463 British Journal of Midwifery • July 2015 • Vol 23, No 7 COMMENT © 2015 MA Healthcare Ltd Early interventions for antenatal mental health difficulties Midwives have a critical role to play in not only identifying women with mental health difficulties but also in referring them on to specialist services. Within the NSPCC, a number of innovative interventions have been developed to support parents with mental health difficulties, with midwives taking a central and essential role in their delivery. Two of these programmes are discussed below. Minding the Baby Minding the Baby is an evidence-based and preventive home-visitation intervention programme for vulnerable first-time young parents and their babies. It was originally developed by Yale University in 2002, and has been found to have a positive impact for parents and children (Sadler et al, 2013). The NSPCC has slightly adapted the programme for pragmatic use in the UK and it is being evaluated in a multi- centre randomised control trial in England and Scotland. Minding the Baby is a relationship-based, interdisciplinary, and trauma-informed programme. It combines two well- researched early-intervention models; home visiting and infant–parent psychotherapy, in order to meet the holistic, complex, multiple-layered care needs of vulnerable families. Midwives work in close alliance with a social worker/ psychotherapist to provide the programme from mid-pregnancy through to 2 years postpartum. Evidence shows that improving parental mental health on its own will not necessarily improve parent–infant relationships or infant outcomes, and any treatment of parental difficulties should focus both on improving symptoms as well as parent–infant interaction quality (Forman et al, 2007). The programme is therefore grounded in attachment theory (Bowlby, 1969) and parental reflective functioning (Slade, 2005), and focuses on addressing parent–infant mental health issues as well as the evolving parent– infant relationship, positive parenting and developmental outcomes. A key feature of the Minding the Baby model is a focus on the development and enhancement of parental reflective functioning, which is defined as an intra- and interpersonal capacity that allows a parent to envision the baby’s (as well as their own) internal experience, specifically her or his emotions, thoughts and intentions. The emphasis on the enhancement of parental reflective functioning stems from the morass of literature that identifies clear concordance between parental reflective functioning and the intergenerational transmission of attachment, and particularly to the development of secure infant–parent attachment (Fonagy et al, 1995; Grienenberger et al, 2005). Parents who are able to use reflective functioning capacity are not simply reacting to their infant’s behaviour; they are responding to the infant’s mental states (e.g. emotions, needs, desires) in a reflective manner. This is associated with a range of positive developmental outcomes for the child (Slade, 2005; Slade et al, 2005). Baby Steps Baby Steps is an innovative nine-session perinatal psychoeducational programme co-developed by the NSPCC and Professor Angela Underdown from Warwick University. Following a home visit, parents attend weekly group sessions in the 6 weeks leading up to the birth, another home visit and a further 3 sessions after the baby is born. The programme is delivered by a midwife or health visitor together with a children’s services practitioner, bringing a crucial combination of skills to address the emotional, social and physical needs of expectant parents. Baby Steps is based on the Department of Health’s Preparation for Birth and Beyond Camilla Sanger Development Manager for Children Under 1 NSPCC Alice Haynes Research and Policy Analyst for Children Under 1 and Neglect NSPCC Gary Mountain Associate Professor in Child & Family Health University of Leeds & Minding the Baby Clinical Supervisor NSPCC Naomi Bonett-Healy Baby Steps Midwife NSPCC Early intervention programmes for mental health from the NSPCC: Part 2 The NSPCC is dedicated to perinatal wellbeing and advocating for a preventive model of care that has the potential to improve the mental health for parents, families and communities. Here in the second of two articles, Camilla Sanger, Alice Haynes, Gary Mountain and Naomi Bonett-Healy describe two evidence-based perinatal NSPCC services facilitated by midwives.