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The Institute of Health Visiting is leading this study in partnership with Professor Jane Barlow at the University of Oxford, funded by The Royal Foundation Centre for Early Childhood, 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 of the promotion of infant wellbeing and social development, and by enhancing health visitors’ ability to identify infants at risk.

Why is the field trial study needed? A range of parent-reported outcome measures (PROMS) and clinician-rated outcome measures (CROMS) have been developed over the past two decades to assess parent-infant relationships. However, most of these were not designed for use by clinicians, or have significant limitations in terms of their use within a clinical setting, and, in particular, by health visitors as part of their routine care of families in the postnatal period. Furthermore, 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 in the UK context.

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 Paris by child psychiatrist Prof. Antoine Guedeney, 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 health visitors’ routine visits 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.

The aim of this study is 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. This will focus specifically on supporting the promotion of the mental wellbeing of infants and their parents and by enhancing health visitors’ ability to identify infants at risk.

Study design: Mixed methods sequential exploratory study, using the explanatory model of implementation theory provided by Normalisation Process Theory (NPT).

Study participants: 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.

Planned study period: 1 May 2023 – 28 February 2024 (10 months)

The findings from this study will provide valuable learning on the implementation of the ADBB with families in England. The study will explore how this approach differs from the current approach to supporting families and promoting infant wellbeing and social development, and has the potential to inform implementation in other sites looking to enhance their support to families across the UK.

An Expert Advisory Group comprising senior academics, government officials and key stakeholders will provide expert advice, scrutiny and challenge 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’. This group includes:

Members of the Expert Advisory Group:

  • Chair – Alison Morton (iHV)
  • Academic adviser – Jane Barlow
  • Project Lead – Vicky Gilroy (iHV)
  • Research Associate – Nafisa Insan (iHV)
  • Mental Health Lead – Hilda Beauchamp (iHV)
  • Royal Foundation – Sarah McMullen
  • Start for Life Unit – Hannah Sereni
  • Parent Infant Foundation – Wook Hamilton, Head of Development
  • Family Partnership – Crispin Day
  • OHID – Lynne Reed and Wendy Nicholson
  • City of Bradford Metropolitan District Council – Sarah Muckle, Director of Public Health.

Published Papers

To cite this report, please use the link to the pdf here:

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