The Royal Foundation Centre for Early Childhood Archives - IHV

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

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.”