New research methodology enables health visitors to identify babies who are failing to thrive

Copenhagen Infant Mental Health Project

Mette Skovgaard Væver is one of Denmark's leading researchers in infant and early childhood mental health.

In 2014, Mette and her colleagues at the University of Copenhagen’s Babylab started working with the French baby examination tool ADBB (Alarm Distress Baby Scale). She quickly realised that there was enormous potential in making the method available to health visitors, day-care workers and others working with infants and young children in Denmark. The ADBB method is a systematic way of observing and assessing a baby’s well-being and is specially designed to detect any early signs of social withdrawal.

Mette therefore developed an effective way to convert the knowledge gained from international infant research into a systematic training program to upgrade the skills of professionals working with babies and young children. The program enables, for example, health visitors to apply the research-based ADBB method in practice when they examine babies and young children for early signs of failure to thrive or social withdrawal. Mette also carries out research into the effects of implementing these methods in the Danish healthcare system.

The ADBB method is a kind of "worry scale" that health visitors can use when visiting families with new-born babies. By using the method, a health visitor can identify any early signs that a baby may be experiencing difficulties due to, for example, the parents' substance abuse, psychological problems, lack of parental competence and/or congenital difficulties the child might have.
Early detection of babies who are failing to thrive enables early intervention, and it is well-documented that this benefits society both socially and economically. When problems with a baby and its family are identified, the parents are offered help aimed at supporting the healthy development of the parent-child relationship.

The sooner the family gets help, the fewer are the long-term and often very serious conditions that a distressed child may develop, such as: behavioural- and aggressive disorders, depressive symptoms or actual psychological disorders.

Copenhagen Infant Mental Health Project (CIMHP)

In 2015, in collaboration with the City of Copenhagen, 100 health visitors from the capital’s various districts took part in the project.

UCPH researchers trained these health visitors to use the ADBB method, which consists of a "worry scale" where a baby is assessed on, for example, their ability to actively initiate eye contact with the health visitor and to express their feelings and needs, e.g. in the form of sounds, crying and smiling.

Results

Following the success of the ADBB method among Copenhagen health visitors, several other local authorities, including Køge, Næstved and Hedensted, showed interest in getting their health visitors to take the UCPH courses.

In Aarhus and Copenhagen, investment cases have been drawn up showing that money spent on upgrading health visitors’ skills here and now will lead to major savings later on, for example in reduced need for child placements and special needs education as more and more families can be offered support in time and fewer children will thus fail to thrive and go on to develop psychological difficulties and behavioural problems when they reach school age and in adolescence.

The health visitor is key to ensuring that social work functions well in Denmark. She is often the only one to see babies who in some cases are otherwise completely "invisible" to the rest of society because they are not in daycare and are only seen by e.g. a doctor if the parents themselves seek help. It is very exciting to see that we have been able to introduce a method that can be used by health visitors within the framework of the current health visitor scheme so that more families who experience difficulties can get access to the help early on that is so vital for a baby. Because of course the infant can't ask for help.

Over the period 2015-2018, Mette Skovgaard Væver and her research colleagues at the Centre for Early Intervention and Family Studies will have trained about two-thirds of all Danish health visitors in applying the ADBB method. Furthermore, Mette’s research shows that health visitors also use the new examination tool in practice, as 80% of the babies in the areas where the health visitors have been trained to use the ADBB method have subsequently been screened with the express purpose of detecting early indications of failure to thrive.

ADBB screening will make it possible in the future to study how many more children who are failing to thrive can be identified earlier with the ADBB method, and to follow their treatment and progress. The implementation of the ADBB method by 39 local authorities is a huge step forward in terms of the quality and consistency of the data we obtain about children's early development across local authorities in Denmark. The implementation of the ADBB method will thus contribute new data which can systematically document the effect of early intervention and its impact on greater problems in society, such as the cycle of intergenerational poverty.

Publications

Guedeney A, Lønfeldt N., Smidth-Nielsen, J., Væver MS (2017):" Implementation of the Alarm Distress Baby Scale as a universal screening instrument in primary care: Feasibility, acceptability, and predictors of professionals’ adherence to guidelines". National Journal of Nursing Studies. DOI: http://dx.doi.org/10.1016/j.ijnurstu.2017.11.005

Smith-Nielsen, J. & Væver MS. (2016): "Effects of maternal postpartum depression in a well-resourced sample: Early concurrent and long-term effects of infant cognitive, language, and motor development". Scandinavian Journal of Psychology, 57, 571-583. doi:10.1111/sjop.12321

Væver, MS., Smith-Nielsen & Lange, T (2016): Copenhagen Infant Mental Health Project: "Effects of the Indicated Prevention Approach 'Circle of Security – Parenting' – A Study Protocol", BMC Psychology, 4:57 DOI 10.1186/s40359-016-0166-8

Væver, MS., Beebe, B., Kirk, O., Snidman, N., Harder, S. & Tronick, E. (2015): "An automated approach for measuring infant head orientation in a face-to-face interaction". Behavior Research Methods, 47(2):328-39, DOI 10.3758/s13428-014-0487-6

Væver, M.S., Krogh, M.T., Smith-Nielsen, J., Kristensen, T. & Tharner, A. (2015): ”Infants of depressed mothers show reduced gaze activity during mother-infant interaction at 4 months”. Infancy, 20(4), pp.445-454. DOI 10.1111/infa.12082

Væver, MS., Krogh, M., Smith-Nielsen, J., Harder, S. & Køppe, S (2013): “Measuring Spatial Proximity in Mother-infant Interaction: A Kinematic Approach for an Examination of the effects of maternal postpartum depression”. Infant Behavior and Development, Volume 36, Issue 3, pp 427–431

The ADBB method is spreading throughout the country

• In the period 2015-2018, more than 39 Danish local authorities will screen all children using the ADBB method and generate a new registry of data relating to infants’ well-being or failure to thrive in Denmark. These data will provide us with new knowledge about the impact of introducing early health and social measures.
• 2015 The first 100 health visitors in Copenhagen are trained to use the ADBB method.
• 2016-17 The remaining 250 health visitors in the City of Copenhagen are trained in the method
• 2016-17 An additional 15 local authorities follow suit, including Vordingborg, Lolland, Hvidovre and Aarhus
• 2017 The first survey of the impact of the ADBB method on Danish healthcare practice shows that 80% of the babies in the areas where the health visitors have been trained in the ADBB method have been screened to detect any early signs that a baby is failing to thrive.
• 2018 Health visitors in a further 22 local authorities will be trained in the ADBB method, including in Høje-Taastrup, Middelfart, Skanderborg and Bornholm.

Investment case from Aarhus

The local authority in Aarhus has calculated that investing DKK 4.4 million in 2017 to train just half of the health visitors in using the ADBB method can be expected to yield a total net gain of DKK 6 million in the years 2018-2031. The savings come from a reduction in the number of hours needed to support children in childcare centres and special-needs classes, as it is expected that the ADBB screening programme will mean that five out of the 40 children currently receiving support will have a reduced need for such support in daycare, and that two children will not need special needs classes.

The Tryg Foundation is funding research into early intervention

Mette Skovgaard Væver’s application of the ADBB method into Danish healthcare practice is being supported by both the Tryg Foundation and by the local authorities who are making it a priority to train their frontline staff in the ADBB method.

Media reviews

September 2017: Interview in Altinget about the need for the systematic screening on infants (in Danish)

September 2017: Feature article in Altinget about the need for a national action plan for early intervention (in Danish)

January 2017: Analysis in the newspaper Politiken about the effectiveness and potential of the ADBB method (in Danish)

January 2017: Interview with the newspaper Ugebrevet A4 about the need for early detection (available in Danish at Ugebrevet A4's website)

August 2016: Article in the magazine Sundhedsplejersken about how to tetect early signs of failure to thrive (in Danish)