‘Exciting’ results from health visitors’ trial of assessment tool

An assessment tool for measuring social withdrawal in babies can help health visitors identify babies in distress and families who need more support, according to the results of a study.

Behavioural signs of excessive or sustained social withdrawal in infants are an early alarm signal that can indicate a need for further assessment or additional support.

The Alarm Distress Baby Scale (ADBB) is an observational tool developed in 2001 for assessing signs of withdrawal in infants aged up to two years.

For the study, funded and commissioned by the Royal Foundation Centre for Early Childhood, a charity set up by the Princess of Wales, researchers looked at the feasibility of health visitors using the ADBB observational tool during their routine six-eight-week postnatal check-up.

A total of 22 health visitors from South Warwickshire NHS Foundation Trust and Humber Teaching NHS Foundation Trust were trained in using the ADBB tool.

Of these, five were trained in the full ADBB assessment and 17 in a modified form of the assessment which involves a quick evaluation of an infant’s behaviours based on five factors: facial expression, eye contact, vocalisations, activity and relationship.

Over the course of four months health visitors used the modified ADBB assessment tool in more than 90% of the six-eight-week postnatal checks they carried out.

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Based on this assessment, they identified behavioural concerns in 10% of babies, resulting in additional support given to those families.

Overall, the health visitors involved in the study reported very positively on the ADBB training, describing it as “hugely beneficial” and “of great importance” to their practice.

The main advantage of the ADBB training was that it was focused on the baby, rather than on the parents’ perspective or environmental factors, those behind the study said.

“Having received the training myself, I can speak to its effectiveness at identifying needs of the baby and parent during those early weeks”

Karen Hardy

Based on the positive outcomes in this small trial, the study authors have suggested that health visitor training in ADBB should be introduced in other parts of the UK.

Karen Hardy, a health visitor at Humber Teaching who that took part in the trial, agreed that it was “extremely useful”.

She said: “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.”

Ms Hardy added: “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.”

She said that this could highlight when things were going well but also enable early identification of babies experiencing distress associated with adverse or challenging family circumstances, so that appropriate support could be provided as early on as possible.

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“It is great to hear that the report is recommending the extension of this training to more health visitors,” Ms Hardy added.

Professor of evidence-based intervention and policy evaluation at the University of Oxford, Dr Jane Barlow, one of the authors of the study, said that whereas previous approaches had focused on the parents’ perspective, this training helped health visitors to “read the baby”.

“The feedback from those involved has been overwhelmingly positive. It is truly exciting to think about impact this could have on families right across the country as we enter the next phase of this research,” Dr Barlow said.

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