Safe Start: The development and effectiveness of an intervention for pregnant (young) women (and their partners) with mild to borderline intellectual disabilities and multi-problems and their newborn babies.

Newborns of mothers with mild to borderline intellectual functioning (MBID) and multi-problems are at extremely high risk for unsafe parenting, including neglect and maltreatment (Knot-Dickscheit & Knorth, 2019). Such parenting results in highly adverse childhood experiences, which in turn tend to cause severe and costly problems later in children’s lives, such as mental health problems, school- and work dropout, social problems, addictions, and delinquency (Murray et al., 2010). These problems do not only place a burden on these families, but also on their social environment, and societal institutions, with costs estimated in surplus of hundred thousand euro per family (Romeo et al., 2006). Unfortunately, these problems are often not prevented, but only ineffectively addressed once they have escalated beyond repair. Of all custodial placements for youth, 25% is in families with MBID (CBS, 2019). To prevent unsafe circumstances for these newborns, it is important to detect highly vulnerable future mothers (and their partners) with MBID already during pregnancy, to support them in this stage, and to ensure a safe environment for their newborn, with an effective intervention. Current interventions around pregnancy for at-risk families have shown that families with modest risk without MBID can be supported effectively (Mejdoubi et al., 2015). However, they were not designed for the extreme cumulation of risk and unsafety in families with MBID and multi-problems, and can therefore not provide sufficient scaffolding to prevent unsafety, nor sufficient clarity to handle imminent unsafety in the interest of the child. To do so, an integral approach is needed. Expertise from clients, clinicians, (our) effective interventions for clients with MBID (HouVast, Lever, 2015; Samen Stevig Staan, Schuiringa e.a., 2017) and (our) preliminary research suggests this requires three key components in addition to current intervention practice: 1) Building mutual trust between family and care worker through open and frequent contact 2) Understanding of, and adaptation to, the specific needs, potential, and limitations of each family 3) Clarity and openness about concerns over safety and clear possible scenario’s for what to do if children will (temporarily) not be safe with their parents, including possible (temporary) placement out of home The intervention Veilige Start (Safe Start) was developed from these core components, and aims to be improved in a continuous feedback loop with clients, care workers, and implementation data. Currently, the intervention has not been systematically re-developed yet and its effectiveness has not yet been evaluated, but is called for by a growing number of municipalities. The present project will therefore: 1) examine needs for support, protective, and risk factors in women with MBID and multi-problems (and their partners) around pregnancy 2) use this information to further develop the intervention Safe Start for pregnant (young) women (and their partners) with MBID and multi-problems, and 3) examine its effects on child safety and well-being, parenting, and family functioning By doing so, the project will address crucial priorities of the Ministry VWS and ZonMw programs to support pregnancies at risk (‘kansrijke start’, ‘zeven stappen plan’, ‘Onbedoelde zwangerschap en kwetsbaar (jong) ouderschap’), and addressed as urgent in a recent review (Jansma & Sondeijker, 2019) concerning 1) Needs, risks and protective factors of women (and their partners) with unintended pregnancy, specifically pregnant women and their partners with MBID and multi-problems 2) Intervention integrated in the social domain, and developed in co-creation with clients and professionals 3) Rigorous test of effectiveness and implementation in actual daily practice with societally relevant outcomes. Trust is key when working with (future) mothers with MBID and cumulative risk on the highly sensitive issue of the safety of their own children (Menting et al., 2015). Safe Start was, is, and will further developed together with pregnant women and their partners with MBID and multi-problems. Clients will be involved in all phases of the studies. The 35 clients who already participated in Safe Start and are often still in touch with their care workers will provide valuable feedback. Current clients will be asked to participate in the inventarisation of needs, potential, and risks (study 1), focus groups for intervention development (study 2) to hear their experiences and suggestions for improvement, and in interpretation of findings (study 3). They will be supported by our Client Bureau, which has experience with client participation support in projects to improve the quality of care. A recent client and the chairman of the client advisory committee and the Client bureau of Partners voor Jeugd will also participate in the advisory board of the project. Experience experts will also be involved in training of research staff for data collection