Community Care, News

“Overwhelmingly positive” results for early years tool pilot


Health visitors trialling the Alarm Distress Baby Scale tool reported enhanced understanding of babies’ behaviour and greater confidence in supporting parents to bond with their children.

A new trial testing the feasibility of a novel baby observation tool has taken place at Humber Teaching NHS Foundation Trust, funded by The Royal Foundation Centre for Early Childhood. The tool is intended to support parent-child interactions and increase the ability of a health visitor to interpret baby behaviour.

The four-month trial ran from July to November 2023 and saw participating health visitors receive training to use the tool, known as the Alarm Distress Baby Scale (ADBB). The ADBB looks for social behaviours in babies, including eye contact, facial expressions, vocalisation and levels of activity and seeks to help parents and practitioners understand the ways in which babies express themselves and their feelings.

Health Visitors conduct a number of regular checks on babies during their first years and the ADBB tool is typically drawn upon within the 6-8 week check. Health visitors who undertook the training reported it had helped enhance their understanding and that they had continued to draw upon those skills throughout all their contact with families.

The pilot ran in two areas initially, Humber and South Warwickshire, but the outcome of this trial is the recommendation that training be expanded to further areas. The findings of the trial have been set out in an evaluation report published by The Institute of Health Visiting and The University of Oxford.

Quantitative and qualitative data were collected over the trial period, and health visitors described their experiences of using the ADBB as “hugely beneficial” and “of great importance” to their work. They reported that the tool allowed them to:

  • Have more meaningful conversations with parents and carers about the emotional wellbeing of their baby;
  • Promote positive parent-infant interactions, attachment, and bonding; and
  • Identify those babies and families in need of greater support during this critical period of development.

Karen Hardy, Specialist Health Visitor at Humber Teaching NHS Foundation Trust said: “We were delighted to have been asked by The Royal Foundation for Early Childhood to take part in this trial. Our Health Visitors have found the training extremely useful and an additional element for them to draw upon throughout all their interactions with babies and parents. Having received the training myself, I can speak to its effectiveness at identifying needs of the baby and parent during those early weeks.

We know that babies are born ready to relate and can communicate how they are feeling from a very young age. The ADDB really adds to the health visitor’s skills repertoire aiding observation and interpretation of babies’ social cues and communication. This not only highlights when things are going well but enables early identification of babies that may be experiencing distress associated with adverse or challenging family circumstances, so that we can put appropriate support in place as early on as possible. It is great to hear that the report is recommending the extension of this training to more Health Visitors”.

Executive Director of The Centre for Early Childhood, Christian Guy, said: “The results of the initial phase of testing are so encouraging. We now want to move quickly to ensure we build on this work, bringing the benefits of this model to more health visitors across the country so that, ultimately, more babies and their families get the support they need to thrive.”

It has been noted that during the trial, the health visitors involved identified behavioural concerns in 10 per cent of the babies they met while using the tool. All identified families were subsequently offered additional support, which ranged from follow-up visits, emotional wellbeing visits and video interaction guidance, as well as connections to Child and Family Centres and referrals to Specialist Perinatal Mental Health and other support services.

Dr Jane Barlow, Professor of Evidence Based Intervention and Policy Evaluation at The University of Oxford, who oversaw the evaluation of the trial said: “Babies are born with amazing social abilities. They are ready to relate and engage with the world around them, communicating how they feel through their behaviours.

Whereas previous approaches have focused on the parents’ perspective, this training has really helped health visitors to ‘read’ the baby during interactions and develop greater sensitivity in terms of the observation of potential attachment and bonding issues that would not have been identified without the training.”