What’s the idea?
The first 1001 days of life, from conception to age 2, are a time of rapid growth and development, during which babies’ brains are shaped by their experiences, particularly their interactions with caregivers, and the foundations for later development are laid [ref. 32]. Mental health disorders can impact on these developing relationships, and services have an important role in supporting parents to build strong, safe relationships with their babies.
Why implement it?
- Where mothers’ interactions are impaired due to poor mental health, positive relationships with other caregivers may buffer the baby against any adverse impacts [ref. 33 and 34].
- The father-baby relationship can be impacted in different ways by poor maternal mental health. Whereas some men are able to develop a positive bond with their baby and note a growth in confidence as a father, others feel that the bonding process has been disrupted, particularly in the case of an MBU admission [ref. 17].
- Perinatal mental health disorders in fathers are associated with poorer outcomes for the baby across a range of domains, including cognitive, behavioural and emotional [ref. 35 and 36] independently of maternal mental health.
- Mental health disorders in grandparents may be associated with poor child outcomes [ref. 37 and 38].
Actions to consider
Explore the relationship between partners/other family members and the baby. Use clinical judgement. Most observational tools used to measure parental sensitivity require comprehensive training and regular supervision and are therefore very resource intensive for use in clinical settings. There are no validated self-report questionnaires measuring the relationship between an infant and father (or other co-parent).
Consider how the partner’s relationship with the baby can be supported alongside the mother’s care. There is some limited but growing evidence on interventions focusing on promoting father-infant relationships. This evidence is particularly limited in families where at least one parent has an identified mental health need, however evidence can be drawn upon from wider early-years parenting studies which have looked at the father or co-parent relationship with the baby.
Be aware of specialist parent-infant services in your local network. These services, where available, may be known by different names, such as PIPs, parent-infant mental health services, infant mental health services, under-5s provision, or early attachment services. More information about these services, including which areas of the UK they work in and what they offer, can be found in a PIP UK report [ref. 28].
Practice tips: box 8
Providing information on caring for the baby or other children
- Partners and other family members may ask for or need information on caring for the baby or other children in the family.
- For some this may be a new role and they may require additional support and information. Acknowledge too that some partners and other family members may already be very skilled in childcare – avoiding making assumptions or inadvertently patronising them.
- Give information about local sources of practical support (such as nursery nurses or health visiting services).
- Give information on relevant aspects of baby care, baby’s cues and child development to support them in their relationship with the baby.
- Families have indicated that when a mother is admitted to an inpatient setting they may need some additional support and guidance on caring for the baby, whether this is in their own home or when they come to visit the mother and baby. They may feel particularly deskilled and side-lined if they have been separated from the baby.
Practice example: Using Video-Feedback Approaches with fathers and other co-parents
Recognising the importance of supporting the parent-infant relationship, a number of services are now incorporating the use of video-feedback based approaches with fathers and other co-parents. These attachment-based video interventions film parents interacting with their infant and use these clips to provide parents with information on their baby’s communication signals, needs and emotions whilst also providing positively-focused strategies on how to support and improve this relationship.
Specialist Mother and Baby Mental Health Service (SMABS), Bradford District Care NHS Foundation Trust
The SMABS team offer short-term specialist treatment during the perinatal period for mothers experiencing severe mental health problems or those who have experienced these in the past. The service sees women who are considering having a baby, are pregnant or have a baby under the age of one.
Some team members are trained in using Video Interactive Guidance (VIG) [ref. 39] , using this with other family members. The team have found that families, regardless of cultural or ethnic backgrounds, tend to want to know about babies and how to care for them.
Therefore, using these more ‘practical’ information-based approaches helps families to engage, works across cultures, and sees families reporting benefits to the parent-infant relationship.
Mind the Dad, South West London and St George’s (SWLSTG) Mental Health Trust
A new pilot service, run in collaboration with the Anna Freud Centre, has recently been established for partners of women accessing the specialist perinatal mental health team. ‘Mind the Dad’ was co-produced with fathers, to consider the name of the service, the location, how they are identified and what is available.
The service offers VIPP (Video Feedback Intervention to Promote Positive Parenting; [ref. 40] to support the father-infant relationship and positive infant development. VIPP will be offered to fathers who identify as having difficulties bonding with their baby or who would like to build confidence in their parenting.
VIPP is offered alongside a wider package of support available to all partners of women accessing their service (including mentalisation-based parenting groups and peer support).
Practice tips: box 9
Exploring relationships and identifying needs
- See both parents together and/or meet with other caregivers to build a relationship with them and understand their parenting needs.
- Involve partners and other family members explicitly in conversations about the baby and their relationships:
- How would you describe your relationship with your baby?
- Who are the other important people your baby spends time with?
- What has the experience of having a baby been like for you?
- What do you like to do with the baby/what does baby like to do with you?
- Is baby care shared and if so, how?
- What do you feel more confident about/enjoy/find more difficult?
- Caring for a baby is hard work. When you are at the end of your tether, how do you cope?
- Observe interactions between baby and other caregivers – are interactions sensitive, responsive to baby’s cues, can they hold the baby’s needs in mind? Consider partners’ and other family members’ beliefs about baby behaviour and communication – support the family to have a shared understanding to promote positive relationships.
- Be mindful that father involvement may vary with different ethnic, religious and cultural factors [ref. 41].
Practice tips: box 10
Build confidence in sensitive caregiving
- Provide gentle, supportive, strengths-based encouragement.
- Encourage opportunities for the partner and other family members to spend time with the baby to develop their own relationship, get to know the baby’s cues, and increase confidence (e.g. free play, organised activities, accessing community groups).
- Notice and highlight to the partner and other family members moments of positive interaction and the baby’s reactions to them, including smiles or eye contact.
- Provide parent-infant interventions, such as video- feedback (either individually or together with the mother; with specialist training and supervision).
- On the MBU:
- involve partners and other family members in baby care on the ward and protect their time with the baby
- recognise and value the partner’s and other family members’ expertise in their baby, especially if they have been very involved in the baby’s care prior to admission
- when preparing for discharge, talk to the partners and other family members about what it has been like to be separated from the baby, how they are feeling about mother and baby coming home, and how baby care will be managed at home.
Practice example: Working with the whole family
Specialist Community Perinatal Services, Devon Partnership NHS Trust
Nursery nursing seeks to ensure the perinatal care plan is family-focused. Nursery nursing interventions involve working closely with parent-infant relationships, and recognise other caregivers within this. Routine practice is to suggest seeing both parents (where applicable) or other family members together.
The nursery nurses have family-focused training and experience. Interventions follow a clear plan. Goals are agreed with parents at assessment, and reviewed after six sessions.
In the antenatal period, sessions focus on helping parents to prepare for the baby’s arrival, practically and emotionally. In the postpartum, interventions include providing advice, bonding support, and building parenting confidence.
They use the Circle of Security framework to consider attachment styles of parents. Commonly, interventions include grandparents and other family members where there is a focus on providing consistent evidence-based messages, resources, and managing generational differences in parenting. Nursery nurses offer specific support to families following an MBU admission, acknowledging that the father has been separated from the baby and preparing them for the transition to home life.
Clinicians report that involving partners and other family members offers many benefits: positive reinforcement through seeing positive interactions modelled by different family members, a sense of shared responsibility, increased confidence in parenting, mothers feeling less overwhelmed with parenting, shared understanding between the couple of their experiences and challenges in becoming parents, increased understanding of baby needs and increased awareness of services in the local community.