Further investment from The Royal Foundation Centre for Early Childhood to support health visitors to “give babies a voice” following the publication of the iHV ADBB Phase Two Study.
Today, the iHV, in collaboration with the University of Oxford, published the findings from its latest evaluation of the use of the Alarm Distress Baby Scale (ADBB) in health visiting practice across the UK. We are also delighted to announce that we will be able to continue to support embedding of the tool within health visiting thanks to further investment from The Royal Foundation Centre for Early Childhood.
The tool, known internationally as the Alarm Distress Baby Scale (ADBB), is used by health visitors within routine checks to promote infant wellbeing. It focuses on a baby’s social behaviours such as eye contact, facial expression, vocalisation, and activity levels to help practitioners and families better understand the ways babies express their feelings and to help parents and carers with bonding and attachment. It can also be used to recognise early signs of psychological distress, enabling specialist support to be accessed as soon as it is needed.
Our evaluation found that:
- ADBB training addresses a clear gap in health visiting practice by strengthening understanding of infant social withdrawal and increasing practitioner confidence in observing and interpreting babies’ behaviour.
- Health visitors reported feeling better equipped to articulate the baby’s perspective, an area they felt is often less emphasised in other training, which tends to focus more on parental behaviours. This enhanced ability to “give the baby a voice” supported richer, more balanced conversations with parents.
- There were measurable changes in practice at the 6–8‑week postnatal review. The proportion of babies identified with concerns increased from 7% to 12%. Yet, importantly, referrals to specialist services reduced, suggesting that ADBB supports earlier identification of emerging needs and enables more proportionate responses within universal services.
- Parents described the 6–8‑week review as reassuring, supportive and confidence‑building. They particularly valued warm, non‑judgemental communication, a clear explanation of their baby’s behaviour and cues, feeling listened to, and emotional support and validation. When introduced clearly, ADBB‑informed observation was experienced as collaborative and empowering.
Eileen Perrins, Perinatal & Infant Mental Health Lead, Institute of Health Visiting, explains more (with thanks to Debbie Barrett & Darren Alderson-Hall – Hampshire & Isle of Wight Healthcare NHS Foundation Trust for co-ordinating, the staff at Bridgemary library for hosting and for all the parents and their wonderful babies for taking part in the filming):
Next steps in this project
The Royal Foundation Centre for Early Childhood has today announced next steps in this project to build upon the positive independent evaluation of the phase two study, with recommendations for ADBB to be commissioned across the country.
Her Royal Highness The Princess of Wales first saw the tool in use when she met health visitors in Denmark in February 2022, and The Centre has been working with the Institute of Health Visiting (iHV) ever since, to bring the benefits of the approach to families in England, Wales, Scotland and Northern Ireland.
Phase one of the study ran in two NHS Trusts from May 2023 – February 2024, exploring the feasibility of implementing a modified version of the tool (m-ADBB) within health visitors’ routine 6-8-week checks with families. It had overwhelmingly positive results.
Phase two of the study, which ran from October 2024 – March 2026, then explored the impact of training health visitors in the ADBB and its modified version (m‑ADBB), across eight sites throughout the UK. This phase set out to assess how training influences practitioners’ knowledge, confidence, and practice; examine changes in identification, referrals and support at the 6–8-week postnatal review; and explore parents’ experiences of the approach.
To support local authorities to take up the use of the tool, The Centre for Early Childhood will fund the iHV to produce a guide to commissioning ADBB, as well as to develop new resources tailored to a UK audience. In line with a key recommendation from the evaluation, The Centre will also fund iHV to create a new ADBB Community of Practice for the next three years, to support practitioners in the continued use and embedding of the tool. This will play a central role in supporting ongoing learning, supervision, and peer support, helping to ensure practitioners are supported to safely and effectively embed the approach in routine care.
Alison Morton OBE, CEO of the Institute of Health Visiting, said:
“The findings reinforce the role of health visitors as highly skilled practitioners, able to build trusted, therapeutic relationships with families and to guide sensitive, open discussions. Getting the right support to families at an early stage can have a hugely positive impact on a baby’s whole life. We want every commissioning body in the UK to consider using this tool so that every family with a newborn can benefit.”
Christian Guy, Executive Director of The Royal Foundation Centre for Early Childhood, said:
“By equipping practitioners and families to understand what babies are communicating from the very start, we can give infants a stronger voice in early conversations, identify where extra support may be needed earlier, and help families build the responsive, nurturing relationships that we know are so important in shaping lifelong outcomes.
“The more health visitors are trained in this use of this tool, the better equipped they will be to help, which is why we are so determined to do everything we can to support its roll out across the UK.”
While the study found the training to be acceptable and impactful, it also makes clear that learning to observe and interpret babies’ behaviour is complex and requires ongoing practice, supervision and support. Successful implementation depends on organisational readiness and system‑level conditions including manageable caseloads, continuity of care, protected time, and clear governance and referral pathways.
ADBB Phase Two Study Report:
