Impact and Evidence series

Transcription

1 Impact and Evidence series Evaluation of THE FIRST YEAR OF Baby Steps Parents Perspectives Helen Brookes and Denise Coster NSPCC Evaluation department March 2014

2 Impact and Evidence series This report is part of the NSPCC s Impact and Evidence series, which presents the findings of the society s research into its services and interventions. Many of the reports are produced by the NSPCC s evaluation department, but some are written by other organisations that the society has commissioned to carry out research on its behalf. The aim of the series is to contribute to the evidence base of what works in preventing cruelty to children and how to reduce the harm it causes when it does happen.

3 Contents Acknowledgements 4 Key Findings: Young people s version 5 KEY FINDIngs 6 Executive Summary 7 Main Report 10 Chapter 1: Introduction 10 Background 10 Method 11 Chapter 2: Knowledge, attitudes and behaviour 15 Acquisition of new knowledge 15 Acquisition of new skills 19 Changes in attitudes 22 Changes in behaviour 23 Chapter 3: Access and support 26 Support 26 Unintended outcomes 32 Chapter 4: Engagement and attendance 34 Facilitators 34 Barriers 40 Chapter 5: Suggested Improvements to Baby Steps 42 Chapter 6: Conclusion 46 Next Steps 47 Impact and Evidence series 3

4 Acknowledgements We would like to thank the Baby Steps practitioners and administrators for all their help and support in recruiting service users for the interviews on which this report is based. We are also grateful to the manager of the prison visitors centre for helping to set up interviews with parents who attended the programme in a prison context. 4 Evaluation of Baby Steps

5 Key Findings: Young people s version Baby Steps is a course to help new parents. The NSPCC has done some research to find out what parents thought of it by talking to 19 people who were on the course. These are the main things they told us: Parents said the course made them feel more confident and helped them make friends. It also helped them learn how to talk better to each other and their children. First time parents liked the course and so did people who had older children. They liked the NSPCC workers because they encouraged them to take part. They also liked that the NSPCC workers visited them at home before the course started. Some parents were a bit worried because the course was run by the NSPCC. They thought it meant they may have done something wrong. Parents who had been on other courses they did not like were also a bit worried about this one. Sometimes one parent on the course was in prison. This made bits of the course harder or made them upset. But they still thought it was a good course. To improve the programme parents said that the course could be longer. They also thought it would be good if the NSPCC worker could change bits of it if parents already knew some of the information. Some parents wanted more information about actually having the baby and about feeding babies. Impact and Evidence series 5

6 KEY FINDINGS Baby Steps is a perinatal education programme the NSPCC has developed in partnership with parenting experts at Warwick University. As part of the formative evaluation of the Baby Steps programme, 19 interviews were undertaken with a sample of parents who had completed the programme during the first year. The key findings were: Parents said that the programme helped them become more confident in their parenting; they developed stronger support networks and gained new skills that meant they communicated better with their partners and babies. Both new parents and parents who already had children said they found the programme useful. Parents thought that the positive attitude of staff and the way they encouraged participation was very important. They also felt that staff visiting them at home before the programme started made a big difference. Some parents said that the NSPCC brand, which they associated with stopping child abuse, put them off the programme initially. Parents who previously had bad experiences of antenatal courses were also more worried about taking part. Some of the courses were run with families where one partner was in prison. This made parts of the programme more difficult or emotional, such as the module on daily routines with babies. But these parents still felt the course had strengthened their relationship with their partner and babies. Parents suggested that the programme could be improved if it started earlier and carried on for longer. They also felt that it would have been better if staff were able to leave out or add topics depending on what the group needed. Some parents would have liked more information about the birth and the practical and emotional issues relating to breast- and bottle feeding. 6 Evaluation of Baby Steps

7 Executive Summary Background Baby Steps is a perinatal education programme that the NSPCC has developed in partnership with parenting experts at Warwick University. The intervention is a group-based programme delivered to disadvantaged parents from the 28 th week of pregnancy. The first version of the programme which is the focus of this report consisted of eight sessions including two after the birth of the child. The updated second version of the programme includes an additional post-birth session The course aims to help vulnerable parents manage the transition to parenthood successfully, with a particular emphasis on the relationship between partners and the development of a positive parent-infant relationship. The programme is co-delivered by children s services practitioners and a health professional (midwife or health visitor), using a range of activities including home visits, group discussions, creative and practical tasks. At the time of writing, the programme was running at five sites across the UK. During the first year the programme was evaluated using a formative evaluation methodology. The aim of the evaluation was to describe variations in practice; identify barriers and facilitators to course delivery; describe experiences of delivering and receiving the course; describe the range of outcomes, and provide opportunities to refine and improve the programme. Methodology and aims As part of the formative evaluation of Baby Steps, 19 semi-structured face-to-face interviews were conducted with a sample of parents who had completed the programme. The aims were to: explore parents experience of the course identify the outcomes parents reported as a result of attending identify the barriers and facilitators to engagement of parents. The sample was selected purposively by gender, geographical area and referral criteria. Interviews took place either in the participants home or the local NSPCC service centre. An exception to this was a father who, being a prisoner, was interviewed in prison, while his partner was interviewed at the prison visitors centre. Where necessary, the interviews were conducted through an interpreter. The full findings from the interviews are set out in this report. Some key themes from the interviews are detailed below. Impact and Evidence series 7

8 Key findings and implications Parents in the sample reported they had benefited from attending the course in a range of ways. They had acquired new knowledge that had prepared them for the challenges of the perinatal period and informed their choices about birth and caring for their babies. They had also learnt new skills, including practical baby care and communication skills, which they had put into practice with positive results. They reported that improved skills in listening and managing disagreements had led to stronger relationships with their partners. An increased understanding of the importance of communicating with their infant, combined with knowledge about how to do this at different developmental stages, had positively influenced their interactions with their babies. Parents also reported that they had improved self-esteem, were more confident about their parenting skills and that they had stronger support networks. The information delivered to parents during Baby Steps was felt to be useful regardless of parents level of prior knowledge. Those for whom it was completely new described it as invaluable, while those with some pre-existing knowledge either through their own experience with older children, the media, or their own research, said that it consolidated or built on what they already knew. It also provided them with an opportunity to ask questions about anything they were unsure about. Practical factors such as support with travel and childcare were important in facilitating parents engagement. Parents were also engaged by the way the course was structured and the content delivered. They especially liked the participative mode of learning and the fact that the course was delivered in a group setting, which afforded opportunities for discussion. The personal qualities of staff also contributed to parents feeling engaged. Practitioners were described as friendly, caring, approachable, affirmative, flexible, responsive, knowledgeable and different from other health care professionals. The home visit played an important role in making parents feel more comfortable about attending Baby Steps, because it gave them an overview of what to expect from the course and an opportunity to ask questions. A key barrier to parents engaging with Baby Steps was that they felt apprehensive about being involved with the programme because of a negative perception of the NSPCC brand. There was particular concern about being referred because they were thought to lack parenting skills, or about their parenting being scrutinised if they attended the programme. A previous negative experience of an antenatal course was also a barrier, because parents assumed that Baby Steps would be similar. The home visit was an important opportunity to reassure parents and address any misconceptions about the course. 8 Evaluation of Baby Steps

9 Offering the course in a prison setting to include a partner who is a prisoner affected participants experience of the programme. The material in the Changes for you and me session, which deals with the changes associated with having a baby, was experienced differently by these parents because of their circumstances. Mothers were preparing to give birth and cope with a new baby alone, while fathers were aware that they would miss the birth of their child and would not be there to help when the baby came home. This session did provide an opportunity for couples to discuss these issues, however, and parents felt that attending the Baby Steps course had strengthened their relationships with partners and infants, as a result of having the opportunity to spend quality time together. Further qualitative interviews in year two of the Baby Steps evaluation will explore more fully the different experiences and outcomes for this group. Parents in the sample really enjoyed Baby Steps and would have liked the programme to start earlier in pregnancy and go on for longer after the baby was born. Other suggestions for changes to the course included increased flexibility in the content of the programme to allow practitioners to add or omit topics to suit the needs of parents in the group. Although participants felt that Baby Steps had prepared them well for the challenges of the perinatal period, there were certain experiences they had not felt prepared for and found difficult, which they would have liked more information on. These included caesarean section; physical recovery from natural birth; colic; brands of formula milks, and the practical and emotional transition from breast- to bottle feeding if breastfeeding is not successful. Next Steps The findings presented in this report will be considered in conjunction with those from the practitioner focus groups and consultation with referrers. They will inform changes to the content and structure of the programme manual; the content of other resources used in the programme such as DVDs and hand-outs, and the marketing materials used to promote the course. Impact and Evidence series 9

10 Main Report Chapter 1: Introduction This report presents the findings of interviews with a sample of the first parents to complete the NSPCC perinatal course Baby Steps. This chapter describes the aims of the parent interviews, the methodology used and how they fit into the overall evaluation of Baby Steps. Background Baby Steps is a perinatal education programme the NSPCC has developed in partnership with parenting experts at Warwick University. The intervention is group-based programme delivered to disadvantaged parents from the 28 th week of pregnancy. The first version of the programme which is the focus of this report consisted of eight sessions,including two sessions after the birth of the child. An updated second version of the programme includes an additional post-birth session. The course aims to help vulnerable parents manage the transition to parenthood successfully, with a particular emphasis on the relationship between partners and the development of a positive parent-infant relationship. The course also aims to create social support for parents and to foster resilience within the parents. Ultimately it is hoped that the course will improve the capacity of parents to care for and nurture their baby. Its contents are aligned to a new expert framework developed by the Department of Health, which sets out key themes that should be covered in antenatal education drawing on expert opinion, research evidence about what makes antenatal education effective, and the views of parents-to-be. The programme is co-delivered by children s services practitioners and a health professional (midwife or health visitor) in children s centres, NSPCC service centres and prisons. Groups accommodate around eight couples (or single mothers and supporters) or twelve single mothers. The course aims to actively involve parents in their own learning by encompassing a range of methods including: whole-group and same-sex discussions talk and listen time creative activities trigger films DVD about the dangers of shaking babies and risk of nonaccidental head injury (NAHI) quizzes 10 Evaluation of Baby Steps

11 building listening, communication and conflict resolution skills. To be eligible for the Baby Steps programme mothers and/or fathers should meet at least one of the following criteria: be aged 20 or under be a substance misuser, recent migrant, asylum seeker or refugee be from a particularly disadvantaged or isolated minority ethnic community have difficulty reading, speaking or understanding English have learning difficulties have low-level mental health problems be a victim of domestic abuse be or have been involved in crime or anti-social behaviour be homeless be a gypsy or traveller lack strong social or support networks live in poverty or severe financial hardship be or have been in the care system not in education, employment or training. The group is not suitable for parents with complex or severe additional needs, such as: parents who are currently experiencing a severe mental illness that would make group participation difficult, or parents exhibiting unpredictable or threatening behaviour. At the time of writing the programme was running in five sites across the UK. Method Purpose of the parent interviews As part of the formative evaluation of Baby Steps, qualitative interviews were conducted with a sample of 19 parents who had completed the programme during the first year. The aims of these interviews were to explore parents experiences of the course; to look into the range of factors that affect these experiences, and to identify the outcomes parents reported as a result of attending. Impact and Evidence series 11

12 Sample Parents were selected purposively according to referral criteria, geographical area and gender as it was hypothesized that these factors may have a bearing on their experience of the programme. Purposive sampling is used in qualitative research to enable the research to describe and understand the full range of views and experiences within the study population. It involves setting quotas using criteria based on dimensions that reflect key differences in the study population that are relevant to the study s objectives, rather than trying to ensure that the sample is statistically representative. Although 28 interviews were set up, due to a high drop-out rate only 19 parents were interviewed. The achieved sample comprised 15 mothers and four fathers from four sites (see Table 1). They had been referred for a wide range of reasons (see Table 2). Please note that referral categories have been combined to ensure anonymity. Table 1. Composition of sample by site Number of Interviews Bradford 9 Tidworth 5 Leeds 2 Swansea 3 Table 2. Composition of sample by referral criteria and gender Female Male Referral Criteria 2 1 Current or ex-offender or partner of offender 3 1 Drug use/mental health/homelessness 3 0 Young parent/care leaver 2 Social isolation 4 1 Refugee/recent migrant/limited English 1 1 Involvement with children s services Recruitment Consent forms were collected by the evaluation team. Practitioners who had delivered the programme to parents were asked to complete a short online questionnaire about each parent who had consented, to gather information about the reasons they had been referred to the service, the date their baby had been born and any other relevant information about their personal circumstances. This enabled the evaluator to select parents that matched the sampling criteria. Completed questionnaires were received for 46 parents, of which seven either could not be contacted, or it was deemed inappropriate for them to be contacted. 1 The evaluator attempted to contact the remaining 39 parents directly, first by calling and, failing that, by texting. Exceptions to this were parents who had completed Baby 12 Evaluation of Baby Steps

13 Steps in prison, who were contacted by the prison visitors centre manager to set up the interviews, and Urdu- speaking mothers, who were contacted by one of the practitioners running their group. Parents were given further information about the aims and objectives of the evaluation and what would be expected of them in the interview. They were then sent a confirmation letter and information sheet. Data Collection Data collection took the form of semi-structured face-to-face interviews. Parents were offered a choice of being interviewed at home or the local NSPCC service centre. Travel costs were reimbursed. One father, a current offender, was interviewed in prison and his partner in the prison visitors centre. Parents with limited English proficiency were interviewed with the help of an interpreter. At the end of the interview all parents (except the father who was in prison) were given a 10 voucher and an information sheet with contact details of a number of national parenting helplines. Interviews were recorded with a digital recorder and transcripts were produced for analysis. Confidentiality It was made clear to participants that all data would be kept confidential unless a child protection concern was identified, in which case standard NSPCC child protection procedures would be followed. Informed consent Practitioners sought written consent for the evaluation from parents at the end of the first session. When the evaluator made contact with parents who had agreed to take part, confirmation was sought that they were still happy to proceed before setting up the interview. Data protection All electronic data was stored securely in password-protected electronic files, and hard copies of information were stored in locked cabinets. Data has been reported on an aggregate rather than individual basis and therefore does not include any identifying details. Analysis The qualitative data from the parent interviews and the focus groups were analysed using a framework case by theme approach. Impact and Evidence series 13

14 Limitations of the research All the parents in the sample had completed the Baby Steps programme. Due to time constraints and logistical difficulties it was not possible to interview those who had chosen not to take part in Baby Steps, or had dropped out of the programme part of the way through. It is therefore likely that there were some parents who had a negative experience of the course or for whom attending led to negative outcomes, whose views are not represented in this report. In addition, the sample did not represent all of the referral criteria in the study population. This was partly due to the difficulty of accessing certain groups of parents (eg mothers in prison), and partly because at the time the fieldwork was conducted there were only a limited number of parents who had completed the course and were eligible to be interviewed. 14 Evaluation of Baby Steps

15 Chapter 2: Knowledge, attitudes and behaviour Participants in the sample talked in positive terms about their experience of the Baby Steps programme, and were able to identify a range of positive outcomes in terms of changes in knowledge, attitudes and behaviour that had resulted from attending the course. This chapter looks at these reported outcomes and the mechanisms through which they occurred. Acquisition of new knowledge One of the objectives of the course was to equip parents with knowledge on a range of topics that would help them to negotiate the emotional and physical transition to parenthood. The level of prior knowledge among participants ranged from those who knew very little to those who were relatively well informed either through their own experience with older children, their own research, or the media. The information provided by the course was well-received by parents at all points along this spectrum. Those for whom it was completely new said that they had found it very informative, while those with some pre-existing knowledge said that it consolidated or built on what they already knew and provided an opportunity for them to ask questions about anything they were unclear about. I ve learnt a lot from it, in terms of how to look after the baby and what to do. Obviously as a first time mother you don t know anything. Without this course, without the information, I would have struggled. (Mum recent migrant) As a course it kind of makes you realise things you didn t know and also confirms things. You get told things from family, friends and you read things and watch them on TV but actually doing a class that confirmed things was really handy and really helpful. (Mum social isolation) Participants reported that they had acquired new knowledge about many of the issues covered on the course. Parents illustrated this by describing examples of times when they had put this knowledge into practice during their pregnancy, labour and in their interactions with their babies or partners. Impact and Evidence series 15

16 Mothers who had a natural birth said they felt better informed and better prepared for labour as a result of attending the course. Labour Mothers who had a natural birth said they felt better informed and better prepared for labour as a result of attending the course. Mothers who had caesarean sections, however, did not feel that the course had prepared them for their birth experience, because this was not covered in much detail. Mothers as well as fathers found practical information such as what to pack in their hospital bag, what items they needed to buy for the baby and where they would be going to deliver the baby helpful. My boyfriend come [sic] to the hospital too so it was really nice for him as well to see what it would be like and what to do because then when we got to the hospital I was like in pain and he was like, Oh I know what to do, and he was talking to the women and he knew where I was going to go and everything because we d gone up before. So it was really helpful. (Mum young care leaver) The information provided to them had enabled them to make informed choices about the type of pain relief that they wanted during labour and also the type of birth that they wanted. She [NSPCC practitioner] took us up for a tour of the maternity ward because I was really worried and we saw the birthing pool and she was saying, That s really good, and I was like, Oh no I don t want to do that, but I actually ended up having a water birth and I thought it was brilliant because I didn t have no back pain or anything like that. She didn t make me have it but she told me about it whereas I didn t know much about it. I d always been told that it was dangerous, but with her telling me about that that s what actually made me go and have a water birth and I loved it. (Mum young care leaver) Parents who had older children drew comparisons with previous experiences where they had felt less prepared and had found it more difficult as a result: 16 Evaluation of Baby Steps

17 It prepared me more for the birth. Last time, I just went in, I did what I had to, I didn t really know exactly what was happening. This time I knew the first, the second and the third, different stages of labour. I knew which bit was which because we learnt them in the class and she explained that my labour may be a bit quicker because it s my second birth, and that was really good, really useful. (Mum involvement with children s services) Infant development Knowledge about infant development gained through the course informed participants interactions with their infant, both prior to birth and once their babies had been born. Parents felt that their interactions with their babies had improved as a result of this knowledge, and reported that they thought more about the consequences of their behaviour and the impact that this would have on their children. Parents also became better informed about the extent to which their babies could hear and respond to them while in utero. We talked to the baby before he was born because we had been told that he could hear us, and he reacted and kicked. (Dad refugee) A good example of the practical impact of a greater understanding and knowledge of infant development were the parents reactions to learning about babies visual acuity at different ages. They reported that it had influenced how closely they held their babies when talking to them. I didn t realise how close the baby had to be at first to be able to see you. It was helpful to be able to know that so that when I did have Kai I realised I had to hold him up for him to see me. That was useful. (Mum social isolation) Having an increased awareness of the negative effect that shouting has on a baby was described as a motivating factor for resolving conflict with their partners in a calmer way. You don t realise even, you don t have to be fighting, but just shouting, how much shouting can affect the baby. (Dad involvement with children s services) Impact and Evidence series 17

18 Changes expected with parenthood The transition to parenthood is a major event in parents lives. Baby Steps tries to furnish participants with knowledge about the possible stresses associated with this change. Parents said that the course had prepared them for becoming a parent and for the challenges they would be likely to face. Parents said that the course had prepared them for becoming a parent and for the challenges they would be likely to face. It prepared me for how hard it was going to be coming home with Joe. You just don t realise until you re actually home but they did say It s not going to be easy. You just make it what it is and learn to know your baby as days go on. It definitely made me feel happier coming home with him. (Mum social isolation) As a result of this knowledge, when problems did arise parents felt more able to cope with them because they had an understanding of what was happening. Their improved knowledge prepared them for some of the realities of life with a baby. In the first couple of weeks after the baby was born, my wife was really struggling and was very anxious. Because of the course, it wasn t as much of a shock to us and we were able to cope with it better. The information helped me to know what was going on and I was able to bear with her. (Dad refugee) Support available Baby Steps prepared parents for life with a baby by giving them knowledge about the kinds of support available to them. Parents reported that as a result of the course they knew about the key areas of support specifically aimed at parents, such as local baby and toddler groups, baby massage groups and helplines such as Cry-sis. Parents also identified that they felt better informed about which professionals to contact under which circumstances. I found session six quite useful in terms of if the baby is crying or distressed or not well, how to deal with it and who to call: the midwife, the health visitor or the doctor. (Mum recent migrant) 18 Evaluation of Baby Steps

19 Due to the type of parents the programme is aimed at, participants interviewed for this study were often not just struggling with the changes associated with becoming a new parent, but had additional support needs relating to problems such as mental health or financial hardship. Parents felt that another benefit of the programme was that Baby Steps also provided information about sources of support available to deal with these issues. They told me I could even get free childcare for my other son when he s two, I didn t know about that. I didn t even know we re entitled to free school meals, and I d been paying 9.20 a week out of my income support money for the last year. I found out quite a lot of stuff. (Mum partner in prison) Acquisition of new skills One of the key features of Baby Steps is that the course aims to assist parents in developing skills that will help them to achieve effective and healthy relationships with their babies and partners. The next section sets out the range of skills that parents identified they had developed as a result of their attendance on the Baby Steps course. Communicating with partners Parents who said that they already communicated effectively with their partners had not felt that they needed to learn new skills in this area. However, parents who did have difficulties reported that they had learnt new ways of communicating with their partner that had been helpful. They had learnt to set time aside to talk to their partner, and to listen to their point of view. The Talk and listen exercise in particular was thought to be a useful tool. The course taught me how to talk to my partner, and the Talk and listen worksheet that they gave us really helped with that. It s hard because he works a lot so we don t have time to talk much but since the course we sit down now when he gets home for an hour and we talk about our days and how the baby has been and about any worries and listen to each other. It s a new way of discussing. Before he used to just come home and spend the evening on the laptop. It has improved our relationship. (Mum social isolation) Impact and Evidence series 19

20 Participants also felt that they had learnt new skills in terms of managing disagreements by staying calm, taking a break if they were feeling stressed and then actively listening to what their partner was saying. We communicate much better now based on what I learnt in the session about how to manage disagreements. We used to not talk and second-guess what each other was feeling [sic] but now we try to take five, stay calm and really listen to each other. (Mum young parent) Parents who had attended Baby Steps in prison felt that the information about managing disagreements was less relevant for them, however, because they had limited time together and tried to avoid having arguments as a result. Among mothers, the emphasis on relationships led to an increased awareness of the importance of involving fathers in decision making about the baby. They were able to anticipate the fact that fathers may feel excluded from the mother-infant relationship, and to mitigate against this. It s in the back of my head to remember that obviously there will be changes in our relationship, sometimes the mother might bond more because like in my case my husband works full time. So I m always conscious that when he comes home I say, Oh I m going to do it this way what do you think? Or what do you think about giving the baby this? So I m not just saying, right, I m doing this and I m doing that. I think it s important to involve him so the relationship grows stronger and he feels a part of it as well. When they did the relationship stuff, it made me aware of that so I m constantly checking and making sure that he agrees. (Mum social isolation) In cases where both parents had attended Baby Steps, having a shared understanding of what to expect during the perinatal period made it easier for them to talk to each other about how they were feeling. 20 Evaluation of Baby Steps

21 I think we listen to each other more and talk to each other more, rather than hold things in. After I had Ciaran and I was feeling a bit low, I was able to say to him I don t feel right, I don t feel myself and I feel weak and like I m getting nowhere, and he was listening, and he was telling me, you know, this is normal this bit you know, because even he listened to what was said in the classes, so that was good. (Mum involvement with children s services) As a result of these improved communication skills parents spent more time talking to each other and listening to each other s point of view. They felt that this had brought them closer and improved their relationships, though the success of this relied on both partners being receptive to it: one woman reported that she had tried doing the Talk and listen exercise with her partner, but it had not worked because he had not taken it seriously. Communicating with babies The programme aimed to provide parents with the skills to communicate with and get to know their infant during the perinatal period. Parents reported that they had drawn on the information from the course about the importance of interacting with their babies, and had learnt ways to do this at different stages of development, including singing to them, playing with them and holding them up to interact with them. They reported that they had learnt how to interpret their infant s behaviour and felt they had responded appropriately. The exercise in which practitioners recorded footage of them interacting with their infant, using it to point out the infant s cues, was thought to have been particularly helpful because it gave parents confidence in the way they were responding to their child. In cases where both parents had attended Baby Steps, having a shared understanding of what to expect during the perinatal period made it easier for them to talk to each other about how they were feeling. They [the practitioners] come here and videoed me and Callum and the baby and then we watched it back and they were saying, Oh look at her there, you know like showing us her body language and they were telling us how she s reacting like she was looking away and they were like, Oh she s bored with that now. So I ve learnt a lot from that. When I am talking to her I know that when she looks away she s like, No I can t be bothered no more. [sic] (Mum care leaver) In some cases, participants acknowledged that they engaged more with their new baby than they had with previous children. Impact and Evidence series 21

22 I m much more full-on with this baby than I was with the others because they taught us to calm them, put their hands together, like talk to them, sing to them. I do all that, and he s just so content. I never did that with the others. (Mum partner in prison) Parents felt that they had been given the skills to manage practical baby care requirements, such as nappy changing, bathing and dressing a baby. Baby care Parents felt that they had been given the skills to manage practical baby care requirements, such as nappy changing, bathing and dressing a baby. Participants reported that they had felt a degree of apprehension about performing these tasks prior to the course. Although this applied particularly to first-time parents, others with older children also felt this to be true because other family members had previously undertaken certain aspects of baby s basic care. With my first child, born in Pakistan, all the family pretty much took over; they did all the tasks. I didn t touch anything until she was six months old. I didn t know even the bathing and nappy changing and stuff; they took care of it all. So initially with this baby I was a bit nervous about how I was going to do it. (Mum recent migrant) Changes in attitudes Participants in the sample reported that they felt more confident during the perinatal period because they knew what to expect and were prepared for it. For example, parents knew what to expect at each stage of their labour, which had enabled them to remain calmer and more relaxed. When I was in labour and I was feeling these pains and stuff I suppose it helped me deal with it. If you don t know what is happening to your body, I think I would have felt out of control, but it helped me be in control of my labour more and keep calm because I knew what was happening to my body and why it was happening. (Mum ex-offender) Parents also said that they felt more confident overall about their parenting skills since attending Baby Steps as they had gained practical skills in relation to baby care and also because of the positive reinforcement they received from staff. 22 Evaluation of Baby Steps

23 I didn t think I was capable of being a mum or that I deserved to be, I really didn t up until going to that group. They were saying, You are capable; you re going to be brilliant. What they ve given me is confidence in my ability. So, everything I do with her I m confident in. So, I m using every aspect of the course. (Mum ex-offender) Fathers reported feeling clearer about their role in the birth, and more confident about communicating with medical staff in order to express either their wishes or those of their partner. Now I know how to speak to midwives instead of just letting them ignore you. Go up and approach them and say this is what I want, I want to do this. I thought that you just let them get on with it, you couldn t say anything. (Dad prisoner) Changes in behaviour Baby Steps sought to influence a range of behaviours in order to improve parenting skills and promote positive relationships between parents and their partners. Participants suggested that the new knowledge and skills they had acquired on the programme had been put into practice and had had positive effects on their behaviour. Changes in interactions with partners and babies as a result of the new knowledge and skills acquired have been detailed already. This section looks at other behavioural changes that parents have reported. Infant feeding One of the behaviours that the programme sought to influence was infant feeding. The course encouraged parents to consider how they wanted to feed their baby, and to enable them to make an informed choice about whether to breast- or bottle feed. There were three types of experience among mothers in the sample who said they attempted to breastfeed: those who had found it relatively easy and were still breastfeeding at the time of interview; those who had found it difficult in the beginning but maintained it and were breastfeeding at the time of interview; and those who had found it difficult and had switched to bottle feeding by the time of interview. Mothers who had difficulty with breastfeeding emphasized the importance of direct one-to-one support in the first few weeks, either from practitioners or from a breastfeeding support group. Impact and Evidence series 23

24 Healthy lifestyle Baby Steps encourages parents to adopt a healthier lifestyle, and some had made changes to their own and their family s diet as a result of attending the course. One lesson that some mothers had learnt was to prioritise their own health above housework or other duties, such as entertaining guests. Parents reported that they had taken the advice from the course about safe sleeping positions for infants and the type of bedding to use in order to safeguard their child against the risk of cot death. The advice was that when you re breastfeeding you feel a bit weak so it s really important that you maintain a good healthy diet; whatever good stuff you eat the baby will get the benefits of that because it will come through your milk. Sometimes when you have guests over you tend to forget about eating yourself because you re too concerned about feeding them and making sure everything is OK, but you have to remember that you eat first and feed the guests later because that s more important. (Mum recent migrant) Infant safeguarding Parents reported that they had taken the advice from the course about safe sleeping positions for infants and the type of bedding to use in order to safeguard their child against the risk of cot death. Parents appreciated this advice as they had often received contradictory advice from family members. The stuff about ways of sleeping the baby was really good. Because obviously when my mum had her babies they were told to sleep the babies on their stomachs, but now you re told to sleep them on their back so that s what I did. So that came in useful. (Young mum) Some mothers reported getting stressed when their babies had not settled, but then they had used the techniques suggested in the NAHI DVD to calm themselves down. They had found that this worked and was really helpful. 24 Evaluation of Baby Steps

25 On the video it says just put them down, leave the room, take a breath and I always, always revert back to that because sometimes, especially in the middle of the night and she s just crying I think, I don t know what s wrong with you, and I m walking her around the room doing everything and nothing works at all and you do get so frustrated and you don t mean it. So I always have to think, Right, just put her down for five, and even if I go to the toilet and she s still screaming in the bedroom I have to leave her for a second, go to the toilet, calm down and go back to her and start again.it was really helpful. I think every mum should see that on the labour ward. (Mum young care-leaver) Impact and Evidence series 25

26 Chapter 3: Access and support As well as changes in knowledge, attitudes and behaviour, parents reported that the Baby Steps programme had strengthened their support networks. This chapter looks at how this occurred and also examines unintended outcomes of the programme as reported by parents. Support In the Baby Steps group, facilitators aim to create a safe space for parents to share their worries and concerns, and to explore and reframe how they want to parent and be as a family. The supportive environment is important in making the parents receptive to the messages delivered and to facilitate the changes in behaviour and attitude. This section explores the range of ways in which parents felt that they had been supported. Some of this support was provided by having a dedicated space to address concerns; share experiences with other parents with whom they developed relationships, and to spend time with partners and infants. Parents were also signposted to additional support outside of the course. This included both statutory services and specific services for parents and babies. In addition, the course encouraged them to tap into their existing support networks. Somewhere to raise concerns The Baby Steps programme targets parents who are vulnerable and may find it more difficult to access information about pregnancy, birth and caring for a baby. This applied especially to those who had recently arrived in the UK or those with limited English proficiency. Having a forum to raise their concerns about pregnancy, labour or anything else that was worrying them, and to have them addressed was very reassuring for parents in the sample. I felt so supported because she [the practitioner] was answering all my questions. I used to get everything off my mind about what would happen in labour and about the pregnancy and anything else and she was saying, Yeah it s normal. Do you know like this sort of took a load off my mind because I were panicking [sic] with it being my first baby and not really knowing what to expect or anything. (Mum young care leaver) 26 Evaluation of Baby Steps

27 Parents drew comparisons with their experiences of interacting with NHS midwives, who had seemed to have little time for them, which made them feel unsupported. It was totally different to my NHS midwife who never had time to answer my questions because there was always someone waiting behind me so she just shooed me out the door. You just didn t feel cared for. (Mum young care-leaver) The group was an especially useful source of support for those who lacked it from elsewhere. It provided an essential first point of contact for parents newly arrived in the UK, who might otherwise have struggled to access services due to language barriers. This course is really helpful, especially for people like us who are new to this country. It made us feel like there is someone there for us, because otherwise we just don t have anyone to go to for support. (Mum refugee) The group was an especially useful source of support for those who lacked it from elsewhere. It provided an essential first point of contact for parents newly arrived in the UK, who might otherwise have struggled to access services due to language barriers. Sharing experiences with other parents The Baby Steps model states that the programme should be delivered to parents who are at roughly the same stage of pregnancy, and that parents with similar needs should be grouped together where possible. Parents in the sample reported that they had drawn a lot of support from spending time with other people in the group who were going through the same experiences as them. It was good to be around people going through the same thing to share experiences, also to hear what other people are worried about during pregnancy and after the baby is born and to compare notes. It gives you confidence that everything is going right. (Mum social isolation) It was felt to be particularly helpful to meet other parents whose circumstances were similar to their own, for example where a partner was in prison, or where a new baby was going be on a child protection plan. Having the opportunity to share these kinds of experiences made parents feel that they were not alone in facing the situation. Impact and Evidence series 27

28 There were other people in the same situation as us with the Social.[sic] I used to go out for a fag with one bloke and we d talk and it just felt like we re all going through it together. (Dad involvement with children s services) Support provided to prisoners and their partners through the Baby Steps programme For parents attending Baby Steps in prison because the father was serving a prison sentence, the sessions afforded them valuable time alone with their partner to talk about the baby and also to discuss parenting issues relating to the older children. On normal prison visits, they did not get the opportunity to do this because the children were always present. It s brought us closer, because I had time with him on my own, just me, him and the baby, without the other children, and we could talk about the baby. I could tell him what was going on at home as well, because like you get a bit of time at the end to talk about stuff. It s meant to be thinking time, but I didn t use it as that, I used it as what s been going on at home, without our Zoe being there, without our Katy, I could tell him, What do you think of this? or, Can I allow Zoe to go down the town? Can I allow Zoe to go to school on her own? Anything that I needed to say to him when nobody was there, I could tell him then. Even now he says to me, We ve spoken more since I ve come to prison than we ever have done. (Mum partner in prison) Couples where the father was a prisoner found that the Changes for me and you session, which looks at physical and emotional changes during the perinatal period and the division of labour in terms of baby care, raised strong emotions for them. Mothers were going through pregnancy without the support of their partner, which they found difficult. They were aware that they would be giving birth on their own and would have sole responsibility for caring for their new baby. This provoked feelings of sadness and anger, but the session also provided an opportunity to discuss these issues and to tell partners how they felt, which they found really helpful. Women who had given birth alone because their partner was in prison had found the opportunity to share their concerns about the birth with the group and with their partner in advance very comforting. It also made them feel less alone during the birth. 28 Evaluation of Baby Steps

29 It was just the thought of knowing I d spoken about my worries and fears in this group, everyone knows what I feel like, and I thought, well, it s ok because I ve spoken to Steve on the course yesterday about what I felt, and he understands how I feel now. It made me feel less alone. (Mum partner in prison) Mothers commented that they were sometimes reluctant to tell their partners how they were feeling or talk about anything negative on prison visits. This was because they had such limited time together that they felt they should focus on positive things, and also because they were concerned about burdening their partners with homerelated worries when they had already a lot to worry about in prison. I don t tell him about my worries and my fears because he s in prison, he s got enough to worry about. But then on the course that day you got a lot out of your system. Like I could say to him, I m not happy you being in prison. Why have you come to prison and left us at home? Why do you always spoil stuff? Just the way I felt, he got it in the neck, but then I went home feeling great. And even Tony said I m really glad you talked to me. (Mum partner in prison) Women who had given birth alone because their partner was in prison had found the opportunity to share their concerns about the birth with the group and with their partner in advance very comforting. It also made them feel less alone during the birth. For fathers in prison, the opportunity to touch the bump during pregnancy was very important and it was felt that it had enhanced the father-infant relationship. This is not usually possible on prison visits because the mother and father are on either side of a table and are under close surveillance by staff. Similarly, being able to spend time as a family and to hold the baby and change a nappy in the two postbirth sessions was something they found very valuable, because this is not possible on normal prison visits. It was felt that this had a positive effect on the relationship with their baby and had helped the bonding process. I spent the whole session just holding the baby and spending as much time as I could with him. It s made my relationship with him a lot better because any time we get to spend together is brilliant. (Dad prisoner) Although there was a prison officer present during the Baby Steps sessions, they took a much more relaxed approach than they would on a normal visit. Impact and Evidence series 29