Past projects

Evaluation of LEAPs Parent and Infant Relationship Service (PAIRS; 2023-2024)

This mixed methods evaluation was funded by Lambeth Early Action Partnership and focused on both PAIRS’ workforce and family-focused activities and took place between December 2023 and April 2024. It included interviews with the PAIRS team (N=6), stakeholders (N=10) and parents who had received support from the service (N=15) regarding their experiences. We also analysed the routine data that the service captures regarding referral, engagement and clinical outcomes.

A key finding from this evaluation is how all PAIRS activities are interconnected. PAIRS cannot be successful in supporting families living in Lambeth without also building capacity within the local early years’ ecosystem. The local capacity building that PAIRS is involved with leads to more awareness of infant mental health and the service which increases the number of appropriate referrals to the service. This in turn means that more parents and carers are being supported and report benefits such as better parent-infant bond, improved confidence in their parenting skills and improved mental health.

Download the PAIRS executive summary and case studies [PDF], showing the impact of PAIRS on the early years workforce and parents.

Together with Baby service evaluation (2019-2021)

This project was funded by the Parent-Infant Foundation to evaluate Together with Baby, a parent-infant mental health service in Essex.

Specifically, this work focused on the barriers and facilitators to service implementation and included interviews with service staff (N=4), service users (N=5), the wider early years workforce (N=9), service commissioners (N=3) and Parent-Infant Foundation staff (N=4).

We also evaluated the training the service provided for the wider early years workforce and identified and analysed available service-level outcomes data (e.g., referral rates, reasons, and sources) and service user outcomes including the parent’s representation of their child (Mothers’ Object Relations Scale), depression, anxiety, risk factors, and child development.

The evaluation findings based on these multiple data sources ‘produced invaluable recommendations’, and are published on the Parent-Infant Foundation website [PDF], included in their Service Development and Implementation Toolkit to aid implementation of additional services, in an academic journal article, summarised in a Youtube video, and were shared in an online webinar.

Evaluation of Mothers and Babies in Mind (2018)

This evaluation took place in 2018, when we evaluated Maternal Mental Health Alliance’s Mums and Babies in Mind programme through interviews with participants (including perinatal mental health professionals, midwives and health visitors) and quantitatively assessed workshop experiences and satisfaction.

Systematic review of measures of parent-infant interaction and attachment (2017)

This systematic review was funded by Family Action and aimed to measures of parent-infant interaction and attachment.

The review identified 26 measures of parent-infant interaction across 125 studies. Only 8 papers looked at father-infant interaction/attachment and only 17 papers specifically validated a measure of mother-infant interaction. Of the 26 identified measures, 5 had psychometric properties reported by more than 10 studies. These were the HOME, the NCAFS, the NCATS, the MBQS and Ainsworth’s Global Maternal Sensitivity scales. These measures have the largest evidence base supporting them.

The Home Observation for Measuring the Environment (HOME) and the NCAST teaching and feeding scales (NCAT and NCAF) were identified as promising measures measuring the life experience of the infant and caregiver-infant interaction respectively. These measures were designed for use in interventions, and are relatively simple to learn how to use and score. They both have considerable evidence supporting their reliability and validity although cultural validity and suitability for use with fathers is unclear for both measures, due to both a lack of studies investigating use with fathers, and unclear results on studies that have taken place.

Maternal mental health, processing of emotion and maternal sensitivity (2014-2018)

This work was carried out by Rebecca Webb for her doctoral thesis. This thesis developed a cognitive model that aimed to understand whether the way mother’s interpret infant facial expressions is associated with maternal sensitivity. The aims were addressed through a systematic review and a study of women with (N = 23) and without (N = 47) affective symptoms and their infants (aged 2-8 months) after birth.

To assess how mothers process infant-related information, validated pictures of infants’ emotional faces were needed. Therefore, a validated set of infant emotional expressions was created and validated on student midwives and nurses and members of the general public. The images were found to have high criterion validity and good test–retest reliability (Webb et al., 2018).

The study with women involved multiple tasks aimed to understand cognitive processes, including

• (i) an attentional bias task where mothers were shown two infant faces and their eye movements were tracked to identify which face was looked at first and how long they looked at each face
• (ii) a disengagement task which required mothers to focus on a central fixation cross, which then turned red or green and an infant’s face appeared behind it. If the cross turned green mothers were required to move their attention away from the face/fixation cross and asked to identify the vertical line which was located on one side of the screen
• (iii) an accuracy task, where mothers were shown infant faces with ambiguous emotional expressions and asked to label the emotion.

The systematic review found that mothers with perinatal affective disorders are faster to disengage from sad infant faces and are more accurate at identifying sadness in infant faces (Webb & Ayers, 2015). However, the disengagement and accuracy tasks found no differences between groups in attentional capture towards infant emotions or accuracy of interpretation of infant emotion. All participants were slower to disengage from infant faces with negative emotion.

A non-significant relationship between anxiety scores and categorisation of emotion was found, in that as anxiety scores increased mother’s sensitivity at categorising emotions decreased (Webb & Ayers, 2019).

The cognitive model hypothesis that maternal affective symptoms would be associated with maternal processing of infant-related information, which would in turn be associated with maternal sensitivity was partially supported. If mothers with affective symptoms were found to fixate first on more positive images in the attentional bias task, then they showed less overall maternal sensitivity. Furthermore, if mothers with affective symptoms look away faster from more positive images in the disengagement task, then they showed more detachment during interaction with their baby (Webb, 2017).