Support for Parent and Infant Relationships

Hogg, S (2019)

Title: Rare Jewels: Specialised parent-Infant relationship teams in the UK

Research source: https://www.pipuk.org.uk/news/specialised-parent-infant-relationship-teams-are-rare-jewels-mental-health-system

Publication date: June 2019

Our Summary: “It’s definitely one of the jewels in the crown”- CCG Commissioner in Leeds describing their parent-infant team.

The research, which was launched at the All-Party Parliamentary Group (APPG) in June 2019, sets out to describe and explain:

• What specialised parent-infant relationship teams are, and why they are so important
•  That in areas where this is offered they are “effective, high quality prevention and early intervention to give every baby the best start in life” (p2)

It was found that nationally 27 such services were available, and that increasingly commissioners are considering funding them. This however, represents only 13.5% of commissioning teams across England. The author argues that this means that most infants live in areas where these or alternative functions are not available for this age group. It was also found that 42% of Clinical Commissioning Groups (CCGs) do not accept referrals for the 0-2 age group. Even where referrals were accepted, the reality was often that these children did not gain access to such services.

In terms of the scale of the need, it has been found in the UK that:

• 10-25% of children have disorganised attachment
• 19,640 babies under 1 year old have been identified by Local Authorities as being ‘in need’
• 25,000 babies under 1 live in a household where two risk factors are present, and 8,300 with three. [Risk factors are considered to be: risk of abuse and neglect, family dysfunction, family in acute stress, and parental disability or illness]

The first 1001 days provides particular opportunities and challenges in which practitioners require specific expertise so that they can work effectively with families in their care.

The research obtained insight using the following methods:

• Parent Infant Partnership UK’s experience of supporting such teams
• A detailed survey of parent-infant relationship teams
• A short survey of professionals (e.g. Child and Adolescent Mental Health Services – 194 responses)
• Desk-based research and conversations with stakeholders
• A Freedom of Information request to all CCGs in England, and to mental health services
• Interviews with commissioners in 4 areas
• Stories of families who have used parent-infant teams

The 27 specialist teams offered high quality therapeutic support to families that were considered to be experiencing challenges that were:

• Severe
• Complex
• Enduring

These services have been found to enable infants to be more able to achieve positive development, and to take the opportunities that are offered to them to support their futures.

The report identified that the following represents gaps in provision in England:

•  That there is no identified accountable body in relation to commissioning parent-infant relationship support
• That where resources are available that these are focussed towards later intervention
• That despite the evidence provided about the first 1001 days, often the needs of infants remain not identified or prioritised

Where parent-infant teams are available they generally work on two levels (p8):

• As expert advisors and champions for parent-infant relationships by supporting the workforce to identify issues and taking action accordingly. Development is made available through training, consultation, and/or clinical supervision
• By providing direct support to families including targeted interventions that are therapeutic in nature

The characteristics of specialised parent-infant relationship teams were found to be as follows:

• Teams were multi-disciplinary
•  They are experts and champions
• They offer direct support
• They assess and offer individualised programmes of support
• Their focus is on the parent-infant relationship
• There is a clear referral pathway
• Referrals are accepted for children under 2 years and their parents

Staffing of the teams reflected the funding that had been made available but commonly included:

• Consultant psychologist / psychotherapist
• Clinical psychologist / psychotherapist
• Parent-infant therapists (e.g. Health Visitors, infant psychotherapists, midwives and clinical psychologists)
• Adult mental health practitioner
• Social worker
• Administrator
• Community outreach or peer support worker

A summary of the recommendations made in the report for England are as follows:

• That all CCGs should commission mental health services which are appropriate for all children and their families. In addition that data should be collected and monitored which could support accessibility of such service
• That commissioners should be held account to government for these services particularly in relation to the youngest children
• That commissioners should give the workforce the opportunity to:
  a. Develop their knowledge, skills and practice in supporting babies’ wellbeing
  b. Be in the position to act early when problems are identified
  c. Further champion the needs of infants
  d. Have access to spaces in which babies are prioritised
• That there should be a government strategy to give every child the best start in life, with parent-infant relationships being at the core of the strategy and associated planning. As a part of this there should be encouragement and incentives for local areas to develop and deliver this
• That there should be clear accountability in relation to this strategy, and that health, children’s services and the voluntary sector should be able to work together to achieve this. Also that talking about ‘Infant, Children and Young People’s Mental Health’ services should be emphasised
• That there should be a ring-fenced and protected budget for this transformation, and that this should be sufficient to meet the needs of the infant population
• That there should be increased funding for research in this area in order to build on the area’s evidence base. Also that ‘What Works Centres’, the Early Intervention Foundation (EIF) and the National Institute for Health and Care Excellence (NICE) should be enabled to work further together further to synthesise the evidence, and to give guidance to commissioners as the result of it
• That government and public bodies should all do more to raise awareness of parent-infant relationships, and the importance that they make in terms of babies brain development

HENRY: 10 Year Impact Report

Title: HENRY (2019), Our Lasting Impact for Children and Families

Research source: https://www.henry.org.uk/impactreport

Publication date: 2019

Our Summary:

“HENRY has given me confidence and ambition to grow as a parent. My children now have a much brighter future”

This 10 year impact report has recently been published by HENRY which details the work that they have been undertaking to support population level change, including closing the ‘inequality gap’.

The focus for the programme (a national charity) is a ‘healthy start’ which includes supporting breastfeeding, improving nutrition, emotional wellbeing, parenting and oral health. They also advocate for wider policy measures including among others restrictions on promoting and advertising ‘junk food’.

Some of the impacts that the national programme are shown to be:

• 23,000 families have been supported, including 34,000 children
• 93% of families lead a healthier lifestyle
• 40% of families eat fewer meals in from of the TV
• 75% of parents have improved emotional wellbeing
• 82% of parents are better at setting boundaries
• 700 programmes have been delivered in community and early years settings

The messages that are provided within the programme use proven evidence-based behaviour change models – e.g. Family Partnership Model:

• Relationships based on trust and respect
• Working in partnership with families
• Empathy
• Strength-based
• Solution-focused
• Building motivation for change.

In terms of the evidence base HENRY has been awarded the highest effectiveness rating by the Early Intervention Foundation. In addition there are several independent studies that show positive outcomes.

An example impact in Leeds (in which HENRY has been working since 2009) seems to show that the prevalence of obesity in primary school age children has been reduced significantly (625 fewer children). This is against a backdrop overall in England in which there has been no such improvement.

The report provides several case studies to illustrate impacts one of which shows how one family has been able to make large changes to mealtimes which are now more positive, and have been able to include much more fruit and vegetables in their diet (p3).

Physical Activity and Story-Telling in the Early Years

Title: Duncan, M. Cunningham, A. and Eyre, E. (2019), A combined movement and story-telling intervention enhances motor competence and language ability in pre-schoolers to a greater extent than movement or story-telling alone, European Physical Education Review, vol. 25 (1): 221-235

Research source: https://journals.sagepub.com/doi/abs/10.1177/1356336X17715772

Publication date: 2019

Our Summary:

This article evaluates a pilot programme which looks at how motor skills and story-telling can combine to improve outcomes for children under 4. According to the data it is argued that both movement and language are indeed of particular concern in the UK.[1]

In the study, nursery aged children were each offered a six week programme in three different types (1) combined movement and language (2) movement only and (3) story-telling only. A wide range of data was collected on the children before, 6 weeks after and 8 weeks after to try and understand the changes that might be being made.

The combined intervention was based on The Gruffalo[2] with movement in a 20 minute session, combined with 5 minutes story-telling prior, and after the movement (e.g. with questions from the practitioners, such as ‘why did the snake move that way?’). The main activities that the children completed in the movement section were jumping, leaping, hopping, sliding, galloping, skipping, throwing and catching.

The results of this novel study were exploratory (It only consisted of 74 children across three early years settings) but showed that the combination intervention seemed to be effective in terms of accelerating outcomes in these areas. However, the authors do argue that much further work would be needed to understand the precise mechanisms by which these changes occurred. The researchers believe that the improvement effect in the innovation were likely due to increases in the amount of oxygen in the brain which in turn leads to improvements in movement and language.

[1] Sylva et al, 2014

[2] Donaldson and Scheffler, 2009