Building ‘Healthy Little Minds’ with Nottingham’s Parent Infant Relationship Team

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Felicity Callon, Senior Project Officer at Small Steps Big Changes in Nottingham, writes about the achievements of the City’s Healthy Little Minds team in improving the health and wellbeing of children and parents.

Background

Felicity Callon

Too many new babies experience complex relationship difficulties with their primary carers. Without specialised multi-disciplinary intervention, unresolved problems can affect future outcomes, be passed on inter-generationally, and incur high costs to the public purse.

The evidence for the importance of the first 1,001 days for mental health and wellbeing is robust and well-established (HM Govt, 2021). From conception to the age of two, the bonds that develop between babies and their caregivers are especially crucial to emotional development (Parent-Infant Foundation, 2019 & 2023.) In the UK, specialised parent-infant teams play a key part in supporting and strengthening these relationships.

In 2021, Nottingham City had no specific evidence-based Parent-Infant relationship support. In line with SSBC’s core principle ‘Children at the heart, parents leading the way, supported and guided by experts’ we filled this gap by partnering with the Parent Infant Foundation as well as local parents and partners to develop a Parent Infant Relationship team.

The Healthy Little Minds team

The result was the introduction of Healthy Little Minds (HLM), a specialised early intervention service aiming to:

  • Improve social & emotional outcomes for children.
  • Lay foundations to support children to build positive relationships, understand their emotions, and increase resilience.
  • Raise awareness amongst the children’s workforce the importance of supporting all parent infant relationships.

HLM offers various targeted interventions, including one-to-one support and home visits, psychotherapy, video feedback, and parenting groups such as Mellow Babies and baby massage. The programme supports families with a range of needs, including those experiencing mental health issues and difficulties bonding with their infants.

Overcoming initial barriers

Any new service, however, is not without its challenges. The HLM team found that establishing referral pathways, clarifying eligibility criteria, and allaying misperceptions around the remit of the service were less than straightforward. They overcame these challenges by engaging with families and local partners to streamline and clarify messaging and referral criteria, and to increase visibility of their service.

As they focused on supporting families, the importance of their work grew locally, and a shared understanding of the team was developed. Their key strengths are in their ability to listen, adapt and respond to individual circumstances, to build connections on which to base long lasting improvements.

“We have worked hard to reduce barriers to our service, ensuring that a broad range of families have access to support to nurture the special relationship with their baby. This has developed rich learning for us around the importance of sensitively capturing and understanding family stories, allowing us to adapt our support to the unique needs of each family.”

Team Manager

Evidence-based interventions to meet family needs

The HLM team meaningfully engage and support parents/carers using strength and evidenced-based interventions that adapt to meet families individual needs. They stand out nationally as an inclusive team that takes families and children with high level needs. Their criteria includes looked-after children and those under child protection. This provides a unique perspective and evidence that adds knowledge to their emerging area of work, leading to a rich understanding of intergenerational trauma, which has supported the development of guidance for parents/carers to help them understand parent-infant relationships. This has in turn contributed to a paradigm shift in the family, and a broadening of the wider workforces’ understanding of family dynamics.

“I liked hearing different people's experiences, knowing I'm not alone - It feels more reassuring to be around other mum's that are feeling similar’’

Nottingham parent.

Locally the shared understanding of parent-infant relationships has improved practice across the mutli-disciplinary team. This is something the HLM team have been driving since their work started, focusing on developing a ‘shared language.’ HLM training is typically the first training that practitioners have had since their degree, bringing the subject to the forefront of their minds and changing the conversation about parenting and its challenges. Investing in the workforce has meant that the team has been able to identify gaps in professional and participant understanding of parent – infant relationships and attachment. They have even worked to produce a toolkit to complement their training offer.

“I understand his cues better and I’m thinking now about how he’s feeling, what he’s enjoying, noticing body language.’’

Nottingham parent.

The team continue to work innovatively and collaboratively and are currently in the process of producing 20 hypothetical concepts like ‘reciprocity’ and ‘containment’ as visual pictures for families. This is particularly valuable for those who may require complex terms to be explained via alternative communication tools, for instance where English is a second language. They have a strong working relationship with the Parent Infant Foundation, ensuring that their work is up to date, evidence-based and sense checked. Their resources have been met with positive reactions from across the field and they are establishing themselves as leaders in the space of infant mental health.

Evaluation findings

Independent interim evaluation findings from the Centre for Mental Health highlight that Healthy Little Minds has effectively supported and improved the mental health and parent-infant relationships of many families.

Direct positive improvements in parental mental health and parent and infant attachment were observed for most parents and infants supported by the HLM programme. These included minor improvements in infant social and emotional development, parent depression, and infant warmth.

There were also significant improvements in perinatal depression, parental anxiety, and goal-based outcomes.

Furthermore, infants of families living in postcodes with an Indices of Multiple Deprivation (IMD) decile rank of 6 demonstrated significant improvements in social and emotional development. These findings emphasise the importance of continuing research to adapt support for diverse family needs and assessing long-term outcomes. Investing in these early interventions is crucial for establishing nurturing relationships and promoting lifelong mental and physical health. The final evaluation report will be available in December 2024.

References and further reading

HM Govt, 2021. The best start for life: A vision for the 1,001 critical days. [pdf] HM Govt. Available at: https://www.gov.uk/government/publications/the-best-start-for-life-a-vision-for-the-1001-critical-days (accessed 11 May 2024).

Parent-Infant Foundation, n.d. What are specialised parent-infant teams? [online] Parent-Infant Foundation. Available at: https://parentinfantfoundation.org.uk/our-work/what-is-a-parent-infant-team/ (accessed 11 May 2024).

Parent-Infant Foundation, 2019. Rare jewels: Specialised parent-infant relationship teams in the UK. [pdf] Parent-Infant Foundation. Available at: https://parentinfantfoundation.org.uk/our-work/campaigning/rare-jewels/#fullreport (accessed 11 May 2024).

Parent-Infant Foundation, 2023. The impact of parent-infant relationship teams: A summary of the evidence. [pdf] Parent-Infant Foundation. Available at: https://parentinfantfoundation.org.uk/our-work/impact/ (accessed 11 May 2024).

About A Better Start

A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK.

Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.

The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier

The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.

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