Summary of the impact

This case study focuses on the construct of mind-mindedness: parents' or carers' ability to `tune in' to what their young children are thinking or feeling. Durham-based research highlighted how parental mind-mindedness is associated with a range of positive child and family outcomes, and has had impact via two main routes: (a) advice and support offered to parents (10,000 copies of the NSPCC's All Babies Count booklet and associated social media sites reaching 800,000 parents), and (b) interventions targeted to improve outcome in parents and families experiencing difficulties.

Underpinning research

Mind-mindedness is defined as caregivers' proclivity to treat their young children as individuals with minds of their own, and is operationalised in terms of caregivers' ability to `read' their babies' thoughts and feelings during play interactions in the first year of life through their use of mind-related comments (Meins & Fernyhough, 2012; Meins et al., 2001, 2012). Caregivers who are mind-minded tend to comment appropriately on what the baby might be thinking or feeling (e.g., saying that the baby likes or is interested in a toy that he is playing with, or that the baby is excited if she squeals joyfully), and avoid making comments that are non-attuned to the baby's internal state (e.g., saying that the baby is bored with a toy when still actively playing with it, or attributing emotions such as fear or anger in the absence of any overt cue to indicate such an emotion). Unlike sensitivity, which assesses global aspects of parenting, mind-mindedness thus focuses on very specific parenting behaviours and gives a clear indication of the parent's ability to `read' the baby's behaviour accurately.

Durham-based longitudinal research (Grants 2, 3 and 5 below, and PhD research) reported that parental mind-mindedness during the child's first year of life is associated with positive outcomes in key developmental milestones in the early years. Higher levels of early mind-mindedness predict (a) a secure infant-parent attachment relationship (Arnott & Meins, 2007; Meins et al., 2012), (b) superior language and play abilities at age 2 (Meins, Fernyhough et al., 2013), and (c) children's understanding of other people's thoughts and feelings at age 4 (Meins, Fernyhough et al., 2013). Higher levels of early mind-mindedness also protect children against later behavioural difficulties, specifically in the context of low socio-economic status (Meins, Muñoz-Centifanti et al., 2013). These positive outcomes are over and above any contribution of general parental sensitivity to the child.

Commenting appropriately on the baby's thoughts and feelings thus lays the foundations for optimal parent-child relationships and scaffolds children's own understanding of other people's perspectives and mental states. Moreover, in the more stressful conditions associated with low socio-economic status, being able to `tune in' to the child's thoughts and feelings enables parents to comprehend their children's behaviour, making them less likely to perceive behaviour as problematic.

Another ESRC award (Grant 4 below) investigated mind-mindedness in mothers who were hospitalised with their babies in order to receive treatment for a range of severe mental illnesses (Pawlby et al., 2010). On admission, depressed mothers tended to make fewer appropriate comments about their babies' thoughts and feelings than did psychologically well mothers. However, this difference was not observed at discharge, highlighting an improvement in mind-mindedness in depressed mothers during their stay in hospital.

References to the research

The underpinning research resulted from five awards: one from The Leverhulme Trust and four from the Economic and Social Research Council (ESRC). The total amount for the five awards was £650,364. For three of the ESRC awards, the principal investigator was Meins (1997-2000, 2001-2004, 2005-2008); Fernyhough was principal investigator for the other award (2003-2006). All of these awards were made while these researchers were full-time (Meins) or part-time (Fernyhough) members of academic staff at Durham University. In September 2000, Meins was awarded a mid-career award from the Society for Reproductive and Infant Psychology for "an outstanding contribution to research".

Publications

Grants

1. September 1997 - February 1999
Meins, E., & Zeedyk, M. S. `Maternal assignment of infants' mental agency as a predictor of security of attachment'; £30,000 funded by The Leverhulme Trust.

2. November 1997 - February 2000
Meins, E., & Fernyhough, C. `Mind-mindedness and security of attachment as predictors of mentalising abilities'; £42,000, funded by the ESRC.

3. October 2001 - April 2004
Meins, E., Leekam, S. R., & Turner, M. A. `Developmental outcomes of joint attention and maternal mind-mindedness'; £204,000, funded by the ESRC.

4. November 2003 - August 2006
Fernyhough, C., Bentall, R. P., Meins, E., Corcoran, R., & Morrison, A. `Infant-mother interaction in a sample of mothers with psychosis.' £41,999, funded by the ESRC.

5. April 2005 - April 2008
Meins, E., Fernyhough, C., de Rosnay, M., Arnott, B., & Vittorini, L. `Internal working models and young children's social-emotional development.' £332,365, funded by the ESRC.

Details of the impact

Our research findings have been disseminated to relevant professionals via presentations, mind-mindedness training courses, the freely-available on-line Mind-Mindedness Coding Manual, media appearances and social media such as Twitter.

Findings from References 1, 2 and 3 above have fed into the NSPCC's All Babies Count programme and Baby Steps perinatal education service. The All Babies Count campaign was launched in November 2011 and has an associated advice booklet that informs parents in simple terms about mind-mindedness (Source 1 below, pp 4-5). The NSPCC reported on the campaign on May 28^th 2012 (Source 2 below). At this time, the booklet had been viewed over 1500 times online and more than 10,000 copies had been distributed to parents via healthcare professionals. The report stated that:

• All Babies Count was Mumsnet's campaign of the week in January 2012.
• All Babies Count was mentioned 6,914 times online, with 5,911 uses of the Twitter hashtag #allbabiescount, reaching an estimated 800,000 followers.
• All Babies Count Facebook tab received 26,950 views.
• All Babies Count microsite was visited by 56,979 people, with 66,137 total visits and a `bounce rate' (i.e., number leaving the site after viewing only one page) of only 8.4%.
• In the launch month, 42% of Westminster MPs stated they were aware of the campaign, with public support from MPs Ian Duncan-Smith, Graham Allen and Catherine McKinnell.

Mind-mindedness research is cited and discussed in the practitioners' manual for the NSPCC's Baby Steps service. The aim of Baby Steps is to support vulnerable families in the transition to parenthood using "a variety of interactive approaches to engage and support parents, and to help them recognise and respond to their babies' cues" (Source 3 below, p. 2). Over 850 parents in England and Wales have accessed this service since April 2012, with positive early evaluation results (Source 2 below).

For the past decade, clinical psychologists at the Royal Bethlem Hospital in London have been using mind-mindedness in their intervention programmes with depressed mothers and those hospitalised on a residential mother-and-baby unit (MBU) for a range of severe mental illnesses. At present, two clinical psychologists on the MBU are delivering a mind-mindedness intervention programme designed by Meins. The intervention involves filming the mother interacting with her baby and then playing the filmed interaction to the mother to highlight times when the mother was being mind-minded and examples of when she was less attuned to her baby's thoughts and feelings. Around 500 mothers on the MBU have benefited from this programme, which has aided recovery and enabled them to return home with their infants. A mother who took part in the programme discussed its importance and effectiveness on Radio 4's All in the Mind (Source 4 below):

"When we looked back at the video it's the first time that I saw my reaction to him... and it was the first time actually that I thought, `Well, how would I feel if I was looking back at that face and hearing that voice?' I'd feel a sense of sadness — that's not the way I need to communicate with him... Before that, I used to think, `Well, you know, he's just a baby.' I didn't think that they had those kind of emotions, and at the time, I thought, `I'm feeding him, he's clothed and I respond to him when he cries.' And if you think, `Well, that's enough, and... the rest will just fall into place', well it's actually not enough. And it's not until you experience the joys of understanding them as a human being, understanding them as a person and seeing them respond to you; there's an immense joy from that. The first time you actually recognise them responding to you, that's when it all changes and it's beyond just meeting their practical needs".

Mind-mindedness research has informed the Minding the Baby intervention programme, which supports high-risk, vulnerable young mothers through an intensive programme of home visits delivered by a nurse or social worker. The aim of Minding the Baby is to make mothers more aware of their babies' mental states and to voice their babies' emotions and thoughts (i.e., facilitate mothers' mind-mindedness). This programme has been running for a decade in New Haven, USA, and the NSPCC began using this programme in 2011 in four areas across the UK. Over a five-year period, the UK-based programme will provide support for 320 families.

Clinical psychologists in Oxfordshire and The Netherlands have applied the underpinning research to their programmes for foster carers and adoptive parents. Mind-mindedness has been used in this context both to help inform the intervention (Source 5 below) and to assess the effectiveness of the intervention programme (Source 6 below).

Recent research in Australia has investigated mind-mindedness in practitioners working in a child-care centre (Source 7 below). Higher levels of mind-mindedness were found to be associated with more sensitive caregiving and more stimulating play and interaction, but mind-mindedness was not related to practitioners' level of qualification. On the basis of these findings, the authors recommended that mind-mindedness should be incorporated into child-care workers' education and professional development. In follow-up work (Source 8 below), these authors report on a workshop programme they developed to increase levels of mind-mindedness in child-care workers. In the UK, mind-mindedness research has informed projects such as The Baby Room at Canterbury Christ Church University which provides support, education and training to childcare professionals who care specifically for the very youngest children (<18 months) in daycare.

Sources to corroborate the impact

Sources

1. All Babies Count: Support for parents. NSPCC document, November 2011. http://www.nspcc.org.uk/help-and-advice/for-parents-and-carers/guides-for-parents/all-babies- count/all-babies-count-pdf_wdf90718.pdf
2. How we made All Babies Count: Reach and impact of the All Babies Count Campaign. NSPCC document, May 28^th 2012.
3. Hogg, S. (2013). Birth and beyond: Supporting parents in the antenatal period. Journal of Health Visiting, 1, 2-5.
4. Radio 4 All in the Mind broadcast: http://www.bbc.co.uk/programmes/b01pbqkh
5. Colonnesi, C., Wissink, I. B., Noom, M. J., Asscher, J. J., Hoeve, M., Stams, G. J. J. M., et al. (2012). Basic trust: An attachment-oriented intervention based on mind-mindedness in adoptive families. Research on Social Work Practice. DOI: 10.1177/1049731512469301.
6. Gurney-Smith, B., Granger, C., Randle, A., & Fletcher, J. (2010). `In time and in tune' — the Fostering Attachments Group. Adoption and Fostering, 34, 50-60. DOI: 10.1177/030857591003400406
7. Degotardi, S., & Sweller, N. (2012). Mind-mindedness in infant child-care. Associations with early childhood practitioner sensitivity and stimulation. Early Childhood Research Quarterly, 27, 253-265. http://dx.doi.org/10.1016/j.ecresq.2011.09.002
8. Degotardi, S., Semann, A., & Shepherd, W. (2012). Using practitioner inquiry to promote reflexivity and change in infant-toddler early childhood programs. In P. Whiteman & K. De Gioia (Eds.), Children and childhoods: Contemporary perspectives, places and practices. Newcastle-upon-Tyne, UK: Cambridge Scholars Publishing. ISBN: 978-1-4438-3456-8

Contacts

Development Manager for Children Under One, NSPCC, Weston House, 42 Curtain Road, London EC2A 3NH.
Institute of Psychiatry and Royal Bethlem Hospital, PO 71, Section of Perinatal Psychiatry, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF.
University of Amsterdam, Nieuwe Prinsengracht 130, 1018 VZ Amsterdam, The Netherlands.
Institute of Early Childhood, Macquarie University, Sydney, NSW 2109, Australia.
Consultant Chartered Clinical Psychologist, Clinical Lead for the ATTACH team and Lead for Mental Health of Looked After and Adopted Children, Oxfordshire County Council.