Background The first 1001 days of life are a critical period of development providing the foundation for good health across the life course. Children’s health, wellbeing, educational and social outcomes are greatly influenced by parent-infant relationships. Given this, there has been increasing policy interest in the impacts of parenting support interventions. The Nottinghamshire NHS Parent/Infant Relationship Initiative (PIRi), delivered within the Nottinghamshire Healthy Families Programme (HFP), aims to support families with identified needs to strengthen their relationships through one-to-one support.

Methods We undertook a mixed-methods evaluation exploring PIRi feasibility, acceptability and impact. Methods were codesigned through workshops with the Nottinghamshire HFP and wider family support services to ensure the evaluation met practice needs. Between May 2023-July 2023 we undertook interviews with Nottinghamshire HFP staff (N=9) and PIRi service users (N=14), alongside analysis of routinely collected outcomes data. Thematic analysis was applied to interview data using an analytical framework exploring service implementation and outcomes. Descriptive analysis was undertaken on service data collected between April 2022-December 2024. This data was complemented and contextualised by qualitative data in our analysis.

Results Parents were overwhelmingly positive about the support and how it increased their confidence, knowledge and skills. Of the 77 people who completed PIRi support, self-reported outcome measures show improved parent-infant interaction (80%, n=62), improved connection with baby (88%, n=68) and improved parent mental health and wellbeing (64%, n=49). Parents valued the one-to-one support of the PIRi, as well as the consistency of practitioners which supported trusting relationships. Further, they described the PIRi support as flexible and tailored to individual needs. Interview data showed mixed awareness of the PIRi and support amongst health visitors within the Nottinghamshire HFP, who are the main referrers. This was a potential barrier as health visitors could not always clearly describe the service and support to parents. Some parents mentioned initial concerns around stigma and judgement until they had a clearer understanding of the support. Health visitors described challenges in identifying parents with PIR difficulties due to limited family contact time, lack of confidence in discussing sensitive topics and fear of damaging practitioner-parent relationships.

Conclusion The PIRi can support parents identified as having parent-infant relationship difficulties. However, there is a need to further embed awareness of the PIRi and the specific support provided across the Nottinghamshire HFP. Given the importance of parent-infant relationships, the findings will be useful to services delivering early intervention for children and families.