Ms Carry Gorney

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Babys First Year - Patterns for a lifetime A
one year programme for first-time mothers and
their babies

• Ms Carry Gorney
• Ms Vicky Aldridge
• Dr Claire Pearson
• Dr Nevyne Chalhoub
• With the participation of
• Health visitors Dipti Aistrop Julie Mitchell
• Qualitative research supervisor Lisa Farnden

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Attachment, neuroscience and use of short-term
therapy formed the basis of our work
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The Model used Project STEEP(Steps to Enjoyable
and Effective Parenting)

• A 25 year long longitudinal study of 180
  children growing up in very deprived
  circumstances known as The Minnesota Parent-Child
  Project 1987.
• THE KEY QUESTION WAS
• What allows some children to develop into
  healthy, competent people even though they grow
  up in especially challenging environments?
• (Stroufe, Egeland Carlson 1975)
• The (US) National Institute of Mental Health
  supported a programme involving 75 families and a
  control group of another 83 families, all at
  risk, from low-socio-economic circumstances.
• The programme used video, group work and
  home-visiting.

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A Complex Intervention

• Weekly home-visiting by Home-Start volunteers
  throughout the year
• Ongoing use of Video by home-visitors including
  clips for the Care Index
• Group-work
• We worked with
• - eight first time vulnerable, at risk mums,
• - eight volunteers,
• - eight babies
• and there was a 0 drop-out rate

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Adaptation

• We used volunteer home-visitors rather than
  professionally trained health visitors
• The programme ran for one year, not two
• The group work was delivered in three blocks of
  eight weeks, instead of fortnightly over two
  years
• Informal events took place during the interim
  periods, involving activities such as
• Swimming
• Baby yoga
• Trip to the seaside
• Enrolling in the baby book programme at the
  library

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Methodology

• Our evaluation consisted of
• A qualitative exploration of the effectiveness of
  using volunteers through focus groups and
  interviews of mums and volunteers.
• These were analysed using the framework approach
• The Care Index pre-, mid- and post-programme

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Care Index

• The Care Index is a scoring system of a 3 minute
  play interaction video clip between mother and
  infant.
• It was developed by Dr Crittenden and is a well
  researched tool with good reliability and
  validity.
• A sensitivity score is obtained for each video
  clip.
• The score is based on an observation of mother
  and baby and the information yielded is dyadic.

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7 aspects of interactional behaviour

• Facial Expression
• Verbal Expression
• Position and Body contact
• Affection
• Turn-taking contingencies
• Control
• Choice of activity

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Care Index Scores
Sensitivity Scale 0-4 Sufficient misattunement
so that play is not possible at all 5 6
Substantial misattunement but in a playful
context 7 8 Some misattunement or
inconsistencies 9 -14 Sensitive
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Qualitative Evaluation themes and sub-themes

• There were seven key themes, each dividing into
  three to five sub-themes
• Reasons for joining the project
• Use of video
• Establishing the one-to-one relationship
• Training and supervision
• Effect of the programme on volunteers
• Group work and community
• Development of the relationship between mums and
  volunteers

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• 1. Reasons for joining the programme
• Volunteer The window I have had into the varied
  experiences of all the people involved in this
  project
• Mum I think it were to get me out of the house,
  it were a new start for me and the babya lot of
  people in the same boat, wed all just given
  birth and felt lousy
• 2. Use of video
• Volunteer I am constantly amazed how the videos
  can encourage and enforce the mums interaction
  with her baby.It sometimes positively changes
  behaviour
• Mum I could see I were a good Mum it made me
  want to do more

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• 3. Establishing the one to one relationship
• Volunteer ..we are not a threat. because we are
  just mums ourselves. But the likes of health
  visitors, doctors, nurses. the mums feel they are
  telling them what to do. Were not coming with
  this aura around ourselves
• Mum She listened to what I was saying, she never
  judged me..
• 4. Training and Supervision
• Volunteer I think the penny dropped that all
  the ways of relating can stem from your own
  relationship perhaps with your mum and once you
  start analysing that you can go further and help
  your mum and baby.

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• 5. Effect of the programme on volunteers
• Volunteer You would look at the baby and speak
  to the baby yourself. It was training us to be
  focusing on the babys needs so we were training
  the mums to be focusing on the babys needs
  without telling her direct. I think just possibly
  we learnt as much if not more than the mothers
  have through this project. It has benefited all
  ways round
• Mum She always put my baby at the centre of
  thing, J always came first, I trusted her
• 6. Group work and Community
• Volunteer We were pulling together werent we,
  all working to a common cause, so thats why we
  were all connected with each other, so everyone
  understands what the other one is working toward
• Mum when you are around other people you can
  watch what they are doing and learn new things
  for yourself, . .Its no good people telling you
  -, you just need to watch it .and do what you
  feel comfortable doing

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• 7. Development of relationship between mums and
  volunteers
• Volunteer I would say it has been a privilege.
  Meeting M before L was born, seeing the
  transition, afterwards just seeing them together,
  just seeing the way L developed and how M has
  coped with an awful lot of problems, she has been
  so resilient and on the other hand she's like a
  little waif.
• Mum Youd ask a doctor about a broken arm but
  would you ask him about a broken heart

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CLOSING SUMMARY

• Our study shows that the programme can clearly be
  adapted to the NHS context.
• There are clear benefits in using volunteer
  home-visitors their non-expert encouraging
  approach engages a reluctant client group who
  regard professionals as a potential threat.
• Six out of eight mothers involved improved in
  their capacity to relate to their babies.
• One mother showed a considerable improvement when
  assessed at 15 months, which is a clear
  indicator that this programme should run for two
  years