Publication date: 28 June 2018
Authors: Kirsten Asmussen and Lucy Brims
This report provides a wealth of information about the evidence for approaches to early intervention for mothers and infants, which may be commissioned and delivered locally as part of the Healthy Child Programme.
What is the Healthy Child Programme?
The Healthy Child Programme 0–5 (HCP 0–5) is an evidence-based framework for the delivery of public health services to families with a child between conception and age 5. This is a universal prevention and early intervention programme and forms an integral part of Public Health England’s priority to support healthy pregnancy, ensure children’s early development and readiness for school, and reduce health inequalities in young children.
When HCP 0–5 was first introduced in 2009 it was based on the best available evidence. This report refreshes the 2009 evidence by consolidating key messages from two recently completed evidence reviews:
- The Rapid Review to Update Evidence for the Healthy Child Programme 0–5, which summarised key evidence from systematic literature reviews conducted between 2008 and 2014 involving activities aimed at supporting young children’s health and development in the early years.
- Foundations for Life: What works to support parent–child interaction in the early years, which assessed the strength of evidence underpinning 75 interventions developed to support children’s attachment security, behavioural self-regulation and cognitive development between conception and the age of 5.
The most robust messages from both reviews have been further updated with a systematic review of evidence published since 2014.
- EIF chief executive Jo Casebourne and PHE chief nurse Viv Bennett reflect on the importance and key findings of EIF’s report
- Report co-author Kirsten Asmussen sets out what we know about the impacts of parental substance misuse, and what we don’t know about how best to help
Evidence-based maternity and postnatal support
Findings from the two reviews and current update are prioritised in terms of activities that are identified as having good evidence of improving child and parent outcomes; other interventions which have been found through robust evaluation to not provide benefits for parents or children, which are described as having no effect; and activities which have not been robustly evaluated, which are described as having weak evidence.
The report sets out the evidence within the following priority areas:
Conception to birth
- transition to parenthood
- smoking cessation
- maternal mental health and harmful drug and alcohol use
- intimate partner violence.
Birth to 12 months
- low-birthweight infants
- exposure to secondhand smoke
- Sudden Infant Death Syndrome (SIDS)
- sleep training
- attachment security
- early language
- maternal mental health
- preventing unintentional injury
- child abuse and neglect.
Key findings are summarised in the following table (click to expand).
Implications for policy and practice
As well as assessing the evidence for a range of common approaches and practices, the report draws a set of wider conclusions that pertain to the Healthy Child Programme and maternity and infant support in the UK.
- The evidence base is growing: Our knowledge of what does and does not work continues to grow at a rapid pace.
- Not all problems are preventable: Prevention of modifiable risks and promotion of positive protective factors is a vital role of health visiting universal services. However, not all problems are preventable through maternity and health visiting services.
- There are few magic bullets or quick wins: The majority of effective interventions identified in this review are relatively intensive – that is, taking place for three months or longer through multiple family visits. However, it does also identify a number of ‘quick wins’: relatively short interventions with evidence of improving child and parent outcomes in the short and long term for large sections of the general population.
- The Healthy Child Programme is a good delivery mechanism for many of the interventions described in this report: The vast majority of interventions and practices identified in this report were developed specifically to be delivered or coordinated by health professionals, including midwives, nurses and health visitors. With minimal additional training in the programme delivery models, it is highly likely that the majority of interventions could be successfully delivered as part of the Healthy Child Programme.
- Good systems are required to identify need and refer families on to additional support as and when needed: While a wide variety of the interventions described in this report can be successfully delivered through routine midwifery and health visiting care, some require delivery by specialist teams. Some of the more intensive interventions also require good referral systems between midwifery, health visiting, adult mental health and social work teams in order to be successful.
- Evidence of effectiveness is not a replacement for ongoing evaluation: The fact that an intervention has evidence from a rigorous evaluation conducted at one time and place does not mean that it will be effective again. The evidence described in this report is therefore not a replacement for good monitoring and evaluation systems as interventions are set up and delivered.
- Evidence that an intervention is effective for parents does not necessarily mean that children will also benefit: Many of the interventions and activities identified in this report have evidence of improving outcomes for parents, but not their children. It is not sufficient to assume that children will automatically benefit from interventions that only have evidence of meeting parents’ needs.
- There is a lack of evidence about when and how to intervene when parents misuse drugs and alcohol: The lack of evidence involving interventions for parents who misuse drugs and alcohol represents a serious gap in the evidence base. More high-quality research is therefore urgently required to understand the extent to which substance misuse interventions improve parenting behaviours and child outcomes.