Minding the Baby


Improving a mother’s relationship with her child

Minding the Baby helps young, first-time mothers to develop a positive relationship and secure bond with their baby. The service aims to help mothers to develop their maternal reflective capacities, to recognise and respond to their baby’s feelings and needs.

How it works

How Minding the Baby works

Minding the Baby helps mothers to understand how best to respond to their baby and how a baby develops, as well as giving parenting advice and practical tips.

Mothers receive support for just over two years. A health practitioner makes visits to the mother’s home. Weekly home visits start in the seventh month of pregnancy and continue until a child’s first birthday. After that, practitioners visit once every two weeks until the baby’s second birthday.

During visits, mothers are encouraged to be aware of their baby’s physical and mental states to help them respond to their needs. For example, they might be asked to put into words what they imagine their baby is feeling.

Practitioners also help mothers who are struggling emotionally, and provide practical support, like:

  • feeding tips
  • help with housing
  • financial advice.
Evidence base

The evidence base

The emotional bond (attachment) between a parent and child is key to child wellbeing. If parents don’t have a good relationship with their baby, this can increase the risk of a baby having behavioural or emotional problems (Sroufe, 2005). Poor attachment is also linked to child abuse (Carlson, 1998).

Parents’ ability to recognise and respond to their baby’s feelings and needs (their reflective functioning capacity) affects the relationship they have with their child (Fonagy et al, 1995; Slade et al, 2005). Research suggests that parents from disadvantaged backgrounds are more likely to have limited reflective functioning (Fonagy et al, 2002; Slade, 2006).

Evidence shows that home-visiting programmes are an effective way of reaching families facing adversities (Heinicke et al, 1999; Kitzman et al, 2010; Lieberman et al, 1999; Olds et al, 2010). But, in the past, services have tended to focus on physical health or attachment and have not looked at reflective functioning (Olds et al, 2007; Lieberman et al, 1999).

Minding the Baby was developed by Yale University in 2002. An evaluation of Minding the Baby in the US found that the programme has positive effects on both health and attachment outcomes (Sadler et al, 2013).

Who it is for

Who is Minding the Baby for?

Minding the Baby is available to mothers who are:

  • 19 and under, or 20- to 25-years-old and receiving means-tested benefits
  • having their first child
  • confident English speakers.

Means-tested benefits are:

  • HealthyStart vouchers
  • Income Support
  • Income-based Jobseekers Allowance
  • Income-related Employment and Support Allowance.

Evaluation of Minding the Baby

We carried out an initial qualitative evaluation of Minding the Baby to find out about practitioners’ experiences of using the model and parents’ experiences of receiving the service. University College London and the University of Reading are now evaluating the impact of the service, through a randomised controlled trial (RCT).

What we learnt

Findings from the initial qualitative evaluation of Minding the Baby include:

  • Parents felt that their parenting skills improved, they learnt more about their baby’s development and better understood their baby’s behaviour and how to respond to it.
  • Parents felt their wellbeing improved and that practitioners helped them manage their personal difficulties. They appreciated that the programme was flexible and tailored to their needs. They received good information and guidance as well as practical help.
  • Parents thought that practitioners delivering the programme were trustworthy, non-judgemental and supportive.
  • Practitioners felt that the programme enabled them to build strong relationships with mothers at an early stage. They were able to give mothers a different, more positive experience of relationships.
  • Practitioners found it was helpful to be paired with another professional who could act as a sounding board and offer support.

(Grayton et al, 2017).

> Read the qualitative evaluation report

How we’re evaluating this service

The initial qualitative evaluation had two components, one focused on practitioners’ experiences of using the Minding the Baby model, and the other on parents’ experiences of receiving the service. A total of 13 practitioners, 16 mothers and three fathers were involved in the qualitative evaluation. Feedback was gathered using semi-structured interview schedules.

The randomised controlled trial (RCT) will measure the impact of the service on:

  • parenting quality and maternal sensitivity
  • attachment security
  • child cognitive and language development
  • behavioural problems
  • postponed childbearing
  • maternal mental health
  • incidence rate of child maltreatment.

Evaluation tools

The tools and methods being used in the RCT evaluation are:

  • Adult Quality of Life
  • Attachment Q-Set
  • Bayley Scales Infant Development, Second Edition
  • Child Behaviour Check List
  • Edinburgh Postnatal Depression Scale
  • Infant Behaviour Questionnaire Revised
  • Norbeck Social Support Questionnaire
  • Parent Development Interview - Revised
  • Parenting Stress Inventory (PSI) Short Form
  • Maternal Sense of Mastery
  • PTSD Checklist-Civilian
  • Service Use and Support Questionnaire
  • State-Trait Anxiety Inventory
  • structured observations, including the ‘three boxes procedure’
  • Yale protocol for health record review.
References and resources

References and resources

Evaluation reports

Grayton, L. et al (2017) Minding the baby: qualitative findings on implementation from the first UK service. London: NSPCC.

Evidence base

Carlson, E.A. (1998) A prospective longitudinal study of attachment disorganization ⁄ disorientation. Child Development, 69, 1107-1128.

Fonagy, P. et al (2002) Affect regulation, mentalization, and the development of the self. New York: Other Books.

Fonagy, P. et al (1995) Attachment, the reflective self, and borderline states: the predictive specificity of the adult attachment interview and pathological emotional development. In: R.M.S. Goldberg and J. Kerr (eds.) Attachment theory: social, developmental, and clinical perspectives. New York: Analytic Press. pp 233-278.

Heinicke, C. et al (1999) Relationship-based intervention with at-risk mothers: outcome in the first year of life. Infant Mental Health Journal, 20(4): 349-374.

Kitzman, H. et al (2010) Enduring effects of prenatal and infancy home visiting by nurses on children. Archives of Pediatric and Adolescent Medicine, 164(5): 412-418.

Lieberman, A.F., Silverman, R., and Pawl, J. (1999) Infant–parent psychotherapy: core concepts and current approaches. In: C.H. Zeanah (ed.) Handbook of infant mental health. New York: Guilford Press. pp 472-485.

Olds, D. et al (2010) Enduring effects of prenatal and infancy home visiting by nurses on maternal life course and government spending. Archives of Pediatric and Adolescent Medicine, 164(5): 419-424.

Olds, D., Sadler, L., and Kitzman, H. (2007) Programs for parents of infants and toddlers: recent evidence from randomized trials. Journal of Child Psychology and Psychiatry, 48(3-4): 355-391.

Sadler, L.S. et al (2013) Minding the baby: enhancing reflectiveness to improve early health and relationship outcomes in an interdisciplinary home-visiting program. Infant Mental Health Journal, 34(5): 391-405.

Slade, A. et al (2005) Maternal reflective functioning and attachment: Considering the transmission gap. Attachment and Human Development, 7(3): 283-298.

Slade, A. (2006) Reflective parenting programs: theory and development. Psychoanalytic Inquiry, 26(4): 640-657.

Sroufe, A. (2005) Attachment and development: a prospective, longitudinal study from birth to adulthood. Attachment & Human Development, 7(4): 349-367.