Child First is a therapeutic, home-based intervention targeted at infants/toddlers/children aged 0 to 5 years old who are at risk of developmental delay, abuse and neglect, and emotional problems. The intervention aims to provide a tailored package of support to meet the unique needs of families. This case study highlights the importance of targeted early support for families facing adversity, with a child at risk of developmental delay, abuse and neglect.
The issue
Aubrey was born prematurely after a difficult pregnancy. During pregnancy, her mother, Sandra let midwifery staff know that she was struggling, in discussions prompted by the Whooley Questions. Sandra shared that she wished she had never become pregnant, she worried she wouldn’t be a good mum, and that Aubrey was causing trouble even before she was born. Aubrey’s father, Johnny shared his concerns about Aubrey and Sandra’s wellbeing during the pregnancy, but was overall excited about becoming a Dad and reassured Sandra that things would be okay and that she would be a wonderful Mum. However, he shared that he had recently had an injury, had been laid off from his construction job and was struggling to find work. These things were causing him stress as he did not know how they were going to afford all the things a new baby needs, but he did not want to share this with Sandra.
Sandra was induced, and Aubrey was born prematurely and spent three months in the neonatal intensive care unit (NICU). This was an incredibly worrying time for Sandra and Johnny, but when Aubrey was discharged home, she fed well, put on weight as expected, and experienced no ongoing health issues. Sandra received some extra support from the midwifery team during her pregnancy and Aubrey’s time in the NICU, and seemed to be coping well during follow up appointments after leaving hospital.
However, at 9 months old, a health visitor noticed that Aubrey was not meeting some of the expected developmental milestones at her routine health review. Aubrey was sitting without support and eating well, but struggled to hold and play with toys, and wasn’t making as many babbling sounds or responding to the health visitor’s attempts to engage her. The health visitor also noticed that Sandra seemed withdrawn during the appointment and struggled to describe any activities or play she did with Aubrey to support her development.
The health visitor arranged follow up ‘listening visits’, with Sandra – Johnny was not back in time– to explore how they were finding parenting and to share their concerns about what they observed during the review. Sandra and Johnny both talked about how their experience of being first-time parents did not match what they read or saw online, and that the challenges, both during pregnancy and in Aubrey’s first few months did make them both feel anxious. This anxiety, combined with sleepless nights and no time as a couple, meant they often missed how life was before Aubrey.
Johnny shared that as he now had two jobs to make ends meet, he felt tired most evenings and didn’t always have the energy to spend time playing with Aubrey. Sandra said sometimes Johnny would get angry and frustrated when she asked him to help with Aubrey in the evenings and would take a couple of tins of beer and go into the bedroom on his own, leaving Sandra with Aubrey.
Sandra shared that she found it difficult to enjoy her time with Aubrey during the day as she was often exhausted after an interrupted night’s sleep and doing housework during the day, while also making sure Aubrey got her meals, milk feeds, and naps. Sandra also shared that because of this, she often placed Aubrey in the cot on her own while she watched TV and took a nap. They shared that they did not really have a wider family network as they had both moved away to a new town for a fresh start.
Sandra and Johnny consented to a referral to their local Family Early Help team for support with the challenges of parenting, and learn new ways to support Aubrey’s development.
The support offered
The family were allocated a family support worker who met with the family in their home. She used a strengths-based approach to work with Sandra and Johnny to build trust and rapport with the parents and over a number of assessment sessions together they created a 3-month plan which included some individual sessions with Sandra, a Dad’s group for Johnny and some joint play sessions with them as a family. The support worker could see that both Sandra and Johnny were really trying but were unable to stick to routines or develop consistency in using the suggested techniques and would often argue about who was doing it right or wrong. It was getting increasingly difficult to soothe Aubrey when she got upset, and at other times she appeared tired and disengaged. Sandra disclosed that Johnny had pushed her to the ground a few times. She said Johnny was becoming verbally abusive and was drinking more and she would often shout and swear back at him, telling him he was a rubbish father. Sandra expressed that she felt Aubrey didn’t like her and she sometimes thought that Aubrey would be better off without her. The support worker discussed her concerns about escalating conflict between the couple and Sandra’s increasingly withdrawn presentation. She shared her worries about Aubrey’s emotional development. It was agreed that the family could benefit from a more intensive therapeutic assessment and support.
The family consented to a referral to the Child First programme, which offers targeted support from two practitioners: a qualified care coordinator who would connect the family to community-based services as part of a needs-driven plan for support and offer general mentoring support; and a qualified clinician who would provide home visiting support. The support offered to the family included the following components: family engagement, a comprehensive assessment of child and family, development of a support plan for the child and family, parent-child psychotherapy, and care co-ordination.
The results
The Child First programme helped to promote a positive and sensitive child–parent relationship during Aubrey’s early years, which helped lay a positive foundation for Aubrey’s social, emotional, and cognitive development. As a result, Sandra and Johnny felt more confident in their parenting, and in their understanding of their daughter and the positive role they played in supporting her development. They were able to clearly enjoy and cherish their ordinary interactions with her and the games they played together. The programme also provided the family with coordinated and integrated care, by offering community-based support, signposting families to relevant services, and facilitating referrals to appropriate service providers. This helped to reduce the psychological stress Aubrey’s parents were experiencing. In the longer term, Child First can lead to reduced risk of negative outcomes, such as child abuse and neglect.
