Institute of Health Visiting launches ADBB study findings

Today, the Institute of Health Visiting (iHV) is delighted to share the overwhelmingly positive findings from their mixed-methods feasibility study into the use of the Alarm Distress Baby Scale (ADBB) in routine health visiting practice in England.

The study, commissioned and funded by The Royal Foundation Centre for Early Childhood, was conducted in partnership with Professor Jane Barlow from the University of Oxford. It sought to explore how acceptable and feasible health visitors found using the baby observation aid, the ADBB, and its shorter modified version, the m-ADBB, during their routine 6-8-week visits to families.

During the ten-month study, health visitors trained in the ADBB and m-ADBB were recruited from South Warwickshire NHS Foundation Trust and Humber Teaching NHS Foundation Trust. Quantitative and qualitative data were collected over a four-month period, during which the trained health visitors used their enhanced skills and knowledge to observe babies’ behaviours and interactions and identify those in need of a more thorough assessment or additional support.

Health visitors described the ADBB approach as “hugely beneficial” and “of great importance” to their practice. Findings demonstrate that both training programmes (ADBB and m-ADBB) were rated highly by all study participants, giving a new theoretical perspective, additional knowledge and skills, and a new vocabulary for explaining their observations of a baby’s behaviour. The use of the shorter validated 5-item version of the scale, the m-ADBB, was found to require minimal additional time and was considered easy to embed into routine health visiting practice (for example, the observation could be undertaken when parents were undressing their baby, or the baby was being weighed). Using the m-ADBB in this way enabled health visitors to:

Have more meaningful conversations with parents and carers about the emotional wellbeing of their baby;
Promote positive parent-infant interactions, attachment, and bonding; and
Identify those babies and families in need of greater support during this critical period of development.

Dr Jane Barlow, Professor of Evidence Based Intervention and Policy Evaluation at The University of Oxford, who oversaw the evaluation of the trial said:

“Babies are born with amazing social abilities. They are ready to relate and engage with the world around them, communicating how they feel through their behaviours.

“Whereas previous approaches have focused on the parents’ perspective, this training has really helped health visitors to ‘read’ the baby during interactions and develop greater sensitivity in terms of the observation of potential attachment and bonding issues that would not have been identified without the training.

“The feedback from those involved has been overwhelmingly positive. It is truly exciting to think about the impact this could have on families right across the country as we enter the next phase of this research.”

Alison Morton, CEO of the Institute of Health Visiting, said:

“Babies can’t talk, but there is now good evidence that they can communicate their experiences of the world around them when we tune in to their behaviours. We are therefore delighted by the positive findings from this study which found that the modified ADBB tool was very workable within universal health visiting practice, providing an important new way for health visitors to observe babies interacting with the people around them. There are many reasons why a baby might be distressed or withdrawn. Spotting these problems as early as possible is important as it will enable health visitors to work with families to ensure that they get the right support and babies can thrive.”

During the study period, health visitors identified behavioural concerns in 23 (10%) of babies as a result of using the m-ADBB. Health visitors were then able to work with families to explore the many possible reasons for this and determine the most appropriate next steps. All identified families were offered additional support, ranging from follow-up visits, emotional wellbeing visits and video interaction guidance (VIG) as well as connections to Child and Family Centres and referrals to Specialist Perinatal Mental Health and other local support services where indicated.

Conclusions and next steps

The quality of interactions that a baby has with their parent or caregiver is associated with their long-term development outcomes. Health visitors have a key opportunity in their routine contacts with families to promote optimal parent-infant interactions and identify emerging concerns. However, assessing these interactions can be quite complex, requiring a robust theoretical understanding as well as sound clinical observational skills.

The ADBB training introduced health visitors to the concept of social withdrawal – a coping mechanism that babies may use if they are experiencing some sort of stress in the environment around them. The additional understanding gained from observing babies’ behaviour from this perspective sat very well alongside health visitors’ existing skills. It helped them to consider how babies let us know they are ‘here, and engaging with the world’ and identify where additional support may be needed.

Executive Director of The Centre for Early Childhood, Christian Guy, said:

“The quality of the relationships between babies and their parents or carers, during the first weeks and months of life, shapes their developing brains and lays the foundations for their future health and wellbeing. So, it is vital that we provide families with the best possible advice and support at this crucial time.

“The results of the initial phase of testing are so encouraging. We now want to move quickly to ensure we build on this work, bringing the benefits of this model to more health visitors across the country so that, ultimately, more babies and their families get the support they need to thrive.”

In light of the positive findings of this study, the report includes recommendations for a second phase of research and evaluation of the tool in the UK context. In addition to several suggested research strands, consideration should also be given to:

a UK-based training programme with amendments to the training to align with the UK context, incorporating the training improvement recommendations from this study
Evaluation of the impact of training in more health visiting sites across the UK
Support systems for health visitors if ADBB/m-ADBB are adopted within health visiting practice, to include continuing professional development, supervision, learning resources and practice opportunities

The iHV, in partnership with the University of Oxford, would like to express its sincere thanks to The Royal Foundation Centre for Early Childhood for funding this important study and for their support and oversight throughout the study period.

Training in the ADBB and m-ADBB was kindly provided by Alexandra Deprez and Jocelyne Guillon of Humagogie training centre. Further details can be found at adbb-scale.com.

To read the full report and recommendations click here

To cite this report , please use the link to the pdf here: https://bit.ly/4a7z2hT

The research team would like to acknowledge the governance and guidance of the Expert Advisory Group:

Alison Morton (Chair) – Institute of Health Visiting
Dr. Sarah McMullen – The Royal Foundation Centre for Early Childhood
Hannah Sereni – Start for Life Unit
Wook Hamilton – Parent-Infant Foundation
Professor Crispin Day – South London and Maudsley NHS Foundation Trust
Lynne Reed and Wendy Nicholson – Office for Health Improvement and Disparities
Sarah Muckle – City of Bradford Metropolitan District Council, Director of Public Health
Professor Carl May – London School of Hygiene & Tropical Medicine

And the dedicated health visitors, managers and research departments at the Humber Teaching NHS Foundation Trust and South Warwickshire University NHS Foundation Trust who participated in the study.

Watch Sky News article: ‘Overwhelmingly’ positive results for trial funded by Princess of Wales as part of early years work

Health visiting study seeks to learn lessons from pandemic

A new £265,000 study led by the University of Stirling is seeking to understand how the COVID-19 pandemic has affected health visiting services across the UK, with a view to improving them in the future.

The 18-month project – funded by the National Institute for Health and Care Research (NIHR) – will explore the changes that health visiting has experienced over the past two years and provide recommendations to enhance organisation and delivery as part of a strong post-pandemic recovery.

The project is led by Dr Erica Gadsby, a Senior Lecturer in Public Health from Stirling’s Faculty of Health Sciences and Sport, and also involves researchers at the Universities of Oxford and Kent.

Alison Morton, Executive Director of the Institute of Health Visiting, said:

“Congratulations to the team, led by the University of Stirling, which has been awarded this prestigious NIHR funding.

“The last two years have been a period of tumultuous change, with health visiting services facing significant challenges in their efforts to support babies, young children and families. Health visitors responded rapidly with service innovations, but many of these adaptations have not been tested in the health visiting context and their impacts are largely unknown.

“This much-needed realist review will help us to gain a greater understanding of the pandemic response in order to learn lessons that can be applied to future emergencies, as well as strengthening the evidence base to support the embedding of new innovations and ways of working.”

The pandemic caused enormous pressure and disruption to child health services, as well as to families and young children, but it also prompted some important innovations in service delivery. The new study will explore how the pandemic affected health visiting services in Scotland, England, Northern Ireland, and Wales, with a view to understanding how the organisation and delivery of services can be improved for a stronger post-pandemic recovery.

The researchers will undertake a ‘realist review’, which is a type of theory-driven review of evidence. They will pull together different forms of information related to what has happened in health visiting services since March 2020 and use that to explore how the pandemic has affected services, service providers and families.

The team includes realist review, health visiting and public health experts, as well as a patient and public involvement lead. A stakeholder group – comprising practitioners, commissioners, policymakers, policy advocates, and members of the public – will advise and provide feedback throughout the project.

The team will work closely with the Institute of Health Visiting and the stakeholder group to ensure the findings of the study are developed into a range of outputs suitable for the various stakeholders and disseminated to the appropriate audience.

Dr Gadsby is supported on the project, Realist Review: Health Visiting in Light of the COVID-19 Pandemic Experience (RReHOPE), by Professor Kendall; Dr Geoff Wong and Ms Claire Duddy (both of the University of Oxford, Nuffield Department of Primary Care Health Sciences); and Mrs Madeline Bell (expert by experience).

Exciting opportunity with iHV – Research Associate

Exciting and unique opportunity with the Institute of Health Visiting

Research Associate

Based in Kent, Essex or London

Applications are invited for a Research Associate at the Institute of Health Visiting (iHV) for a fixed term period of ten months. The post is available from early March, following successful appointment. The research is funded by Health Education England (HEE) working across Kent, Surrey and Sussex.

Applications are invited from highly motivated researchers with an interest in public health, doctor-patient communication, behaviour change, implementation science and/or health services research to join the iHV as a research associate. The post holder will join the research team to work on the, “Improving the delivery of different news study 2”. This study follows the feasibility study which was completed in 2019. It is an applied research study involving both families and Healthcare Professionals (HCPs) to establish best practices for delivering different news to families. “Different news” describes the process of imparting information relating to an unborn child or a newborn having a condition associated with a learning disability. This mixed-methods study aims to expand on the findings of the feasibility study and to develop, deliver and evaluate a training intervention to improve the process of delivering different news to families. The post holder, who will have a doctorate relevant to requirements of the post, will be based in Kent or Essex and will be prepared to travel within their post.

For further details, job description and how to apply

Applications close: 9.00 am on Thursday 20 February 2020

Interviews: Monday 2 March 2020

Start date: ideally early March 2020

iHV welcomes BabyClear study to reduce smoking in pregnancy

Research published today by the University of Newcastle shows that the BabyClear programme, implemented in the north east of England to reduce smoking during pregnancy, has been very successful.

Pregnant women are almost twice as likely to quit smoking if they are supported from their first midwife appointment – and then are more likely to have heavier, healthier babies. Newcastle University researchers evaluated the “BabyClear” programme which follows the National Institute for Health and Care Excellence (NICE) guidance around smoking in pregnancy by screening all pregnant women for smoking using carbon monoxide monitoring.

Dr Cheryll Adams CBE, executive director, iHV, said:

“It is excellent that the pilot BabyClear programme in the North East has been so effective in helping women to stop smoking, yet there is more work to be done. Using this approach across the whole country, we can significantly reduce the number of pregnant women who smoke and, as a result, reduce perinatal mortality and morbidity – so giving more children a better start in life.”

The implementation of the BabyClear programme in the North East was supported by SFAC and Smoking in Pregnancy Challenge Group members Fresh North East.

For further details, read Newcastle University press release