Parent-Infant Relationship Resource Cards by Jane Dickens and Lisa Milne
The Parent-Infant Relationship resource Cards are a highly visual tool designed to facilitate understanding of the parent-infant relationship for practitioners and parents. The cards include information on neurodevelopment, building a relationship with your baby in pregnancy, infant cues and appropriate responses, and key concepts of the parent-infant relationship development. All these aspects foster secure attachment and therefore are fundamental to parent-infant mental health. The pictorial element of the cards enables them to be accessible across cultures and a valuable tool when working through interpreters. The Parent-Infant Relationship Resource Cards are an interactive tool so can be used as an intervention to help parents develop skills and knowledge and deepen their understanding of their child and themselves.
NICE (2014) recommends that health professionals can assess, and provide information and treatment for mother-baby relationship issues; the parent-infant relationship resource cards support this requirement. The Department of Health (2014) identify that Transition to Parenthood and the Early Weeks (High Impact Area 1) and Maternal Mental Health (Perinatal depression) (High Impact Area 2) are essential areas of Health Visitor input and this resource will assist HV in this service delivery. High Impact Area 1 states: Preventing and intervening early to address attachment issues will have an impact on resilience and physical, mental and socioeconomic outcomes in later life and on this basis health visitor within BDCFT are working to bring parent-infant mental health to the centre of all contacts.
The resource specifically addresses areas highlighted by the Maternal Mental Health Pathway (2012, DH) including ‘Promoting positive mental health and wellbeing of mother; Preparing families for parenthood; Promoting the neurological development of child, the negative impact of stress; Promoting positive mother and father relationships; Promoting the importance of parent and baby mental health/attachment; Promoting attuned, sensitive parenting that supports baby’s early development; Promoting importance of father and wider family (involvement.)
Health Visitors access a rolling program of parent-infant relationship training. This is evidenced based training and is at an advanced level with theory, research and practice elements. The evaluations for this training are excellent. For most participants this training is the first opportunity that they have had to learn about parent-infant mental health. Training must be supported to ensure that practice with families develops in line with government guidelines. As requested by Health Visitors, this resource was developed to embed the parent-infant training with the aim of improving practice and sits alongside Perinatal, including Parent-Infant Mental Health Consultations for Health Visitors provided by the Perinatal Mental Health Lead. This resource has been created and shaped through a partnership of Perinatal Mental Health Lead within mental health and practitioners within Health visiting.
Each Health Visiting team member and other ICP appropriate practitioner will have a copy of the resource. The cards will support practitioners’ conversations reflecting key messages. Where there are particular concerns the cards can be used interactively to facilitate the parents understanding of the parent-infant relationship or particular skills such as noticing cues and appropriate responses (maternal sensitivity) (Ainsworth, 1979), imaging what the baby is experiencing (mind mindedness)(Meins, 2002; Fonagy, 1997).
Use of the sample pack with families and practitioners has influenced the final product and feedback has been extremely positive with key messages from practitioners being that it would enhance their service delivery and that families reported that enhanced their understanding and therefore their relationship with their baby.
An audit and evaluation process is underway.
Initial Parent Feedback for Parent-Infant Relationship Resource Cards
Nine South East Asian mothers provided feedback and the mothers were keen to do so:
‘I didn’t know a little baby was able to communicate so much. I wish I had known this with my first child who is 2 ½ and I find it difficult with behaviour and fussy eating just now.’ (mother of 6 week old baby)
‘I have been talking to my baby and looking into her eyes much more because the HV showed me the cards. I think my baby and I are very close because of this (Talking and looking into her eyes).’ (mother of 2 week old baby)
‘I like the slides of the brain growth, I didn’t know it was so important to respond to my baby before. I am looking out for her signs more now. I didn’t know she could communicate before’. (mother of 6 week old baby)
‘I want the best for my baby. I wish my parents knew all this. They don’t understand me and my baby. The HV has helped me have confidence in bringing up my baby, and the cards/pictures made it easier to understand’. (mother of 9 month old baby)
‘I already have been looking into my baby’s face and he looks at me. But I didn’t know that it was actually helping his development. I am amazed about how much a new baby can do. The cards have helped me.’ (mother of 2 week old baby)
‘[The pictures are] to the point with a lot of information but in a few words – the pictures are also good, for example – the crying picture explains what kind of cry. When speaking/smiling at a baby – you don’t know why you are doing it but I understand why now.’ (mother of 10 week old baby)
Parent feedback themes:
- Increasing knowledge
- Understanding baby
- Enhancing Closeness
- Endorsing appropriate behaviour already doing with baby, positively changing behaviour and encouraging specific behaviour
- Mutual gaze, cues, brain development, baby’s communication
- Understanding what parents do
The cards were used at clinics and home by an experienced HV. The cards were used at the antenatal visit, birth visit at 6 weeks, 10 weeks and 9 months
- 100% of mothers stated that the cards were very helpful
- 100% of mothers stated that the use of the cards made them more aware of how important the relationship is between you and your child
- 100% of mothers stated that the use of the cards made them feel more confident caring for their baby
- 100% of mothers stated that the use of the cards made them understand more about the way that their baby was communicating with them
- 100% of mothers stated that the use of the cards helped them to interact with their baby better
- 100% of mothers stated that the way the cards looked was helpful
- 100% of mothers stated that pictures were helpful to understand the meaning
- 78% of mothers stated that the size of the cards was helpful
“This is so fantastic – exactly what we need, this will fit in with the projects and groups we want to run with families and children. This would be perfect for the Family support workers to use” – Cluster Manager
9 professionals consisting of 1 Interpreter, 1 Student Nurse, 4 Health Visitors and 2 family Support workers.
- Useful when there is a language barrier and useful for interpreters
- Helping responsiveness of parent to child
- Increasing knowledge of infant cues
- Making conversation easier between practitioner and parent
- Keeping conversation focused
- Accessible – real people, lots of photos
- Increase knowledge of practitioners (training tool)
- Improving practitioners practice / encouraging evidence based practice
- A prompt to practitioner knowledge/embedding training
- Helping practitioners share knowledge with parents
- Emphasises babies needs not just ours
Non- health visiting staff answered a series of questions that were pertinent to their particular area of practice.
- Student nurse and family support workers felt that the cards has improved their understanding of the parent-infant relationship,
- Student nurse family support workers and interpreter felt that the cards would help communicate with the client
- Family support workers and interpreters felt that the cards would assist the client’s relationship with the infant
- Family support workers felt that they would assist embedding parent-infat relationship training into practice
- Family support workers and interpreter felt the cards would be effective in helping parents recognise the everyday things they can do that make a difference.
The nine practitioners were asked for specific feedback regarding the design of the resource pack:
- 100% of practitioners felt that the overall presentation of the cards was excellent
- Practitioners felt the size of the cards was useful ( with cards scoring 98/100)
- Practitioners felt the cards demonstrated diversity (with cards scoring 98/100)
- Practitioners felt the pictures on the cards were relevant to clients (with cards scoring 98/100)
- Practitioner felt that the resource were a useful visual tool when language was a barrier (with cards scoring 98/100)
- Practitioners felt the resource could be used flexibly (with the cards scoring 98/100
- Practitioners felt that the information was of high quality (with cards scoring 100/100)
- Practitioners felt the quantity of information was right (with cards scoring 100/100)
Student Nurse: I think the cards are very useful to help staff understand how a client’s baby is responding and to help the client understand how their baby is responding and why.
The pictures are of real people and babies rather than emotions so the client can relation to the different emotions displayed by the baby. These will also be useful for students that are new to the profession as they can match a card to the baby’s response.
Family support worker : The resource packs seem like a very useful pack with useful information to use daily with parent, giving and sharing important knowledge regarding their child’s development. This is something I would definitely use on my home visits, but unfortunately there haven’t been and packs available to us yet.
Interpreter: Pictures are very helpful – especially when there is a language barrier. This will be helpful for interpreters in their understanding and it would be good for all HVs to use these at all the visits they go to with an interpreter.
HV: These cards are a similar style to cards I used in midwifery practice and they reinforce and support evidence based practice and keep practitioners focused. I look forward to using them.
HV: I haven’t had the opportunity to use the cards but am looking forward to using them very much. The presentation is very good. They are a good size as they fit in your hands, there are lots of good pictures, I think they would help when there is a language barrier, they can be taken out to be used singly, they are in an easy language to understand and there seems lots of info.
HV: The yellow and blue is great. The cards emphasise their [babies’] needs not just ours.
HV: Wouldn’t normally ask antenatal question but I try to since the parent-infant relationship training and the cards will prompt me to ask the questions and talk about these issues antenatally. The cards make the conversation easier – less stigma attached to asking – makes the client feel less singled out and the cards show it is universal, so people can talk more. The cards are particularly to my team as they are useful as a visual tool when language is a barrier.
Ainsworth, M.S (1979). Infant-Mother Attachment. American Psychological Association 34 (10): 932–937.
DH (2012) Maternal Mental Health Pathway. Available from: https://www.gov.uk/government/publications/maternal-mental-health-pathway
DH (2014) Public Health Contribution of Nursing and Midwives: Guidance and Children’s Health. Available from:
Fonagy, P. and Target, M. (1997) Attachment and reflective function: Their role in self-organization. Development and Psychopathology, 9, 679–700
Meins et al. (2002). Maternal Mind-Mindedness and Attachment Security as Predictors of Theory of Mind Understanding. Child Development 73 (6): 1715–1726
NICE (2014) Antenatal and postnatal mental health: clinical management and service guidance Nice Clinical Guidance 192. London: NICE