Background
We want every family to access the support they need to achieve the best start in life for their babies. For perinatal mental health and parent-infant relationship support, this means access to universal services to help spot and respond to issues before they develop into more complex problems. Cornwall’s lead for perinatal mental health and parent-infant relationship strands identified that some families in the community were unable to access the support they needed due to a variety of challenges, including the rurality of the county. Using both the core Family Hubs and Start for Life progamme funding and the additional Trailblazer funds, Cornwall set about transforming the way in which their services are delivered to ensure that every family in Cornwall has access to the support they need.
The intervention
Introduced virtual delivery of perinatal mental health and parent-infant relationship services: The team in Cornwall are introducing innovative methods of delivery for perinatal mental health and parent-infant relationship support, to overcome specific challenges associated with rurality. Support can now be accessed through ChatHealth, an NHS messaging service hosted within the advice line which is used to communicate with families. It is widely used, particularly by young parents. The messaging service enables the team to improve their responsiveness and get information on relevant services to families as quickly as possible. Since its implementation in January 2024 up to the 31 May 2024, ChatHealth has sent and received over 6,000 text messages. Cornwall are currently exploring the feasibility of implementing a mobile hub to provide families who cannot access physical Family Hubs the opportunity to engage with services.
Maximised the effectiveness of every interaction with a family: To ensure that all families are able to access the level of support they need, the team in Cornwall recognised that it was essential to maximise the effectiveness of every interaction they have with a family. For example, the team have embedded a pathway step for parent-infant relationship screening throughout all universal offer services. Midwifery colleagues in Derriford and Royal Cornwall Hospitals are being supported to use an antenatal screening questionnaire about parent-infant relationships. Postnatal staff now use the adapted Leeds Early Attachment Observation Questionnaire to understand how parents feel about their relationship with their baby, helping them to refer families to the relevant support accessed through Family Hubs.
Supported staff training and development to build sustainability: The team in Cornwall wanted to ensure that any interventions they proposed complimented the existing perinatal and parenting specialist offers by layering services. Using Family Hubs and Start for Life programme funding, the team aimed to reduce waiting lists for specialist services by ensuring that more staff members in Family Hubs are able to provide support where appropriate. This involved investing in the training of universal, voluntary, and third-party workforces to provide screening and initial support to families. A comprehensive approach has been taken to the training and development of the workforce:
- 45 health visitors responsible for wellbeing checks received Brazelton Newborn Observation Training to better identify families in need of support;
- 25 staff members within the health visiting context received training in Dialectical Behavioural Therapy to support families in crisis;
- 75+ universal staff completed Babies in Mind Training, which supports the implementation of Leeds Early Attachment Observation. Staff can now recognise attachment, what that looks like within the family dynamic and identify parents who may need additional support;
- NSPCC Coping with Crying training has been rolled out to the Foundations for Life team (who provide early parent-infant relationship and mental health support) to complement their unique skill set and enhance their understanding of the parent-infant relationship;
- Trauma-informed supervision/case consultation for staff has been introduced across the health visiting service to build understanding about the impact that trauma can have on children and the parent-infant relationship; and
- Three perinatal champion health visitors were identified to support services, building sustainability into the system. Health visitors focus on in-reach within the neonatal unit, Family Hubs and families’ own homes. Perinatal champions also facilitate relationships with the voluntary, community and social enterprise (VCSE) sector and are co-facilitating the pilot of intensive Circle of Security interventions.
In addition to the interventions above, Cornwall also offer targeted Video Interactive Guidance groups for parents and babies and Solihull groups through Homestart Kernow, which is part funded by the Family Hubs and Start for Life Programme.
Implementation Steps
1. Commitment from the senior leadership team from the very beginning
The team suggested that this leadership was integral in navigating challenging conversations, particularly with external partners.
2. Identify the needs of local families through a whole system approach
This involved bringing together service providers and external stakeholders (e.g. from the health, education and VCSE sectors) in one room to better understand how they could support families and focused on the relevant adversities which are increasing for families within Cornwall. The team used a range of data sources to support this work, including internal, Integrated Care Board and primary care data, Index of Multiple Deprivation, Public Health Profiles and NICE guidance. Research from the Parent Infant Foundation and the Avon Longitudinal Study of Parents and Children was also consulted.
3. Explore opportunities to complement and build on existing services
Through whole-system discussions, adaptations and areas for improvement of interventions were identified and targeted. This approach allowed staff members to reflect on how interventions could be delivered differently.
4. Identify the skills needed to deliver comprehensive services
The team identified how training could be used to broaden the support offered. This was enabled by the investment in upskilling the universal, voluntary and third-party workforce.
5. Procure training from external providers
Family Hubs and Start for Life programme funding was used to procure large training contracts from external providers.
6. Encourage access to services for fathers and co-parents
The team introduced groups specifically aimed at fathers and co-parents. They also introduced a dedicated engagement officer within the parent-infant relationship team, who is linking with another fathers’ engagement worker within the Wild Young parents’ group to share learning and collaborate.
The impact of the intervention
By investing in the upskilling of universal staff members and enabling the virtual delivery of interventions, Cornwall have been able to improve families’ access to perinatal mental health and parent-infant relationship support. Additionally, the team indicated that a legacy of the Family Hubs and Start for Life programme has been the increased maturity in other services. Co-location and interaction within Family Hubs led to the desire and determination to increase the availability of evidence-based, validated offers and ensure that other services are complimentary.
Other key areas of impact include:
- Following training activities such as the Babies in Mind Training, practitioners are now “looking at what is happening in the family with a different lens”. This has helped to develop interventions to suit the needs of families within Cornwall.
- Staff members feel more empowered within their roles and recognise the effectiveness of their interventions in supporting families.
- Specialist health services are now receiving referrals earlier due to improved engagement across the system.
- Improved staff capability to record and monitor key performance indicators. There are plans to monitor referral rates to specialist services.
Key lessons learnt
A strategic lead for each workstream and the overall project from the outset would have been beneficial. Whilst existing staff members do have the knowledge and capability to handle strategic responsibilities, capacity is often a challenge. For example, some training providers required extensive engagement and a number of barriers needed to be overcome to procure training. This led to delays in the procurement and roll-out of some training to staff members, which had knock-on implications for the team’s ability to evidence the impact of some training interventions at this stage. Delays in procurement could have been reduced if a dedicated strategic lead had been in place to drive this forward.
Overall, the team highlighted Family Hubs and Start for Life programme funding as their most important resource. New equipment to facilitate perinatal mental health and parent-infant relationship groups was also important. In addition, over 200 staff packs were delivered to provide staff with the tools to undertake internal data requirements, improving data collection and performance monitoring.
Top tips for implementation
- Engagement and relationship building: “Engaging the right people”, including staff members, senior management, Family Hubs and most notably external partner agencies. To foster effective working relationships, external partners should be reassured that they are not in competition with the local authority. Instead, they are working together with a shared vision to support local people in addressing their parent-infant relationship and perinatal mental health needs.
- Perseverance: Overcoming challenges associated with the procurement and management of service providers, or finding consensus amongst perspectives of stakeholders in relation to service delivery, requires consistency and dedication.
- Establishing a clear vision at the outset: The team recognised the need to clearly define the vision and intended outcomes. The vision reminds staff of the rationale behind parent-infant relationship and perinatal mental health interventions and the wider purpose of their efforts.
Additional resource: DHSC guidance entitled: ‘Reflecting on parent-infant relationships: a practitioner’s guide to starting conversations about parent-infant relationships’ features prompt questions derived from the Leeds EAO Questionnaire and is shared with all 75 local authorities which are part of the Family Hubs and Start for Life programme.
This case study has been produced by the Start for Life Unit within the Department of Health and Social Care, in partnership with RSM and Cornwall Council. By sharing promising examples of delivery, we hope to facilitate connections between LAs across the country and support local delivery of Start for Life services. For further information please contact familyhubs.startforlife@dhsc.gov.uk
The data included in these case studies is self-reported by Local Authorities and has not been quality assured by the Department of Health and Social Care. The views expressed are those of the authors and not necessarily those of the Department.
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