New government-issued conversation prompts are being tested across eight local authorities to help health visitors and family support workers spot when a parent is struggling to bond with their baby. The problem is practical: there are currently no reliable tools for identifying parent-infant relationship difficulties, despite strong evidence that early relational problems can affect a child’s long-term development. In March 2024, the Department of Health and Social Care published three simple prompts practitioners can use during routine visits to open conversations about the parent-baby relationship. But no one yet knows whether these prompts actually work, whether they reach families who need them most, or whether they inadvertently widen inequalities. This 14-month study will compare four local authorities using the prompts with four matched authorities that are not. Researchers will interview practitioners and parents—particularly from marginalised groups—and track monthly referral rates to parenting programmes. If the prompts prove acceptable and effective, the team will co-produce guidance for rolling them out equitably across England. If they do not work, the findings will still inform what should come next.
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Background It is crucial to identify and support parents and carers experiencing parent-infant relationship difficulties. However, there is a lack of suitable tools for identifying issues in the parent-infant relationship. New guidance published by the Department for Health and Social Care (DHSC) in March 2024 provides 3 conversation prompts for practitioners to explore a parent or carer s relationship with their baby. Objectives The main aim is to evaluate acceptability, feasibility, and impact of the new parent-infant relationship prompts, to inform practice and policy. The six key objectives are to: Identify barriers and enablers to adopting the prompts Describe how prompts are implemented within existing systems of support Understand practitioner and parent experiences of the prompts Understand how inequalities might influence implementation Evaluate the impact of the prompts on referrals to relevant services Develop co-produced guidance for equitable implementation of the prompts Methods with delivery timeline This 14-month project comprises three work packages (WPs). Using a mixed-methods multiple case study design, we will recruit four local authorities using the prompts, and four matched local authorities not using the prompts in months 1-4. Cases will be matched based on population demographic characteristics of selected local authorities. The Health Equity Implementation Framework will facilitate understanding of any inequalities in delivery of the prompts. An embedded parent advisory group (PAG) with lived experience of parent-infant relationship difficulties will ensure the research is inclusive and relevant. WP1 will address objectives 1-5 using qualitative methods. Focus groups and interviews throughout months 4-10 will explore practitioners and parents perceptions of the prompts, in sites using the prompts. Purposive sampling will be used to invite participants from marginalised groups. Stakeholder interviews will be conducted in sites not using the prompts, to explore why they were not adopted. Framework analysis in months 5-12 will analyse each case individually, and across cases to understand patterns of implementation. WP2 will address objective 5 using quantitative methods. Monthly referral rates to universal parenting programmes will be collected from all sites across months 4-9. In months 10-12, referral rates for sites using and not using the prompts will be compared in percentage points. If data quality allows, a difference-in-difference analysis will assess whether these changes are causal. WP3 will address objective 6, generating recommendations for future policy and practice. Findings from WP1 and 2 will be triangulated to produce rich case studies of implementation. An online national stakeholder workshop in month 13 will use a world cafe approach to discuss findings and co-produce recommendations with stakeholders for integrating the prompts equitably into practice, or to discuss why the prompts are not appropriate. Anticipated impact and dissemination Co-produced recommendations for practitioners will facilitate equitable implementation of the prompts for future practice, or, if the prompts are found not to be acceptable, identify recommendations for next steps. Knowledge from WP1-2 will be disseminated in quarterly project reports for DHSC and published in academic journals. Infographics and short accessible animations will be produced to share with stakeholders and practitioners.
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