Babies Brains’: A mental health program
for promoting parenting
skills for parents of ‘at risk’ children.
Dr Pam McGrath, B.Soc.Wk., MA., Ph D
International Program of Psycho-Social
Health Research (IPP-SHR)
National Research on Disability and Rehabilitation Medicine
Griffith Health Institute
LO5, Level 1
PO Box 1307
Kenmore Qld 4069
Nicole Rawson-Huff, BSc (Hons) Project Officer
International Program of Psycho-Social
Health Research (IPP-SHR)
National Research on Disability and Rehabilitation Medicine
Griffith Health Institute
LO5, Level 1
Hamish Holewa, B. Sc (Comp Sci), B Ed, GradDipHEcon
Institute of Health and Social Science
160 Ann St
McGrath P, Rawson-Huff N & Holewa H (2012). ‘Building Babies Brains’: A mental health program for promoting
parenting skills for parents of ‘at risk’ children. International Journal of
Psychosocial Rehabilitation. Vol 16(2) 106-113
authors would like to thank the many participants who gave their time
and insights to this research project. The authors would also like to
thank Mr Neil Alcorn & Ms Teresa Vant and the staff at the Mater
Parent Aide Unit, Mater Hospital. The authors wish to acknowledge team
members that contributed to this report, including: Ms Mary-Anne
Patton, Ms Bo McGrath, Ms Elaine Phillips & Mr Michael Bouwman.The
authors acknowledge the support of the Institute of Health and Social
Sciences and the Faculty of Sciences, Health and Engineering,
CQUniversity and Centre of National Research on Disability and
Rehabilitation Medicine, Griffith University.
Building Babies’ Brains (BBB) program aims to educate new parents,
particularly parents of children considered psychologically ‘at risk’,
about the vital impact their interactions have on their child’s brain
development and mental health. BBB offers a comprehensive support
package which includes recruitment into the ‘Getting to Know You’
(GTKY) parent education workshops, 12 months Mater Aide follow-up
support and 18 months subscription to Noah’s Ark services. This paper
presents research findings on an evaluation of the GTKY workshop that
indicates that such a program has the potential to be a significant
proactive mental health initiative for parents and infants.
Factors associated with positive outcomes include the provision of
social support and normalisation of the parenting experience,
self-esteem and confidence building through networking with peers, self
expression in a non-judgemental group environment, and parental
education through information provision. Limitation and suggestions for
further developments of the program are included. The hope and
expectation is that the findings will help encourage the further
development of such programs elsewhere.
Keywords: Mental health, rehabilitation; parents; infants; psychosocial; communication.
Bayer and associates (2007) note, mental health problems are a public
health issue affecting as many as 20% of children in modern
communities. The quality of parent-infant communication has
long-lasting effects and is seen as an important factor associated with
the mental health of the developing child (Hotelling, 2004). Attachment
studies of families at social risk demonstrates that disorganized
attachment behaviours in infancy are important precursors to later
psychological and mental health disturbances (Baradon, 1999; Lyons-Ruth
et al., 2006). This early vulnerability is related to patterns of
parent-infant affective communication observable by the end of the
child's second year. Thus, interventions that promote positive
parent-infant interactions are noted as strategies that can help to
reduce the risk of poor developmental outcomes for the child (Leitch,
1999). Literature indicates that good infant mental health places the
child at a lifelong advantage for sound teenage and adult
The Building Babies’ Brains (BBB) program aims
to educate new parents, particularly parents of children considered
psychologically ‘at risk’, about the vital impact their interactions
have on their child’s brain development and mental health. BBB offers a
comprehensive support package which includes recruitment into the
‘Getting to Know You’ (GTKY) parent education workshops, 12 months
Mater Aide follow-up support and 18 months subscription to Noah’s Ark
services. This paper presents research findings on an evaluation of the
GTKY workshop, independently conducted by the International Program of
Psycho-Social Health Research (IPP-SHR), that indicates that such a
program has the potential to be a significant proactive mental health
initiative for parents and infants.
The Building Babies Brains (BBB) Program
Mater Parent Aide Unit (MPAU) at Mater Children’s Hospital, Brisbane,
Australia, in conjunction with Noah’s Ark Children’s Resource Centre
has been conducting a pilot project titled, ‘Building Babies Brains’
(BBB). BBB aims to educate new parents, particularly parents of
children considered psychologically ‘at risk’, about the vital impact
their interactions have on their child’s brain development and mental
health. This is in response to peer-reviewed recognition of the need to
promote emotional availability and secure attachment during a baby’s
first 12 months of life (Berlin & Cassidy, 2001). As Hotelling
(2004) details, educational strategies are now available to facilitate
and improve the basis of effective communication for parents and their
infants. BBB is a support and education package based on presentation
and discussion of a training DVD delivered to new parents who have been
referred to the Mater Parent Aide Unit from the Community Hospital
Integration Nurse and who have difficulty being ‘emotionally’ available
to their newborn. The program offers enrolment in the ‘Getting to Know
You’ (GTKY) workshops, 12 months support services offered by the Parent
Aide Unit and membership to Noah’s Ark play group.
GTKY workshops are run over a 7 week period and are designed to
educate and support new parents who have difficulty being ‘emotionally
available’ for their newborn. The program teaches parents to recognise
and respond more appropriately to their infant’s earliest
communications, including: enhancing the infant’s brain
development, promoting emotional wellbeing and facilitating the
development of ‘secure attachment’. The program is offered to 4 groups
of parents over a 12 month period and started on the 21st of July 2008.
The GTKY program has been designed and developed by the NSW Institute
of Psychiatry. Theoretically the GTKY workshops are based on the
Transactional Model (Sameroff, 1975; Sameroff & MacKenzie, 2003)
that respects the dual contribution to the child’s development of both
nature and reaction to events in the environment. In the Transactional
Model the infant is perceived as developing in maturational sequences
fostered or hindered by their relationship to significant others
responsible for physical, emotional and social support. The GTKY
program recognises the value of early interaction to brain and
behavioural development through an understanding of a phenomenon known
as ‘neural plasiticity’, which is a process by which experience is
incorporated into the structure of the brain. As detailed by Nelson and
Bosquet (2000), neural plasticity means that both positive and negative
experiences can alter the structure and function of the brain, and as a
consequence affect cognitive, social and emotional functioning during
The study was an evaluation
of the GTKY workshops based on a qualitative methodology. Human
Research and Ethics Committee approval was obtained from both hospital
and university HREC prior to commencement of data collection and full
consent obtained from participants. The data collection was conducted
at CQ University and analysis and write up completed at Griffith
Interviews were conducted after the
participants had completed the course. The program evaluation
focused on the individual positive and negative experiences with the
program and the perceived changes that participants experienced in
their parenting skills, relationship with their infant and in the
Potential participants were
identified by a MPAU member, who was independent of the course , with
the assistance of an IPP-SHR Project Officer. A MPAU member promoted
and provided project information about the study during the end of the
GTKY courses. Included in this information was a project description
and potential requirement if agreeing to participate. Participants were
informed that they may be contacted by an IPP-SHR project officer and
if they did not wish to participate, that they could either tell the
MPAU member or IPP-SHR Project Officer. If they agreed to participate,
the IPP-SHR Project Officer arranged an interview time. Participants
were selected from the five Building Babies Brains’ courses.
Twenty-three potential participants were contacted, with ten declining
participation or being unable to be contacted. Thirteen parents
participated in the in-depth interviews, consisting of twelve mothers
and one father. Participants ranged in age from 21 to 43 years. A
diverse family composition was represented in the cohort with nine
married, two separated and two single parent families. Twelve of the
families had one child whilst one had a family composition of two
Interviews were conducted by an IPP-SHR research
member. The interviews were audio recorded, transcribed verbatim and
de-identified. Once transcribed, the interviews were loaded into the
QSR NVivo computer package and coded (free nodes). The coding was
conducted by IPP-SHR project officers experienced in the NVivo computer
package. The naming and development of the codes was driven by the
exact words of the participants. All data collected were entered into
codes. The data were then thematically analysed by collapsing the free
nodes down into broad thematic categories and used to provide an
evaluation of the BBB program.
Project management and collaboration was managed using Quadrant™, an online Qualitative collaboration software tool.
The Course Experience
participants were referred to the course by Mater Parent Aide staff,
with some referrals originating from the Young Women’s Program and from
other health care professionals at the Mater Hospital. Most
participants indicated that they wanted additional support and
appreciated the referral to the program:
• I kind of went along because I felt that I needed as much support as I could get.
noted that attending the course after the birth of their baby was
beneficial as it allowed them to raise issues associated with their
newborns as they happened. Participants indicated the informality of
the course and the small class sizes gave them confidence in expressing
issues to the group, for example:
Cause it was only two mothers we had a bit of time just to talk
generally, just about us rather than the course and so in that sense I
think I got my needs met in that I was able to talk about those issues,
The participants also appreciated the non-judgemental environment, for example:
(Interviewer) Was there an accepting feel within the room that you
could pretty much throw anything out there? (P) Yeah yeah it was pretty
open for it, yeah it was fine yeah, it is nice to feel that space.
courses that did not have a high attrition rate, the ability to
socialise following the formal component of the course was also valued,
The best thing I liked was very, very friendly. It’s not like formal
meeting sort of thing [unclear] having sandwiches and then tea, watch
DVD and then talking about things with other mums.
even in such a supportive environment, one participant indicated that
participating in a group is a difficult experience, for example,
Yeah for me personally I found it quite difficult, I’ve had a pretty
tough time throughout, yeah having both of them so yeah I find the
whole group thing quite -difficult personally but not because they’re
not lovely and everything.
For some, the
continuing relationships between course participants led to the
development of a playgroup after the course had finished.
Yep, yeah so it’s been really good because … we decided you know
we all got on so we made like a baby group that we see every fortnight.
for courses in which the majority of attendees failed to attend,
participants indicated that the course did not offer many social
opportunities. For some, travel distance or return to work inhibited
relationships with course participants after the cessation of the
course despite participants mentioning that it may be beneficial.
participants indicated that their male partners attended the course and
that they were appreciative that the course was open to partners.
One participant also appreciated the learning opportunity that the
course provided for her partner, particularly as this was the first
child for her partner. However, due to the lack of other fathers
present in the course and the consequently high number of mothers
present, two participants indicated that, after the initial welcoming
experience, their male partner felt intimidated and ceased course
Course Structure and Delivery
BBB course is based on the viewing of a DVD on baby development
followed by informal discussion of the content and the distribution of
relevant written material. Tea and refreshments were offered as
part of the informal group experience. There was some
disagreement on the suitability of course structure and delivery.
participants indicated that the DVD was the correct length as due to
fatigue from caring for a newborn, they were not able to remember much
material and appreciated the reduced information and content:
…weren’t very long at all. That was great because you know if they
had’ve given us a big lengthy DVD, you know, lots of material, I
basically wouldn’t, I wouldn’t of been able to concentrate cause I was
only really able to concentrate for short periods you know.
a few participants indicated that it would have been better to have a
more structured and organised course with much more content. In
particular, participants indicated that the DVD was not long enough and
did not cover enough content for the time dedicated to the course.
was a strong indication that the amount of written information provided
to course participants was adequate, with many indicating that they
already felt overburdened with information and written material from
Practical Issues to Course Attendance
team at BBB organised transport for the course attendees. A majority of
participants indicated that the provision of transport, and
communication with BBB concerning the arrangement of transport
facilitated course attendance. Some participants indicated that the
provision of transport assisted them in leaving the house with their
baby and decreased isolation, apprehension and anxiety, for example:
they did, they did at first cause otherwise I’m not allowed to drive
for a couple weeks (Interviewer) yes cause your operation, yes. (P)
yeah that was really helpful, so I wouldn’t feel confident drive myself
and the baby at that time, really nervous as well.
Participants also noted the ease of parking helped in maintaining course attendance.
Social Support and Normalisation
majority of participants indicated that the BBB’s course allowed them
the opportunity to leave their domestic premises and attend a social
function which catered for themselves and their infants, for example:
It does help because I know a lot of people they won’t really go out.
If they have some sort of social interaction they’ve got more of a
reason to you know be social with their babies and that.Many
participants found that being able to attend a social situation in a
safe and relaxed environment assisted in creating confidence to be able
to leave their house with their new born. A majority of
participants indicated that they felt an affinity with staff and
described them in positive terms. Participants noted that this helped
them to continue participation in the course, for example:
Indeed, social contact and creating a network was mentioned as a strong factor for continued attendance, for example:
• It was more the social side of things, I think that's why I kept going.
• I mean it was lovely, they were all lovely you know and they provided lunch and that was nice.
indicated that the informal method of the course and strong social
environment assisted in raising questions to peers, learning from
others and normalising their own experience of caring for an infant.
Sharing experiences of parenting allowed participants to reflect on
their practices and gain confidence and lessen anxiety associated with
their perceived parenting abilities, for example:
No I really enjoyed it, I enjoyed all those little moments because of
it and you know I knew things were normal and I was doing things right
so it just made me more relaxed and happy with what I was doing.
was particularly important for parents that did not have many other
parents in their immediate social network. Participants also noted that
it was helpful to compare and observe babies of similar age and their
development. Many participants indicated that the information provided
by the course made them more confident parents, enabling them to better
interact with their newborn, for example:
No just keep on doing that and yeah, just keep helping out other
mothers who, like me who you know, haven’t had a lot to do with kids
and sort of been thrown into the deep end so yeah it’s good. Yeah I
did, I actually was very thankful that I did that course because I was,
when I was telling other people about the course they were like, wow I
wish I had done that when my kids were little so you know, yeah so.
Baby Development Issues and Bonding
participants indicated that the course helped in understanding
development, nurturing and the importance of interaction.
Participants indicated that the course enabled them to understand cues
and gestures made by their infant and how to respond appropriately to
such communications, for example:
Oh like you know maintaining, just like you know some of the things
like eye contact and learning how when they’re tired and when they’re
hungry and how they communicate and you know that smile that they give
right at the beginning isn’t wind, it’s actually, you know they’re
actually smiling at you. I got some beautiful smiles and I appreciated
that when she said that cause when (baby) did smile it was like, ‘yes
she’s smiling, it’s not wind’ you know.
subtle cues associated with infant fatigue was also commonly noted and
appreciated by course participants, for example:
What I do particularly remember was like we were talking about looking
out for baby signs, like baby messages. Like when they’re tired, when
they blink a lot and when they’re you know because of their attention
span they, it’s quite small, yeah I never really knew much about that.
it was noted that the participants learnt the importance of activities
such as eye-contact and its impact on infant neural development, for
I saw DVD, even really brand newborn baby can see who’s their mum
through contact them with eyes, things like that. I really didn’t
expect that, I didn’t know that so that was I think, that was you know
the biggest information that I got from.
course also assisted participants in understanding the impact that a
positive social and caring environment had on brain development, for
They showed us a diagram that was quite recent about a baby’s brain and
how to make it positive and you know a good childhood how many things
in the brain there was whereas if they had I don’t know, I guess
parents that were mean to them and like from an abusive childhood the
development would go back because the first five years are the most
important as childhood like with the developmental and foundations and
making them safe and that.
associated with learning baby cues and signs were appreciated as
participants indicated the material had not been covered in other
provided discussion on a number of limitations of the present course
and made recommendations for the future development of the program.
Many participants indicating that not only would they have liked to
know about the course before birth, but to have had the chance to meet
and develop relationships with other expectant parents and develop
familiarity with the course convenors. Early contact would provide
parents with a good opportunity to obtain information regarding the
immediate time after birth.
Participants felt that the title
‘Building Babies Brains’ was incorrect as it did not reflect the
course’s primary emphasis on understanding babies cues and the impact
that positive relationships have on neurological development. The need
to explain the course content and objectives before enrolment was
Numerous participants felt the DVD and course
content was too basic and condescending. Some participants felt that
the information presented in the course was already readily available
and wished that they had been informed of the content before
participation. In particular, a majority of participants indicated that
they would have appreciated more discussion regarding the reality of
caring for a newborn and the time and energy required. Participants
indicated they would appreciate information and the opportunity to
discuss issues associated with fatigue, time management and
relationship information. This is particularly important as many
participants indicated they had fragmented relationships and unstable
living situations. In addition, every participant expressed a desire to
obtain more information regarding breastfeeding and would have
appreciated the support and advice of a lactation consultant. A strong
recommendation from the research is that a lactation consultant and
child health nurse be integrated in the class content and delivery.
were problems with the program for those who attended groups with small
numbers. Indeed for some, the group numbers were sometimes as small as
two attendees. For those with a male partner, there was agreement on
the need to incorporate greater partner involvement. Such participants
thought that a group specifically designed for fathers would assist in
their parent confidence and skills, understanding their baby and
contribute to having a greater involvement in parenting.
findings indicate that the BBB program assisted parents to better
understanding infant brain development and methods of infant
communication. Participants indicated that they were better able to
apply this new knowledge and understood the importance of positive
nurturing and interaction with their infants. Leitch (1999) had similar
findings with regards to the use of videotaped educational information
as a method of facilitating very early mother-infant interaction. The
findings resonate with the work of Censullo (1994) who found that there
was a significant increase in the level of responsiveness and parental
self-esteem scores after the intervention based on a
parent/infant interaction coaching procedure.
indicated that this social component and knowledge gained from the
course assisted in raising their confidence levels regarding their
parenting skills and ability. The provision of transport, venue
location and easy parking was also noted as a positive practical
component to course attendance. Participants also indicated that the
course provided opportunity to socialise with other parents who were
also experiencing similar phases of development with their infant. This
social component normalised their parent experience and alleviated
social isolation. Scott and associates’ (2001) research on
parent-focused education groups similarly found that social contact was
an important aspect of the group experience and provided evidence of
continuity of this contact after the completion of the groups.
Scott and associates (2001) concluded that such programs may be
an important vehicle for enhancing social support during the transition
to parenthood and thus be a useful primary prevention strategy.
range of recommendation for future development of the course are useful
not only for the convenors of the present BBB course but for other
readers seeking to run such a program.
findings from the BBB program provide fresh insights on the potential
for parental support and education groups as a proactive mental health
strategy. The hope and expectation is that the research findings can be
used by others in the field of mental health for further program
development as a resource that can reach a wide diversity of
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