1 Tameside and Glossop Integrated Perinatal and Parent Infant Mental Health Model (May 2017) Introduction Tameside’s approach to meeting the mental health and emotional needs of parents and their infants is based on two fundamental principles: 1. The potential complexity of factors involved from conception through to early life is such that no single practitioner or intervention can be expected to meet the family’s needs . 2. Parental mental health problems around the perinatal period are rarely rooted solely in the present. The impending birth of an infant can stir up unresolved issues that draw the parents past right into the present, potentially interfering with their growing relationship. These two principles have profoundly shaped the provision of services in Tameside. With regard to the first of these principles, Tameside’s innovation has been to provide a small specialist service that has provided a way of integrating a huge number of health and children’s service practitioners, along with volunteers. In doing this, Tameside has provided a service that is both cost effective and able to draw on the expertise of a great many people. In relation to the second principle, the Tameside and Glossop Early Attachment Service (EAS) has drawn together evidence based findings from neuroscience, attachment and developmental research, and has done so within a broadly psychoanalytic framework that focuses on the crucial significance of the relationship between the parents and their infant. Tameside’s aim in its provision of services is also straightforward, namely, to effectively and cost effectively meet the needs of all families, right up to those with the most severe mental health problems and/or safeguarding issues. Adherence to the first of the principles above is how we achieve this. It is essential to recognize that no single intervention can be expected to rectify a situation. Rather, a variety of interventions are needed and in most cases they need to be adapted, rather than employed “off the peg”. Each family is considered entirely on its own merit, and referrals are made to whichever personnel or service is appropriate to deal with specific issues. In relation to the most severe cases, it is highly likely that psychiatry will be involved, and safeguarding if that is the nature of the issue.
Transcript
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Tameside and Glossop Integrated Perinatal and Parent Infant Mental
Health Model (May 2017)
Introduction Tameside’s approach to meeting the mental health and emotional needs of parents and their infants is based on two fundamental principles:
1. The potential complexity of factors involved from conception through to early life is such that no single practitioner or intervention can be expected to meet the family’s needs.
2. Parental mental health problems around the perinatal period are rarely rooted solely in the present. The impending birth of an infant can stir up unresolved issues that draw the parents past right into the present, potentially interfering with their growing relationship.
These two principles have profoundly shaped the provision of services in Tameside. With regard to the first of these principles, Tameside’s innovation has been to provide a small specialist service that has provided a way of integrating a huge number of health and children’s service practitioners, along with volunteers. In doing this, Tameside has provided a service that is both cost effective and able to draw on the expertise of a great many people. In relation to the second principle, the Tameside and Glossop Early Attachment Service (EAS) has drawn together evidence based findings from neuroscience, attachment and developmental research, and has done so within a broadly psychoanalytic framework that focuses on the crucial significance of the relationship between the parents and their infant. Tameside’s aim in its provision of services is also straightforward, namely, to effectively and cost effectively meet the needs of all families, right up to those with the most severe mental health problems and/or safeguarding issues. Adherence to the first of the principles above is how we achieve this. It is essential to recognize that no single intervention can be expected to rectify a situation. Rather, a variety of interventions are needed and in most cases they need to be adapted, rather than employed “off the peg”. Each family is considered entirely on its own merit, and referrals are made to whichever personnel or service is appropriate to deal with specific issues. In relation to the most severe cases, it is highly likely that psychiatry will be involved, and safeguarding if that is the nature of the issue.
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Since the parent-infant relationship may be negatively influenced by many issues in the life of the mother and father, including the risk of mental ill-health over the perinatal period, all therapeutic work can begin before the birth of the child. Often it can be difficult to establish clear water between the perinatal mental health needs of the parent and the relationship between the parent and the infant. It is important that perinatal specialists and parent-infant relationship specialists work together in the wider professional network around parents and parents to be. Every time we can help to reduce the overall burden on a family then we are removing an obstacle to its success and increasing the likelihood of the child’s positive development. Almost invariably this calls for complex multi-agency working (PIPUK, 2017). The Tameside EAS model and the Tameside Integrated Parent Infant Mental Health Pathway Tameside’s EAS helped develop a service pathway which is used to guide the linkage of agencies, volunteers etc and help practitioners think about the level of support a parent and infant might need both in terms of their mental health and parent-infant relationship. However, the pathway is not the model, it is only part of it. EAS does not simply provide services, or even simply coordinate them. Rather, EAS strategically leads across the borough in partnership with all services to foster a change in the culture amongst practitioners and communities to raise awareness of the importance of the perinatal period. This is done by fostering the development of practitioner knowledge and skills, and providing consultation and supervision to other professionals about their own cases. In this fashion, EAS has been able to ‘grow’ a service from very small beginnings using a very small team. Such an approach assures the continuing maintenance and development of the service, even if changes to available resources occur in the future.
Background The health and care of parents and their new babies are usually provided by a range of services and professionals who not only have different focuses and training, but who also may have different understandings of mental health. Some of this care may focus on the health and development of the infant and some may focus on the parent’s problems and anxieties. No arena is more complex than that of perinatal parent infant mental health. Infants start to be influenced by their emotional and physical environment from the moment of conception, and the two years following birth is fundamental to the subsequent development of the individual (as clearly highlighted by the government’s 1001 Critical Days manifesto). This critical period can be hugely emotionally arresting for the parents as well, where a parent’s own experience of childhood may be stirred and interfere with the relationship to the baby. With the promising investment of perinatal monies into services, we have an opportunity to better meet the needs of parents and their infants. Pregnancy, birth and the first 24 months can be tough for every mother and father, and some parents may find it very hard to provide the care and attention their baby needs. But it can also be a chance to
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affect great change, as pregnancy and the birth of a baby is a critical ‘window of opportunity’ when parents are especially receptive to offers of advice, support and treatment (1001 Critical Days Manifesto, 2015).
The Tameside model is comprehensive, cost-effective, sustainable and effective. It offers to change the culture amongst practitioners and communities. This model of culture change can be achieved through everyone sharing an understanding of the importance of:
1. The perinatal period is a time of heightened sensitivity, emotional upheaval, rapid physiological changes and exposure to the baby’s raw emotions can stir unresolved issues from the parents own early childhood and interfere with the relationship to the baby (Ghosts in the nursery, Fraiberg, 1975).
2. From birth to age 18 months, it has been calculated that connections in the brain are created at a rate of a million per second. The earliest experiences shape a baby’s brain development, and have a lifelong impact on that baby’s mental and emotional health (1001 Critical Days manifesto, 2015).
3. Attachment is the name given to the bond a baby makes with its caregiver/s. There is longstanding evidence that a baby’s social and emotional development is affected by the quality of their relationship to their parents. The importance of the first relationship between an infant and parent cannot be understated (1001 Critical Days manifesto, 2015).
Imparting this knowledge and helping everyone in the community to understand their role in supporting families during the perinatal period is done by threading knowledge through all levels and across all services (e.g., Maternity, Health Visiting, Adult mental health, Children’s Centres, Children’s social care, and Non-statutory organisations, etc). This has meant developing resources for parents that are universally available, and organising and facilitating training for practitioners from a wide range of settings. Core to this are the Health Visitors, Midwives, Children’s Centre, Home Start and IAPT staff who have been trained and supported (through consultation and supervision) by the EAS staff to develop and use a comprehensive knowledge and understanding of perinatal mental health and parent infant mental health in all their work (see Appendix for table of services provided by multi-agencies for families from pregnancy to their child’s 2nd birthday). They will have the confidence, skills and knowledge to identify mental health and parent infant relationship difficulties and work with parents. Health visitors and midwives take responsibility for the less serious parent-infant relationship difficulties and, through receiving support from EAS in this work, grow in confidence, knowledge and skills in this vital area. This frees up the time of more specialised clinicians to see those parents who are most in need of their attention.
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antEE
Maternity
Enhanced Midwifery
Perinatal/PIMH liaison
EAS/Enhanced Maternity
liaison
Community Midwifery
NICU
Health Visiting
Antenatal Visits
Healthy Child programme
PIMH/perinatal Mental Health
Building Community Capacity –
Home Start
Home Start
PIMH Coordinator
PIMH volunteers
Adult Mental Health
Healthy Minds: Babies
Can’t Wait
Perinatal/PIMH Specialists
RAID/Home treatment
team
CMHT/Inpatient Unit
Children’s Social
Care
Leaving Care/LAC
Women’s Centre
Children’s Centres
Single Point for
Parenting/parent Infant
relationship group Referrals
Parent-infant
relationship
EAS 0-5
MBU –Wythenshaw
Hospital
FNP
PIMH Integrated Pathway
Given the numbers of parents who would benefit from early perinatal and parent-infant relationship support, a comprehensive prevention and early intervention approach is the only feasible option. Therefore it is important to provide a strong emphasis on promoting understanding of perinatal parent infant mental health from the ‘bottom up’, rather than providing a service from the ‘top down’.
Meeting different levels of need: the Thrive model In Tameside we have always been of the opinion that all families should have a service available. Of course, people with very severe needs deserve the most intense and immediate attention. At the same time, it must not be forgotten that the vast majority of families are not in this category. Even a very small improvement in family functioning can potentially have a huge actuarial impact on society. In order to achieve a service that can work at so many different levels it has been essential to develop a way of sharing a conceptual framework about the needs of different families, and how the services would seek to meet their needs. Currently, Tameside and EAS have adopted the Thrive model for this purpose. The T&G Integrated PIMH Pathway was revised in 2016 and also adopted the Thrive model. The THRIVE model proposes to replace the tiered model with a conceptualisation of a whole system approach that addresses the key issues outlined above and is aligned to emerging thinking on payment systems, quality improvement and performance management. Rather than an escalator model of increasing severity or complexity, the framework outlines groups of children and families, and the sort of support they may need.
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The THRIVE framework below conceptualises five needs-based groupings for infants, children and young people with mental health issues and their families. The image on the left describes the input that is offered for each group; that on the right describes the state of being of people in that group.
Tameside and Glossop Integrated Parent Infant Mental Health Pathway (2016)
The 2016 pathway was revised by a multi-agency working group, with the aim of promoting a seamless, flexible and high quality responsive care for all families. It also has been developed to capture all possible services who may come into contact with families during the perinatal period. Thereby providing guidance to all services on how to manage the risk of mental ill health and parent infant relationship problems, and how they might support the family to access services in a timely manner. The current version of the PIMH pathway represents a major revision of the 2011 document and has been guided by: The 1001 Critical Days Manifesto (2013), the Ante-natal and Post-natal NICE guidelines (2014), and the Tavistock and Portman NHS Foundation Trust and the Anna Freud Centre (AFC) THRIVE model for children, young people and their families mental health services (Wolpert, Harris et al., 2014). It was also guided by the increasing recognition that Fathers can also present with difficulties during the perinatal period (see NSPCC, All Babies Count: The Dad Project, 2014).
Thrive, Early Attachment Service (EAS) and their partnerships
EAS has adopted the Thrive model and therefore, ensures we are supporting families throughout the model. While we may not directly work with families who need advice, we may be developing resources for their use, or supervising the practitioner who may
be running a group the family is attending. We ensure that our expertise, knowledge and skills is accessible and at the front door (see EAS Thrive Model in Appendix).
EAS provides a Consultation Service, Supervision and Training
EAS staff are embedded within Maternity, Health Visiting, Early years, CAMHS, Home Start, Women’s Centre, Social Services and Adult mental health services. This ensures cross fertilisation of the approach and seamless pathways for parents into other services. It also allows EAS to see on the ground what is working, what is not, and where are the gaps and thereby enabling us strategically to influence and develop services for families. For example, EAS developed a post-natal programme (Early Start) as there was a gap in provision of a parent infant relationship group for parents and babies post-natally. We have recently trained a number of multi-agency staff in Baby Bonding which facilitates both individual and group approaches for parents antenatally and post-natally and focuses on reflective functioning and enhancing the parent-infant relationship. EAS is a specialist psychotherapeutic service. EAS staffing should include a child psychotherapist and others may be health visitors, clinical psychologists, and social workers (see staffing model in Appendix). EAS is clinically led by Consultant clinical psychologist who has had additional specialist training in Psychotherapy and Psychoanalysis. The Lead is important not only in clinically managing the service, but strategically leading the development of perinatal and parent infant mental health services across the borough. The team provides a consultation service for all children and adult services staff, as well as providing direct clinical intervention. Perinatal Adult Mental Health Practitioner: In Tameside we have a dedicated perinatal adult mental health practitioner based in Healthy Minds. This role has been crucial in raising awareness of the importance of the perinatal period both in terms of mental health and the parent infant relationship in adult mental health services. In addition, the role has enabled the development of services that better meet the needs of parents during the perinatal period. In 2015 Healthy Minds created the Babies Can’t Wait initiative. Now all referred parents have priority access to specialist mental health care during the antenatal period and up to the 2nd birthday of their child. Parents are encouraged to feel that their infants are welcome in sessions and their infant’s needs are kept in mind throughout the session. Support is provided for the parent to gain confidence in consoling infant distress and in helping the infant emotionally to regulate; difficulties with this can be actively addressed within therapy. Parental support needs within and outside of sessions are considered and if necessary liaison with other agencies will take place. Healthy Minds have two perinatal clinicians who have a special interest and further training in parent infant mental health and attachment, and receive additional supervision from EAS. Home Start: Whilst specialist PIMH support is available to families from EAS, Adult Mental Health, Maternity and Health Visiting, we realised what was missing was low
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level support for parents individually and also help to engage them with local children’s centres and other community provision. This type of proactive parental engagement and support would be most beneficial in ensuring the best use of specialist resources whilst promoting long term community support networks to build resilience. This gap in services led to a partnership between EAS and Home Start. The CCG funded a Parent Infant Mental Health (PIMH) Coordinator based in Home Start. The PIMH Coordinator works with EAS to promote and enhance the importance of the parent-infant relationship with families during the 0-2 period. Through the PIMH Home Start Coordinator, the paid and volunteer workers work in close partnership with EAS and other specialist services, forming a vital conduit for ensuring that escalating needs are identified and met earlier. Training and supervision of the PIMH Home Start coordinator is provided by EAS. A training programme in PIMH was developed by EAS, Home Start and Tameside Health Visiting for the volunteers. The training of volunteers has been very successful and effective. The partnership with Home Start has allowed us to develop further services where we are now working together on a project looking at improving the engagement of fathers during the perinatal period.
A further partnership within this initiative was developed with Tameside Health Visiting. Health Visitors are specialist community public health nurses with expertise in promoting the health and development of children aged 0-5 years, and family and community health. A service priority for Health Visitors is to engage with communities in a way that builds local capacity.
EAS and Children’s Social Care
Recently EAS has created a new post in partnership with Children’s Social Care. We have appointed a social worker to the team. In particular, we are interested in young parents who are Care Leavers and ensuring we support them during the perinatal period to reduce the effects of transgenerational trauma. In addition, we are also interested in supporting parents who have had previous children removed and are at high risk of having another baby taken into care. We are currently running a women’s group for women who fall into this group. The group has been well attended and is helping mothers begin to reflect and understand emotionally what has happened to them, and has also given them the confidence to engage in other services.
Training
From a strategic view EAS recommends external training for multi-agency staff to ensure Tameside is providing the latest evidence based practice (e.g., NBAS, NBO, Antenatal Baby Bonding training, etc). In addition, EAS develops and delivers a rolling programme of high quality multi-agency training in parent-infant relationships, and perinatal mental health. Training is always reviewed and revised in relation to feedback and also new research. Training of often co-delivered with colleagues from Adult Mental Health, Maternity and Health Visiting.
EAS Direct Specialised Clinical Intervention
EAS offers a specialist therapeutic service in the community as well as reaching into the post-natal wards, adult inpatient wards, Neonatal Intensive Care Units and on Mother
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and Baby Units as required. The team works closely with specialist midwives for mental health, safeguarding and teenagers, Family Nurse Partnership teams, Community Mental Health (Adult), Healthy Minds and Healthy Young Minds, General Practitioners, Children’s Social Care and multi-agency early intervention teams. The team works from a psychoanalytic model and employs a range of therapeutic approaches. We are directed by the principle of ports of entry, where we consider the need to be flexible and open to ensure we can find a way in to meet the needs of parents and their infants, at a time when they are in emotional turmoil. This often means that initially no one therapeutic approach is taken, but that the focus is to find a way to engage the family and to begin to effect a shift emotionally. We focus on both the ‘inner’ and ‘outer’ worlds of expectant and new parents, and how they adapt to the changes and react to the emotions that are stirred during the perinatal period. Neither parent nor infant is a passive recipient of what is going on. While the infant is affected by the parent, the parent also is deeply affected by infant. Parental reflective capacity (Fonagy, Jurist & Target, 2002) has been identified as crucial to promoting healthy relationships. In other words, a parent’s capacity to keep her infant in mind makes it possible for him to discover his own mind. Parent infant psychotherapy has a momentum of its own, as issues reverberate back and forth on several registers –between the therapist and parent centres on present concerns and moves back and forth between past and present, between mother and child, and back to the mother’s own past, hopefully helping the parent understand what they are feeling, but also what the baby is feeling. EAS Interventions include: parent-infant psychotherapy, Interaction guidance, and adult psychotherapy. Families may receive a range of interventions depending on their changing needs and there is no restriction on the length of time a family receives support from EAS.
SUMMARY
EAS was commissioned over 10 years ago. We started from humble beginnings but have grown considerably, due to the support of enlightened commissioners who have had the foresight to see ahead for the need and importance of developing early intervention services. The strength of the service comes partly from the drawing together of neuroscience, attachment and developmental research, placing it within a psychoanalytic framework that focuses on the crucial significance of the relationship between the parents and their infant. Also, the small specialist team coordinates the efforts of many services, practitioners and volunteers, thus enabling a cost-effective service that can respond to all levels of service need, including those with severe problems. This team itself provides a clinical service, but also develops and offers training, and provides consultations to other professionals. It has also provided us with a framework to think about the emotional effect of this work on practitioners and they type of training and support they need in order to carry out the work.
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Dr. Pauline Lee Consultant Clinical Psychologist , Lead for EAS May 2017
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TAMESIDE PROVISION TO SUPPORT THE PARENT INFANT RELATIONSHIP FROM PREGNANCY UP TO 2 YEARS
AGE LEVEL OFFER PREGNANCY Thriving Getting it right from the start DVD/Booklet: Given out by maternity at 20 week scan
and by Health Visitors. This booklet and accompanying DVD on attachment and bonding is for new parents to meet the views from parents that they want information about relating to babies, in an accessible format, which featured parents they could relate to, and included what happens when things go wrong. Developed by the Early Attachment Service (EAS) in Tameside in partnership with the Brazelton Centre UK the booklet draws on the Neonatal Behavioural Assessment Scale (NBAS) was a key influence. Now available on YouTube in full version and separate chapters: https://www.youtube.com/watch?v=8isPZ8JYTR8. It has also been translated into
Thriving Ante-Natal workshop offered by Midwives. Antenatal classes open to all, partners are encouraged to attend. Parent infant relationship discussed alongside skin to skin contact, dads advised that they too can provide this.
Getting Advice and Getting Help
Home Start PIMH volunteers – Partnership with EAS, Home Start PIMH coordinator and Tameside Health Visiting. Home Start volunteers are trained in 4 session training in PIMH to work with families from pregnancy up until the child’s 2
nd birthday.
Thriving and Getting Advice, Getting Help
Baby and Me Antenatal-Postnatal Group - Group for parents which focuses on enhancing parents' capacity to think about their baby as an 'intentional being' with its own feelings, and to try to see the world from the baby's point of view. This heightened awareness and sensitivity helps parents to bond with their baby, and helps the baby to form a secure attachment to its parents. This in turn has a significant impact on the child's cognitive, social and emotional development. Baby and Me will be co-facilitated by multi-agency staff.
Getting Help, Getting Advice
Referral to Healthy Minds. The ‘Babies Can’t Wait’ agreement means that all pregnant women or those with children under the age of two years and their partners can access Healthy Minds (IAPT) service directly following referral, avoiding any wait
Getting more help and getting risk support
Referral to enhanced midwifery service for extra support during pregnancy/postnatal period Referral to specialist consultant at hospital, Referral to specialist midwife, and Provision for extra/more flexible visiting schedule via enhanced team
Getting more help and getting risk support
Mellow Bumps- 6 weeks group for pregnant women and dads-to-be • 2 hours a week for 6 weeks • reduces toxic stress • introduces babies’ brain development • explains the social capacities of babies • identifies parents’ own needs
Getting help and Getting more help
Family Nurse Partnership (FNP) 20 weeks gestation under 19 years of age
MODERATE-HIGH Early Attachment Service (EAS) – pregnancy to 5 years of age
Women’s Group
POST-NATAL BIRTH TO 1 YEAR
Thriving and getting advice
Newborn Behavioural Observation (NBO) – birth to 3 months. NBO is a tool that provides an introduction to parents to their newborn’s behaviour, personality and preferences, thereby promoting the development of the parent-infant relationship. It is used with babies from birth to three months old and the process helps build a collaborative relationship between parents and health professionals. All Health Visitors, all Midwives from Enhanced Team, Nursery Nurses are trained in NBO. Parents will be offered it by Health Visitors universally at the new birth visit.
Early start post-natal group – birth to 1 year. Post-natal group for parents and babies that focuses on enhancing the parent-infant relationship and infant development.
POST-NATAL BIRTH TO 1 YEAR
Getting help Referral to Healthy Minds. The ‘Babies Can’t Wait’ agreement means that all pregnant women or those with children under the age of two years and their partners can access Healthy Minds (IAPT) service directly following referral, avoiding any wait.
Getting help Nurture Well: This is a therapeutic group for mothers and babies offered by Healthy Minds which focuses on mental health and the parent-infant relationship. It aims to nurture mother’s wellbeing and help them to nurture well; to promote the mental health recovery of new mothers; and to promote and nurture a positive attachment between mother and infant.
Getting help and getting more help
NBAS: Birth to 8 weeks: NBAS is an in-depth screening tool which assesses infant functioning in autonomic, motor, state and social interactive systems, and identifies infant strengths, personality, and areas that would benefit from support. A Health Visitor from each team is trained and accredited to provide NBAS. Their provision of NBAS and additional knowledge and supervision is a valuable resource for other Health Visitors and teams in their localities.
Getting Advice and Getting Help
Home Start PIMH volunteers – Partnership with EAS, Home Start PIMH coordinator and Tameside Health Visiting. Home Start volunteers are trained in 4 session training in PIMH to work with families from pregnancy up until the child’s 2
nd birthday.
Getting more help and getting risk support
Mellow Parenting – infants under 12 months 14 week group for parents with social and emotional needs, including anxiety and depression
• improves parental mental health • increases positive parent-child interaction
Mellow Parenting programmes break negative cycles and build good relationships. They’ve been shown to improve parent-child interaction, child behaviour problems, parents’ wellbeing, parents’ effectiveness, child development, self-esteem and confidence and children’s language development.
Women’s Group - therapeutic group for supporting women who have had previous children taken into care
Getting more help and getting risk support
Early Attachment Service (EAS) - pregnancy to 5 years of age
6 months to 2 years
Thriving and getting advice
SOLIHULL APPROACH UNDERSTANDING YOUR CHILD’S BEHAVIOUR Group It is based on the principles of containment, reciprocity and behaviour management. A train the trainer model, led by Health Visiting, will cascade the Solihull Approach to all early years staff working with families with ongoing supervision and support within the EAS supervision network.
Getting Advice and Getting Help
Home Start PIMH volunteers – Partnership with EAS, Home Start PIMH coordinator and Tameside Health Visiting. Home Start volunteers are trained in 4 session training in PIMH to work with families from pregnancy up until the child’s 2
nd birthday.
Getting help Referral to Healthy Minds. The ‘Babies Can’t Wait’ agreement means that all pregnant women or those with children under the age of two years and their partners can access Healthy Minds (IAPT) service directly following referral, avoiding any wait
1 year to 2 years
Getting more help and getting risk support
Mellow Parenting –14 week group for families with additional health and social care needs • improves adult wellbeing • improves child behaviour, language and learning
• increases positive parent-child interaction Mellow Parenting programmes break negative cycles and build good relationships. They’ve been shown to improve parent-child interaction, child behaviour problems,
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parents’ wellbeing, parents’ effectiveness, child development, self-esteem and confidence and children’s language development.
Getting more help and getting risk support
Women’s Group - therapeutic group for supporting women who have had previous children taken into care
Getting more help and getting risk support
Early Attachment Service (EAS) - pregnancy to 5 years of age
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EAS and Thrive:
•EAS offers:
•Mellow Bumps
•Mellow Parenting
•Parent-infant psychotherapy
•Adult psychotherapy
•parent work
•Group for Women who have had their children removed or are at risk
•LAC/Leaving Care
•PIMH Risk Assessment
•EAS consultation and joint working with colleagues and services
•Multi-agency working
•observational and emotional assessment
•EAS—Health Visitor Liaison
•EAS- Enhanced maternity liaisan meetings
•EAS joint working with colleagues
•Baby and Me Ante-natal-post-natal group (EAS superrvision)
•Solihull Approach/Parenting (EAS supervision)
•Consultation with colleagues and services
•Healthy Minds Nurture Well group (EAS supervision)
• NBAS (EAS supervision)
•Single Point Under 5’s
•Baby and Me Ante-natal-post-natal group (EAS superrvision)
•Early Start post-natal group (EAS development, training and supervision)
•NBO (EAS supervision)
•Solihull Approach/Solihull parenting ( EAS supervision)
