5. What are the core principles and models of delivery of interventions that aim to prevent parent-baby separation?
The previous sections have allowed us to understand the problems and the negative outcomes which might be mitigated by preventing parent-baby separation. Our next focus was on the potential impact of services that could mitigate these outcomes. To do this, we set out to examine the principles and models of services with the aim of preventing parent-baby separation, to understand what underpins this type of prevention work.
As highlighted above, only the Magu service in RCT has the prevention of parent-baby separation as its primary purpose. We therefore focused our analysis of other services with similar aims. The services aim to mitigate the negative outcomes resulting from infants entering care, as well as preventing parents from recurrent care proceedings.
We identified services from four different local authorities with published evaluations on similar services, as well as best practice guidelines for pre-birth intervention. These formed the basis for our analysis for this question and the subsequent question on beneficial outcomes.
All of the reviewed services explicitly aim to support prospective parents considered vulnerable or with a high risk of the child being removed. Some also specifically look to support young mothers under the age of 25. However, the duration of support offered differs between services, and many services are delivered in formal cooperation with voluntary sector partners. Table 5 below provides an overview of the services reviewed as part of this report.
We first describe the core principles of the services, before discussing common features in how they are delivered.
Table 5: Reviewed services which aim to provide intensive pre-birth support.
Name of Service | Local Authority | Duration of Support |
Baby and Me | Newport City Council | From 12 weeks in pregnancy, up to 6 months post-birth |
Thriving Babies: Confident Parents | Manchester City Council | Pre-birth (varying, but on average, from around 16 weeks of pregnancy), continuing until 3 to 6 months after the birth |
Positive Choices | Calderdale Council | Mostly pre-birth, but not always, continuing for up to two years |
Jig-So | Swansea Council | From 17 weeks of pregnancy, up to the child’s second birthday. |
Core principles
In reviewing the evaluations of the four services, we identified six key principles that guide practice. Early referrals provide a basis for the support offered, which is relationship-focused, strengths-based, trauma-informed and holistic. Ongoing support is then offered after the birth of the child.
Early referrals
Referral to the service as early as possible is a core feature, and considered a significant difference from mainstream children’s services (Turnpenny et al., 2022). It is beneficial to begin support as early in the pregnancy as possible, and this is recognised by a range of stakeholders, especially practitioners (Burch, Allen and Coombes, 2020; Research in Practice, 2022). This allows those receiving the support time to make positive choices, reduce risks, and make practical plans (Turnpenny et al., 2022). Many parents need early help to address mental health or substance use problems, or to secure stable housing (Mason et al., 2022).
As stated above, the time at which support begins varies between the different services, with one making changes to children’s social care systems to allow for earlier referrals (Research in Practice, 2022). Once the case is accepted, services aim to allocate staff quickly with minimal wait: some services aim to provide first contact on the same day, or within 48 hours of allocating the case to a lead member of staff (Turnpenny et al., 2022).
Relationship focused
Focusing on building trusting relationships is central in ensuring positive engagement with the service (Turnpenny et al., 2022). The service in Calderdale highlighted the importance of forming this relationship given the difference in power dynamics, compared to the usual relationship with statutory services (Burch, Allen and Coombes, 2020). Trusting relationships can result in more in-depth understanding of parental life circumstances, challenges and capacity, informing the strengths-based support provided (Research in Practice, 2022). These relationships may be especially important for service users: they can be therapeutic and as important to parents as the sessional content delivered by the service (Turnpenny et al., 2022; Burch, Allen and Coombes, 2020). Based on their strong relationships, practitioners can provide robust evidence for social workers on the extent parents can make changes prior to the birth of the infant, improving confidence in decisions made by statutory services (Research in Practice, 2022).
Strengths-based
Support offered by the four services starts by focusing on the strengths of service users, their families and existing support networks, building on existing resources and resilience factors (Turnpenny et al., 2022). This is done in a non-judgmental and empathetic way, which also looks at areas where users would like to target support (Burch, Allen and Coombes, 2020). As highlighted by the stakeholders of one service, this turns the usual model of engagement on its head, with the focus on what the user intends to achieve rather than social workers stating the changes required (Turnpenny et al., 2022).
Trauma-informed
The support offered to parents intends to help families understand their own trauma and how they can break that cycle for their children (Jig-So, 2022). For one service, nearly all service users had significant adverse childhood experiences (ACEs), typically associated with domestic violence, neglect, abuse and substance use in the family during childhood (Turnpenny et al., 2020). Practitioners may receive training on ACEs, providing specialised support to explore the trauma and ACEs experienced by parents, and the potential impact of these on parenting: this forms a central part of the support offered by the services (Turnpenny et al., 2020; Research in Practice, 2022).
Holistic
The services provided are holistic, focusing on the parent and their family unit. It is recognised that parent and child needs are intertwined, making it difficult to improve outcomes for the child without understanding parent and family vulnerability (Turnpenny et al., 2020). As discussed in the models of delivery section below, the support offered also looks at a range of different factors in family life, aiming to reduce risk and promote wellbeing in a number of ways.
Ongoing support
Ongoing support also appears to be a key principle of many of the models, although this is often not made explicit. All the services continue for some period after the baby is born, with a focus on continuing to provide support throughout care proceedings and if the child is taken into care (Burch, Allen and Coombes, 2020). One service highlighted the need to gradually step-down support with parents but recognised that some parents continue to require support after the programme end date (Research in Practice, 2022). Where this cannot be provided by the service, referrals are often made to other universal or specialist services, depending on need.
Models of delivery
As well as the core principles which guide how the services are delivered, the preventative approach also relies on understand what service delivery involves. Each of the services we reviewed offers a similar set of core activities, with these underpinned by common management practices.
Practitioners tend to offer core one-to-one sessions, which largely consist of home visits with a project worker. This may include educative sessions covering a wide range of parenting skills, such as safe sleeping, breastfeeding and bottle making and baby brain development (Turnpenny et al., 2020). Other focuses of educative sessions include child bonding and attachment, as well as explanation of, and support through, statutory social services processes (Burch, Allen and Coombes, 2020). Alongside this educative focus, one-to-one sessions may also have therapeutic input. As discussed in the section on trauma-informed practice above, these one-to-one sessions may involve discussion of current and historic parental experiences, and how to overcome these barriers to become a successful parent (Research in Practice, 2022). While it is acknowledged that content will differ for each service user, depending on their respective strengths and needs, there is often core content which is highly encouraged, if not compulsory.
Group sessions are also common among the services, though these tend to be voluntary. Several different groups were offered by services, including an antenatal group, peer mother and baby support, a group parenting skills course, and a healthy relationships course targeted at males (Ward et al., 2019; Research in Practice, 2022). Some of these groups focused on providing educative content, in many cases replacing some of the content delivered via home visits, whereas others intended to strengthen support networks and reduce self-isolation. They were also often delivered by voluntary sector collaborating partners. Where group sessions were not part of the service itself, there was often an explicit aim to help parents access other existing groups.
Services also offer practical support, often helping with money management or accessing housing, furniture, baby items and nurseries (Ward et al., 2019; Burch, Allen and Coombes, 2020). This can also include administrative support, including registration of the birth, or with a GP (Turnpenny et al., 2020). Evidence highlights how highly valued this is by parents, with one evaluation highlighting practitioners’ knowledge about other services, acting as “tenacious advocates” for mothers (Turnpenny et al., 2020; Research in Practice, 2022). When the model of pre-birth support is established and well-recognised, it can become easier to facilitate access to other services, although one evaluation highlighted that it remained difficult to provide access to mental health or drug and alcohol support (Burch, Allen and Coombes, 2020).
Working with both parents was also a key feature of the services we reviewed. There was often a particular focusing on engaging fathers, as part of educative sessions, but often also with specific focus on healthy relationships, fatherhood, and masculine identities (Ward et al., 2019; Turnpenny et al., 2020). One service identified the engagement with fathers to be more successful than previous services working with vulnerable first-time parents, while another highlighted positive examples of working with parents sensitively on sensitive topics, with engagement of fathers facilitated by a male key practitioner (Burch, Allen and Coombes, 2020; Turnpenny et al., 2020). The evaluations discuss some attempts to engage with extended family, but it is not clear if there is a consistent model for this, even across cases within the same service. However, one service highlighted that there were fewer documented examples of successful engagement (Turnpenny et al., 2020).
In order to deliver these services, there are common management practices mentioned across services. Practitioners can be flexible in their working practices to offer support as they see fit to families, and managers allow practitioners to do this (Burch, Allen and Coombes, 2020). In one service, a staff member highlighted the importance of team culture, and desire to support families in any way they can (Ward et al., 2019). This may involve doing what is needed in the moment, going beyond their job roles, and it is recognised that there is a freedom for practitioners to make judgements on what the best approach is for the service user. Low caseloads enable this flexibility: facilitating the building of relationships and allowing for the one-to-one support needed in delivery.
Shared commitment and buy-in across the team and external partners are also crucial enablers for these types of service. Staff understand each other’s capabilities and work together to achieve the best outcomes for service users (Ward et al., 2019). This means that everyone is working to the same vision and understands what needs to be done to accomplish that. One service also highlighted that this identity became well known across a range of professionals working with vulnerable parents, encouraging referrals from a range of routes (Turnpenny et al., 2020).
These key principles and models of delivery provide an understanding of how services focusing on preventing parent-baby separation set about their goal. Later in this report, we utilise these principles and delivery models to determine the impact of the Magu service in RCT, which has the same primary purpose.
Key Points
Evaluations of four services similar to Magu were reviewed. All four services begin with early referrals and lead to ongoing support post-birth.
The core principles of services are: relationship focused; trauma informed; and providing a strength based, holistic engagement model that differs from statutory services.
Services work with both parents educating on a range of parenting skills and providing practical support.
Several different types of voluntary group sessions in addition to core 1:1 sessions are common.