Centre for Early Childhood announces further investment as evaluation recommends ADBB is commissioned across the UK

The Royal Foundation Centre for Early Childhood has today announced next steps in its project to bring an innovative observational health visiting tool – known internationally as the Alarm Distress Baby Scale (ADBB) – to the UK. This follows the publication of a highly positive evaluation of phase two trials, which recommends it is commissioned for use across the country.

The tool is used by health visitors within routine checks to promote infant wellbeing. It focuses on a baby’s social behaviours such as eye contact, facial expression, vocalisation and activity levels to help practitioners and families better understand the ways babies express their feelings. It can also be used to recognise early signs of psychological distress, enabling specialist support to be accessed as soon as it is needed.

Her Royal Highness The Princess of Wales first saw the tool in use when she met health visitors in Denmark in February 2022, and the Centre has been working with the Institute of Health Visiting (iHV) ever since to bring the benefits of the approach to families in England, Wales, Scotland and Northern Ireland.

Following the overwhelmingly positive results of phase one, the Centre funded a second phase of the study across eight sites in the UK to explore the impact of training health visitors in the ADBB and its modified version (m-ADBB).

The evaluation, undertaken by the iHV in collaboration with the University of Oxford, found that ADBB training addresses a clear gap in health visiting practice by strengthening understanding of infant social withdrawal and increasing practitioner confidence in observing and interpreting babies’ behaviour.

Health visitors reported feeling better equipped to articulate the baby’s perspective – something they felt is often less emphasised in other training, which tends to focus more on parental behaviours. This enhanced ability to “give the baby a voice” supported richer, more balanced conversations with parents.

The evaluation also identified measurable changes in practice at the 6–8-week postnatal review. The proportion of babies identified with concerns increased from 7% to 12%. Importantly, referrals to specialist services reduced, suggesting that ADBB supports earlier identification of emerging needs and enables more proportionate responses within universal services.

Parents described the 6–8-week review as reassuring, supportive and confidence-building. They particularly valued warm, non-judgemental communication, a clear explanation of their baby’s behaviour and cues, feeling listened to, and receiving emotional support and validation. When introduced clearly, ADBB-informed observation was experienced as collaborative and empowering.

To support local authorities to take up the use of the tool, the Centre for Early Childhood will fund the iHV to produce a guide to commissioning ADBB, as well as to develop new resources, tailored to a UK audience. In line with a key recommendation from the evaluation, the Centre will also fund iHV to create a new ADBB Community of Practice, for the next three years, to support practitioners in the continued use and embedding of the tool.

This will play a central role in supporting ongoing learning, supervision, and peer support, helping to ensure practitioners are supported to safely and effectively embed the approach in routine care.

Christian Guy, Executive Director of The Royal Foundation Centre for Early Childhood, said:

“By equipping practitioners and families to understand what babies are communicating from the very start, we can give infants a stronger voice in early conversations, identify where extra support may be needed earlier, and help families build the responsive, nurturing relationships that we know are so important in shaping lifelong outcomes.

“The more health visitors are trained in the use of this tool, the better equipped they will be to help, which is why we are so determined to do everything we can to support its roll out across the UK.”

Read the full evaluation report on the Institute of Health Visiting website.