Childrens Centres

Local Evaluation Report

Baby Massage

Prepared by Sarah Taragon

Red Door Associates
June 2004

Contents
Exec Summary

Page 2

Introduction
BM
Keystone BM courses

Page 3
Page 4

Methodology

Page 5

Results
Observation
Questionnaires
Interviews
Attendees analysis
Cost

Page 5
Page 5
Page 7
Page 8
Page 8

Conclusions
General
Targets
Cost benefit

Page 9
Page 9
Page 10

Recommendations

Page 10

Tables
Table 1 - Targets Identified by Programme Manager for Baby Massage
Table 2 - Targets Identified by Baby Massage Tutor
Table 3 Evaluators view of the targets currently met

Table 4 - Indirect impact on targets and potential to meet

additional targets

Page 4
Page 7
Page 9

Page 10

Appendices
Appendix A References for information on impact of baby massage
Appendix B Keystones targets
Appendix C Evaluation Questionnaires and schedules

Notes
Throughout this report Keystone has been used as a shortening for Keystone Sure Start
Childrens Centre
The term mother is used to refer to the carer of the baby attending the course and
potentially covers other relationships (though in fact, all those attending to date have been
mothers).

Acknowledgements
Many thanks to Kay Beuzeval (Course leader) for her input and support with this evaluation and
also to all those attending the November/December courses.
Thanks to Sam Magne & Angela McTiernan of Red Door Associates for advice on editing of the
report.

Exec Summary
This report provides an evaluation of the baby massage courses provided by Keystone, focused
mainly on courses delivered during November/December 2003. Courses consist of five weeks of
2 hour sessions and are run by Kay Beuzeval a local massage tutor specialising in baby massage.
Courses are run in local community centres/accessible venues and are attended by an average of
8 carers per course with their babies. Courses are run in an informal and practical way so that all
attendees are able to practice the different massage techniques and movements. As well as baby
massage, the courses teach about more general parenting skills and child development.
A number of research tools were used in evaluating the massage groups including: participant
observation by the researcher; evaluation questionnaires to attendees (completed by seven
carers); semi-structured interview with course leader; and desk research on benefits of baby
massage and analysis of monitoring data. This evaluation did not look at the long term impact of
baby massage for the baby (as this is already well documented) but focused on the benefits for the
mothers attending courses and the impacts/benefits of the courses in terms of Keystones targets.
The results show that the courses: are enjoyed by participants; are meeting their aims in teaching
baby massage skills; are low cost; are providing wider parenting information/skills; and provide a
good way for new mothers to network and get access to other support and groups. However,
those who could perhaps gain most from the courses are not attending (eg those with special
needs, bonding issues).
The following are the Keystone targets that the Baby Massage courses help to address:
Parenting support & info available for parents
Raised levels of confidence & self esteem & reduced stress experienced in relationships
between children and parents.
Information & guidance provided for mothers on breast feeding, nutrition, hygiene and
safety.
Promote up-take of learning opportunities for adults
Cross referral between services, increasing access to support
Creation of self-organised groups & support services
Recommendations based on the results, include the following:
Continue to run the courses on a regular basis and investigate ways of mainstreaming the
courses

Targeting & widening attendees eg trying groups for teenage mothers, babies with
special needs, and fathers. This would increase the targets the courses help to meet.

Consider piloting one-to-one massage tutoring for families with particular needs

Consider widening the scope of the courses to include more of the general parenting
information or link people directly into follow on courses on other practical techniques or
parenting issues etc (eg learning to play courses).

Formalise the links between the baby massage courses and the local parent & toddler
groups (eg Babalicious) so that it is easier for people to move on to these support/social
mechanisms.

Congratulations should go to the course leader for the positive impact these courses are making
for many families.

Introduction
This report provides an evaluation of the baby massage courses provided by Keystone, focused on
courses delivered during November/December 2003. The Evaluation has been undertaken by
Sarah Taragon of Red Door Associates (Keystones Local Evaluators).
Background - Baby Massage
There is much research that has been done internationally to document the impact of baby
massage both for the baby and their carer. The following benefits are widely documented (in this
case sourced from Benefits of Baby Massage, Saasha Pleka - www.beyondfertility.com):

Premature infants who are regularly massaged are hospitalized an average of six fewer
days than non-massaged babies (USA today, May 28 1996)

All infants, whether premature, underweight or healthy/full-term, thrive and benefit from
massage

One study showed massaged infants gained 47% more weight than unmassaged infants
given the same number of calories (Tiffany Fields, Uni of Miami School of Medicine, Tactile
Kinesthetic Stimulation Effects on Preterm Neonates Pediatrics Journal 777, 1986)

Massaged babies are more alert when awake, more easy to soothe and readily able to
sleep

Massage teaches a baby how to relax

Massaged babies showed better performance on the Brazelton Scale with habituation,
orientation, motor activity and regulation of behaviour

Massage promotes emotional security, respect and a healthy body image

Infant massage stimulates digestion, passing of gas, and relieves symptoms of colic

Massage increases circulation and can assist with normal growing pains

When parents massage their babies, they promote quality time, create better bonding and
increase confidence in their own parenting skills. They enhance intimacy, understanding
and the ability to nurture

Nurturing touch is a natural way to relieve stress for both care giver and baby

A parent who massages his or her infant becomes more aware of the babys cues and
learns to understand the babys special and unique needs

As Carla Steptoe (a nurse and massage practitioner) states (www.infantmassage.com):

Benefits for infants
Improves immune system
Helps baby learn to relax
Promotes sounder and longer sleep
Promotes positive body image
Promotes bonding and communication
Helps to regulate digestive, respiratory, and circulatory systems
Helps relieve discomfort from gas and colic, congestion & teething
Decreases production of stress hormones
Benefits for parents
Provides a special focused time that helps deepen bonding
Helps parents to understand and respond appropriately to babys nonverbal cues
Promotes feelings of competence and confidence in caring for baby
Improves parent-infant communication
Increases parents ability to help child relax in times of stress
3

Eases stress of parent who must be separated from child during the day
It is fun and relaxing for parents to massage their children

Other benefits
Cross cultural studies show that babies who are held, massaged, carried, rocked and
breast fed grow into adults that are less aggressive and violent and are more
compassionate and cooperative.
Recent research shows benefits for premature infants, children with asthma, diabetes and
certain skin disorders.
Mothers with post natal depression have shown improvement after starting infant massage
Teenage mothers have shown improved bonding behaviour and interactions with their
infants.
Please see Appendix A for further references to research related to baby massage impacts.

Keystones Baby Massage Courses

The programme runs regular baby massage courses. Courses consist of five weeks of 2 hour
sessions and are run by Kay Beuzeval a local massage tutor specialising in baby massage.
Courses are run in local community centres/accessible venues and are attended by an average of
8 carers per course with their babies. Courses are run in an informal and practical way so that all
attendees are able to practice the different massage techniques and movements. As well as baby
massage, the courses teach about more general parenting skills and the importance of eg building
in time for one-to-one space with your baby, and the importance of bonding/respect for your baby.
The courses pass on an ethos of parent/child time and teaches about communicating with young
babies and reading their needs. The courses give parents confidence in listening to their child
which builds self esteem and permission to behave positively to their child. The courses also build
in the opportunity for parents to learn from each other and discuss practical and emotional issues
involved with being new parents.
The Sure Start Programme Manager identified the courses as hitting the following targets for the
programme: ie the reasons for running the courses (please see Appendix B for more details of the
objectives and targets of Keystones programme):
Table 1 - Targets Identified by Programme Manager for Baby Massage
Improve Social & Emotional Development
1.4N Parenting support and information available to parents
1.2N Agree & implement (in culturally sensitive way) care for mothers with Post Natal Depression
2.9L Provide support to parents in times of crisis
Raised levels of confidence and self esteem amongst parents and reduced stress experienced in
relationships between children & parents.
Improve Health
2.2N Information & guidance provided for mothers on breast feeding, nutrition, hygiene and safety
2.8L Increased health promotion work
Improve Ability to learn
4.6L Promote take-up of learning opportunities for adults
Strengthening Families & Communities
4.3N, 4.7L Families empowered to steer Sure Start programme, services & planning through
positions on parent & exec boards, parent forums and working groups
Cross referral between Sure Start services, increasing access to support

Consultation Methodology
This evaluation has not looked at the long term impact of baby massage for the baby as this is
already documented we are taking this as a given (see evidence in the Introduction to this report).
We have focused on the particular benefits for the mothers attending courses and the additional
impacts/benefits of the courses, particularly in terms of the Keystone targets.
A number of research tools were used in evaluating the November/December massage groups:
Participant observation by the researcher (and her baby) in one course
Evaluation questionnaires to attendees at both courses (see Appendix C) nb at one
course, one of the questionnaires was completed on large wall posters
Semi-structured interview with course leader
Informal feedback from other Keystone staff
Desk research on benefits of baby massage
In addition, analysis of monitoring data of attendees of courses between November 2003 and May
2004 was undertaken.

Results
Observation
Participant observation in the course gave the evaluator the best possible understanding of the
way the courses are run and the experience of attending the courses. A summary of her main
observations can be found below, and her experience in attending the course underlies the rest of
this report.

All those attending enjoyed the experience babies and carers

Courses provide an excellent bonding opportunity for mothers/carers through joint learning
in a safe space

The tutor was excellent at making the space feel comfortable and relaxed and understood
that the babies all had individual needs and may not be fully partaking in massage at all
times

Mothers were made to feel very comfortable to let their babies cry, sleep, feed etc

The course was an excellent way to pass on more general parenting advice and
information particularly on respect for your baby, non-verbal communication, physical and
quality time with your baby etc and the tutor made good use of this opportunity

The course was practical and non academic (therefore accessible to all) and gave a large
amount of information enabling attendees to take the skills away with them

Good back up sheets & written information was provided along with references for
additional books/resources for those who wanted them

The course enabled sharing of much information between mothers on issues they were
facing, on equipment and on solutions to problems/queries

The course provided a good introduction to Sure Start activities and was well linked to the
local parent & toddler group (Babalicious) and the toy and book libraries (which visited the
venue during a couple of the sessions)

Questionnaires
Feedback from the course participants is summarised below. For a
copy of the questionnaires used and the post-it consultation process,
please see Appendix C. Three people completed the two

Gained information outside

of massage from other
mums and what they do with
their babies.
5

questionnaires, and four gave comments on the post-it consultation (around 60% of those signed
up for these two courses).
What people liked was:
Gaining a new/improved skill (7)
The atmosphere (5)
Sharing experiences with other mothers (5)

Learning a new skill and

being able to help my
baby when he has wind.

The only thing people said that they disliked about the course, was it starting so early in the day.
Three people gave ideas for future courses, and one stated that it didnt need improving:
perhaps watching a video perhaps a couple of weeks longer
me being there every week but Kay very good at showing what we had missed
I dont think there was enough time allowed to feed, change, sleep & massage. Cushions
for mums to sit on
The majority of comments made about changes to their own
behaviour, focused on spending more time with their baby (3),
relaxing more with and around their baby (4) and being more
aware of the things that stress their baby (2).
Learnt that babies
pick up on your feelings
and behaviour

Aware of making baby

& surroundings less
stressful and aware of
their ways of
expressing themselves.

Confidence in
handling my baby

Seven comments were made relating to their babys behaviour. Most simply stated that their baby
enjoyed the massage. One person said that their baby slept better following a good massage and
another that massage had calmed her baby down before her bedtime feed.
Seven mothers completed the second evaluation questionnaire (see Appendix C). Four attended
the Stonehouse course and three the Keyham one. Two people had found out about the course
from the midwife, two at antenatal classes, one through their health visitor, one from a friend and
one from a leaflet in a shop. The reason most people attended the course was to learn baby
massage, share an experience with their baby. All the respondents said the course had given
them the information and skills they expected.
One person had used other Sure Start services the others were all new to the programmes
services. Two of the new users, have gone on to use other Keystone services. All the
respondents said they might (5) or would definitely (2) use other Keystone services in future.
The following are suggestions for other support/activities respondents felt that Sure Start could
provide:
Family outings, holiday activities, parent groups, other courses on new skills
Would like to attend Indian head massage course (for pampering)
Baby signing
More baby and parent groups

Attendees at all the courses fill out an evaluation form devised by the Tutor. Details from
seventeen of these forms (from courses held April 2003 March 2004) were available to the
evaluator. These showed that those attending find the courses clear to understand and
6

comfortable to take and see some change in their relationship with their baby following the course.
All the attendees said they would recommend the classes to others. The following are quotes
taken from the forms:
I feel much happier
with my baby now.
Massage has given us
something special to do
together.

I have really enjoyed the

massage class. Its given me
a chance to learn massage
properly, bond more with my
baby and meet other mums
& babies.

I thought baby massage

was good as I thought I
bonded with my baby a bit
better it also helped to
relax and unwind.

Interview with Tutor

Part of the interview with the course tutor (Kay Beuzaval) focused on the Keystone targets and part
on what benefits she sees from the course and the informal feedback she had received (see
Appendix C for a copy of the interview schedule).
The targets that the tutor felt that the baby massage courses helped to meet are shown below.
Table 2 - Targets Identified by Baby Massage Tutor
Improve Social & Emotional Development
1.4N Parenting support and information available to parents
1.2N Agree & implement (in culturally sensitive way) care for mothers with Post Natal Depression
1.5L Reduce incidence of domestic abuse in families
local Raised levels of confidence and self esteem amongst parents and reduced stress
experienced in relationships between children & parents.
Improve Health
2.2N Information & guidance provided for mothers on breast feeding, nutrition, hygiene and
safety
Improve Ability to learn
3.5L Provide services for children with special needs
Strengthening Families & Communities
4.3N, Families empowered to steer Sure Start programme, services & planning through positions
4.7L on parent & exec boards, parent forums and working groups
4.6L Promote up-take of learning opportunities for adults
Local Creation of self-organised groups and support services
Local Cross referral between Sure Start services, increasing access to support
Discussions with the tutor on the benefits of the course mainly focused on the additional benefits ie
assuming the documented benefits of massage itself. Much of the discussion was focused on the
group support that occurs within the courses the courses are particularly effective in building
strong links between attendees which are often developed after the courses finish. The best
example of this was the setting up of Babalicious (a parent and toddler group) by attendees at one
of the courses. However the tutor is aware of many informal networks that the course has
enabled. Within the courses much support and learning takes place between attendees the
courses are run in such a way to enable this to occur.
The tutor felt the link with Keystone was valuable the programme provides the venues, materials
(towels, mats, oil etc) and publicises the courses. The courses often provide a good introduction to

Sure Start which builds an involvement with the programme. The tutor works with the community
development worker to try and involve attendees in other Sure Start services.
Because of the nature of the courses (ie practical), they are accessible to all and anyone attending
can learn a lot from them. There are no barriers due to literacy, past experience or language.
However, there may be some cultural issues for women from some ethnic backgrounds in
massaging male children in public.

Analysis of Attendees (November 03 May 04)

During the six month period November 2003 May 2004, a total of 41 mothers with their babies
attended baby massage classes run by Keystone. 51% (ie 21) were from within Keystones area.
Three families (7%) attending had one parent whose ethnic background was other than white
british (2 white other, and one other mixed). One family attending spoke Spanish as their first
language all other families had English as their main language spoken in the home. Two of the
attending mothers (5%) had disabilities/special needs.
Attendees Ward (Keystone Area)

14

12

10

Ten of those mothers attending, joined

Keystone directly at the Baby Massage
course however, only 2 of these were
actually with Sure Starts area. The
courses are aimed at babies under 6
months, and the majority of babies
(64% of those for which we have
information) were 3 months or less
when they started the courses.

St Peter

Keyham

Stoke

Cost
The overall costs of the classes are as follows: 250 for tutorial fees; 5 p/h venue rental (75 per
course). In addition, during the first 2 years of running courses, 600 has been spent on
equipment (including massage mats, books, oils etc). The overall cost of each course is, therefore,
325 plus a proportion of equipment costs in the case of the 6 month period for which we look at
attendee statistics, this would work out to around 3.65 per person (150 over 6 months to 41
attendees). The cost per person per course (based on an average of 8 mothers and their babies)
is, therefore 44.28 for a five week course (including handouts and oil) ie 4.41 per hour. This
would be generally comparable with the cost of an evening class if taken with a local college. It is
considerably cheaper than the alternative of using a health visitor to show a mother how to
massage - the average cost for hourly child contact being 34 (Source: NESS Cost Effectiveness
Evaluation Methodological Report, Sep 2001).
Currently, attendees do not pay anything towards courses whether they are in the Keystone area
or not, so all costs fall to Keystone.

Conclusions
The results show that the courses are enjoyed by participants, are meeting their aims, are low cost
and provide a good way for new mothers to network. The following bullet points summarise the
conclusions made based on this Evaluation:

The courses are providing a positive (often initial) introduction to Keystone to local mums

The courses are enjoyed by attendees and provide a comfortable way to learn a new skill
and more about babies and parenting

The courses provide a good way to meet other mothers and to get plugged into informal
support networks and other parent & toddler groups

Attendees are learning more than just massage techniques also about respecting their
baby, learning their distress signals and how to listen to their needs, and how their own
behaviours and stress impacts on their baby

The courses have a low unit cost for something that gives new mothers support and
techniques for coping now and in the longer term

Massage is well documented as being beneficial to babies health and to the relationship
between baby and carer

50% of attendees are not from within the Keystone area

Taking into consideration all the feedback, my own experience in attending the courses and the
views of the course leader, the following tables show the keystone targets that the Baby Massage
courses are currently helping to meet, and those which there is potential for them to meet or which
are being met in an indirect way. Those marked with (a) were those targets originally identified by
the Programme Manager and those marked (b) are those the course tutor identified.
Table 3 Evaluators view of the targets currently met
Target
Target
Ref
Improving Social & Emotional Development
1.4N
Parenting support & info available for
(a) (b)
parents
Local
(a) (b)

Raised levels of confidence & self

esteem & reduced stress experienced
in relationships between children and
parents.
Improving Health
2.2N
Information & guidance provided for
(a) (b)
mothers on breast feeding, nutrition,
hygiene and safety.
Strengthening Families & Communities
4.6L
Promote up-take of learning
(a) (b)
opportunities for adults
Local
Cross referral between services,
(a) (b)
increasing access to support
Local
(b)

Creation of self-organised groups &

support services

Comments

Through informal parenting information and sharing of

experiences between attendees. There is scope to
develop the impact the courses have on this target.
The courses provide a means of mothers/carers
gaining confidence in handling their baby and
techniques to relax baby & mother. This target is
probably the one the course has the most impact on.
Through informal parenting information and sharing of
experiences between attendees. There is scope to
develop the impact the courses have on this target
through extending the courses.
Attendees learn a new skill through attendance on the
course (ie a learning opportunity in itself)
The courses are well linked to other Keystone
services thru the venues and the community dev
worker.
There is one good example where one of the courses
led to the setting up of a parent & toddler group by
those attending the massage course. The courses
are excellent for bonding through the shared learning
experience.

Table 4 - Indirect impact on targets and potential to meet additional targets

Target
Target
Ref
Improving Social & Emotional Development
1.2N
Agree & implement care for mothers with
(a) (b)
PND
1.5L
(b)

Reduce incidence of domestic abuse in

families

Improving Health
2.8L
Increased health promotion work
(a)
Improving Ability to Learn
3.3N
Increased use of libraries

3.5L
(a) (b)

Provide services for children with special

needs

Strengthening Families & Communities

Families empowered to steer Sure Start
4.3N &
Programme, services and planning,
4.7N
through positions on parent & Exec
(a) (b)
boards, parent forums and working
groups.
Families enabled to take up benefits/find
Local
work

Comments

There is potential to target these courses at

mothers with PND and this would need to be done
to achieve any major impact on this target.
Some potential through reducing stress for baby
and potentially easing family situation through
better sleep and a better relationship between the
carer and baby. Tenuous.
Some informal health promotion is done through
general parenting advice and discussions during
sessions.
Due to the shared venue for one of the courses,
attendees are also able to visit the book and toy
libraries. This is a good way to introduce people to
additional services.
There is potential to target these courses at special
needs children however, this has not been done
to date so no impact on this target can be seen.
The courses could be the first step in this and
have been for some of the mothers involved in
setting up Babalicious. However, no direct link.

There is a potential link with this target in that the

course is successful in building confidence and
networking parents/carers to each other and other
services. However, no direct impact.

We can see that the major outputs of these courses are on:
improved networks
information sharing
confidence building
reducing stress
At Target Level (see Appendix B) we would see evidence of likely impact from these courses on
the following targets:
The Programme will have increased by ?% the amount of children under 4 years with
normal levels of (i) personal, (ii) social and (iii) emotional development (1.1N)
Reduce by 10% the number of 0-3 yr olds admitted to A&E with i) gastroenteritus, ii) lower
respiratory tract infection, iii) severe injury and iii) severe injury. (2.3N)
Increase by 6% the number of children with normal speech & language development at age
2 & increase by ?% the number of children with normal levels of communication, language &
literacy by foundation stage (by 2005/6). (3.1N)

Cost Benefit
At this stage we have not looked at the future savings for child support and care services in any
detail, but we would expect to see some savings against the following areas, where mothers and
their babies have attended baby massage courses:
10

Improved bonding leading to less abuse and improved parent/child relationships leading to
less need for health visitor/social services support

Improved health of baby due to impact of physical touch on health (particularly in low
weight and pre-term babies) and therefore less need for GP and hospital services

Improved informal support structures for mothers from other mothers and therefore less
need for health visitor and social services input

Reduced stress for baby and mother (and techniques for coping with stress) leading to less
need for support generally and healthier mothers & babies

Referral and information during the course leading to better informed and supported
parents (eg on nutrition and parenting) and early support where needed (reducing crisis
costs at a later date)

Recommendations

Targeting & widening attendees particularly try groups for mothers with PND, teenage
mothers, babies with special needs, and fathers. This would increase the targets the
courses help to meet.

Need to gain external feedback on impacts eg via feedback from health visitors (Red Door
can advise on methods of doing this) and continue to use evaluation forms etc to monitor
feedback on courses and to build up a long-term picture of feedback.

Continue to run the courses on a regular basis and investigate ways of mainstreaming the
courses for example, they could be organised by a health visitor, could have a minimal
cost implication for attendees and could request people to bring their own oil and towels
etc. Other ways of meeting the costs long-term should be investigated with EYDCP and
health services, plus identifying free/low cost venues (eg church halls, existing childcare
providers) could help with mainstreaming. Evidence of the impact of these courses and the
benefits of baby massage should be highlighted when doing this, and links made to the
priorities of these agencies and the longer term savings that are gained where carers and
babies have a stronger bond and where babies are healthier. Perhaps courses could be
run as part of existing parent & toddler groups or in nursery settings?

Pilot one-to-one massage tutoring for families with particular needs (eg PND, history of
violence, premature/low weight babies etc) probably one or two visits and then move
person into group course. Would need to evaluate the added benefits of this approach for
hard-to-reach individuals.

Continue to use a variety of promotional techniques particularly making sure that health
visitors and midwives are promoting the courses (and other Keystone activities).

Consider widening the scope of the courses to include more of the general parenting
information or link people directly into follow on courses on other practical techniques or
parenting issues etc (eg learning to play courses).

Formalise the links between the baby massage courses and the local parent & toddler
groups (eg Babalicious) so that it is easier for people to move on to these support/social
mechanisms.

11

Appendix A
References to research articles on the impact of baby massage. For further articles see
www.infant massage.com:
Adamson Macedo E. Effects of tactile stimulation on low and very low birthweight infants during the first
week of life. Current Psychological Research Reviews 1985;4:305-308
Cody AL. The effects of infant massage on the attitudes and perceptions of mothers who massage their
hospitalized premature infants. Dissertation Abstracts International 1995;56:2858
Developmental care for promoting development and preventing morbidity in preterm infants. Symington A,
Pinelli J. Cover sheet. Title. Developmental care for promoting development and preventing morbidity ...
10/17/2001
Field T, Scafidi F, Schanberg S. Massage of preterm newborns to improve growth and development.
Paediatric Nursing 1987;13:385-7
Field TM. Schanberg SM. Scafidi F. Bauer CR. Vega Lahr N. Garcia R. Nystrom J. Kuhn CM.
Tactile/kinesthetic stimulation effects on preterm neonates. Pediatrics 1986;77:654-8
Freeman EK. The effects of interpersonal stimulation on growth and development of premature infants.
Dissertation Abstracts International 1970;31:2982
Harrison L. Olivet L. Cunningham K. Bodin MB. Hicks C. Effects of gentle human touch on preterm infants:
pilot study results. Neonatal Network. 1996;15:35-42
http://www.miami.edu/touch-research/Field, T., et al. 1986, May "Tactile/Kinesthetic Stimulation Effects on
Preterm Neonates." Pediatrics, Vol. 77.
Klaus, M.: Maternal-infant bonding, Saint Louis, 1976, the C.V. Mosby
Koniak Griffin D, Ludington Hoe S, Verzemnieks I. Longitudinal effects of unimodal and multimodal
stimulation on development and interaction of healthy infants. Research in Nursing and Health
1995;18:27-38
Koniak Griffin D, Ludington Hoe SM. Developmental and temperament outcomes of sensory stimulation in
healthy infants. Nursing Research 1988;37:70-6
Marshall Klaus, John Kennell, and Phyllis Klaus (1995). Bonding: Building the Foundation of Secure
Attachment and Independence. Reading, MA: Addison-Wesley.
Massage for preterm/low birth-weight infants Size: 94KB,
URL:http://www.nichd.nih.gov/cochrane/Vickers/Vickers.htm
Modrcin McCarthy MA. The physiological and behavioral effects of a gentle human touch nursing
intervention on preterm infants. Dissertation Abstracts International 1993;54:1336
Montagu, Ashley (1978), Touching: The Human Significance of the Skin. New York: Harper and Row.
Oehler, J. 1985, Feb. "The Development of the Preterm Infant's Responsiveness to Auditory and Tactile
Social Stimuli." Dissertation Abstracts, Vol. 45(8B).
Prescott, J. 1975, Apr. "Pleasure/Violence Reciprocity Theory: The Distribution of 49 Cultures, Relating
Infant Affection to Adult Physical Violence." The Futurist.
Rice RD. Neurophysiological development in premature nenonates following stimulation. Developmental
Psychology 1977;13:69-76
Rose SA. Schmidt K. Riese ML. Bridger WH. Effects of prematurity and early intervention on responsivity
to tactual stimuli: A comparison of preterm and full-term infants. Child Development 1980;51:416-425
Scafidi F. Field T. Massage therapy improves behavior in neonates born to HIV-positive mothers. Journal
of Pediatric Psychology. 1996;21:889-97
Scafidi FA, Field TM, Schanberg SM, Bauer CR, Tucci K, Roberts J, Morrow C, Kuhn CM. Massage
stimulates growth in preterm infants: a replication. Infant Behavior and Development 1990;13:167-88
Scafidi FA, Field TM, Schanberg SM, Bauer CR, Vega Lahr N, Garcia R, Poirier J, Nystrom G, Kuhn CM.
Effects of tacktile/kinesthetic stimulation on the clinical course and sleep/wake behaviour of preterm

neonates. Infant Behavior and Development 1986;9:91-105

Solkoff N. Yaffe S. Weintraub D. Blase B. Effects of handling on the subsequent development of
premature infants. Developmental Psychology 1969;1:765-8
Sperier, J. 1982. Infant Massage for Developmentally Delayed Babies. Denver, Colo.: United Cerebral
Palsy Center.
Strauss, L. 1982, Apr. "The Effects of Tactile Stimulation on the Communicative, Social-Emotional, and
Motor Behaviors of Deaf-Blind-Mulithandicapped Infants. Dissertation Abstracts, Vol. 42(10A).
White JL, Labarba RC. The effects of tactile and kinesthetic stimulation on premature infants.
Developmental Psychobiology 1976;9:569-77
White Traut RC, Goldman MB. Premature infant massage: is it safe?. Pediatric Nursing 1988;14:285-9
White Traut RC, Nelson MN, Silverstri JM, Patel MK, Kilgallon D. Patterns of physiologic and behavioral
response of intermediate care preterm infants to intervention. Pediatric Nursing 1993;19:625-9
White Traut RC, Nelson MN. Maternally administered tactile, auditory, visual, and vestibular stimulation:
relationship to later interactions between mothers and premature infants. Research In Nursing & Health
1988;11(1):31-9
White Traut RC, Tubeszewski K. Multimodal stimulation of the premature infant. Journal of Pediatric
Nursing 1986;1:90-5
White Traut RC. Hutchens Pate CM. Modulating infant state in premature infants. Journal of Pediatric
Nursing. 1987;2:96-101
White Traut RC. Maternal-infant interaction as a function of maternal stimulation of the premature infant
initiated at twenty-four hours of infant age. Unpublished Doctoral Dissertation, Rush University, Chicago
1983

Appendix B Keystones Targets

As part of our work with Keystone, the local evaluators have broken down the programmes targets
into two levels these are shown below. Therefore feedback on impact against the outputs should
also have an impact on the targets and objectives. Evidence in this report is shown against the
outputs level only.
The Sure Start OJBJECTIVES (the overall goals that the programme is motivated by)
The Keystone TARGETS (the impact the local programme should have for beneficiaries)
OUTPUTS & IMMEDIATE IMPACTS (the purpose of the Keystone projects & activities)
All targets/outputs starting with a number followed by an N are national Sure Start targets all
those with an L are identified local targets. Those with no number, marked Local, are targets the
evaluators have identified as inherent within the programme (from the business plan, annual
programmes and liaison with staff).
Objective 1
Improving Social & Emotional Development
Targets
1.1N

The Programme will have increased by ?% the amount of children under 4 years with normal
levels of (i) personal, (ii) social and (iii) emotional development

Outputs and immediate impacts

1.2N
Agree & implement care for mothers with PND
1.4N
Parenting support & info available for parents
1.5L
Reduce incidence of domestic abuse in families
2.9L
Provide support to parents in times of crisis
Local
Raised levels of confidence & self esteem & reduced stress etc.
Objective 2
Improving Health
Targets
1.3N
2.1N
2.3N
Local
Local

Local
Local

100% of families of babies visited in first 2 months of childs life

Reduce by 6% the number of mothers smoking during pregnancy
Reduce by 10% the number of 0-3 yr olds admitted to A&E with i) gastroenteritus, ii) lower
respiratory tract infection, iii) severe injury.
Decrease in waiting list time for specialist services following GP referral.
Healthier children incl:
- birth weight avg increased
- lower incidence of cot death
Foetal alcohol syndrome decreased.
Reduction of cases of the following, related to poor oral health by end of 2006:
- Poor nutrition
- Speech & language difficulties
- Emotional health problems
- Oral health problems

Outputs and immediate impacts

2.2N
information & guidance provided for mothers on breast feeding nutrition, hygiene & safety
2.4N
Ante-natal advice, support & information available to all pregnant women & their families.
2.5L
Increased flexibility & availability of local health checks
2.6L
Improved access to community dental services.
2.7L
Increased access to specialist services, especially drug & alcohol services
2.8L
Increased health promotion work
Local
Sure Start able to reach out to all families, enabling them to link in with Sure Start services

Objective 3
Improving Ability to Learn
Targets
3.1N
Increase by 6% the number of children with normal speech & language development at age 2 &
increase by ?% the number of children with normal levels of communication, language & literacy
by foundation stage (by 2005/6).
3.2N
All 0-3 year olds to have access to good quality play & learning opportunities, helping them
progress to early learning goals at school.
Local
Increased referral to other specialist services in the city through Portage
Outputs and immediate impacts
3.3N
Increased use of libraries
3.4L
Increased provision of physical activity for parents & children.
3.5L
Provide services for children with special needs

Objective 4
Strengthening Families & Communities
Targets
4.1N
12% reduction in number of 0-3 yr olds living in families where no-one is working (by 2005/6).
4.2N
75% of families report personal evidence of increased quality of family support service.
Local
Reduce the proportion of benefits unclaimed
Local
Emergence from the Programme of a structure to enable parent influence across multi-agency
services.
Local
Continuity of service ensured for children as they pass the age of 4 years.
Local
Parents able to address own needs on self-help basis
Local
New styles of service adopted by mainstream as a more inclusive way of working
Outputs and immediate impacts
4.3N &
Families empowered to steer Sure Start Programme, services & planning, through positions on
4.7N
parent & Exec boards, parent forums & working groups
4.4N
Referral links established with Job Centre Plus, Local training providers & further ed institutions.
4.5N
Increased availability of accessible childcare through work with EYDCP
4.6L
Promote up-take of learning opportunities for adults
Local
Cross referral between services, increasing access to support
Local
Creation of self-organised groups & support services
Local
Families enabled to take up benefits/find work & reduce financial stress
Local
Overcome parents experience of fragmented/unco-ordinated delivery of service.
Local
Access to services improved for parents by: service linked childcare provision and/or adaptive
work practice to meet local and community needs
Local
X adults supported with improving basic literacy & numeracy skills improving both employability
and parents ability to assist childrens language development

Appendix C Research Tools

Baby Massage Course - Evaluation Questionnaire
Sure Start Keystone are trying to find out more about who is using their services, what
people think of their services, and what local families want them to provide. Please take a
few minutes to complete the form below, which will help us in doing this.
1) Which baby massage course did you attend:
Venue: Date (eg Nov/Dec 03):
2) How did you find out about the course? .
3) Why did you attend the course? .
4) Has the course given you the information & skills you expected (Please circle one option)?
Yes

Some

No

5) Had you used any other Sure Start services before starting this course (please circle)?
Yes

No

If yes, which service(s)? .

6) Have you used any other Sure Start Services, since starting the course (please circle)?
Yes

No

If yes, which service(s)? .

7) Do you plan to use other Sure Start services in future (please circle one option)?
Yes

Maybe

No

If yes, which service(s)? .

8) What other support/activities would you like for you & your family (which Sure Start
could provide)?
..
..
..
9) Please give any other comments/ideas: .
..
..

Baby Massage Course - Evaluation Questionnaire (b)

Sure Start Keystone are trying to find out more about who is using their services, what
people think of their services, and what local families want them to provide. Please take a
few minutes to complete the form below, which will help us in doing this.
Which baby massage course did you attend:
Venue: Date (eg Nov/Dec 03): ..
What did you like about the course?

What did you dislike about the course?

What ideas do you have, that would have improved the course for you?

What difference has the course made:

To your behaviour

Other comments

To your babys behaviour

Semi-Structured Interview
Kay Baby Massage (Dec 03)
Introduction
Explain a bit more about the SS evaluation & my role and this particular evaluation.
Impact of Classes
What benefits/changes she notices in the mothers & babies attending the classes.

Get a couple of case studies that can be quoted.

What does she think the longer term impacts of BM are?

Who does she think would most benefit from the classes are these
women/families attending? Discuss potential for widening access eg tasters,
fathers courses etc.

Sure Start

Does she have an understanding of what Sure Start is trying to achieve?

What support does she get from Sure Start (eg management, resources,
equipment)?

How has she found working with/for Sure Start?

Is there anything Sure Start could do that would improve the service she can offer?

Go through Sure Start targets, and put into yes, no & ?. Look quickly through
yes & no for any queries. Look at ? in more detail.

From what she knows about Sure Start, what overall impact does she think they are
having?

Is there anything else she thinks Sure Start should offer for local families?