Improving engagement with services to prevent Sudden Unexpected Death in Infancy (SUDI) in families with children at risk of significant harm: A systematic review of evidence.

Joanna Garstang,Debbie Watson,Anna Pease,Catherine Ellis,Peter Fleming,Peter S Blair

doi:10.1111/cch.12875

Abstract

This paper reports part of a wider systematic review commissioned by the English National Safeguarding Panel on Sudden Unexpected Death in Infancy (SUDI). The wider review covered three areas: interventions to improve safer sleep practices in high-risk families, interventions to improve engagement with services and decision making by parents at high risk of SUDI about infant sleep environments. Here, we report the qualitative and quantitative studies reviewed under the engagement strand. Parental engagement is understood to be a multidimensional task for health and social care professionals comprising attitudinal, relational and behavioural components. Following a PROSPERO registered systematic review synthesizing the three strands outlined, 28 papers were found to be relevant in the review of interventions to improve engagement with services in families with children at risk of significant harm through abuse or neglect. No studies were found that specifically focused on engagement of families at high risk for SUDI, so these wider engagement studies were included. The different types of intervention reported in the included studies are described under two broad themes: Enablers (including parental motivation and working with families) and Barriers. Given the focus in the studies on interventions that support parental engagement, the Enablers theme is more extensive than the Barriers reported although all studies noted well-understood barriers. The evidence underpinning these interventions and approaches are reviewed in this paper. We conclude that effective engagement is facilitated by experienced professionals given time to develop supportive non-judgemental relationships with families in their homes, working long-term, linking with communities and other services. While these conclusions have been drawn from wider studies aimed at reducing child maltreatment, we emphasize lessons to be drawn for SUDI prevention work with families with children at risk of significant harm.

Highlights

We conclude that effective engagement is facilitated by experienced professionals given time to develop supportive non-judgemental relationships with families in their homes, working long-term, linking with communities and other services
While these conclusions have been drawn from wider studies aimed at reducing child maltreatment, we emphasize lessons to be drawn for Sudden Unexpected Death in Infancy (SUDI) prevention work with families with children at risk of significant harm
Each year in England and Wales, there are around 300 cases of Sudden Unexpected Death in Infancy (SUDI) (Office for National Statistics, 2020), SUDI is defined as the death of an infant that was not predicted as a possibility in the 48 h prior to the death or to the collapse that led to death irrespective of the final diagnosis (Fleming et al, 2000)

Summary

Introduction

Each year in England and Wales, there are around 300 cases of Sudden Unexpected Death in Infancy (SUDI) (Office for National Statistics, 2020), SUDI is defined as the death of an infant that was not predicted as a possibility in the 48 h prior to the death or to the collapse that led to death irrespective of the final diagnosis (Fleming et al, 2000). The proportion of SIDS cases occurring in socially deprived families has increased with the decline in overall numbers (Blair et al, 2006), with highest rates in mothers under 20 years old (Office for National Statistics, 2020). The literature review considered qualitative and quantitative research in three separate but linked areas: interventions to reduce the risk of SUDI in high risk families, understanding how high risk parents make decisions around infant sleep and interventions to improve engagement with professionals in families with children at high risk of abuse and neglect. Parental engagement was considered key as a previous thematic analysis of 27 SUDI cases with significant safeguarding concerns, subject to Serious Case Review (SCR—the predecessor to CSPR) found that non-engagement with health, social care or substance misuse services was a prominent feature in 18/27 families (Garstang & Sidebotham, 2019). We look at lessons from these studies for SUDI prevention in families with children at risk of significant harm

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