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‘All Eyes on the Baby’ – developing a multi-agency approach to preventing Sudden Unexpected Death in Infancy (SUDI)

• A new project aims to support the implementation of a multi-agency approach to tackling Sudden Unexpected Death in Infancy (SUDI).
• ‘Eyes on the Baby’ is a collaboration between Durham University’s Infancy and Sleep Centre, Durham Integrated Care Board, Durham County Council Public Health Team and partners.
• The work identified a wide range of staff groups in County Durham whose work brought them into contact with vulnerable families with babies.
• It then developed a training programme for those groups of staff, to enable them deliver situationally appropriate ‘safe sleep’ support or advice.
• The training programme was offered to those groups of staff across County Durham, and its impact was evaluated.
• The work has been led by Professor Helen Ball from Durham University’s Infancy and Sleep Centre.
• It has been funded by National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC).

Read the project report

Background to the project

Rates of SUDI have fallen sharply in the UK over the last 30 years, largely due to wide-scale infant sleep messaging over recent years, such as the Lullaby Trust’s ‘Back to Sleep’ campaign.

As a result, most sudden and unexpected deaths of babies in England now cluster in the most deprived communities – where simple public health messages can be difficult to implement.

Factors that increase the rate of SUDI include babies being placed on their front or side for sleep rather than their back, being exposed to smoke during pregnancy or after birth, being placed to sleep in situations such as in a cot full of soft toys or loose bedding, sleeping on a sofa, sleeping with an intoxicated parent, or sleeping in a room alone.

The way to help most families avoid this is to teach them about infant sleep safety and how to avoid the sleep situations that can increase the risk of SUDI.

However, some families miss the opportunity to receive this information for a number of often complex reasons, including:

• They don’t or can’t engage with the antenatal or postnatal care opportunities they are offered.
• They were given the advice but not at a time or in a way they could absorb it and so they don’t recall it.
• The circumstances of their lives or the context in which they find themselves, makes it difficult or impossible for them to act on the advice – for example their living space or conditions, or access to financial resources.

These families need additional support to prevent SUDIs and reduce the growing regional and socio-economic disparities in infant death rates across the UK.

Why do we need a multi-agency approach?

In 2020 a report from the National Child Safeguarding Practice review panel recommended that tackling SUDI in the UK is too challenging and complex to expect that any further reductions in infant deaths in the UK can be accomplished by health professionals alone.

Due to a lack of funding and heavy workloads, there is a lack of sufficient contact between health professionals and the most vulnerable families, and the opportunities to build relationships with and offer services to has been greatly eroded in recent years.

These issues lessen the ability to make a difference to the most vulnerable groups.

As a result, the National Safeguarding Practice Review recommended adopting a multi-agency approach to SUDI prevention.

The Eyes on the Baby project was developed in response to this recommendation. Its aim was to develop and implement a multi-agency approach to tackling this issue in County Durham as a pilot area.

Since the recommendation of the 2020 Child Safeguarding Practice Review Report, only a handful of local authorities have attempted to implement a multi-agency approach for SUDI prevention. None have publicly documented and evaluated the process of implementation to date.

Developing the project

This project brought together key partners including Durham University’s Infancy and Sleep Centre, Durham Integrated Care Board, Durham County Council Public Health Team and partners to develop this multi-agency approach.

As part of the work, SUDI Prevention in County Durham was mapped to identify key contact points where safer sleep information was shared and by whom.

This highlighted the infrequency of universal safer sleep discussions – both antenatally and postnatally.

It also highlighted that staff felt they lacked knowledge and confidence regarding safer sleep guidance.

The project committee identified a broad range of staff groups whose work brought them into contact with vulnerable families in County Durham.

These roles spanned a wide range of areas, from paramedics to housing officers.

Job roles were grouped, based on the frequency and degree of contact with vulnerable families and training for these groups of staff was co-produced and offered to these groups of staff via online learning.

Parents also took part in the research, sharing their views on who they believed were the ‘right’ people to talk to families about SUDI. They suggested health professionals and staff who had existing relationships with parents, were best placed. They also highlighted that staff who give safer sleeping advice to vulnerable families need to be non-judgmental and try to offer different solutions.

Read more about the workforce groups and training strands in the Eyes on the Baby project report

Find out more about the Eyes on the Baby training and implementation package

Pre-and post-training surveys assessed staff knowledge and confidence, and follow-up surveys captured staff feedback and engagement. Normalisation Process Theory (NPT) was used to support user engagement and embed SUDI prevention into everyday practice.

The initial phase of the project was then evaluated using surveys, interviews, and group discussions.

Project findings and recommendations

In June 2023, the project team published a report describing the co-production, pilot, and evaluation of the multi-agency SUDI approach in County Durham.

The report offers 12 key recommendations for developing a successful multi-agency SUDI prevention approach for vulnerable families. They include:

• Cast the net wide and invite all staff who may have contact with potentially vulnerable families. Those who provide support in a crisis are particularly important as they are often involved with families who are ‘out of routine’.
• Set clear expectations about the type of SUDI prevention activities each job role is expected to take on and provide appropriate training.
• Establish evaluation of training and engagement at multiple time-points along the implementation pathway, and as an ongoing process (Normalisation Process Theory is useful for assessing how SUDI prevention was accepted and embedded by staff.)

You can read all 12 recommendations in the project report

What’s next?

Colleagues from County Durham will continue to roll out and implement a multi-agency approach to SUDI in their locality.

The project team are also working with colleagues in Northumberland to pilot the approach across the county.

The team are keen to continue this work by examining how best to ensure SUDI prevention for vulnerable families becomes integrated into the work of multi-agency teams – and would be keen to hear from any other local safeguarding partnerships. Public Health Teams or CDOPs (Child Death Overview Panels) who would like to discuss implementing this approach in their own areas.

If you would like to find out more, please email [email protected]

Download the project report: Eyes on the Baby: Multi-agency SUDI prevention for County Durham

Blog: Keeping all eyes on the baby

Professor Helen Ball shares why a multi-agency approach by Local Authorities, Early Years and family-facing services, is needed.

Read the blog