Key Highlights
What was this case study? South Warwickshire NHS Foundation Trust adopted the Parent and Baby Star as part of their Health Visiting service to demonstrate the full impact of their health visits.
Why was the Star chosen? – the Trust wanted a tool that would be flexible enough to work with parents who had differing needs, and to enable conversations that were about ‘doing with’ rather than ‘doing to.’
What was the impact? 80% of parents had improved in at least one outcome area between the antenatal visit and the six-week check, 58% in two or more outcome areas and 37% in at least three outcome areas. They reported a clearer picture of the lived experience of the family, more focus on the essential issues, and an improvement in parents’ ability to self-assess.
“The fact that the Parent and Baby Star was looking at perinatal mental health meant it tied in beautifully with the first 1001 critical days and the outcomes we wanted to show within health visiting” – Sam Game
South Warwickshire NHS Trust and the Parent and Baby Star
In 2019 South Warwickshire NHS Foundation Trust became the first NHS trust to adopt the Parent and Baby Star as an integral part of their Health Visiting service for the parents of newborns. The trust wanted to demonstrate the full impact of health visits but, crucially, was looking for a tool offering a “do with” rather than a “do to” model.
The Parent and Baby Star is the Star for people being supported with perinatal mental health and wellbeing. It was developed for parents who may need extra support during the perinatal period (during pregnancy and during the first year after having a baby). It helps new parents and the people supporting them to identify progress towards key outcomes like mental and emotional health, housing and essentials, support networks and looking after your baby.
Why was the Parent and Baby Star chosen?
Sam Game, Outcomes Star & Parenting Lead at the Trust, says that for Health Visitors who are coming into complex situations with new parents, it can be easy to fall into being directive with advice and support. However, conversations that open up possibility and ask more about what a person feels able to do can get more buy in from families. “The real shift I’ve been pushing with my staff is that as a Health Visitor, within a very short time, you’re thinking ‘this is what we need to do’, but actually you need to take parents on that journey. Otherwise, they might feel bombarded and not want to do it,” says Sam.
The Parent and Baby Star is a perfect fit for an enabling approach like this. “We really liked that the Star dovetailed so much with what we were already doing,” says Sam. “The fact that it was looking at perinatal mental health meant it tied in beautifully with the first 1001 critical days and the outcomes we wanted to show within health visiting.”
“The Star areas give families a really good handle on what health visitors do. We can leave them with a clear picture that says if you need more support in any of these areas, come back to us."
Implmenting the Parent and Baby Star
Health Visitors are highly skilled and extremely busy people, and many don’t use IT in their day-to-day practice, so the Trust took a lot of care with the implementation. Sam’s team decided to start small, with just one Star reading at the postnatal visit at six weeks. If a parent placed themselves at less than 3 on any scale, the Health Visitor would see them again and offer regular support, doing more Stars as needed.
The team made up special packs for Health Visitors with a coloured laminated Star diagram, User Guide, and short Scales for parents. All health visitors received a full day’s training. And in an inspired move, the team gave everyone a Star to go on their lanyards after training.
“At first, Health Visitors thought it was a bit cheesy,” says Sam. “But very soon they liked being able to show that they were trained – and children really like the fact that Health Visitors have a Star on their lanyard.”
The initial project proved so successful that health visitors and service users wanted more. Sam’s team did an audit after the first year, and the main theme was that they should be doing more Stars and more regularly.
As a result, the Trust brought in an additional Star reading at the antenatal visit. “We avoided the birth visit because a lot of data and assessment already takes place at that point,” says Sam.
The Impact the Parent and Baby Star has had
Warwickshire now has over 4,800 Stars under its belt, with multiple benefits across service delivery, including a clearer picture of the lived experience of the family, more focus on the essential issues, and an improvement in parents’ ability to self-assess. Many of these benefits align with the six principles of
Across Warwickshire, Sam has found that 80% of parents had improved in at least one outcome area between the antenatal visit and the six-week check, 58% in two or more outcome areas and 37% in at least three outcome areas.
Sam identifies that the Star gives families a clearer idea of the role of health visitors. In the past, although the health visitors had a clear agenda, parents might experience the visit as just ‘a chat’ and not necessarily remember what was covered.
“The Star areas give families a really good handle on what health visitors do,” says Sam. “We can leave them with a clear picture that says if you need more support in any of these areas, come back to us. The outcome areas give parents permission to say: ‘my relationship has broken down, or my support network’s gone to pot, or my housing’s not good, but I can still phone my health visitor – it doesn’t just have to be about my baby.’”
Unlocking deeper conversations
Health visitors found that the precise parameters of the Star and the trust that it engendered could often unlock deeper conversations. “It makes it easier to focus on the important issues and ask relational questions,” one health visitor told Sam.
“One or two parents surprised me by admitting they weren’t connecting with their baby when on the surface, all appeared well. You get that partnership feeling much more when using the Star. We’re getting richer information and more honest information out of families than before.”
“When someone has a small baby, they worry if they’re doing it right, but how do we define what’s right? Being able to say to families that they’re doing well and pictorially showing them that by using the Star helps them to understand that they’ve got strengths.”
Building belief that change is possible
For parents, the Star’s visual nature helps them understand what they’re doing well and what they can aim to change. “We like the pictorial element of the Star,” says Sam. “I think it’s really powerful because otherwise parents can get lost in the words used by the professionals. They can see progress on the Star diagram and realise they’re doing OK, and that’s very reassuring.”
“When someone has a small baby, they worry if they’re doing it right, but how do we define what’s right? Being able to say to families that they’re doing well and pictorially showing them that by using the Star helps them to understand that they’ve got strengths.”
Supporting to parents build capabilities to do things differently
The action plans that form part of many Star readings are an important developmental tool. Sam encourages health visitors to complete them with all parents requiring additional support: “There’s something really valuable about how the Star makes it clear so parents know what they need to do, and what the health visitor will do before they see them again.”
Sam emphasises the importance of health visitors not doing things for parents, but to support them on their own journey of change.
“Taking them on that process is helpful,” says Sam. “It enables families to realise that it’s about them. If they’re going to feel empowered to parent, it’s about how they do it and their strengths and motivations.”
One parent commented: “I was struggling with my mental health, and it showed on the Star. The health visitor and I agreed on the help I felt I needed. After a few weeks, she used the Star again, and we could both see the difference the support I had received had made.”
Tailoring the support to the person
As a universal service, health visitors need a tool that is flexible enough to work with parents who are managing relatively well and those who have complex needs. Warwickshire has found that the Parent and Baby Star works well across the spectrum of needs – and gives real flexibility to parents themselves.
“Where parents can’t see the wood for the trees, the Star can help with that,” Sam comments. “It enables health visitors to support parents to identify which issues to deal with first and give them that choice and autonomy (unless it’s a safeguarding issue), which is really quite powerful.”
The Star can also be used with both parents, which can often be helpful for inclusion and communication between them. And importantly in a service that is at full capacity, it’s a highly effective way of working out where additional support is needed, allowing health visitors to concentrate efforts where they are most valuable. “If parents are at 4 or 5, the chances are that they can use universal services and are doing OK, so we can use the Star to help health visitors let go of families too,” says Sam. “The Star allows us to demonstrate to families when they are managing well without additional support and when they need further support.’”
Holistic – looking at the whole picture and joining the dots
Another benefit is that the scales allow parents to see the whole picture of their situation with a new baby more clearly, meaning that they and health visitors spot things that might otherwise be missed. This can range from relatively straightforward issues, such as understanding that the parent’s own health matters, as well as the baby’s health, to more sensitive areas. The “Relationship” scale, for example, covers a range of possibilities, from communication problems following birth to domestic abuse.
“My relationship with my husband wasn’t healthy, and we used the Star with the health visitor, it showed,” reports one service user. “The health visitor discussed the impact the relationship might have on me and my children and helped me to think more about things. After our meeting, I decided to start taking steps to get help for me and my children.”
Highlighting the impact of the wider environment
The Housing and essential outcome area in the Parent and Baby Star looks explicitly at whether parents have a stable and suitable home and money for basics such as food, heating and baby equipment, and at how much stress this is causing them. As well as assessing parenting, health visitors are aware of other external factors affecting the parent’s ability to cope. While health visitors often cannot help with these directly, they do acknowledge the problems and refer to other services where possible.
The Star data also helps to identify particular pockets of need. Sam’s team used it to compare the level of need before and after lockdown during Covid across all fifteen teams of health visitors and found a significant increase in the need for social support experienced by one team.
“Health visitors didn’t have any spare capacity, so we decided to pilot a project with Home-Start who are going to provide social support as well as support with the basics,” says Sam. “They’re going to use the Star to decide which parents are offered entry into the pilot project as well as use it again at the end to assess change.”
The impact: the Star facilitates an enabling approach
The overall experience for Warwickshire has proved highly positive – for health visitors, managers, and parents alike. And while Sam’s team already championed an enabling approach, the Star has made that much easier to put into practice.
As Sam comments: “It’s much easier to be inclusive when you’re using the Outcomes Star.”
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