Organisation submitting example
Hertfordshire County Council (Childhood Support Services)
Local authority/local area:
Hertfordshire County Council
The context and rationale
Through training multi-agency professionals and social marketing, My Baby’s Brain conveys to parents of babies and toddlers, in everyday language, the principles of attachment behaviours and their contribution to early brain development. Practitioners incorporate this into their day-to-day work with families, with the help of accessible written materials and resources.
Kate Cairns Associates http://www.fivetothrive.org.uk/
Family Matters Institute http://www.familymatters.org.uk/
Background to the Project and Knowledge Base
My Baby’s Brain is a response to the growing body of research in neuroscience and consequent recognition in recent years of the vital importance of brain development between the ages of 0 and 3, for a child’s learning and social and emotional wellbeing, and positive outcomes in adulthood, and the importance of everyday attachment interactions in the home learning environment, in promoting healthy development.
It is also a response to the increasing emphasis in the Allen Report (Early Intervention: Next Steps) and other policy documents, on early intervention in the early years, both in terms of prevention and of early identification and addressing of risk factors in potentially “troubled” families.
The project was also inspired by the Centre Forum report, Parenting Matters, which advocated a strategy similar to the “5-a-Day” healthy eating campaign, conveying simple, easily accessible child development theory and home-learning messages to parents of all backgrounds. This report also provides examples of similar initiatives in New Zealand and Scandinavia, for example, which we wanted to replicate in Hertfordshire.
Description of the idea behind My Baby’s Brain
In response to the above, My Baby’s Brain was conceived in order to convey in simple, accessible language, to parents of very young children, the principles of attachment behaviours and the direct impact they have on a baby’s brain development. The principles were encapsulated into a set of activities summarized under “Five to Thrive”: Respond, Cuddle, Relax, Play and Talk. “Five to Thrive” and the materials that explain it were developed by Kate Cairns Associates, who are experts in this field see http://www.fivetothrive.org.uk/.
In discussion with a wide range of multi-disciplinary partners including health, early education and social care services among others, it was clear that there was a need for a consistent approach to communicating this message, to counteract mixed messages and to dispel myths relating to parenting practices passed onto parents via family and friends, especially from older generations, where ‘received wisdom’ differed from current knowledge.
We decided that the best means of conveying this information was to commission training for professionals who had regular everyday contact with parents of young children, who would then weave the “Five to Thrive” message into their everyday interactions with parents.
Description of practice
My Baby’s Brain has included the following five elements, which have been evaluated over the initial trial phase:
i) “Five to Thrive”: A 5-a-day style campaign, developed for us by Kate Cairns Associates, to promote key messages regarding baby brain development. With a strong evidence base in neuroscience, expressed in plain language, these messages underpin the following additional project elements. The Five-a-Day key messages are: Respond, Cuddle, Relax, Play and Talk.
ii) A bespoke one day training course for practitioners who have direct contact with parents of children 0-3.
iii) A post-natal session for new parents designed as an add-on to existing post-natal parent education.
iv) The production of resources designed to support parents’ understanding of this subject long after the project ends.
v) An independent evaluation
of the impact of the project on both professionals and parent. The final report was produced in June 2012.
In addition, My Baby’s Brain was featured in an International on-line Paediatric Neuropsychology Symposium on Baby Brain Development at University College, London and the Journal of Developmental Medicine & Child Neurology, in May 2012, and has been brought to the attention of the All-Party Parliamentary Social Mobility Working Group and Graham Allen’s (M.P.) Early Intervention Interest Group.
Through training front-line practitioners to incorporate the My Baby’s Brain “Five to Thrive” message into their daily practice, it has reached in excess of 400 parents. Practitioners have shared the information in differing ways and have often changed their working practices as a direct result of this. The resources that have been produced that go in tandem with the message have also been very well received by practitioners and parents alike. All practitioners are eager to continue to disseminate the message and related resources to parents that they work with.
This has included:
• A social care senior practitioner explaining “Five to Thrive” with a family where there were child protection concerns.
• A Hertfordshire Safeguarding Children’s Board representative willing to incorporate “Five to Thrive” into local safeguarding forums.
• Health visitors including “Five to Thrive” in post-natal sessions and baby massage sessions.
• A midwifery commissioner eager to include “Five to Thrive” in ante-natal practice.
• The Library Service (through Bookstart) running sessions for new parents and parents-to-be incorporating “Five to Thrive”-related activities.
So far the project has been delivered through a multi-agency, multi-disciplinary group of 70 practitioners. These have included health visitors, social workers, children’s centre workers, library (Bookstart) staff, family support workers, Homestart volunteers, and statutory and PVI sector parenting practitioners. In the next phase of the project, midwives also will be involved at the antenatal stage. Parents have also been involved, in the developmental stages of the project, in consultation over the content of the written materials.
As well as in the direct delivery, the above have also been involved through attending two stakeholder consultation events, and through regular monthly updates to which they have been invited to respond. In addition, a group of health visitor students adopted the project for their parenting module, and studied it in depth under the title ‘Supporting Parenting: a Public Health Approach.’ Throughout the project we have also involved a specialist organisation in the field of attachment theory and practice, Kate Cairns Associates, who were commissioned to deliver the training and to produce the materials, and also the Think Tank ‘Centre Forum’, who produced the Parenting Matters report referred to above.
For more information about Five to Thrive resources including ‘My Baby’s Brain’ posters, please visithttp://www.fivetothrive.org.uk/ or contact the C4EO team at C4EO team at the NFER.
Evidence and evaluation - making a difference to children, young people and families
We commissioned an independent evaluation from the Family Matters Institute see http://www.fivetothrive.org.uk/, which is also available from the C4EO team at C4EO team at the NFER.
Chiefly, the purpose of this was to:
• Evaluate the impact of the training on practitioners’ knowledge, measured by a series of course-specific acquired knowledge questions included in the pre and post questionnaires.
• Determine the impact of the training day on practitioners’ confidence in delivering information to parents in regard to the ‘Five to Thrive’ areas.
• Assess the impact of the training on parenting self efficacy and confidence measured by a ‘pre and post’ parenting confidence scale.
• Measure ‘pre and post’ parenting confidence in the ‘Five to Thrive’ areas.
The evaluation included both qualitative investigation of parents’ and professionals views and quantitative data.
The results of the evaluation are summarised as follows:
The ‘My Baby’s Brain Five to Thrive’ message was received positively by both practitioners and parents. Statistically significant differences (p=<0.025) were found in regard to practitioners’ knowledge and confidence in the area of baby brain development as well as parental self efficacy, confidence within the ‘Five to Thrive’ areas and the perceived importance that parents bestow upon these five areas. Qualitative results, collected from practitioners, suggest that the ‘Five to Thrive’ message had a particular impact on the confidence and self esteem in parents suffering from depression and post natal depression. Practitioners stated that they were seeing noticeable differences in the parent’s confidence on subsequent visits after sharing the message. In addition to this, reassurance was a thread that was seen to weave through all of the data with practitioners feeling reassured that they were delivering the right message and information and parents feeling reassured that they were ‘doing the right thing’ in their parenting practices. This seemed to enhance self confidence in all groups and also more importantly dispelled myths around parenting practices passed onto parents via family and friends especially older generations.
Sustaining and replicating your practice
The year 2011-12 was an evaluated pilot year. In view of the positive evaluation, we plan to repeat the training, which reached 70 practitioners, to a further 250 this year. The method of incorporating the “Five to thrive” messages into existing everyday working practices, rather than setting up parenting courses or classes or specific extra sessions, will make the project more sustainable in the context of limited budgets. In addition, we aim to develop in-house trainers to enable us to continue the process of informing new practitioners without recourse to outside commissioning.
Following recommendations from the evaluation, particularly parent feedback, we envisage that this year we will make some changes. For example we will involve midwifery managers in taking the messages to parents at an earlier stage, including at the antenatal stage. We will also seek to reach parents who are suffering from depression, in particular post-natal depression, since the feedback indicates that this is a circumstance where attachment behaviours are at risk and need reinforcing.
We are also investigating possible means by which we can reach larger populations of parents, economically with a social marketing (social norms) approach, through digital and other media.
In the first year, excluding staff time, the project cost £22,000. This included the training, evaluation, and stakeholder events. The project reached just over 400 parents and 70 practitioners, and received positive feedback. This year the costs are likely to be a little higher, but we will reach our target of training a further 250 practitioners, and therefore potentially a further 1500 parents.
Learning from the experience
Much has been learnt from the first year. We would absolutely recommend that a rigorous independent evaluation is built into any similar project from the start, that this evaluation should include qualitative as well as quantitative methodologies and that it should involve both practitioners and parents as the key respondents.
We also would recommend bringing together from the start, a stakeholder group of positive, constructive but critical partners in the development of the project. These, critically, must include those agencies whose staff will be participating in the delivery of the project.
We are reassured that the project, and the training and materials in particular, have adhered to a solid scientific evidence-base. This is vital to ensure the credibility of the project with a range of agencies, which have expertise in the field.
As referred to above, we have learnt that parents value having this information as early as possible, including at the antenatal stage. This is something we will address in the second year. It is also, however, linked to a more general concern, that the emphasis on the crucial importance of early attachment to later outcomes can bring anxiety and pressure to bear. Several parents and practitioners have expressed the anxiety that a project such as this might concern parents who believe that they can “miss the boat” and that it might be too late to repair the damage caused by insufficient attention to attachment behaviours. Others have expressed the concern that some parents might become over-zealous in stimulating a child. Therefore we think it is important to present a balanced message which addresses these concerns. One of the “Five to Thrive” activities is “Relax” and it is important to emphasize this dimension, as well as stating clearly that the brain continues to develop beyond early infancy.
One challenge was to ensure that the language was meaningful and accessible for all parents, whilst not jeopardizing the fidelity to the neuro-scientific basis of the activities presented. We addressed this by asking families and practitioners, as well as specialists, for their views on the booklets and posters.
Another challenge was ensuring that we had commitment from key agencies. This was addressed by convening the stakeholder group and involving key professionals in the development of the project from the start.
A challenge for the future will be to evaluate the impact on children themselves. This remains a challenge that we will be actively discussing with local research centres, including the local University research centre.
We believe that this area of work is crucial to children’s development and wellbeing, and in preventing risk factors throughout childhood and adult life. Therefore it needs to be replicated and we intend to sustain it in Hertfordshire as an integral part of our early help offer, by seeking to reach potentially all practitioners with contact with young children, and potentially all parents of new babies. We would recommend that others do the same, but would make a plea for fidelity to the scientific basis of the project, so that the principles are not diluted by less than thorough application of theory to practice.
The following eight core behaviours have been identified as part of successful elements of leadership (see National College for Leadership of Schools and Children’s Services/C4EO (2011). Resourceful leadership: how directors of children’s services improve outcomes for children. Full report. Nottingham: NCSL.
1. Openness to possibilities: Innovation is an important principle in the leadership of the Childhood Support Services team and the eagerness to break new ground was integral to the initiation of the project.
2. The ability to collaborate: The success of the project depended on collaboration with health visiting, midwifery, children’s centres, library services, etc. and the encouragement of the partnership approach was vitally important.
3. Demonstrating a belief in team and people: The original proposal was innovative and ambitious and the managers allowed the originator the time and latitude to ‘run with it’, test out possibilities, and research a variety of options. This trust and belief in her ability and encouragement was motivating and enabled her to achieve without unnecessary barriers.
4. Personal resilience and tenacity: The managers who initiated and developed the project are renowned for their tenacity and resilience, can-do attitude and the readiness to overcome obstacles and challenges. These have been essential features of the project’s continuing development.
5. The ability to create and sustain commitment across a system: This is a feature of the further development in the second phase of the project, which has required the commitment of managers across children’s services, particularly in health visiting, children’s centres, specialist social care and safeguarding services and the Safeguarding Children’s Board.
6. Focusing on results: Evaluation of outcomes has been integral to the project from the start. Following the initial evaluated pilot, the second phase will be even more thoroughly evaluated and will include an examination of the project’s contribution to the Early Help strategy throughout the county.
7. The ability to simplify: It would have been easy to overcomplicate the message of My Baby’s Brain –conveying the principles of neuroscience and attachment in everyday language, was a priority, as was the equally accessible communication to professional partner agencies.
8. The ability to learn continuously: In addition to the evaluation, the continuous feedback from participant agencies and individuals – whether parents or practitioners, or external ‘critical friends’ have been essential to the project’s development.
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