NSPCC Gwynne Rayns Development Manager Arlene Murdoch Social Worker Mary Philips Nurse Practioner

1. Minding the Baby:
An Inter-Disciplinary Reflective
Parenting Programme
Gwynne Rayns Development Manager
Arlene Murdoch Social Worker
Mary Phillips Nurse Practitioner

2. A pioneering programme:
Carefully crafted by Profs Arietta Slade, Lois Sadler and Linda Mayes,
Yale University
Minding the Baby (MTB) is an intensive home visiting programme for
vulnerable first time mothers who are aged under 25
Pairs of social workers and nurse practitioners jointly work with each
family from the third trimester of pregnancy until the baby reaches age
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Focus is on maternal and infant mental health and as well as delivering
practical nursing and family support
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3. Pregnancy is an ideal opportunity for preventive intervention
Strong evidence about home visiting programmes (such as Family Nurse
Partnership) to prevent maltreatment
To date – limited explicit focus on parental and infant mental health as key
factors in these programmes
The emerging field of ‘reflective functioning’ provides important insights about
how we might prevent maltreatment in at-risk families
Limited use of social work and mental health expertise in delivery
Clinic based Parent-Infant Psychotherapy is expensive
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4. Core of the model:

5. Roles and common goals
Social WorkerNurse
Mental health promotion
Perinatal depression and
anxiety
Infant assessment
Dyadic play and
developmental guidance
Family intervention
(counselling/relationships)
Legal court systems
Crisis intervention
Case management
Assessment
Prenatal care and health ed
Nutrition; breastfeeding; labour
plan etc.
Child health and develop
Safety and injury prevention
Child development
Anticipatory guidance and
parenting skills
Mother’s health
Physical and mental health
Family planning
Smoking, nutrition, exercise
Secure Attachment
Reflective Parenting
Primary Care Giver-
Child relationship

6. Visiting schedule
• After enrollment and consent: engagement and assessment
phase
• NP and SW alternate visits
• Weekly home visits through child’s first birthday
• Every other week visits in child’s second year
• Graduation at child’s second birthday
Schedules individualized as needed

7. Supervision model
• Core line management supervision – case based
• Interdisciplinary supervision from whole Yale team –
focus on reflective practice and model fidelity
• Discipline specific supervision – focus on learning new
skills and practice
• UK based clinical supervision – focus on reflective
practice and skills building

8. Sophia – 14 years
Poor school
attendance
Domestic
abuse
Neglect
Temporary
accommodation
Statutory
supervision order
Poor maternal mental
health
Parenting of
siblings
Trauma
Risks
Early sexual
activity

9. Slide title runs here
• Re
RF relates to a parents capacity to make sense of their
child’s internal states, thoughts feelings and intentions
•High RF – forms the basis of healthy and secure attachment and effective
parenting
•Low RF – is associated with poor attachment and is a risk factor for abuse
and neglect
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10. Slide title runs here
• Re
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Some examples of “ reflective functioning”
Clinician: Name the good feelings you had during pregnancy?
Mum: None, I don’t know
Mum: Hmmm…….only when he kicks when I know he’s ok (laughs)
…….I get a really good feeling like when I go out and buy baby things
and like talk to my boyfriend about like baby things,
Mum: getting all her stuff as well, all her clothes and things and going
through it all and everything and saying “aw, she’s going to be in this…

11. Slide title runs here
• Re
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Some examples of “ reflective functioning”
MUM: When he is at his dad’s he gets upset at night time and calls for
me – I think that is because he is worried I am going to leave him again
MUM : I think my son is a lot happier because I can talk through (with
MTB) things that stress me out so I don’t get stressed with him
MUM : I have always wanted a better life for my son than I had

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Programme delivery- MtB Model in Action
Concerns Strategies
Non-Engagement Tenacious working
Avoidant behaviour Mentalisation techniques
Crisis Management Practical solutions & panic reduction
Child protection and welfare Liaison with statutory services and
honest and open working with parents
Maternal trauma
(Ghosts in the Nursery)
Strategies to develop maternal
reflective functioning
Pregnancy Interview
Child Development Assessment and review
Modelling appropriate play
Transition and Endings Effective planning and signposting to
other agencies

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Listening to the baby Speaking for the baby
Mentalising
Positive
mirroring
Age and stage
development assess
Child observation

14. Evaluation
3 sites York, Glasgow and Sheffield
Qualitative evaluation of first cohort
families
Second cohort recruiting now
Impact and cost effectiveness
Randomised controlled trial
Led by Prof Pasco Fearon at UCL
Key outcomes: Parent-infant
interaction; secure attachment;
Quality of parental sensitivity
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