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The Hexagon: An Exploration Tool
The Hexagon can be used as a planning tool to guide selection and evaluate potential programs and practice for use.
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Core Components
The Peep Antenatal programme: Getting to know your baby, is a universal group for expectant parents that spans the antenatal and postnatal period. Following an initial 1:1 visit, the programme can be delivered in a group for 5 additional antenatal sessions. At least one postnatal session is offered, and further sessions from the Peep Learning Together Programme can be included. The programme is clearly operationalised, with the content and delivery of each session clearly described. The primary focus is on parental reflective function, that is the ability of the parents to think about their baby, imagine and tune into its feelings, consider what it is trying to communicate and respond sensitively. Further descriptions are provided for the other key concepts of containment and marked mirroring. Detailed materials are available to practitioners who have completed training. In keeping with the Peep Learning Together Programme, Peep Antenatal used the same four key principles of learning to underpin the structure of each session, which the developers summarise as opportunity, recognition, interaction and modelling (ORIM). Each session has “talk time” where a topic is raised and discussed. This maybe supported by video clips or a practical activity. Interaction with the unborn baby is practiced through sharing of stories and songs and rhymes. Between sessions, parents are encouraged to think about, talk to, and be aware of their unborn baby between sessions.
The programme is not targeted to any specific group; however, sites frequently target delivery according to local need. The programme is not restricted to first time parents and explicitly emphasises the role of fathers and wider family.
Fidelity
Fidelity to the model is primarily managed through training, provision of materials and supervision. Supervision is required for delivery of the Peep Antenatal Programme, and available supervision is a pre-requisite of training. It is expected that fidelity to the key concept of the programme would be included within supervision. There are no specific fidelity monitoring tools developed for the programme.
Modifiable Components
Guidance around modifications and adaptations to the programme are highlighted during practitioner training. The programme can be delivered as a multi-family group programme with two facilitators, to a smaller group, such an extended family, or to an individual. The programme has been used with a wide range of parents, from younger to older parents, first time parents, those with older children and foster parents. The programme is structured as five antenatal sessions and a postnatal session. However, practitioners are encouraged to consider whether they wish to change the number of sessions, and to select content from the options provided, appropriate to the group they are working with.
It is acceptable for sites to add their own sessions, for example on breastfeeding advice, into the programme
Support for Organisation / Practice
Peeple UK are the programme developers for the Peep Antenatal Programme: Getting to know your baby. They are based in the UK, with centres in Oxford and Edinburgh. Peeple UK are also the developers of the Peep Learn Together Programme.
Implementation Support
Peeple UK can provide some assistance with the implementation of the programme, predominantly via training. They are readily available to provide training with services in the UK. Peeple UK can undertake discussions with service commissioners around implementation of the programme. The practicalities of implementation are discussed in training with practitioners. Once trained, materials are readily available through the Peeple website.
Licence Requirements
There are no licence requirements, however practitioners need to sign a practitioner declaration specifying the use of training materials and renew their website log-in annually.
Start-up Costs
Training for at least two staff costs £190pp +VAT, plus a small budget for any materials, such as books for babies and a weighted doll. These and are not specific to the Peep programme, and therefore sites may already have them.
Building Staff Competency
Qualifications Required
Practitioners need experience of working with families and young children, and to hold a level 7 qualification SCQF or (Level 3 RQF). A range of practitioners are suitable, such as health visitors, midwifes, early year workers, nursery nurses and psychologists.
Training Requirements
The Antenatal training is a single day costing £190 +VAT per practitioner and includes access to required resources. Training is available in the UK including Scotland, either on the basis of individual places, or as an in-house training for a group of staff.
Supervision Requirements
To be eligible for training, practitioners need to ensure they have access to regular reflective supervision. This supervision needs to be from someone familiar with the key concepts covered in the programme and the programme materials.
Theory of Change
The Peep Antenatal programme is based on the psychological theories of reflective function, containment and marked mirroring. The primary focus is on sharing with parents/carers the importance of reflective function, and providing opportunities to develop and increased awareness of their own and baby’s thoughts and feelings and how these influence behaviour. Through increasing reflective function, the programme aims to contribute to the development of secure attachment between parents/carers and baby.
Antenatal / Perinatal: from conception to birth - Rating: 2
Research Design & Number of Studies
One pilot evaluation has been completed, in collaboration with Peeple and University of Warwick.
Outcomes Achieved
The evaluation found that attendance at an 8 week Peep Antenatal group was associated with
Parent Outcomes
• Some improvement in parental Reflective Function
• Some improvement in behaviours associated with sensitive parenting over the course of the intervention
The nature and size of the evaluation meant there was no assessment of the statistical significance of findings. Longer term follow-up that could include child outcomes was not available.
Key References
Maskell-Graham, D. (2014). Peep Reflective Parenting Programme (Pilot): A therapeutic intervention beginning in late pregnancy: Brief interim findings: main messages. Warwick Medical School.
Need
Comparable Population
Peep Antenatal is a preventive programme for expectant parents. It can be delivered to targeted groups such as those in areas of deprivation, or those parents about which there are additional concerns.
Are expectant parents a specific priority for your organisation? Desired Outcome
Is an improvement in parental reflective function, parent-infant relationship and attachment security, a priority for your organisation? Are there other initiatives that are targeting parent reflective function in your area?
Need Score
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Fit
Values
The Peep Antenatal programme is a preventive, strengths based approached focussed on very early relationships.
Is such an approach in keeping with your organisation’s current priorities? Priorities
Peep Antenatal is not an inherently targeted programme, however the flexibility within the programme allows sites and practitioners to tailor the programme to the specific needs of a group, or family.
Do you have a priority group of expectant parents that would benefit from the Peep Antenatal programme? Existing Initiatives
Peep Antenatal can work alongside other initiatives such as Family Nurse Partnership, Homestart, universal parentcraft provision, family centres and the Peep Learning Together Programme.
Are there local initiatives that would be complementary to Peep Antenatal in your area? Peep Antenatal programme finishes in the early post-natal period.
Do you have services within your organisation or local area, that you could refer families on to if required?
Fit Score
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Capacity
Workforce
Peep Antenatal delivery requires a minimum of two practitioners, with a Level 7 (SCQF; or Level 3 RQF) qualification and experience of working with parents (and babies) in the antenatal and postnatal period. Practitioners need to have access to regular supervision on Peep Antenatal work.
Do you have suitable practitioners and supervisors available, with sufficient time within their job plan? Peep Antenatal courses also aim to engage with fathers and others wider family members, this is sometimes achieved through twilight or evening sessions or weekend sessions.
Is your organisation and workforce able to support programme delivery at these times? Technology Support
The programme has the option to use video clips, but this is not a core requirement, and alternatives are provided.
Administrative Support
Peep Antenatal programmes need expectant parents to be identified and engaged in the programme in the antenatal period.
Do you have sufficient administrative support, structure and relationships in place to identify parents and engage them in the programme quickly? Financial Support
Initial training costs are £190pp +VAT for each of the two practitioners. The main ongoing costs are in relation to practitioner time, with some additional cost for resources and group room and hospitality if being run as a group.
Do you have funds available for training and any required materials? Do you have finances to cover recurring group delivery costs?
Capacity Score
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