Core Components

Baby Steps is available for all parents, whether first or subsequent pregnancy. Parents are contacted from 18-24 weeks gestation and then receive an initial home visit to facilitate engagement which precedes 6 subsequent group sessions. Families receive a further home visit after their baby’s arrival, followed by 3 final group sessions.

Core group themes are:

• strengthening parent-infant relationships
• strengthening couple relationships
• building strong support networks
• improving feelings of self-confidence as well as levels of low mood and worry
• helping parents to understand babies’ development

Group sessions, with up to eight families attending, include films, group discussion and activities which aims to foster parents’ confidence and promote a positive parent-child relationship. Parents are videotaped with their baby at the second home visit with the footage reviewed alongside a group facilitator, scaffolding parents’ interpretation of and responses to infant cues.

Fidelity

The Baby Steps programme manages fidelity through a comprehensive manual, extensive training and implementation support and adherence to licence, with monitoring of engagement and attrition rates.

Practitioners’ group delivery is observed (via videotaped footage) by a Baby Steps supervisor during the training phase, to facilitate shared reflective review of group content and process. Further videotaped review of group delivery is at the discretion of each site.

Modifiable Components

The programme is clearly manualised for each session, with core components that must be delivered, but flexibility with regards to how this is done to fit with specific group needs. Training equips facilitators with necessary skills to manoeuvre this balance of course content and individual parent contexts.

Baby Steps has been delivered within a prison setting and across a range of community settings.

Programme handouts have been adapted for use with parents with learning difficulties, low literacy or with English as a second language.

Practitioner training is delivered in person by NSPCC at the licenced site.

Support for Organisation/Practice

Implementation Support

Baby Steps provide, as standard, a thorough readiness assessment and pre-implementation support. Once sites have committed to the licence, Baby Steps provides tailored implementation support which is intensive in the early period and tapers off as the programme becomes more embedded within services. Over the initial period, this takes the form of monthly on-site visits to review implementation strategies and maintain a presence on local steering groups. As the programme becomes more embedded, Baby Steps also offers online support, linking participating sites to be able to share practice, and provides twice annual Community Practice events to bring sites together to share learning.

Baby Steps implementation support includes data planning.  Implementation data is collated centrally, and each site collects their own evaluation data in line with local commissioning structures, which are agreed with Baby Steps support.

Licence Requirements

Baby Steps must be delivered under licence. The initial licence period is for three years.

Start-up Costs

Start-up costs include licence and implementation support costs, training costs and the cost of group session resources (if these are not already available within local maternity services) and start from £16,500 depending on local requirements. In addition, any practitioners who join an existing Baby Steps team after the initial site training will be required to join a central multi-site Baby Steps training at a cost of £650 per practitioner.

Building Staff Competency

Qualifications Required

Groups are facilitated by two practitioners – one being a Health Visitor or Midwife and the other working within Children’s Services, for example a family support worker. Selection of appropriate group facilitators is incorporated within the readiness assessment and implementation support package.

A core licence component is the appointment of an Operational Lead role. Their tasks include managing staffing, liaising with managers and service providers and maintaining a sense of a Baby Steps team to ensure continuity and consistency of delivery.

Training Requirements

Training is five and a half days in total, taking place over three separate blocks. Initial 3-day training is followed by up to six months of the practitioner facilitating the programme. At this stage, days 4 & 5 of training take place, with learning then consolidated with a final half day which includes reflective review of videotaped group delivery. Training of new Baby Steps teams is delivered on site and scheduled to fit with local implementation plans. 

The programme has developed a Train the Trainer structure to support site sustainability, which has been rolled out across a number of sites. 

Supervision Requirements

Reflective supervision is required to take place at least three times during the delivery of every group. Provision of this supervision is ‘in-house’, determined by local site policies and logistics. Supervisors are offered Baby Steps programme events to support their practice.

It has been demonstrated over four service evaluations that Baby Steps participation increases parental report of positive attachment to their baby, as well as improvements in parental knowledge and confidence.

Theory of Change

The programme centres on recognition of the importance of the parent-child relationship for children’s healthy development. With tenets in Attachment theory, facilitators are trained to model a ‘safe base’ for parents, along with mindfulness tools to reduce stress and allow ‘mental space’ for their baby. The programme also emphasises the core role of the relationship between parents and so is designed to facilitate positive, supportive relationships within couples and between parent and child.

Values

Baby Steps is based on the importance of the parent-child relationship and equipping parents with the core skills to provide a nurturing, positive environment for their baby.

• Does this align with the inherent values of your organisation?

Priorities

The programme is applicable for all parents but is specifically targeted at parents who might need additional support in the antenatal and early post-natal period, whether due to their physical or mental health or their social context. The programme aims to mediate potential risk factors for positive development of the parent-child relationship.

• Is working with vulnerable parents to help build their knowledge, skills and confidence in developing a positive parent-child relationship a core priority for your organisation?

Existing Initiatives

• Does your service already provide interventions to support parents with their parenting confidence and enhancing their relationship with their child?

Workforce

Baby Steps is facilitated by a Health Visitor or Midwife, along with a Children’s Services worker. They are required to undertake six days of training, punctuated by reflective practice review and to deliver the programme over an extended period of time (approximately four months) with nine group sessions and two home visits for each family. In addition, practitioners are likely to require additional time for phone calls and ‘catch up’ visits to sustain participant engagement.

• Do you have staff with these professional backgrounds who can be released to have this protected time for training and programme delivery?

Each site must appoint a Programme Lead to coordinate and sustain programme delivery according to licence agreements.

• Do you have staff capacity to appoint a practitioner with appropriate experience and expertise to this role?

Technology Support

Baby Steps requires the use of video cameras or tablets to record practitioner group delivery and to record a parent-infant interaction.

• Do you have access to video cameras or tablets and the appropriate site-level permission in place to facilitate the storage and review of video footage?

Administrative Support

Baby Steps requires processing of referrals, printing and copying of group materials, evaluation data collection and the compilation of regular reports to Baby Steps central team.

• Do you have administrative capacity within your organisation to meet these requirements?

Financial Support

Baby Steps requires the purchase of an initial 3-year licence and implementation support and training package starting from a cost of £16,500 depending on local requirements. In addition, any practitioners who join an existing Baby Steps team after the initial site training will be required to join a central multi-site Baby Steps training at a cost of £650 per practitioner. If a site opts to bring in additional staff resource to run Baby Steps groups, the cost of setting up a Baby Steps team will vary depending on the scale of the programme and the scale of the programme should be guided by local need and/or resources available. There may also be costs for provision of reflective supervision if this is not going to be provided by the Operational Lead.

• Do you have the finances to purchase the licence and meet the costs of any subsequent additional training and reflective supervision?

Group delivery may incur running costs for materials, practitioner travel, venue hire, hospitality, parent transport or creche if local sites wish to provide these things as part of their service delivery to maximise engagement in the programme.

• Do you have finances to cover these recurring group delivery costs?

Comparable Population

Baby Steps is delivered to parents from the 7th month of their pregnancy. It is particularly relevant for parents who are likely to need additional support in the early stages of their baby’s life and/or those who are less likely to access standard antenatal provisions. This is likely to include parents who are living in vulnerable social and/or emotional contexts such as those with mental health difficulties.

• Does your organisation have existing contacts with parents in this population?
• Are you likely to receive sufficient referrals for eligible families to populate a recurring programme of Baby Steps groups?
• Is the delivery of groups suitable for the geographical spread of your organisation?

Desired Outcome

Baby Steps outcomes have demonstrated improved parent-child attachment and increased parental knowledge and confidence. It is intended that Baby Steps would run alongside or embedded within existing universal services.

• Are these outcomes current core priorities for your organisation?
• Do you have other initiatives that are supportive of addressing this need and would work alongside Baby Steps?