RESEARCH 

better First 
outcomes 
steps to 
A postnatal group was set up in Walsall to offer support to new 
parents in dealing with the challenges they face. It’s been such a 
success it is now being rolled out. Jayne Hollinshead and Keri 
Christie explain. 
The transition to parenthood can be stressful, and 
The PHE identification of the six early years many women feel isolated 
as they care for a baby 
high-impact areas for health visiting (PHE, 2014) (Deave et al, 2008). 
The significance of positive 
provided an opportune and timely framework for support during the 
transition is well evidenced, 
the development of the course (see box, page 44). and it provides a 
pivotal opportunity for health 
Local child health data evidenced poor outcomes 
# visitors to 
utilise their public health role to facilitate 
that could be addressed while facilitating local and promote parental 
efficacy (Solmeyer and 
parent networks (PHE, 2016). Feinberg, 2011). Increasingly, new 
mothers have no 
The First Steps group was designed to run for access to extensive social 
systems, and a growing 
six weeks, each session lasting for one and half body of research has 
highlighted social support as 
hours. Two members of staff – usually a health necessary in promoting 
maternal confidence and 
visitor and a nursery nurse – would facilitate optimising parenting skills 
(Cabral, 2013). 
the group to ensure that, if a parent required In Walsall, local women 
reported to health 
additional support, help was available. It was visitors that they had little 
opportunity to gain 
piloted with a group of 10 mothers and, each an understanding of what to 
expect in the early 
week, a different topic was covered. postnatal weeks. They were 
therefore often unprepared for the demands of parenthood. 
WEEKS ONE TO THREE Almost one-third of children (29.2%) in 
Walsall live 
Week one covered the transition to parenthood, in poverty (HMRC, 
2011). The lower an individual’s 
which is a pivotal life change in terms of roles, social economic position, 
the worse their health 
responsibilities and identities for men and women will be (WHO, 2011). 
This indicates considerable 
(Deave et al, 2008). Parental wellbeing is fragile disadvantage for 
residents of the borough. 
during this transition period, with many new Furthermore, children 
resident in Walsall have poor 
parents feeling overwhelmed by their new role health and wellbeing 
compared with the national 
(Solmeyer and Feinberg, 2011). averages (Public Health England (PHE), 
2017). 
The PREview tool in Preparation for Birth and Supporting disadvantaged 
families early in 
Beyond (Department of Health, 2012), was used a child’s life is a 
cost-effective way to improve 
to develop this session. The session included outcomes for families in the 
short and long 
a quiz that enabled parents to collectively term (Field, 2010), so health 
visitors decided to 
consider true and false statements about the resurrect the traditional 
postnatal group. It was 
 demands of parenthood. Members of the group hoped this would allow 
parents to think about 
were encouraged to think about what they their parenting role and the 
child’s developmental 
worried about in their new parental role and needs, and to become 
equipped with knowledge 
their aspirations for themselves and their infant. and skills to address 
health needs for themselves 
This highlighted similar concerns that the new and their children. The 
overall aim of the course 
mothers shared. It was acknowledged that stress was to reduce social 
isolation for local parents and 
and anxiety could occur at this time, and parents to promote positive, 
confident parenting. 
were encouraged to consider resources and 
42 Community Practitioner September 2017 

KEY POINTS 
After identifying a gap in provision for new parents, health visitors set up First Steps postnatal group. 
# 
Its main aim was to reduce social isolation for the parents, help them cope with the emotional challenges they faced and 
promote confident parenting. 
# 
The group presented a chance for health visitors to encourage parents to think about their role and the child’s 
development, and increase awareness of their family’s health. 
# 
Giving support to disadvantged families early in a child’s life is a cost-effective way to improve outcomes for families in 
the short and long term (Field, 2010). 
# 
Early intervention can promote infant development and help protect against emotional ill health. 
 
 THE BOROUGH OF WALSALL, COMPARED WITH THE REST OF ENGLAND 

29.2 
% 
The percentage of children living in poverty in Walsall (the national average in England is 20.1%) 
of 4- to 5-year-olds and 19.8 
% of 10- to 11-year-olds in Walsall are obese 
of worst-performing areas for child poverty 
(Sources: PHE, 2017; HMRC, 2011) 

11.3 
% 
The borough is in the bottom 
RESEARCH 
support networks available to them. These included family, friends, voluntary agencies, such as Home-Start children’s centres, 
health visiting teams, libraries and leisure centres. 
In week two, play and development was explored. Evidence from neuroscience and social science demonstrates that the first 
two years of life are of fundamental importance in creating solid psychological and neurological foundations to optimise lifelong 
social, emotional and physical health, and educational and economic achievement (Department for Education, 2013). It also 
recognises that strong parent-child attachment and positive parenting can influence a child’s conduct, educational achievement, 
health, physical and emotional wellbeing. 
A family support worker demonstrated how to make treasure baskets to teach young babies how to select, touch, taste and feel. 
The nursery nurse led a discussion about the developmental ability of young infants, aimed at improving parental insight into the 
value of play and positive parent-child interaction, facilitating a good attachment between caregiver and infant, thus leading to 
better long-term emotional and social outcomes for the child (Naughton, 2013; Department for Education, 2013; NICE, 2012). 
The importance of warm, sensitive and responsive communication was reiterated and the parents were informed about infant 
states and infant cues. 
In week three, perinatal mental health was covered. Mental disorders during pregnancy and the postnatal period can have 
serious consequences for the mother, infant and other family members (NICE, 2014). Disorders are common; many are serious 
and can have long-lasting effects on maternal health and child development (Maternal Mental Health Alliance, 2014). 
The health visitor led a discussion with the group regarding the prevalence of mood disorders in the antenatal and postnatal 
periods. Parents were encouraged to consider the signs and symptoms of anxiety and depression, and were made aware that their 
health visitors were available to support them should they be experiencing any difficulties. In addition, other support such as the 
GP and local talking therapy service was signposted. 
An emotional wellbeing practitioner from Walsall Healthcare NHS Trust attended the session to explore with parents ways of 
promoting positive emotional health, including mindfulness techniques, exercise and socialisation. A short mindfulness exercise 
was practised as part of the session. Participants were then asked to reflect on enjoyable activities prior to parenthood and how 
they might incorporate some ‘me time’ into their lives as parents. 
WEEKS FOUR TO SIX Introduction to solids was in week four. Developing healthy eating and activity habits early in life is 
critical for optimum growth and development and for maintaining a healthy weight throughout childhood and later life (iHV, 
2015). Parents completed a quiz to ascertain their knowledge and beliefs around the nutritional requirements of their infant and 
readiness for solid foods. A group discussion was followed by a DVD that demonstrated baby-led weaning, as recommended by 
NHS guidelines (NHS, 2017). 
Week five’s session was on managing minor illness and reducing visits to A&E, which have increased by around 25% over the 
past 10 years (NHS England, 2017). The majority have been deemed 
September 2017 Community Practitioner 43 
 
. 
RESEARCH 
44 Community Practitioner September 2017 
THE SIX EARLY YEARS HIGH-IMPACT inappropriate attendances that could have been 
AREAS managed within a primary care setting (Roland and 
Abel, 2012). The session aimed to educate parents on managing common minor illnesses; the health visitor determined parental 
knowledge of these and explored how they could manage them. 
Parents then watched an interactive presentation on the common reasons for attending the local emergency department, such as 
fever, coughs and colds, and chicken pox. They were provided with evidence-based information on how to self- manage these 
conditions and were advised when to seek medical advice. Home safety information was also discussed in relation to the age and 
stage of a child’s development in the early years. The last of the six sessions offered the opportunity for parents to share contact 
details, to facilitate ongoing relationships to offer mutual support. This promotes the development of social capital and enhances 
social cohesion by local networking beyond the confines of the First Steps group (Mackereth and Appleton, 2008). Health 
visitors assisted parents in taking footprints of their baby on a printed poem as a memory of the group and of how the health 
visiting team supported their transition to parenthood. 
Following each session, parents evaluated its usefulness and their confidence in relation to newly acquired knowledge. This 
enabled the facilitators to consider any required amendments. 
ONGOING BENEFITS The final course evaluation gave parents the opportunity to describe how attending the group had 
benefited them. Learning to parent was the motivating factor for attending and, while the social aspect was an advantage, the 
group particularly valued being able to receive professional advice alongside other mothers. They also praised the opportunity to 
share aspects of parenting that caused anxiety. 
Mothers from the group have continued to meet weekly. They described to health visitors how they gained the longer-term 
value of supportive friendships that developed as a result of the group. Subsequent group graduates have been signposted to the 
social sessions, which have been successfully running for over a year. 
The initiative has been so successful it is being rolled out across the health visiting teams and will be offered across the 
borough by the end of 2017. And, as a result of the perinatal mental health session addressing the benefits of physical activity on 
emotional wellbeing, one mother set up a Walsall Ready Steady Mums parent- led exercising group. It meets weekly for a buggy 
walk and to share experiences of parenthood and extend social support networks. 
The new service vision has a specific community tier, and practitioners need to influence managers and commissioners to 
understand that caseloads provide a legitimate 
# 
Transition to 
gateway into the community, enabling health parenthood and the 
visitors to familiarise with existing networks and early weeks. 
mediate between communities and the health 
# 
Maternal mental health. 
service agenda. The course has been awarded 
# 
Breastfeeding 
a grant from the Burdett Nursing Fund to be (initiation and duration). 
developed further and is being accredited by the 
# 
Healthy weight, healthy 
Institute of Health Visiting. 
CP nutrition (to include physical activity). 
JAYNE HOLLINSHEAD 
# 
Managing minor 
Senior lecturer, University of Wolverhampton illnesses and reducing hospital 
KERI CHRISTIE attendance/admissions. 
Health visitor, Walsall Healthcare NHS Trust 
# 
Health, wellbeing and development of 
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