CEO of For Baby’s Sake Trust, Amanda McIntyre and Director of Operations, Judith Rees, told us more about the programme and about influencing and informing change in the future.
For Baby’s Sake is a programme, launched in 2015, as a response to the effects of domestic abuse on unborn and very young babies. Originally open to families in London and Hertfordshire, the programme has expanded to Blackpool and Cambridgeshire, with dedicated teams embedded in these areas. The Trust have also since set up For Baby’s Sake Connect; a remote delivery model (sessions are via video and phone) which reaches those families in areas where they do not have access to a dedicated For Baby’s Sake team.
The importance of intervention
With one in five children in the UK experiencing domestic abuse, For Baby’s Sake is an important and potentially life changing intervention. Research shows that in the early years of a baby’s life, exposure to domestic abuse can have a significant impact on a child's future development, affecting cognitive and emotional growth. Left unresolved, trauma can have profound effects on an individual later in life and in turn, wider society as a whole. The risks associated with domestic abuse can be reduced by protective factors in children’s lives, especially by secure relationships between parents during infancy. However, parents can find it harder to give their baby warm and sensitive care if they did not have it themselves during their own childhoods. This is why For Baby’s Sake supports parents to break the cycle of domestic abuse and give their baby the best start in life and their model incorporates support with recovery from unresolved trauma.
Eligibility and referrals
The programme is for both co-parents when they are expecting a baby and there is domestic abuse in their relationship and who are both over the age of 17 when the baby is born. Both parents need to join during pregnancy. Either or both parents may already have other children. Parents may join whether or not they are together as a couple (at the outset or subsequently). They may wish to stay together, or to separate, or be undecided about the future of their relationship as a couple. The programme can be offered where either parent is experiencing Domestic Abuse (DA) or if there is bi-directional DA and the risks of DA are anticipated to recur, endure and/or escalate. Parents must reside within the areas where For Baby’s Sake operates, otherwise the service is available via For Baby’s Sake Connect.
Eligible parents can either self-refer to For Baby’s Sake or can be introduced by statutory agencies including midwifery and health visiting services, social care services, GP services, police or probation or local voluntary and community sector services.
For Baby’s Sake takes a unique approach, with practitioners working individually and separately with both parents for up to two and a half years, combining evidence-based elements to break cycles of DA, address the impact of parents’ own childhood trauma and improve adult mental health, alongside parenting interventions focused on infant mental health and parent-infant attachment.
The programme is primarily split between individual antenatal and postnatal modules and sessions, tailored to meet the holistic needs of mothers, fathers and babies. The programme is delivered by highly trained, multidisciplinary practitioners.
Antenatal - Following a Getting Started phase of robust risk and needs assessment and building motivation through motivational interviewing, the therapeutic and safeguarding approach of For Baby’s Sake continues with a focus on safety and reducing stress. Mothers and fathers each work through gender-informed modules (respectively Opening Doors and Basic Tools). These include: psychoeducation, trauma-focused and cognitive behavioural therapy exercises for anxiety and depression; promoting physical and emotional safety for all family members, especially the unborn child; an understanding of domestic abuse and its impacts; preventing further traumatisation; a cognitive behavioural therapy framework to address negative thinking and patterns of denial, blame, anger and rage. These modules also look at what they have learnt about being a woman or a man.
Both parents also separately participate in an antenatal parenting module, titled ‘Where’s the Baby?’. This attachment-focused module helps parents to understand what their baby needs in the womb and how their baby’s brain develops antenatally and until the age of two. It supports them to bond with their baby whilst in the womb and to understand what babies need to ensure a secure attachment; parents also learn how to read their baby’s cues from birth. If parents already have other children, the attachment-focused parenting support within For Baby’s Sake will also help them with these relationships, so parents can support the cognitive and emotional development of all their children.
Postnatal - Following the baby’s birth, each parent undertakes the Newborn Behavioural Observations (NBO) separately with their practitioner. NBO is a relationship-building tool, used with parents and their baby from birth to 3 months old, to help them understand and respond to their newborn’s unique communication. The next parenting intervention for each parent is Video Interaction Guidance (VIG), which again supports communication and sensitive attuned parenting. Each parent is guided to analyse and reflect on video clips of their interactions with their baby in order to enhance communication and bonding within their parent-infant relationship.
Parents then separately undertake the Healthy Expression of Feelings module, with their individual practitioner, which is in two parts. The first part supports parents to explore and understand feelings of guilt and shame and how they might use dissociation as a way of coping or masking these feelings of vulnerability. This strengthens the foundations for emotional self-regulation. The second part provides support to distinguish between a range of emotions they may be feeling as adults (including happiness, sadness, frustration) and to express them in a healthy way. The second part is complemented by a Healthy Expressions of Feeling – Parenting module which, again delivered separately, supports both co-parents to be attuned and to respond sensitively to their baby’s different emotions.
Parents will also engage in one-to-one Inner Child sessions and examine their own childhoods and whether they wish to incorporate or differentiate from how they were parented; these sessions also focus on parents’ own needs and self-nurture, including supporting parents to process feelings related to adverse childhood experiences and to draw on sources of resilience from their childhoods. This is followed by a module on Self-Esteem and Assertion, covering self-esteem and assertion, behavioural skills development and goal setting.
In the baby’s second year, extra support is available to both parents to aid sustained recovery from mental health problems, such as post-traumatic stress and/or anxiety. Both co-parents also complete the Keep Calm and Carry On Parenting module, delivered separately, which assists parents in managing their toddler’s behaviour and in setting routines. Parents who already have a toddler when they join For Baby’s Sake will be offered this module earlier on, to help them in their parenting of their toddler. Towards the end of the programme, For Baby’s Sake practitioners will offer support to parents on having a safe and healthy co-parenting relationship. The content is tailored to reflect individual needs and also depends generally on whether the parents will be co-parenting together as a couple or co-parenting apart, having separated.
An End of Programme Review is then undertaken when a parent completes or leaves the programme. Adhoc support is also provided to mothers and fathers, as required and practitioners begin work with families around ending the programme in advance of the final session, which can be up to when their baby reaches 2 years old.
Evaluation & impact
King’s College London conducted an independent evaluation of the programme’s operation during the prototype phase in two sites in Hertfordshire and London from 2015-2019. The evaluation report includes a literature review, systemic review, quantitative analysis, stakeholder interviews and evidence from a sample of parents who agreed to be interviewed and undertake clinical assessments up to three times during the course of the evaluation.
The evaluation confirmed that For Baby’s Sake is reaching its target population of families with complex needs, including mental health needs, and complex trauma histories. Substantial proportions of men and women participating in the evaluation had symptoms of depression, anxiety and PTSD, while 77% of fathers and 52% of mothers met criteria for disordered personality traits.
For the babies, birth and child development outcomes at one and two years (including babies’ social, emotional and behavioural development) were largely in the normal range and only a third of families had any social care input at the two-year stage. This contrasted with 70% at baseline, of which 56% were either under a Child Protection Plan or Child in Need processes.
The evaluation highlighted the change mechanisms within the approach, including the holistic whole-family nature of the programme, its timing, the therapeutic relationship between parents and practitioners and the therapeutic combination of trauma-informed and attachment-focused support.
Mothers and fathers engaging in For Baby’s Sake were positive about the programme, with many describing how it had exceeded their expectations. They were able to identify the impacts for them, their relationships and their children, and to explore their successes, including gaining confidence and recognising and challenging abusive behaviours.
The following quotes illustrate the impact of For Baby’s Sake for parents who grew up experiencing traumatic childhood adversities including domestic abuse:
“It’s allowed me to heal and come into myself. It’s given confidence to be a good mum and to really say what it is that I think and feel. And also stand up for myself and say what it is I’m willing to accept and not accept.”
“I came into the programme thinking, ‘Am I just broken beyond repair?.... “I just feel really grateful to the team at For Baby’s Sake, for the support they've given us at the start of our child's life…He’s had the best start in my family as far back as anyone can remember and that is not an accident.”
For Baby’s Sake Trust continues to strive to take learnings from the programme and sector research to inform policy and practice, and to ask for change within society. Going forward the Trust endeavours to share resources which would be useful for professionals delivering similar services in the sector. Excitingly at the time of writing, the Trust is looking to incorporate Family Drug and Alcohol Court referrals into the programme in areas where the programme is set up and via For Baby’s Sake Connect and has started discussing this with the Centre for Justice Innovation.
For further information visit The For Baby’s Sake Trust website at https://www.forbabyssake.org.uk .The comprehensive website includes information on the programme, the full King’s College London evaluation and its summary, plus a wealth of useful support tools and resources.
This case-study was compiled by Jason Watt in 2021