All Babies Count: Prevention and protection for vulnerable babies.All Babies Count: Prevention and protection for vulnerable babies
Chris Cuthbert, Gwynne Raines and Kate Stanley NSPCC 2012 72 pages
This is an edited version of a review taken from www.preventionaction.org with permission of the publishers
This NSPCC report reviews what can be done in terms of preventing the abuse of very young children. Foster care and adoption receive some attention in the section on tertiary prevention on p 40 but despite this, the rest of the document is useful in helping carers and professionals to perceive their work in its wider context.
The report begins by laying out some shocking statistics: in England, 45 per cent of case reviews following the death or serious injury of a child concern a baby less than one year old; babies are eight times more likely to be killed than other children; of all babies in the UK, 19,500 live in homes where an adult has used a Class A drug in the last year; 39,000 are in homes where there is domestic violence; 93,500 babies have a problem drinker in the household; and 144,000 have a parent with a common mental illness.
Part 3 of the report (pp 34-40) looks at what can be done and considers effective and innovative practice by focusing on 'what works' or 'is promising' with regard to preventing maltreatment during pregnancy and the baby's first year of life.
The principles of effective programmes are defined on four dimensions. With regard to design and content, the approach should be theory driven, of sufficient dosage and intensity, comprehensive and engaging. In terms of relevance it has to be appropriately developed, well timed and socio-culturally relevant. Delivery is also important, so well-qualified, trained and supported staff are essential. Finally, methods of assessment and quality assurance must be in place if the findings are to refine the service.
The discussion adopts a three-tier model of prevention looking initially at primary prevention and noting the positive evaluations of midwifery and Sure Start services. The identification of touchpoints or key moments for intervention is also encouraged. Antenatal education is obviously key in all of this, and needs to include the psychological and social impacts of parenthood as well as medical information. Men also need to be involved. One-Plus-One, Relate and the Tavistock Centre for Couple Relationships are singled out for special mention in these respects. Hospital-based education programmes that help parents cope in the early weeks have been shown to improve bonding and babies' brain development and reduce the risks of physical abuse. The establishment of community support groups, such as the Community Mothers model, is recommended.
Secondary prevention targets vulnerable groups prior to the occurrence of any maltreatment. If it is to be effective, important contributory factors such as mental illness, substance abuse and family violence have to be addressed. The Nurse Family Partnership home visiting programme is cited as achieving good results in a number of areas, such as women's prenatal health, reduced child injuries, fewer subsequent pregnancies, greater intervals between births, the involvement of fathers, more employment, reductions in need for welfare payments and better school readiness. The benefits gained by young people endure and are observable in adolescence.
Less is known about some important areas, however, and initiatives are still being trialled. Domestic abuse is one such area but advocacy-based interventions and cognitive trauma therapy show considerable promise. For the children, child-parent psychotherapy and the Domestic Abuse Intervention Programme developed in the US city of Duluth are noted. Substance abuse also remains a serious problem and screening during pregnancy offers an opportunity to produce behaviour change. The T-Ace programme offers a methodology for identifying risk cases and Brief Interventions, Parents under Pressure and the Vulnerable Infants Project in Scotland offer ways forward.
Tertiary prevention is applied after maltreatment has occurred and seeks to stop recurrence or deterioration in the child's circumstances and is the point at which fostering and adoption become significant. A preBirth Risk Assessment helps in this respect, as does further specialist assessment post-abuse. The New Orleans Intervention Model, Parent-Interaction Therapy and Child/Infant Psychotherapy are named as three proven models in this area, the first of these indicating when adoption becomes the way of promoting the child's best interests.
An especially useful section of the report (Annexe C) discusses the policy and practice changes that are needed in each of the four UK countries to implement the report's recommendations.
The NSPCC is impressed by the rigour that has gone into proving the effects of these programmes but also stresses the importance of the skills and performance of the practitioners who implement them. It also recognises that evidence-based programmes have to be incorporated into systems if they are to achieve widescale implementation.