The rationale
Prior to the Family Hubs and Start for Life Programme, North Lincolnshire’s parent-infant relationship service model primarily targeted families with the most pressing needs, however there was limited support available for those with mild or moderate needs. Coupled with local data revealing elevated rates of babies exhibiting insecure or disorganised attachment styles, the team set about devising a new parent-infant relationship service framework to address the spectrum of needs within the community.
The intervention
Within North Lincolnshire, the team are committed to building a ‘one family’ approach so that all services support babies, children, young people and families as a whole.
The new parent-infant relationship service framework focused around four core concepts:
- Implementing a dedicated Parent-Infant Emotional Wellbeing (PIEW) team
- Development of a multi-agency approach
- Building referral mechanisms
- Engaging with underrepresented groups
Implementation steps
1. Set-up of a dedicated PIEW team
North Lincolnshire recognised a new team would be needed to deliver parent-infant relationship support within Family Hubs. The PIEW team was introduced to provide a wide range of interventions, including Video Interactive Guidance (VIG), Solihull Approach Perinatal Plus, Triple P Baby and Watch, Wait and Wonder. The multidisciplinary team is made up of a mix of roles including a clinical psychologist, a dedicated team lead, two perinatal well-being health visitors (job share), three PIEW workers and a senior administration assistant. The team have a particular focus on early identification and intervention for parents experiencing mild to moderate mental health conditions or families facing challenges within the parent-infant relationship.
2. Conduct a multi-agency skills audit.
Aligned with the ‘one family’ approach, North Lincolnshire recognised that all staff members within Family Hubs should have awareness of the importance of good perinatal mental health and parent-infant relationships. The team conducted a skills audit to identify training needs across the whole workforce and looked at previous training undertaken by staff members, their day-to-day experiences and identified any skill gaps. This enabled the development of a multi-agency comprehensive training delivery plan. Initially, the training was focused on practitioners in the PIEW team to ensure the safe, effective and sustainable delivery of specific interventions, however going forward, the skills audit will be used to shape the continuing professional development (CPD) offer for the wider professional network.
3. Built relationships with voluntary and community partners
The PIEW team works closely with the voluntary and community sector (VCS) as part of the ‘One Family’ approach to supporting local families. For example, the team have strengthened its partnership with Voluntary Action North Lincolnshire who lead the First Steps Forward initiative. First Steps Forward aims to help families facing inequalities which significantly impact on the future life chances of children. It is a bespoke service which offers a variety of interventions including parenting support, coaching and mentoring and mental health support offered by MIND.
4. Establish referral mechanisms
Parents/carers can self-refer and access the PIEW service via their local Family Hub, email or Facebook messenger. In addition, the PIEW team have established new referral mechanisms so that any health professional or partner agency can refer families with mild to moderate mental health needs or parent-infant relationship challenges to the PIEW team via email. Upon referral, the parent/carer is contacted by the team and an initial assessment takes place at home by a specialist perinatal wellbeing health visitor. Since the referral process has become operational, the service has received 70 referrals.
5. Give families a voice
Following a PIEW referral, North Lincolnshire take an opt-in approach to support for parents, however the health visitor will always clarify parents’ consent to participate when they first contact the family. This is further iterated during the initial assessment before the family’s needs are communicated with the multidisciplinary PIEW team. Furthermore, the team in North Lincolnshire use parent-carer panels as a mechanism through which parents feedback to staff members on the services they have accessed within Family Hubs and identify opportunities for improvement.
6. Engage underrepresented group
In partnership with the VCS, the team in North Lincolnshire have developed a peer support offer across universal services. Peer support staff members, provided by the VCS, have a particular focus on underrepresented groups such as young parents, ethnic minority communities and families in deprived areas. This has facilitated support networks to grow. Parents/carers also have access to a digital offer of virtual online Solihull programmes to enable families to access advice and help as required.
7. Build sustainability
: The PIEW team in North Lincolnshire is co-located in Family Hubs, thereby enabling co-delivery and sustainability between different teams operating in the hubs. Teams have built mutual respect for each other’s expertise due to regular communication and an increased understanding of each other’s roles and responsibilities. The programme has created team-wide celebration of the workforce, education and CPD which will last beyond the programme duration. Professionals learn from each other allowing expertise to be transferred between services.
8. Assess impact
The team in North Lincolnshire is creating a series of “pen portrait” case studies to demonstrate how the programme has impacted individual families. Practitioners plan to set up a feedback form on SurveyMonkey, which will be sent to families after an intervention is completed. Currently, “your opinion counts” forms are sent to all families via a direct link. Paper evaluations are routinely completed during the last session of VIG as part of the planning. The team are also considering various ways to gather feedback from fathers who access mental health support. A locally led evaluation of the programme’s success has been planned.
The impact of the intervention
North Lincolnshire suggest that their dedication to delivering a new parent-infant relationship service framework has resulted in a number of successful outcomes for families and those working within the service.
Improved parental confidence:
- Impact data collected pre and post intervention highlighted parents who engaged with the PIEW team felt that they better understood the thoughts and feelings of their babies. In turn, their responsiveness to their babies’ needs had improved. In particular, locally collected data demonstrated that parents’ confidence increased following engagement with VIG sessions.
- More generally, parents reported feeling supported by trusted professionals in the field.
- Parents also reported using techniques learnt from evidence-based interventions with their older children, which has improved their overall parenting experience.
Examples of service user feedback include:
“I no longer feel detached or an unfit mum, I want to interact and play with my son. Thank you”.
“I had time to learn about my baby. It helped with the process of becoming a new dad again. We now like to sing together”.
Increased awareness of available services and improved co-working:
- Parents reported feeling more confident in asking for support and knowing where to find it. The work with the VCS has further helped raise awareness amongst parents on the services available within North Lincolnshire.
- Universal practitioners have also become more aware of the correlation between parental mental health and infant mental health. New referral mechanisms mean it is much easier to signpost parents to the right service. Staff members reflected that they have been able to build safe and lasting relationships with families.
- As a result of co-working, the services feel more joined up to families. For example, as local authority colleagues and NHS staff are now all referred to as the same service and as part of the same team, parents have fed back that it feels much more joined up and seamless.
Increased engagement with fathers:
Engagement with fathers has increased as a result of the VCS-delivered peer support specifically targeted at this group. It is anticipated that the peer support provided by the VCS will continue to build on this engagement rate.
Key lessons learnt
Data sharing across the system has been challenging. A key lesson learnt is the need to identify which data should be collected (for national and local data collection) at the outset to demonstrate the impact of interventions. Having a dedicated member of staff who has time to truly understand what is required before services are formed would have been beneficial to collate data effectively.
Furthermore, significant capacity is required to analyse local data, which is often collected via different data collection systems. Cross-referencing user information across different systems requires substantial time and effort.
Top tips for implementation
- Create open communication and collaboration across all services. This includes encouraging service leads to regularly meet and develop strategies together, to pool expertise and knowledge, which can be used to ensure that services complement each other and learning can be shared.
- Develop a multi-agency approach to service delivery. Having all local services work towards a shared vision helps provide the best possible service offer for families even when the team are struggling with capacity
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 North Lincolnshire 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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