Minding the Baby:An Inter-Disciplinary Reflective

Parenting Programme

Gwynne Rayns Development Manager

Arlene Murdoch Social Worker

Mary Phillips Nurse Practitioner

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A pioneering programme:

Carefully crafted by Profs Arietta Slade, Lois Sadler and Linda Mayes, Yale University

Minding the Baby (MTB) is an intensive home visiting programme for vulnerable first time mothers who are aged under 25

Pairs of social workers and nurse practitioners jointly work with each family from the third trimester of pregnancy until the baby reaches age 2

Focus is on maternal and infant mental health and as well as delivering practical nursing and family support

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Pregnancy is an ideal opportunity for preventive intervention

Strong evidence about home visiting programmes (such as Family Nurse Partnership) to prevent maltreatment

To date – limited explicit focus on parental and infant mental health as key factors in these programmes

The emerging field of ‘reflective functioning’ provides important insights about how we might prevent maltreatment in at-risk families

Limited use of social work and mental health expertise in delivery

Clinic based Parent-Infant Psychotherapy is expensive

Core of the model:

Roles and common goals

Social WorkerNurse

Mental health promotion

Perinatal depression and anxiety

Infant assessment

Dyadic play and developmental guidance

Family intervention (counselling/relationships)

Legal court systems

Crisis intervention

Case management

Assessment

Prenatal care and health ed

Nutrition; breastfeeding; labour plan etc.

Child health and develop

Safety and injury prevention

Child development

Anticipatory guidance and parenting skills

Mother’s health

Physical and mental health

Family planning

Smoking, nutrition, exercise

Secure Attachment

Reflective Parenting

Primary Care Giver-Child relationship

Visiting schedule

• After enrollment and consent: engagement and assessment phase

• NP and SW alternate visits

• Weekly home visits through child’s first birthday

• Every other week visits in child’s second year

• Graduation at child’s second birthday

Schedules individualized as needed

Supervision model

• Core line management supervision – case based

• Interdisciplinary supervision from whole Yale team – focus on reflective practice and model fidelity

• Discipline specific supervision – focus on learning new skills and practice

• UK based clinical supervision – focus on reflective practice and skills building

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Sophia – 14 years

Poor school attendance

Domestic abuse

Neglect

Temporary accommodation

Statutory supervision order

Poor maternal mental health

Parenting of siblings

Trauma

Risks

Early sexual activity

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RF relates to a parents capacity to make sense of their child’s internal states, thoughts feelings and intentions

•High RF – forms the basis of healthy and secure attachment and effective parenting

•Low RF – is associated with poor attachment and is a risk factor for abuse and neglect

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Some examples of “ reflective functioning”Clinician: Name the good feelings you had during pregnancy?

Mum: None, I don’t know

Mum: Hmmm…….only when he kicks when I know he’s ok (laughs) …….I get a really good feeling like when I go out and buy baby things and like talk to my boyfriend about like baby things,

Mum: getting all her stuff as well, all her clothes and things and going through it all and everything and saying “aw, she’s going to be in this…

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Some examples of “ reflective functioning”

MUM: When he is at his dad’s he gets upset at night time and calls for me – I think that is because he is worried I am going to leave him again

MUM : I think my son is a lot happier because I can talk through (with MTB) things that stress me out so I don’t get stressed with him

MUM : I have always wanted a better life for my son than I had

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Programme delivery- MtB Model in Action

Concerns Strategies

Non-Engagement Tenacious working

Avoidant behaviour Mentalisation techniques

Crisis Management Practical solutions & panic reduction

Child protection and welfare Liaison with statutory services and honest and open working with parents

Maternal trauma (Ghosts in the Nursery)

Strategies to develop maternal reflective functioningPregnancy Interview

Child Development Assessment and reviewModelling appropriate play

Transition and Endings Effective planning and signposting to other agencies

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Listening to the babySpeaking for the baby

Mentalising

Positive mirroring

Age and stage development assess

Child observation

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Evaluation3 sites York, Glasgow and SheffieldQualitative evaluation of first cohort families

Second cohort recruiting nowImpact and cost effectivenessRandomised controlled trialLed by Prof Pasco Fearon at UCL

Key outcomes: Parent-infant interaction; secure attachment; Quality of parental sensitivity