Panel Presentation from the Evidence Based Parenting Programmes and Social Inclusion conference held at Middlesex University, 20th September 2012

1. Mellow Babies:
A big help for very little
people
Dr Christine Puckering
Consultant Clinical Psychologist
and Research Fellow
Royal Hospital for Sick Children, Glasgow.

2. Babies are designed to communicate – they
can’t do much else…
• “There is evidence that even newborn infants, with
their very immature though elaborate brains,
limited cognitions, and weak bodies, are
specifically motivated, beyond instinctive
behaviours that attract parental care for immediate
biological needs, to communicate intricately with
the expressive forms and rhythms of interest and
feeling displayed by other humans” (Trevarthen,
2001)

4. Some brain basics – the neuron

5. Sequence of development
• At birth, sensory and motor areas are myelinated
and the vegetative functions are working
• The frontal lobes do not begin to function until
six months and are not fully myelinated until
adolescence/early adulthood
• The capacity to make judgements and control
emotion is not fully organised until the frontal
lobes are in action and the types of decision made
are formed by experience

7. Normal diurnal production of
cortisol
Waking Bed time

8. Diurnal production of cortisol in
abused and neglected children
Waking Bed time

9. Graph of the Yerkes –Dodson Law
Performance
Low Medium High
arousal arousal arousal

10. When do we learn best?
Source: J Heckman & D Masterov (2005) Ch 6, New Wealth for Old Nations: Scotland’s Economic Prospects

11. THE LONG TERM EFFECTS OF EARLY
EXPERIENCE:
•1) The wiring of the brain
•2) Sensory Integration
•3) Emotional Literacy
•4) Belief Systems
•5) Relationship patterns
•6) Empathy, conscience/moral
development

12. WHAT ARE THE OUTCOMES FOR
YOUNG PEOPLE OF POSTNATAL
DEPRESSION?
• Increased risk of depression especially early
onset depression
• More social and behavioural problems lasting
into adolescence
• Poorer language development
• Poorer cognitive development especially in
boys and in families with other social
problems
• NB just treating maternal depression does not
change risk to child!!

13. Who needs most support?
The parents who are least likely to engage in
and benefit from parenting interventions are*
• Young
• Poor
• Poorly educated
• Lacking social and partner support
• Suffering from psychological disorders
themselves
*NICE report 2006

14. What works in targeted services for
infant mental health?
• Narrow focus on sensitivity alone
• Between 5 and 16 sessions
• Between 6 and 12 months of age (no
advantage in antenatal intervention)
• Programmes including fathers showed
increased sensitivity in fathers but diluted
effects for mothers
• The use of video feedback increased effect
sizes for sensitivity
Bakermans-Kranenburg M.J., van IJzendoorn M.H., Juffer F., 2003. Less is more: meta-analyses of sensitivity and attachment
interventions in early childhood. Psychological Bulletin 129(2), 195-215.

15. WHY DEVELOP THE BABIES PROGRAMME?
The developmental needs of the child and the
corresponding parenting tasks are specific to this
stage i.e lunch-time activities and workshops’ content
Early intervention: focus on preventing attachment
problems and increasing parental attunement.

16. MELLOW BABIES: THE INITIAL DIRECTION
• Hard to engage families with a history of significant
mental health and relationship difficulties
• Significant post-natal depression
• Child protection

17. Components of the Programme
• Careful recruitment
– Low levels of literacy
– History of adverse relationships
– Low self-esteem
– Low trust
• Child care and transport help
• Personal group
• Parenting workshop using parent’s own video
• Hands-on lunchtimes
• “Homework” to practice skills at home

18. TYPICAL DAY:
09:30 - Breakfast/Welcome
10:00 - Personal Group
11:30 - Break
11:45 - Lunch
12:30 - Activity
01:00 - Workshop
02:30 - Finish

19. Personal Group
• A chance to reflect on the mother’s
story
• A chance to reflect on current
relationships
• A chance to reflect on mother’s mental
health (CBT)

20. Clouds
What I thought
What the group thought
What the group thought
What I felt
What I did

21. Mother-baby activities
Aim: to get mothers and babies face to face and
attentive to each other and to have fun
• Gentle Touch
• Book reading
• Interactive coaching (mirroring)
• Nursery rhymes
(see weekly programme)
(also good for babies and dads)

22. Parenting Workshop
• Feedback on mother’s videotape
• Psycho-educational material
• Dimension of parenting
– Anticipation
– Autonomy
– Responsiveness
– Cooperation
– Distress
– Control

23. Baby Cues

24. Have A Go (homework)
• A chance to practice mother-baby
interaction
• A chance to challenge negative
automatic thoughts

25. Child Protection Outcomes
• 2 groups
• 10 families
• 13 children
• Child Protection involvement with 7/13
children

26. Child Protection Outcomes
Child Protection Involvement
• 7 children on the Child Protection
Register at start of program.
• 2/7 children de-registered by 6 month
follow up stage. Legal proceedings
dropped on 1 case.
• 3/7 children returned from care at follow
up point but remained on register

27. Child Protection Outcomes
• 2/7 children remained in care. Court
report provided by Mellow Parenting
supporting the Local Authority’s
application for Care Orders and Freeing
for Adoption.

28. Waiting-list controlled trial
(postnatal depression)
• 11 mothers completed trial
• 2 mothers dropped out
• 6 W/L controls

29. Edinburgh Postnatal Depression Scale in
Mellow Babies Group and Waiting List Controls
20 Mellow Babies
Waiting list
15
10
5
0
Before After P=0.035

30. Positive Interaction Measures in
Mellow Babies and Waiting-list
Control groups
200 Mellow Babies
Waiting List
150
100
50
0 B A
ef fte
o re *P<0.023 r

31. Negative Interaction Measures in
Mellow Babies and Waiting-list
Control groups
20
15 Mellow Babies
Waiting List
10
5
0 B A
ef fte
o re r
*p<0.025

35. What Mum’s Gained From Mellow Babies I
• I learned to open and share my feelings.
• The best thing was being able to sit relaxed, and
cry, or say nothing or listen.
• The most important thing I learnt was that I am
worth it.
• The most important thing I learnt was how to be
more interactive with babies.
• I now put him somewhere safe when he is upset
and I cannot stand it.
• It felt really good because everybody
understands you.

36. What Mum’s Gained From Mellow Babies II
• It was good seeing yourself on video because
you see the difference in them and how you
and your baby have bonded together.
• The video meant you could see how different
things were (compared to the beginning).
• How did it feel in the group? Totally relaxed
and trusting each other.
• I don’t get so upset. Think first.
• I can go out now. Trying to think positive.
• The most important thing was listening to
other people’s feelings, and my own