound evidence from MBRRACE, alongside the tragic real experiences of the families that the MBRRACE reports bring sharply into focus, provides the foundation for the iHV Champions mental health training modules on risk and inequalities. We act with urgency to get the lessons from MBRRACE into practice and have now trained 3,900 Multi-Agency Champions. We are confident that sharing this learning is making a difference and saving lives – but we know we need to do more.

“Having attended the launch today I have come away more determined to shine a light on the importance of maximising the health visitor role in this area. As a system we must urgently reflect on the learning, including that: in 2020, women were 3 times more likely to die by suicide during or up to six weeks after the end of pregnancy compared to 2017-19; the majority of deaths by suicide and mental health causes occur later in the first postnatal year; and very few women who died by suicide in 2020 had formal mental health diagnoses, but significant numbers had a history of trauma.”

Health visitors are there for every family throughout the perinatal period and beyond. As such, as part of the “whole system”, health visitors play a vital role in building trusting relationships with families, identifying and responding to mothers at risk, offering pro-active, evidence-based and life-saving interventions, including timely referral on to specialist services when needed. But they can only do this effectively if they (and the whole perinatal mental health system workforce) are available in sufficient numbers, with the right training and capacity. We know we need more health visitors and, more importantly, we know that mothers and their families need them.

The iHV remains deeply committed to addressing inequalities and driving change. Alongside our partners, we won’t stop until every family, irrespective of where they live, has access to a health visitor who has the right qualities, competence, and capacity to deliver high-quality, personalised, and compassionate mental health care.

infographic of MBRRACE report findings

Read the full report

Read the Lay Summary

View infographic

UNICEF UK – Guaranteeing every baby and toddler the best start in life

Today’s report Early Moments Matter: Guaranteeing the Best Start in Life for Every Baby and Toddler in England, published by UNICEF UK, presents stark findings that over 2 million families with children under 5 in Britain are struggling financially or with their mental health.  The report, which includes data from a new YouGov poll, reveals that 1 in 3 parents – over 1 million families – are struggling to get any professional support, with 37% struggling to get help when their child is unwell.

The report highlights how basic support services like health visiting, mental health support, affordable early education and childcare should be available for everyone regardless of where they live – but instead, gaps in availability means that families across the country are missing out. UNICEF UK warns that waiting lists are long, provision is patchy and, in some areas, not there at all. Despite the unequivocal evidence on the importance of the first years of a child’s life, the charity warns that this lack of basic support is putting children’s immediate and long-term wellbeing and development at risk, and it is also having a damaging effect on parents’ mental health.

UNICEF UK is calling on the Government to address this by providing a “Baby and Toddler Guarantee” through a nationally-recognised suite of connected services, with accountability for their delivery held at the highest level of government. The Baby and Toddler Guarantee should include accessible, quality, and fully resourced maternity services, health visiting support, mental health support, SEND provision, infant feeding support, and early childhood education and care.

The Institute of Health Visiting welcomes the call for this “Guarantee” which would put an end to the current postcode lottery of support and also advance the UK government’s mission to ‘level up’ the country. The package of services included in The Baby and Toddler Guarantee should deliver the collective commitments referenced in Start for Life Vision and Family Hubs programme, the Healthy Child Programme and the NHS Long Term Plan, which together cover universal, targeted and specialist support.

Alison Morton, iHV Executive Director says:

“I am grateful for organisations like UNICEF UK who are standing up for the rights of babies and young children, whose voices have been ignored for too long by adults with the keys of power. Lifelong inequalities take root in early childhood, yet babies and young children in Britain today are currently the innocent victims of events that they have no control over. These inequalities are not inevitable, and the report’s authors present a clear plan of action to prevent unnecessary harm. However, it is also clear that, if we fail to take the warnings in this report seriously with meaningful and swift action, they will have dangerous and potentially life-changing consequences for too many of our youngest citizens.”

The report makes the following recommendations to the UK Government:

  1. Commit to making The Baby and Toddler Guarantee a reality for every baby, young child and family across the country.
  2. Make early childhood a national priority for the Government with Cabinet-level leadership to drive the delivery of The Baby and Toddler Guarantee and ensure coherence between Government departments.
  3. Deliver across-Government strategy for early childhood that builds on the vision and commitments in Best Start for Life, and responds to the challenges of workforce, funding, and governance with joint outcomes for early childhood development that sit across departments.
  4. Commit to track and monitor progress towards delivery of The Baby and Toddler Guarantee for every baby, young child, and family across the country.

In addition to a comprehensive commitment to service provision, The Baby and Toddler Guarantee must also address the “baby blind spot”’ in government decision-making by ensuring that every decision made by any government department considers its impact on and wellbeing of the nation’s youngest citizens. Currently, this would include the government’s evolving response to the COVID-19 pandemic and its response to the cost-of-living crisis.

Sign the Petition

UNICEF UK’s Early Moments Matter (#EarlyMoments Mattercampaign launches today.

Sign up to UNICEF UK’s petition calling on the UK Government to introduce a National Baby and Toddler Guarantee here

Read the report

Read the full report Early Moments Matter: Guaranteeing the Best Start in Life for Every Baby and Toddler in England here

 

 

Roundtable on the importance of early childhood

The Duchess of Cambridge will host a roundtable at the Royal Institution today to mark the release of new research from The Royal Foundation Centre for Early Childhood.

A year on from its launch, The Centre for Early Childhood will be unveiling the findings of new research into early childhood development, as The Duchess of Cambridge and the Centre host a small roundtable to discuss the results and broader importance of early childhood development to society.

The roundtable will be attended by representatives from the early years sector; the Secretary of State for Health, Sajid Javid; the Minister for Families, Will Quince; and officials from the Department of Health and Social Care and the Department for Education. Together, they will discuss the findings of the research published today, and the huge opportunity that there is to shape the future of our society by focusing on the importance of early childhood to lifelong outcomes.

Conducted by Ipsos UK on behalf of The Royal Foundation Centre for Early Childhood, the research comes two years after The Duchess’s landmark survey – ‘5 Big Questions on the Under-Fives’ – which attracted the largest ever response to a public survey of its kind with over 500,000 responses in one month, sparking a national conversation on the early years. The research delves even deeper into public perceptions of early childhood, focusing on three key areas: the prioritisation of the early years; the link between the first five years of life and lifelong outcomes for mental health and wellbeing; and the support parents seek when raising young children.

Seven in ten people say the early years should be more of a priority for society.

Earlier this year, The Duchess travelled to Denmark where she learnt about how the Danish approach has created an enabling culture for early childhood development, specifically how it has promoted infant mental wellbeing alongside physical health, and how it harnesses the power of nature, relationships and playful learning in the first five years of life. The service in Denmark is modelled on the health visiting service in England. However, in contrast, the work to support families in the earliest years in Denmark is a national priority and the workforce is afforded much higher status and greater investment than their counterparts in England.

Today’s research also follows over a decade of work by Her Royal Highness in which she has seen first-hand how some of today’s hardest social challenges have their roots in the earliest years of a person’s life. The Duchess is committed to raising awareness of the importance of early childhood experiences and of collaborative action to improve outcomes across society. She launched The Royal Foundation Centre for Early Childhood in June 2021.

Speaking about the research published today, The Duchess of Cambridge said:

“Our experiences in early childhood fundamentally impact our whole life and set the foundation for how we go on to thrive as individuals, with one another, as a community and as a society.

“The findings published today present us with a huge opportunity and demonstrate there is real appetite from the public to bring this issue up all of our agendas. There is more we can all do – every member of society can play a key role, whether that is directly with a child or by investing in the adults around them – the parents, the carers, the early years workforce and more.

“If we come together to raise the importance of early childhood development, we’ll soon see that healthy, happy individuals make for a healthier, happier world. Which is why every second we spend with a child, is an investment in our collective future.”

Alison Morton, iHV Executive Director, says:

“The findings from today’s research, alongside the long-term commitment of the Duchess of Cambridge to raising awareness of the importance of early childhood experiences, provide an opportunity to shift the needs of babies and young children higher up the national agenda. With such a vast body of evidence making the case for investment in the earliest years of life, we hope that today’s Roundtable will ‘light the touch paper’ for the change that so many of us who work in this field have hoped for – but hope is not enough. In the words of the Duchess of Cambridge, there is definitely ‘more we can do’ and it starts in the heart of government.”

Go to Ipsos UK to download the report

Read the Key Findings of Understanding public attitudes to
early childhood

UK fathers in the first year after birth – we need to do better

The iHV welcomes the important findings of the latest report, ‘Bringing Baby Home’ published by the Fatherhood Institute for Fathers’ Day and Infant Mental Health Awareness Week. The report is based on the findings of a systematic scoping review of the UK literature on UK fathers in their baby’s first year after the birth. The report presents findings on men’s adjustment to fatherhood; relationship with their partner; associations of ‘father-factors’ with mother wellbeing and child outcomes; engagement with services; and related policies in the four countries of the UK.

The Fatherhood Institute’s hard-hitting conclusion is that NHS maternity, health visiting and other family services are failing babies by ignoring their fathers during the first postnatal year. It finds that even without the additional challenges of the COVID-19 pandemic, services are often not set up to engage with, assess and support new fathers. This is despite clear evidence that fathers’ physical and mental health has a significant impact on babies’ future health and wellbeing, on key maternal outcomes and that the perinatal period can be a ‘golden moment’ for encouraging better health behaviours among fathers.

Alison Morton, iHV Executive Director, says:

“Health Visitors know and understand the important role that fathers play in family life and the health and wellbeing of all family members – they wholeheartedly agree with the premise of this report and want to be enabled to deliver father-inclusive services. The report’s hard-hitting findings make difficult reading, with stories of families being let down – but they point yet again to the need to address the root cause of this problem. If things are to change, we need to address the systemic and structural challenges that are hampering efforts to deliver father-inclusive services. We also cannot ignore the ‘elephant in the room’ – we need more health visitors – we have a national shortage of around 5,000 health visitors and this results in less time being available to provide families with the support they need, and families are facing the brunt of this with a postcode lottery of support.

“This report provides clear evidence that this needs to change and that investing in father-inclusive care and early help makes sound economic sense. At the iHV we have great examples of where health visiting services have developed father-inclusive services, we have also trained health visitor ‘Father Champions’, but more needs to be done. We agree with the report’s authors that ‘father-inclusive care’ should be the norm and not the exception.”

The report’s authors make four key recommendations for how services could be improved:

  1. Fathers’ names, contact details and NHS numbers should be entered onto NHS birth notifications so that fathers can be contacted directly by services. As is the case for mothers, the father’s NHS number would link to his medical record for use by practitioners and for research purposes, within a framework of data protection law and ethical guidelines.
  2. All tax-funded services and interventions for families in the perinatal period – including those commissioned by central government (e.g. the Reducing Parental Conflict programme and Family Hubs) should be commissioned, designed, delivered, promoted and evaluated in ways that recognise fathers’ own need for support (whether or not they share a household with the child’s mother) and their impact on children and mothers. Practitioners should use evidence-based strategies to achieve high levels of father-inclusion, and should follow (and where relevant be inspected against) key guidance. The Fatherhood Institute is working with the Royal College of Midwives to produce a father-engagement toolkit, to be published in October 2022.
  3. The government should fund, pilot and evaluate a scalable, locality-wide approach to embedding father-inclusive practice across a whole network of perinatal services in a number of local areas.
  4. Given the unavailability of parental leave to the vast majority of UK fathers, and the huge significance of fathers’ participation in solo parental care in baby’s first year for later care patterns, the government should pilot new approaches to leave taking, focused on different groups of working fathers, including those who are employed, self-employed and working in the ‘gig economy’. Ways in which employers do or could support fathers should be included in the pilot.

Adrienne Burgess, Head of Research at the Fatherhood Institute, who co-authored the report, said:

“We ourselves were stunned, when we pulled this research together, to discover the extent to which infant and child outcomes (and outcomes for mothers, too) are impacted by fathers’ behaviour and characteristics in the first few months after the birth. It is also deeply disappointing to discover that no systematic support is offered to new fathers by NHS providers – no recognition of their role, or even, sometimes, their existence.”

At the Institute of Health Visiting, we are keen to be part of the solution – we have been working with the EU PATH Partnership and Dad Matters UK to produce a suite of new resources for healthcare professionals on father-inclusive services.

Look out for our blog on ‘All things Dad’ on Friday 17 June which launches these resources and sets out the work that we are leading to support ‘father-inclusive’ services.

Read Bringing Baby Home Main report

Read Bringing Baby Home Exec Summary

Read Bringing Baby Home Recommendations

 

 

 

 

 

 

Publication of the Independent Review of Children’s Social Care

The long-awaited Independent Review of Children’s Social Care, led by Josh MacAlister, was published this morning. The review aimed to identify the challenges facing children’s social care in England and ways to ensure that children grow up in loving, stable, safe families and, where that is not possible, care provides the same foundations.

In his opening remarks, the review chair states,

“The time is now gone for half measures, quick fixes or grandstanding. Changing the easiest bits, papering over the cracks, or only making the right noises, may in fact make matters worse. It will create the illusion of change but without the substance. It will dash hopes and fail another generation.”

The Review consulted closely with thousands of care-experienced children, young people and adults, and the practitioners who work with them, and formed an Experts by Experience Board to support all stages of the process and shape the recommendations. Alongside numerous organisations working with children, the Institute of Health Visiting submitted written evidence to the review’s consultation in March 2021 and participated in the Child Safeguarding Practice Review Panel’s National Review to examine the circumstances leading up to the tragic deaths of Arthur Labinjo-Hughes and Star Hobson.

The review highlights numerous challenges in the current system including difficulties with multi-agency working, unnecessary barriers to sharing information about children, and a ‘broken care market’. The review also acknowledges that children’s social care can only function effectively when the wider system and welfare state is working well to support children – the report cites the work of the Institute of Health Visiting highlighting the knock-on impacts of recent cuts in health visiting, stating:

“Children’s social care picks up the needs of families which universal and other services cannot address. Therefore, getting the right support for families through universal services and, wherever possible, addressing issues before they escalate is critical”.

The review concludes that our current approach to children’s social care is not working, with record numbers of looked after children and a system skewed towards helping families only when they reach crisis point and children have already been harmed. In recent years, the system has been further strained as more families are struggling due to the impacts of the pandemic and the cost of living crisis has tipped more families with children into vulnerability. As health visitors, we are well aware that babies and young children are a particularly vulnerable group as they are less visible to other services, leaving many with unidentified and unmet needs.

The review provides a stark warning that,

“Without a dramatic whole system reset, outcomes for children and families will remain stubbornly poor and, by this time next decade, there will be approaching 100,000 children in care (up from 80,000 today) and a flawed system will cost over £15 billion per year (up from £10 billion now). Together, the changes we recommend will shift these trends and would mean 30,000 more children living safely and thriving with their families by 2032 compared to the current trajectory.”

The Institute of Health Visiting joins with other charities working with children responding to today’s report and calling for change.

Alison Morton, iHV Executive Director says,

“Today’s report is a wake-up call for our nation – too many vulnerable children are being let down as services often intervene with too little, too late. We cannot continue to ignore the voices of so many children and young people that have been captured in this report – sadly what they have told us has been known for far too long. And as health visitors, we will also continue to advocate for babies and young children whose needs are so often overlooked. Urgent action and investment is now needed to address the underlying root causes and fix a struggling system. We hope that policymakers will seize this opportunity and build a future where every child feels safe, secure, seen and supported”. 

Read the report here

#StepUpForChildren

New evidence paper published by the National Children’s Bureau

New evidence paper published by the National Children’s Bureau: Impact of investing in prevention on demand for statutory children’s social care

The final report of the Independent Review of Children’s Social Care is expected imminently. To support the launch of the Review, the National Children’s Bureau (NCB) has worked with their academic partners to showcase the latest research on children’s social care.

The NCB’s new evidence paper (Impact of investing in prevention on demand for statutory children’s social care) demonstrates that investing in prevention, including family support and early help, can reduce demand for more expensive crisis support later, and also leads to better services overall.

The NCB says:

“We have a unique opportunity to strengthen families and invest in early intervention. We must seize this moment to transform children’s lives for the better. Rarely has the case for early investment been so clearly articulated. We have to seize the moment”.

Highlights from the evidence paper:

  • Increased spending on children’s social care preventative services (including family support and early help) has a positive impact on:
    • Ofsted judgements
    • Numbers of Children in Need
    • Rates of 16–17-year-olds starting periods in care.
  • The distribution of local authority spending on prevention has become increasingly less well matched to need.
  • Two recent papers have reinforced the contributory causal relationship between family poverty and levels of child abuse and neglect and the demand for children’s social care services, including rates of entry to care.

The evidence paper concludes with a brief summary of further contextual research on the association between household income and intervention, and on systems-thinking in children’s social care.

You can read more in the NCB’s evidence paper here.

You can join the iHV in raising awareness of the publication of the NCB’s evidence paper and share on social media using the prepared tweet below:

The imminent #CareReview is our chance to secure a future where every child feels safe, secure & supported @NCBtweets’ new evidence paper shows how investment in preventative services can help build that future, saving money in the process. https://bit.ly/3yO2Y2D