Developing an ante-natal intervention to promote infant mental health
Background & Scientific Rationale
There is a large body of evidence that strongly suggests that infant mental health in the period from conception to 2 years is greatly influenced by the quality of the interaction between the baby and primary care giver.1 This interaction is believed to have a direct effect on infant brain development, on social and emotional self-regulation and on the quality of attachment that the infant develops towards his/her caregiver. Growing bodies of research provide evidence for the link between secure attachment by the age of 2 and long-term benefits including better mental health outcomes in adolescence. Recent evidence, however, suggests that the quality of parental-child interaction may be decreasing. For example reports of some parents focusing their attention on their mobile phones rather than their child may indicate one aspect of this decrease, while data from ChiMat Child Public Health profiles suggests that mental health problems among young people in Herts are increasing (e.g. the rate of young people aged 10 to 24 years who are admitted to hospital as a result of self-harm is higher in the 2011/12-2013/14 period than in the 2008/09-2010/11 period), The growing recognition of the importance of the specific nature of parent-infant interaction, including parental awareness of their child’s internal processes, has been summarized in a recent editorial by WHO in the Lancet.10 A number of important recent policy reports have highlighted the public health importance of this issue and strongly recommended the provision of early intervention support to parents, including in pregnancy, to increase parenting self-efficacy and promote interaction that leads to secure attachment6,7,8,9. While some evidence of the effectiveness of early intervention in infancy is now available to underpin practitioners’ work, as summarized in a recent report by the Early Intervention Foundation,16 the need for further evidence is widely recognized – including on untested interventions that are already being used with parents. This study will develop an ante-natal programme, My Baby’s Brain Ante-Natal (MBB-AN) as a universal intervention that is intended to be easy to adopt by both parents and practitioners and which enables parents, increasing their self-efficacy and giving them confidence and the knowledge that they need to support their child’s social and emotional development. The target population will be ante-natal parents (those having first or subsequent children). The study will also provide the opportunity to test the reliability of the ante-natal version of the Tool to measure Parenting Self-Efficacy (TOPSE) as an outcome measure of ante-natal parenting interventions.
The aim is to develop a universal intervention that can be used in community settings to support parents during the ante-natal period to use effective interaction with their babies in order to develop secure attachment and promote infant mental health. We will develop an ante-natal intervention based on the Five to Thrive approach: Respond, Cuddle, Relax, Play, Talk, using the idea that a series of manageable steps enables key messages about brain development and attachment behaviours to take hold in parents’ minds (Kate Cairns Associates).
Developing the intervention: We will conduct two focus groups with staff and two with parents (one antenatal group; one postnatal), which will explore views on the practicality and acceptability of initial plans for format, content and time span of the potential intervention. This will include issues relating to timing of delivery, delivery staff (midwife, health visitor or children’s centre staff), delivery mode, recruitment routes and venues. The analysis of the groups will be conducted in conjunction with PPI representatives. The findings will inform the decision about which route(s) should be tested and will be used to refine the initial plans prior to implementation.
Testing the programme: Following the initial stages of development, the refined intervention will be tested out within two Hertfordshire Children’s Centres and one CC in another county. We anticipate that at least two different routes of delivery will be undertaken. To assess the acceptability and practicalities of the intervention, a researcher will observe sessions within each centre, and conduct interviews with approximately nine staff and 15 parents. Five of the 15 parents will also be followed up post-natally to explore their views on any sustained effects of the intervention at 4 months post-intervention.
A consensus event will be held at which a summary of the research findings will be presented to a group of key stakeholders and discussions will be had about how the intervention might be modified for future delivery. Additionally, the participants will be asked to discuss the potential outcomes for a pilot trial, assuming secure attachment and parenting self-efficacy as the primary outcomes.
Expected Output of Research / Impact and added value
- Create a dedicated space on our existing parenting website to promote the intervention.
- Social media/networking: An existing e-Community of Practice for health visitors to share and build knowledge around the intervention.
- Research outputs: Publication in peer reviewed journals, Disseminate findings from each phase of the study at REACH (Research network in Adolescent and Child Health), and other networking events, produce a lay-summary leaflet to circulate via our networks and the project website, provide a stakeholders event on completion.