Throughout this year, we will be shining the spotlight on a service, community, team or individual putting ACEs or trauma informed approaches at the heart of what they do. Our first focus is on Gloucestershire’s Health Visiting Service.

Tell us about health visiting?

The Health Visiting Service workforce consists of Specialist Community Public Health Nurses- Health Visiting (SCPHN), Public Health Nurse Practitioners and Community Nursery Nurses who provide expert information, assessments and interventions for babies, children and families. This includes first time parents (mothers and fathers) and families with complex needs. Health visitors help to empower parents to make decisions that affect their family’s health and wellbeing and their role is central to improving the health outcomes of populations and reducing health inequalities.

Who do you work with?

We work across many stakeholders, settings and organisations to lead the delivery of the Healthy Child Programme 0-5 (HCP), a prevention and early intervention public health programme at the heart of the universal service for children and families. The overarching aim of public health services for children under 5 is to protect and promote the health and wellbeing of children in the early years.

How do you build ACEs into your approach to families?

Adverse childhood experiences, both in the child and in the parent are on the list of concerns that our team looks out for when meeting with parents and babies in our routine checks.  When identified, we can begin working with parents to help them feel closer to their child, reducing the likelihood of attachment issues and post-natal depression, as well as helping to break the cycle of ACEs at a very early stage. We are the only health visiting service in England to be fully trained in Neonatal Behavioural Observation (NBO) and we are now also training our staff in Video Interaction Guidance (VIG). Both are observational tools used to help health professionals and parents identify the kind of support a baby will need for successful growth.

Tell us more about NBO and VIG

Neonatal Behavioural Observation is a relationship-based, structured, neurobehavioral observation tool that can be used with babies from birth to 3 months old. Using this, professionals can spend just ten minutes with new parents, helping them to get to know their baby and understand their unique characteristics, strengths and struggles. Research suggests that it helps parents to feel closer to their baby and more confident as a parent, and reduces the incidence of postnatal depression.

Video Interaction Guidance (VIG)

Video Interaction Guidance can help strengthen the communication and relationship between a carer and child, by viewing short video recordings of interactions alongside a trained VIG ‘Guider’. It can help to bring about positive changes in behaviour through an enhanced understanding of successful interactions. Using video, parents and carers can look at and think about positive interactions with their child and find ways to improve their relationship. It can be used from birth and through childhood, whenever it’s needed.

What outcomes have you seen?

We receive many positive comments from professionals and parents using these tools.

  • It feels like the ‘missing piece’ of what we do as HVs.  I introduce it antenatally. Parents’ response has been consistently positive. It is wonderful to see the parents’ realisation of how amazing their newborn actually is already and see that relationship strengthen in front of you.
  • I would like to do this on so many more of my clients because it changes clients’ views and practices as parents empowering and enabling them to improve in their relationships with their children, in some cases reducing the need for ongoing services.  I think it will reduce costs to our services because we are using something that has a strong evidence base.
  • I noticed that a child would not go to her mother for comfort or reassurance before VIG, several months after VIG the child still goes to her mother for comfort and reassurance.  The children were on a Child Protection Plan and now have no Social Care involvement.  The family were offered the Universal Family Offer, and more recently when there has been a crisis in the family they have accessed support before it has got to needing Social Care involvement.
  • One mother scored 14 and 15 respectively on the GAD7 and PHQ9 mental health screening tool before VIG, after two cycles of VIG her scores changed to 3 and 4 respectively so does not currently require any further input from other services.
  • A father has told (Health Visitor) how powerful the Video clips are and how much more confident he is in his parenting since starting this intervention.

 Who can we contact to find out more about this approach?

Find out more about the service at