Baby Steps Evidence, impact and evaluation

Children and young people now award winnerWe worked with Warwick University to develop a service to help new parents in need of extra support.

The evidence so far suggests the service can help improve parent-child relationships and decrease parental anxiety and depression.

How abuse in infancy affects children

Babies under one are particularly vulnerable to abuse and neglect. One third of serious case reviews in England relate to babies under the age of 1 year (Brandon et al, 2012). In England and Wales, babies are seven times more likely to be killed than older children (ONS, 2015).

Abuse has life-long impacts, and early adversity can cast a long shadow. Recent neurological and psychological research highlights more clearly than ever before how critical pregnancy and the first years are to a baby's development. They provide the essential foundations for all future learning, behaviour and health.

Read more about the importance of early intervention

How Baby Steps is helping prevent child abuse and neglect

Pregnancy and the first few months of a baby's life are an extremely important time for families.

Research suggests that the parent-child relationship and the capacity to provide love, care and nurture are of major importance to the child's development and wellbeing. The dad or partner plays an important role in supporting the mother to maintain healthy behaviours that benefit their baby. A woman whose partner remains involved during pregnancy is more likely to attend antenatal care, take better care of her health and to deliver a healthy baby. The speed at which a woman recovers from postnatal depression is also linked to the quality of her relationship with her partner.

Despite the importance of this life stage, opportunities to support parents and their babies during the transition to parenthood are often missed. Many vulnerable and at-risk populations, who are most likely to need support, do not receive any antenatal education or support on top of their standard midwife care. A survey by The Royal College of Midwives and Netmums found that 75% of expectant mothers in low-income households receive no antenatal education at all (RCM, 2011).

Where antenatal education does exist, it is of variable quality and usually aimed solely at mothers. It also tends to focus on the medical aspects of childbirth, and can therefore fail to prepare parents for their new role in caring and supporting their baby when they go home after the birth. There are few evidence-based programmes designed to improve the wellbeing of disadvantaged families as they prepare for the arrival of their baby.

There is promising evidence that antenatal education that focuses on the transition to parenthood, with a focus on the relationship between partners and the development of a positive parent-infant relationship can improve parent and child outcomes. The promotion of secure attachment and reflective functioning can play an important role in prevention of abuse and neglect.

Baby Steps aims to:

  • improve outcomes for parents and their babies and generate substantial savings later on
  • promote informed choices and resilience before conception to create the conditions for families to thrive.

It is based on the Department of Health's Preparation for Birth and Beyond framework (Department of Health, 2011) but also incorporates other evidence about risk and protective factors in the perinatal period.

How we're evaluating this service

Using qualitative and quantitative data we evaluated the overall experience of Baby Steps users and measured the services’ effect on parental metal health and relationships. We hope to extend our research to include a control group in the future.

Baby Steps was evaluated during the first 3 years of delivery.

During the first year, a process evaluation was carried out which had 3 components: 

  • Focus groups 
    Held with practitioners  to explore their experiences of delivering the programme.
  • Survey
    148 parents were surveyed immediately after they had completed the service. This explored their satisfaction with the programme immediately after they had completed it, and whether they thought it was helpful.
  • Interviews
    51 parents were asked about their experience of the programme and how they thought it had helped them. We selected parents for the interviews with a mix of characteristics such as gender, geographical area and referral criteria. Some interviews explored how the programme worked for particular groups, such as parents in prison and those from minority ethnic families.

The process evaluation demonstrated that the programme had the potential to be beneficial to parents, and that they appreciated it.

A second stage of the evaluation was conducted, measuring the programme’s envisaged outcomes using self-report psychometric measures. The measures were obtained at 4 time points:

  • T1: before the programme started
  • T2: at the end of the last antenatal session
  • T3: at the post-birth home visit
  • T4: at the last postnatal session (T4).

In addition to the psychometric measures, data on birth weight, length of gestation, and delivery mode were collected from parents at the first home visit following birth as indicators of healthy birth outcomes.

Parents were also contacted 6 months after they had finished the course and asked to complete the measures and answer some additional questions about the longer term impact of the course.

It’s hoped that in the future a randomised controlled trial will be conducted to enable us to be confident that the outcomes observed are attributable to Baby Steps, and to understand the cost-effectiveness of the programme.

Collecting data from, and obtaining interviews with, vulnerable parents during and after they had finished the course was a big challenge. This affected the numbers of interviews we could conduct and the amount of data collected at 6 months post course. 

We worked hard to overcome this by working with practitioners and prison staff (when Baby Steps was run in prisons) to help them engage with parents and explain about the evaluation. We translated the measures for parents who didn’t speak English and we used interpreters to help us conduct interviews. If parents found it difficult to travel because of cultural or logistical reasons we interviewed them in their own home, or offered taxis.

Practitioners needed to feel confident about administering the measures to parents. We worked together to help them see the value of the evaluation and deal with the practicalities.

One of the measures used in the evaluation identifies anxiety and depression so staff might need to make a referral based on the answers given. We provided training, detailed guidance and worked with the Family Nurse Partnership to present examples of good practice which our staff could draw on.

This evaluation was carried out internally by the NSPCC evaluation department. It used the following tools:

  • Relationship Quality Index (parents relationship quality)
  • Rosenberg Self Esteem Scale (self-esteem)
  • Prenatal  Attachment Inventory  and Adapted Prenatal Attachment Inventory for fathers (parents relationship with their unborn baby)
  • Mother Object Relationship Scale (parents relationship with their baby)
  • Hospital Anxiety and Depression Scale (anxiety and depression).

Find out more about the tools used to measure outcomes

Contact Denise Coster for more information.

What we've learnt so far

Parents were very enthusiastic about the Baby Steps programme, and reported that it gave them new knowledge that prepared them for parenthood and helped them to feel more confident as parents. Findings suggest that parents will be better equipped to provide sensitive, responsive care to their babies, which may ultimately result in these children having better long term outcomes.

Read the evaluation.

What we're doing next

In the future we will further develop the evidence base for the programme and develop a social franchise model to enable other providers around the UK to take on Baby Steps; strengthening the evidence for the value of this programme and enabling it to reach more families.

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References

  1. Brandon,M. et al (2012) New learning from serious case reviews: a two year report for 2009-2011  London: Department for Education.

  2. Office for National Statistics (2015) Focus on violent crime and sexual offences, 2013/14. Newport: ONS

  3. Royal College of Midwives (2011) Low-income women 'poorly served' by midwifery services. London: Royal College of Midwives