Core Components 

The Neonatal Behavioural Assessment Scale (NBAS) is a neurobehavioural assessment for newborn babies which provides a strength-based, in-depth profile of an individual baby from birth to 2 months, premature babies from 37 weeks gestation and developmentally delayed babies. The programme can be used with parents who may be at risk for postnatal depression, post-traumatic stress disorder, and emotional or relationship difficulties with their babies. The tool is primarily used for research purposes but can be delivered as a targeted clinical intervention. Using the NBAS identifies the newborn’s responses to his/her new extra-uterine environment, the newborn’s contribution to the parent-infant relationship and the newborn’s individuality enabling practitioners to help parents understand more about their baby’s uniqueness, capabilities, behaviours and communication.  Practitioners can then share with the parent their baby’s strengths and areas of vulnerability from which suggestions and guidance to support the baby can be given. 

The NBAS focuses on (1) Different behavioural states, (2) Sleep, (3) Response to faces and voices, (4) Response to sound and light when sleeping, (5) Crying and soothing and, (6) Activity and reflexes.  The NBAS assessment scale includes 53 scorable items which are either administered or observed including Habituation; Social interactive responses and capabilities; Motor systems; State organisation and regulation; Autonomic system and Reflexes.  

For clinical use, an NBAS practitioner carries out a 20–40-minute session with each family covering the 53 elements of the tool.  For research purposes, less parental involvement is required with a reduced assessment time. 

The NBAS is supported by a training book and kit, standardised forms and an online support platform. 

Fidelity 

Fidelity of the NBAS is maintained by ensuring trainers are rigorously trained with standardised training.  Practitioners are strongly encouraged to participate in supervision to regularly review their skills and ensure they remain focused on maintaining effective ways of delivering. Fidelity is also supported with the use of standardised kits, a training book and recording guidelines and forms.  Materials are available to practitioners through an online central training platform. 

Modifiable Components  

The NBAS is standardised however, practitioners are trained to adopt respectful sensitive approach towards each population, exploring any cultural differences they may need to be aware of.  

The Brazelton Centre UK is a national charity which is part of a network of training centres across the world dedicated to the teaching and certification of the Neonatal Behavioural Assessment Scale (NBAS) and Newborn Behavioural Observational (NBO) SystemTM. The parent centre, the Brazelton Institute is based in Boston, USA. 

Support for Organisation / Practice 

Implementation Support 

The Brazelton Centre UK offers training and certification in the NBAS to professionals across the UK. Implementation supports are available on request. This can include support around staff selection and data collection, as well as how to integrate the NBAS into services, processes and record keeping. They are also able to support connections with similar services already using the NBAS.   

Licence Requirements 

There are no formal licencing requirements.  The Brazelton Centre holds the license with the developer in the US. 

Start-up Costs 

Training for one practitioner in the NBAS costs £745. This includes the 2-day training course, NBAS kit and manual, certification, post training support supervision and access to resources on the online training platform.   Group bookings are also available and cost £745 per person for groups of 15 – 39. The cost reduces the more staff are trained; 40 – 100 people costs £710 per person, 101 – 199 people is £670 per person and 200+ is £635 per person. 

A 50% discount is offered if NBO training has been completed in advance. The one-day refresher course taught via Zoom, costs £175 per person.  Group bookings for the one-day refresher course onsite are available for 12-20 participants to be negotiated directly with the Brazelton Centre. 

Building Staff Competency 

Qualifications Required 

The NBAS is designed for professionals who care for mothers and babies in the newborn period including Midwives, Health Visitors, Occupational Therapists, Family Support workers, Neonatal Nurses and Doctors, Paediatricians, Physiotherapists, Language Therapists, Psychologists, Psychiatrists and Nursery Nurses etc.   

The NBAS is more suitable for practitioners with a small and focused caseload to enable time for the development of the necessary skills and complete certification which can take up to 12 months.  

Training Requirements 

To implement the NBAS requires 2-day training in the use of the tool. The training teaches participants how to administer and score the NBAS tool through presentations, interactive exercises, and video demonstrations.   

It is highly recommended that certification is obtained, particularly if applying NBAS clinically. To become a certified practitioner an NBAS trainer will evaluate participants administration and scoring of their use of the NBAS tool on 1 or 2 healthy babies requiring 90% reliability in both competence and scoring to certify.  Re-certification every 3 years for practitioners is not compulsory, but it is highly recommended for researchers. A one-day refresher course is also available (2-day training is a pre-requisite). 

Supervision Requirements 

The Brazelton Centre UK offers ongoing supervision session at no extra fee, delivered via conference calls/Zoom. NBAS supervision sessions are run once a month for 1 hour each and are open to anyone who has attended the training. These sessions are optional and can be attended as frequently as required.  

Theory of Change  

The Neonatal Behavioural Assessment Scale (NBAS) is founded on the assumptions that infants are social beings ready to communicate, that babies’ communication through their behaviour and that infants’ communication is not random, their rich repertoire of social responses, intentions and emotions are evolutionary designed to draw out caregiving from parents. The NBAS focuses on the newborn developmental agenda offering a window into the neurological integrity of the central nervous system of the newborn.

Values 

The Neonatal Behavioural Assessment Scale (NBAS) focuses on the importance of giving newborn babies a voice, the child-parent relationship, and helping parents understand their baby’s behaviour, development, communication and individual uniqueness.  The Brazelton Centre UK believes that every child deserves to have the best start in life and every parent deserves to be supported as they transition to parenthood. 

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

Priorities 

The NBAS is a research tool and a parenting intervention, designed to empower parents to learn about their baby’s likes and dislikes and ways of supporting them. Positive and responsive interaction between a parent and their newborn baby plays an essential role in that baby’s social and emotional development by building networks and connections in the brain that will set that individual up for life and make sense of their world. Using the NBAS enables practitioners to get a better understanding of the baby’s behaviour and share this with parents, so it becomes easier to care for their baby. 

• Is helping parents understand their baby’s development and behaviour, to better care for their baby a priority for your organisation?
• Is having a first response parenting intervention a priority for your organisation?

Existing Initiatives  

• Does your service already provide an early intervention approach which aims to improve the parent-child relationship, communication – giving babies a voice and the best chance in life?
• Does your service already provide an approach with aims to strengthen the relationship between infants and their parents in the newborn period?
• Are existing initiatives effective and acceptable to families?
• Are there components in the NBAS that are not met by existing interventions or approaches?

Workforce 

The number of practitioners required to implement the Neonatal Behavioural Assessment Scale (NBAS) is one, but the numbers a service chooses to train should depend on the needs of the population they are serving.  Although only one practitioner is required to deliver the approach, Brazelton UK recommended that services train more than one practitioner, as this can support the reflection and competency development of practitioners. 

• How many families does your organisation intend to support using this approach in the first year?
• Based on this number do you have the required number of staff to train in this approach?

Practitioners training to use the NBAS should be working with infants and families from birth to 2 months, mature babies from 37 weeks gestation and developmentally delayed babies. They should have an understanding of newborn behaviour and development and have a professional qualification involved in work with infants (e.g. midwives, Neonatal Unit staff, health visitors, neonatal doctors, perinatal mental health practitioners, paediatricians, psychologists, physiotherapists etc.). 

• Do you have practitioners with appropriate experience and competencies?

The time commitment required for each practitioner involves time for the training (pre reading, 2 days training) and implementation. Using the NBAS with a family can take from up to 20-30 minutes depending on the items administered, based on needs of the parents and state of the baby.  

• Can your organisation support the time commitment required for practitioner training and delivery of this approach?

Technology Support 

To train and deliver the NBAS, no technology support is required. If practitioners are engaging in online training, supervision, or delivery they require a device with the relevant software and internet connection. Practitioners can also access online resources through the Brazelton UK’s training platform 

• Do your practitioners have the required technology to access the training platform, supervision, training and delivery of the approach?

Administrative Support 

• Do you have the administrative support and systems to manage referrals?

Financial Support 

The practitioner training course costs £745 with a 50% discount if NBO training has already been completed. The one-day refresher course costs £175 per person 

• Does your service have the finances to support either the funding of individual places, or a wider role out of the intervention?

Comparable Population  

The Neonatal Behavioural Assessment Scale (NBAS) is delivered on a face-to-face basis and has been implemented globally by practitioners.  Research has demonstrated effectiveness in the use of NBAS in Japan including infants with disabilities and low birthweight infants with cerebral injuries.  

• Do you have sufficient demand to provide parents with support in understanding newborn behaviour and thereby support the healthy development of early parent- baby relationships?

Desired Outcome 

The NBAS aims to enable practitioners to get a thorough understanding of a baby’s development and behaviour and to share this with parents to support them to more easily care for their baby. 

Outcomes from evaluations have demonstrated improvement in Lack of Confidence in Caregiving (LCC) and Nursing Child Assessment Teaching (NCAST) in infants with disabilities along with improvements in orientation and state regulation of infant behavioural profiles identified in low birthweight infants with cerebral injuries.  

• Are these outcomes a current priority for your organisation?
• Do you have other existing initiatives that would be supportive of addressing this need and achieving these outcomes?