Timetable and Budget
| Description | Deadline/Limit |
|---|---|
| Deadline for Stage 1 Applications | 13 February 2024, 1 PM |
| Notification of outcome of Stage 1 Application | April 2024 |
| Deadline for Stage 2 application | 04 June 2024, 1 PM |
| Notification of outcome of Stage 2 Application | November 2024 |
| Earliest Potential Project Start | January 2025 |
| Project Duration | Up to 18 Months |
| Budget | £200,000 |
Introduction
The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for a single research project to evaluate the Family Hubs and Start for Life national initiative ‘Prompts for Keeping Parent-Infant Relationships in Mind’.
The evaluation evidence would support the Department of Health and Social Care (DHSC) to understand the effectiveness of the prompts and what further support practitioners might need in order to have effective conversations with parents and carers about the relationships they have with their babies.
Background
Supporting delivery of the Best start for life vision: In March 2021, the Best Start for Life: Vision for the 1,001 critical days [1] set out a vision that every new parent and carer has access to compassionate, timely and effective mental health support to develop a secure bond with their baby.
Our vision is that every family will be supported by a range of professionals and volunteers, each of whom brings skills, knowledge and empathy to interactions with families. From their first appointment, every parent and carer must feel that they are heard and that they can ask for help.
Family Hubs and Start for Life Programme: The Family Hubs and Start for Life programme [2] is a £300m programme announced in the 2021 Spending Review. The programme is designed to transform support for families and deliver a step-change in outcomes for babies, children, parents and carers across 75 selected local authorities over 3 years (2022-23 through to 2024-25 financial years).
£100m of the Family Hubs and Start for Life programme funding has been allocated specifically to look at perinatal mental health and parent-infant relationships.
As part of this £100m funding package, DHSC, in collaboration with academics, practitioners, parents and other stakeholders, such as third sector organisations, have developed a series of national initiatives that seek to support local authorities, and the practitioners within them, to develop their parent-infant relationship service offers. One of these initiatives is the ‘prompts for keeping parent-infant relationships in mind.’ The prompts, a set of three questions supported by a wider framework and wrap-around guidance, are designed to act as conversation starters to support practitioners when speaking to parents and carers about their relationship with their baby.
Parent-Infant Relationships: A key feature of our earliest days are the relationships we have with those closest to us: our parents and carers.
Parent–infant relationships refer to the quality of the relationship between a baby and their parent or carer. Good parent–infant relationships nurture ‘secure attachments’, which are the basis for optimal infant mental health promoting healthy social, emotional, and cognitive development.
Extensive academic evidence has identified that strong parent-infant relationships are crucial for good social, emotional and cognitive development as babies grow. It is therefore important that we are able to identify families who may be having difficulty in developing a ‘secure attachment’ with their baby and supporting them as much as possible to do so. A key part of this is being able to have conversations with families about the relationships they have with their babies to understand if they need additional support in forming a secure attachment.
We recognise that many practitioners will already be having conversations about parent-infant relationships with families, but we also know that some practitioners may find this difficult or may not feel confident in doing so. To support practitioners in having conversations with families about parent-infant relationships, and to keep them in mind during interactions with families, we have developed a set of prompts and wrap-around guidance. We hope the prompts will lead to practitioners feeling more confident in having conversations with families about their relationships with their babies which in turn will promote earlier identification of families who may need support, leading to better outcomes for the family and children longer term.
The prompts: The prompts are a set of three questions that will act as conversation starters for practitioners. The prompt questions form the first step of a three step framework that has been developed in collaboration with academics, practitioners, parents and carers. The prompts and the three step framework are supported by wrap-around guidance that local authorities can use when determining how best to implement the prompts in their local area. A summary of the three step framework is set out below:
Step 1: Starting the conversation: The first step of the framework looks at using the three questions to start the conversation with the caregiver about the relationship they have with their baby.
Step 2: Identifying strengths and areas of need: This step of the framework looks at further exploring the answers the caregiver gave in step 1, especially if the answers raised concerns for you. This step of the framework covers the use of clinically validated assessment tools to investigate further.
Step 3: Signposting, referring or providing additional support: The final step of the framework looks at referring families and caregiver for additional support if you think it is appropriate.
The prompts are intended for use by a variety of frontline practitioners including, but not limited to, health visitors, midwives, family support workers and social workers. It is important to note that use of the prompts will be optional for practitioners rather than mandatory and there is some uncertainty around the rate of uptake post-publication.
The prompts have been developed from pockets of existing practice and the three prompt questions themselves have been taken from the Leeds Early Attachment assessment tool [3].
To date, we have conducted some small-scale policy testing with a number of local authorities. The findings helped us to develop a final iteration of the prompts and guidance that we are looking to publish in early 2024. Following publication and some promotional activity, the prompts will be available for use by all local authorities in England.
We are seeking research to evaluate the prompts post publication not only to obtain an understanding of their effectiveness, both in terms of supporting practitioners to feel more confident and ensuring families in need of additional support are identified in a timely manner, but also to understand whether and how to strengthen support for practitioners to help them to interact effectively with families.
This is an exciting opportunity to evaluate a brand new initiative. The output of the evaluation will be used to support future policy development in this space, strengthening national support to improve perinatal mental health outcomes for families. This will be a valuable step forward in achieving the vision of the Family Hubs and Start for Life programme to ensure that every baby has the best start to life.
Research priorities
We are seeking research proposals that would enable us to explore the impact, delivery and effectiveness of the prompts from the perspective of practitioners and parents and carers.
We are seeking proposals for an evaluation that covers (but not limited to) the following key areas:
1. Practitioners experience of and views on the prompts
- How did the practitioners use the prompts? How did practitioners understand the prompts and their purpose?
- What did practitioners like/dislike about the style and delivery of the prompts? Were there any feelings or concerns that it provoked?
- How did practitioners think the prompts were received by the parents and carers who they spoke to?
- Did practitioners think the prompts supported them to have more meaningful conversations with parents and carers about their relationship with their baby?
- Did practitioners think the questions asked were inclusive and reasonable in terms of parents’ and carers’ privacy and cultural background?
- How were the questions received by those where English was not their first language?
2. Parents and carers experience and views on the prompts
- How did parents and carers experience the prompts?
- Were the prompts acceptable and appropriate for parents and carers?
- Were the prompts able to facilitate a meaningful conversation with a practitioner about the relationship they have with their baby?
- How did parents interpret the prompts?
- What would encourage parents to talk about their relationship with their baby
3. Are the prompts feasible within current practice in England?
- Is there additional resource (i.e., time or effort) required for practitioners to use the prompts? Did this displace other activities the practitioners carry out?
- To what extent can the prompts integrate into existing practices? How does this vary across the different local authorities?
- How do the prompts work with existing best practice about parent-infant relationships?
4. What were the short-term outcomes?
- How did the prompts help practitioners?
- What happened as a result of practitioners using the prompts?
- Did practitioners feel more confident in having conversations about parent infant relationships as a result of using the prompts?
- Did the using the prompts result in the practitioner identifying families who needed additional support or offering the parent or carer additional support?
- Were there any unexpected outcomes from the practitioners (positively or negatively) as a result of using the prompts?
- How could the prompts be improved to better support practitioners?
- What additional support do practitioners feel they need to better support parents and carers with their parent-infant relationships?
5. Do practitioners need other kinds of support??
- If practitioners have not used the prompts, or have not found them useful, was there a reason for this?
- Are there other resources that practitioners would find useful to support them in having conversations about parent-infant relationships?
- Would practitioners find additional training in this area useful? What kind of training would they find most beneficial?
The specific research questions listed under each of the key areas above are suggestions. We welcome applicants proposing questions based on their expertise, but this specification should be used as a basis when considering what, if any, additional questions would support the aims of this research.
Areas out of scope for this programme of work
The research is focused on England, areas within the UK but not in England are considered out of scope.
For the purpose of this research, we are interested in the impact that the prompts are having for families with children under the age of two. The use of prompts beyond this age are therefore out of scope for this programme of work.
The evaluation will not assess the clinical predictiveness of the prompts.
Eligibility
Eligibility for the NIHR PRP is laid out in our Standard Information for Applicants and applies to all calls unless otherwise stated in the individual research specification.
Technical requirements / Expertise required
This evaluation will likely involve mixed methods and could draw upon both quantitative and qualitative approaches.
Applicants should demonstrate the following:
- Expertise and familiarity with perinatal mental health and parent-infant relationships
- Expertise in evaluating complex health interventions
- Interest in the Start for Life programme and early years policy area
- Expertise disseminating research findings to different audiences.
Outputs
In terms of outputs, we expect the following:
- An interim report/findings halfway through the project (~ 9 months). This could be in the form of a presentation to DHSC policy officials and relevant stakeholders.
- A full research report that sets out methodology, key findings and a series of recommendations for taking work forwards in this space.
- A final presentation of key findings and recommendations.
We also request regular project updates to discuss progress against agreed timelines. The appropriate frequency can be agreed with the successful applicants, but we would anticipate updates in the region of every quarter as a minimum.
Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers will need research evidence to meet key policy decisions and timescales, so resource should be flexible to meet these needs. A meeting to discuss policy requirements with DHSC officials will be convened as a matter of priority following contracting.
Budget and duration
Applications will be assessed on value for money, we would not expect them to cost more than £200K.
The duration of the project should be as short as is consistent with delivering a high-quality study. In order to maximise the benefit from the findings, the research will need to commence as soon as possible following selection of the successful proposals and placing of contracts. Capability to start promptly will be an advantage and for this commissioning round, applicants should demonstrate that studies can start by the relevant date.
Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.
Management arrangements
A research advisory group including, but not limited to, representatives of DHSC, other stakeholders (such as NHSE, local authorities, academics and practitioners, lay members) and the successful applicants for the research should be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:
- Provide regular feedback on progress
- Produce timely reports to the advisory group
- Produce a final report for DHSC sign off
Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR. Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review. The successful team will be expected to provide regular feedback on progress, interim reports as agreed with DHSC and a final report.
Guidance on Health and Care Inequalities and associated data collection within NIHR PRP Research:
Health and care Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects.We are now assessing all NIHR research proposals in relation to health inequalities. We ask that you please clearly identify in the research plan section of the application whether your application has an inequalities component or theme as well as how this research hopes to impact inequalities or not. Please also detail the core set of inequality breakdown data that will be collected, if applicable. More information on this request can be found in the Standard information for applicants.
References and key documents
- [1] Gov.UK. Early Years Healthy Development Review. [Online]. March 2021. Available from: The Best Start for Life - The Early Years Healthy Development Review Report
- [2] Gov.UK. Family Hubs and Start for Life Programme, Local Authority Guide. [Online]. August 2022. Available from: Family Hubs and Start for Life programme: local authority guide
- [3] Hunter, Ranger and Ingram. Leeds Early Attachment Observation Tool. [Online]. March 2021. Available from: Development and use of the Early Attachment Observation tool for infant mental health