Thriving Babies, Confident Parents 

Briefly describe the initiative/ project/service; please include your aims and objectives

The Thriving Babies: Confident Parents programme aims to improve outcomes for vulnerable, ‘high
risk’ babies, both pre- and post-birth, by providing an early, coordinated, multi-agency intervention
for parents who are recognised as having specific vulnerabilities.

The programme seeks to allow babies to thrive by intervening early, ensuring that they are living in
safe, stable, permanent homes and can remain with their families and communities. The ‘Think
Family’ focus ensures that services and interventions are coordinated to address parental
challenges, whilst the use of trauma-informed, culturally appreciative practice promotes safety, trust,
and empowerment in our collaboration with families.

The programme brings together statutory and voluntary and community sector organisations into a
multiagency partnership led by two voluntary sector providers with a national scope: Barnardo’s and
Home-Start together with Manchester City Council children’s services (Early Help and social care).
The programme also involves other statutory and Voluntary and Community Sector (VCS) partners,
including midwifery, health visiting, Vulnerable Babies Team, CAPS, Early Help, Early Years, and
adult and children’s social care, creating a core team of multi-disciplinary practitioners. We support
parents who may have previously had children removed from their care, who are themselves social
care experienced and/or have complex vulnerabilities.

Key Aims:

Promote the health, wellbeing, and safeguarding of children, so babies can thrive by having safe,
stable permanent homes, remaining with their families and communities

Reduction in the number of babies becoming cared for within first year

Achieving early permanency through earlier intervention

Support good or improved child attachment to birth parents, improved parenting confidence and
efficacy

Provide targeted outreach and other forms of tailored support for families from ethnic minority
communities to ensure that services were culturally attuned.

What are the key achievements?

There has been an overall reduction in babies becoming Looked After in Manchester since TBCP implementation: from 84 babies (19.4% of all admissions) in June 2020 to May 2021, down to 71 babies (13.6% of all admissions) in the following year June 2021 to May 2022. Latest figures show that for every initial £1 invested, a return of £1.70 is received.

All forms of practical help were very highly valued by parents and instrumental in building trust and creating sustained engagement with the Programme. “I will miss her because she was like my little fairy godmother to be honest. That‘s what I call it. She was brilliant.” (Parent 14)

The cultural innovation in this project is the true partnership working with the VCSE partners. Being part of the inception design and delivery of the project – as evidenced by steering group chair being a rep from the VCSE partner, as well as being core attendees at case planning and allocation meetings.

An independent external evaluation of TBCP was carried out by The Institute of Public Care at Oxford Brookes University. That evaluation found:

Consistently high quality interventions led by keyworkers, characterised by a mix of educational and therapeutic sessional work with parents and practical support.

TBCP demonstrates strong triangulated evidence of positive parenting practices, parent attunement, secure child/parent attachments and reduced parent risk factors.

Evaluators found evidence of effective operational and management structures, governance procedures, and leadership.

TBCP has been delivered as planned and intended. Provided effectively engaging, multi disciplinary and culturally attuned support for parents presenting with high and risks and complex needs.

Programme / intervention acceptance is high: limited disengagement, valued by parents.

With qualitative evidence suggesting improved resilience, coping skills and ability to make positive choices

Intensive intervention during pre proceedings has enabled relatively swift decision making around permanency planning. Case files provided clear evidence of multiagency coordination and working facilitated by key practitioners in three-quarters of cases (27/36)

Parents valued all key aspects of the offer including practical help, developing parenting skills and learning about baby development, as well as emotional support. Practical support from key practitioners, such as arranging food bank parcels and emergency top-ups or helping parents to secure suitable accommodation were mentioned frequently and were instrumental in allowing some parents to focus on the therapeutic/education aspect of the intervention. Learning/educational aspects of the programme were also welcomed by parents, especially those who were first-time parents or have had children a longer time ago. Learning about how the baby brain and development as well as the opportunity to practice skills in the home environment with a supportive professional was valued by parents and potentially contributed to confident parenting.

Many parents participating in an interview also described how TBCP had helped them to better understand their baby’s development and needs and, as a result, how they had become more competent and confident parents with “thriving babies”.

“The most useful thing I got out of TBCP was probably the way you interact with baby. We don’t talk to them like a baby, we talk to them like a little adult basically. Like they understand and [are] getting cleverer by the day, learning all the time. And we wouldn’t have done that, we wouldn’t have got as involved as we do now, without [key practitioner’s] input. It’s definitely got the best out of baby, everyone always says how developed they are for their age.” (Parent 15/Mother).

“She was so nice, she was really nice, she helped me a lot with everything. She explained this stuff. It’s a lot different [from when I had my other children]. I was really scared when social services came back on my case and I lost my confidence and she helped me with that.” (Parent 6)

Many of the parents in TBCP had not previously had the opportunity to learn these skills or to draw on positive parent role models.

“A lot of the parents that I’ve been working with who were in Thriving Babies had no understanding of attachment and very limited understanding of play and safe sleep and things like that. And a lot of the work … has been around that, and I know the parents have found that really useful. So it’s about that kind of information shown to parents that might have been quite vulnerable or not had a lot of understanding with had some adverse childhood experiences themselves.” (Social worker 2)

How Innovative is your initiative?

The innovation in the TBCP programme, comes not only from the intensive strengths-based support to parents before the birth of the child but also in the partnership with the voluntary and community sector organisations who were a fundamental part of the inception design and delivery of the project. This is a true partnership with the VCSE, with all partners proactively attending case planning and allocation meetings, chairing the project steering group and delivering interventions.

The TBCP programme team and practitioners were committed, from the outset, to doing things differently, working flexibly to adapt to change and respond to the varying needs of families. The established core team across the VCSE and Early help provides multi-dimensional support with the capacity to bend and flex, allowing interventions to avoid the confines of rigid procedural systems. Similarly, the development of the Think Family work within the programme was innovative and progressive with no fixed blueprint for how this work would be structured.

The team is committed to responding to the data which showed that there was an over representation of Black, Asian and Minority ethnic families within the care population. Cultural attunement, awareness and humility are fundamental to the programme’s ability to engage with diverse communities. Culturally appropriate resources have been developed, all documents translated into the chosen language of parents and translation services included in the programme design (individual translators formed part of the team around the family for the duration of the intervention). Feedback showed that this was an effective approach, creating sustained and confident inter-agency and inter-family relationships which helped to support positive change.

Five key elements distinguish TBCP from Manchester City Council’s existing Early Help “business as usual” offer and were seen as “core” to the model by professional stakeholders. These are:

1. Multiagency partnership of statutory and voluntary organisations. – this project showcases true, integrated partnership working across statutory and voluntary organisations – the initial idea was proposed by a VCSE organization, based on their experiences of supporting citizens with young babies. The VCSE organization approached MCC to be the vehicle for hosting, coordinating and supporting the approach. The inception, design and implementation of the project was co-worked by all statutory and voluntary sector partners, evidenced by the steering group being chaired by a representative from Barnardo’s.
2. A “Think Family” approach.
3. Very early identification and intervention with vulnerable families including relatively early in a pregnancy.
4. Use of therapeutic as well as educational (parenting) sessional work with families.
5. Practical support provided alongside sessional workWhen asked how stakeholders would characterise TBCP’s work with families, four key features were identified – these were also clearly reflected in the programme’s training offer (see next section).

1. It works positively with risk and it is flexible responding to parents’ needs
2. It is strengths-based, building on parents’ resources and resilience factors, including motivation and engagement. “We look to their strengths and to help them to pursue their goals. And it’s not about us telling them what to do, because you can tell someone to do something, but they give you the face value. So yes, I’m going to do it. But we always say to them, What do you want to achieve? And how can you achieve it? And we support them along the way.” (Core Team 3)
3. It is relationship-based recognising that building trust with the key practitioners is central to positive engagement and that this trusting relationship can be therapeutic in itself.
4. It is holistic, focusing on the person and family as a unit (see Think Family). Workforce Roles and Training The programme invests heavily in workforce development across the partnership. Practitioners have access to a range of evidence-based interventions. Core staff are supported by an intensive and well-resourced training offer, consisting of the following elements:
5. Motivational interviewing techniques. Bespoke Cultural Competence Training. Attachment and Endings. New-born Behavioural Observations (NBO) Training. Domestic abuse (Safe & Together). Presentations by invited professionals from partner agencies often responding to specific demand during the implementation of the Programme (e.g. on perinatal mental health, foetal alcohol syndrome). Enhanced training for Home-Start volunteers (particularly around safeguarding). Trauma-informed approach with ACES training Focus on culture, behaviours and development of Manchester ‘Think Family’ approach

 

What are the key learning points?

The programme has demonstrated strong evidence of promise in terms of its impact. Key learning from the pilot study regarding the implementation of a model like this include the importance of:

– Having a clear model with clear aims and desired outcomes from the start of the programme

– The Communications strategy developed was critical to the implementation and success of the programme. Early and sustained communications, messaging and “publicity” about the model across all statutory and partner services (just at the start is not enough) raised the profile of the programme and drove referrals leading to interventions for 50% more families than intially planned.

– Sustained leadership support for implementation beyond the initial pilot phase into “mainstreaming” of funding of the service which is now offered across the city.

– Having a multidisciplinary panel as a platform to “receive” referrals, hold multidisciplinary discussions about and undertake detailed planning in relation to individual families.

– Highly committed staff who are committed to working differently and have the capacity to engage effectively and build trust with parents in this cohort, to work effectively with children’s social care services as well as a range of partner organisations, and to learn new skills.

– Regular, high-quality supervision for operational staff

– Regular review and monitoring of outcomes for children and families.

The evaluation findings also identified some areas for further consideration and development in particular:

– To improve access to mental health or emotional wellbeing supports for parents and to strengthen the “Think Family” approach to realise its full potential and monitor its potential.

– To further improve supports for fathers to participate well and benefit from the programme (a good start has already been made in this respect).

– Further consideration of the optimal timing for starting an intervention.

– Strengthening learning and exchange of experiences across services working with families during pregnancy. Although there was a noted risk that practical support might create dependency, the independent evaluation found no evidence of this in the case files and help was generally provided with a clear long- term/sustainable purpose (e.g. create safe and hygienic home conditions, improve financial situation, etc.).

Based on administrative/management data and stakeholder interviews, three key supports for the provision of an effectively functioning service were identified:

1. Highly committed staff and leadership.

2. Training tailored to the specific programme of support – planned and responsive.

3. Regular supervision (formal) and informal supports, peer support

The core team had a male key practitioner, which appeared to further facilitate the engagement of fathers by providing a male role model. “There are not many males in this role. When the women are coming around, I kind of feel a bit left out. But when [key practitioner] came out I was comfortable with him because he’s a bloke and it was better for me personally to get a male’s perspective. (Parent 15/Father) However, the involvement of fathers is one of the areas where practitioners and stakeholders believe the programme could be further strengthened, reflecting broader challenges and emerging trends in children’s social work practice: “Dads quite often aren’t involved. But it is a gap that we’re not addressing, their role, particularly if domestic violence has been involved. But I think that’s a gap within society and services in general. … If the father doesn’t want to be involved with the family at all, they’re just walking away, but it just seems to be a missed opportunity, that we can’t do a little bit more around there. (Project Team 5)

TBCP was initially launched in the North and Central localities within Manchester. Following a successful pilot year, it was scaled up to be a citywide programme and a permanent team was established within MCC. TBCP is a flexible model of system change that embeds the voluntary sector organisations in service delivery. Lessons learned about the ways of working, flexibility to adapt and the multi agency approach have also been adapted and applied to other programmes under Manchester’s Think Family umbrella. These success factors can be scaled and replicated in other areas where there is need.

Additional Comments

Manchester is proud of the success of the Thriving Babies: Confident Parents programme. It has demonstrated an innovative effective and impactful approach which has supported babies to remain, where it is safe to do so, with their parents. Throughout, the Thriving Babies practitioners have been committed to supporting those with complex and high risk needs, and have achieved positive outcomes for babies, who are safe, happy, healthy and thriving.