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A Year of Firsts

NBO NBAS International 

A brief review by J. Kevin Nugent

A Year of “firsts”

While 2014 was a year of many “firsts” in our work with the NBO and NBAS - a year remembered as much for the friendships forged in Edinburgh and for Berry Brazelton's presence there, as for the ideas shared and collaborations planned, for our first trainings in China, Denmark and Iceland and for the launch of Joao Gomes-Pedro’s book, Valuing Baby and Family Passion, among other achievements. But I think you will agree - when we look back on the year that has just gone by - 2015 was a singularly unique year of “firsts”. We can’t claim that the Harvard NBO and NBAS International Trainers Meeting in 2015 was a “first” – actually it was the 30th anniversary of the first International Trainers meeting which took place in Berlin in 1985 – but it was a “first” in that it drew a whole new generation of trainers and aspiring trainers to Boston from across the globe, for the first time. So, I would now like to invite you to join me in reviewing the 2015 NBO and NBAS training and research activities and other related achievements throughout the year, beginning in January. 


The United Kingdom: Joanna Hawthorne and Betty Hutchon organized the first special UK Training of Trainers Meeting at the Møller Centre, Churchill College, at the University of Cambridge. I (JKN) joined the trainers, who included Jeanette Appleton, Libi Deller, Megan Eccleson, Melanie Gunning, Inge Nickell, Emily Hills, Stephanie Hunt, Lisa Hodge, Maureen Lancaster, Gui Marquine, Alison Pritchard, Maggie Wood and Maggie Redshaw. The emphasis was on quality control and the focus was on mentoring Trainers in order to maintain the highest standards in our NBAS and NBO training. That the National Health Service (NHS) England recommended NBAS and NBO training for all health visitors working with babies in the first 3 months of life is undoubtedly due to the indefatigable work of Joanna Hawthorne and Betty Hutchon and a testament to the dedication of the Trainers and administrative staff who make up the Brazelton Centre UK.


Brazil: The first NBO Training to take place in Brazil was presented at the Department of Pediatrics, Universidad Federal de Minas Gerais, Belo Horizonte on March 27-28th, 2015. The trainers were Lise Johnson and Beth McManus, while the facilitators were Claudia Regina Lindgren Alves and Lívia C.Magalhães, who attended the Harvard Meeting. Claudia and Livia are conducting a study to examine the effects of the NBO on the parent-infant relationship among at-risk infants and their families.

Italy: The international conference “Mi fido di te – I TRUST YOU! ” – A tribute to T. Berry Brazelton was organized by Gherardo Rapisardi, NBAS trainer and long-time colleague and took place in Rome on March 13-14th. Seven to eight hundred health care and education professionals from all over Italy attended the conference. I was given the privilege of presenting the keynote address: “The Development of the Sense of Trust and the Gift of Hope: the contribution of T. Berry Brazelton”. Our colleague, NBAS Trainer, Nadia Bruschweiler-Stern spoke on “Supporting Early Relationships and the Birth of the Family”, while future NBO trainers Luca Migliaccio and Fabia Banella, part of the new generation who participated in our November meeting, each delivered inspiring presentations on their work with infants and families.

United States: In March, there was another NBO “first” in the United States. While NBO training has been an integral part of Kristie Brandt’s Infant-Parent Mental Health Fellowship Napa program for the past 10 years, the program is now affiliated with the University of California at Davis - the UC Davis Infant-Parent Mental Health Fellowship program - under Kristi’s direction. Connie Keefer and I made up the faculty for the training, which took place on March 29th at Napa, California.

Sweden: Kari Slinning was invited to speak at the 2015 Stockholm Conference on Ultra-early Intervention: Commonalities and differences of interventions; cost-benefit analyses; collaboration and partnership in patient and family-centred developmentally supportive care. Kari’s presentation was on the NBO and its uses with at-risk infants.


United States: Jessica Dym-Bartlett presented a paper on the NBO at the Society for Research in Child Development (SRCD) meeting in April. The paper entitled, “A Randomized Study of the Effects of a Short-Term Strengths-Based Newborn Intervention on Mother-Infant Interaction” was presented at the Biennial Meeting of SRCD in Philadelphia, USA.

Australia: NBO trainer Campbell Paul’s article, “Seeing Things Through My Eyes”: Understanding the Baby’s Perspective and Contribution to Psychodynamic Couple and Family Work”, was published in Couple and Family Psychoanalysis, 5, 1, 1-5 (2015). The article, which was included in the November Meeting folder, focuses on the use of the NBO and on Esther Bick’s Infant Observations approach. “These two powerful training tools can be very helpful in developing the therapist’s capacity to effectively communicate with babies and parents”, he writes.


South Africa: The first NBO training to take place in Africa was held in Johannesburg, South Africa, on May 11-12th, 2015, at the Ububele Parent-Infant Programme. The NBO training team consisted of Campbell Paul and Susan Nicolson. Ububele is an educational and psychotherapy trust providing training and services to improve the emotional development of children under 7 years. The program is directed by Katherine Frost and Tony Hamburger, who hosted the training. It was such a pleasure having Katherine and Niki Dawson join us for the Harvard meeting. They are planning to set up an NBO training site at Ububele.

United States: An Introduction to the NBO workshop was presented by Connie Keefer at the 26th Annual Partners in Perinatal Health Conference in Norwood, Massachusetts. 


Australia: Susan Nicolson conducted the first NBO training with Aboriginal workers in Northern Victoria, Australia, in June. (See the attached NBO Australia Newsletter for further information).

United Kingdom: An article by NBO practitioners, Amanda Holland and Dianne Watkins, based on an evaluation of the use of the NBO by Health Visitors in Wales, “Flying Start Health visitors: views of implementing the NBO: barriers and facilitating factors”, appeared in the UK published journal, Community Practitioner, 88, 4, 33-35. Results of their study revealed that a majority of practitioners felt that NBO implementation benefited parents and enhanced the parent-infant relationship. (This article was also included in the readings folder for the November Harvard meeting).


United States: The first NBO training with the Salish & Kootenai tribes, Montana, the United States, took place in August 2015. Constance Keefer and Yvette Blanchard conducted the training. The Flathead Indian Reservation is their home and of the approximately 7,753 enrolled tribal members, about 5,000 live on or near the reservation.

United Kingdom: An article by our colleague and Trainer, Deanna Gibbs, “Supporting the Parent-infant relationship: using the Neonatal Behavioral Observations in the Intensive Care Unit” was published in the Journal of the Association of Paediatric Chartered Physiotherapists, Volume 6, Number 1, 26-34, 2015. This paper highlights the impact of a NICU admission on parenting and explores how the NBO can be implemented by therapists to promote positive parent-infant interaction. (Deanna’s article was also included in the Harvard Meeting folder). An article by Pauline Lee and Catherine Mee, on the Tameside and Glossop Early Attachment Service, which appeared in Community Practitioner, August, 2015, describes how the NBAS and NBO are being used by Health Visitors, Midwives, Community Nursery Nurses, Social Workers and Early Years Workers to support the parent-infant attachment process in a comprehensive parent-infant mental health service based on a psychodynamic model. (This article also appeared in the November meeting folder). 

Hong Kong: Betty Hutchon offered training on the NBAS to the Hong Kong Occupational Therapy Association. 


United States, UK, Australia, Norway: The Zero to Three Journal, bestowed a significant “first” on us by featuring five original articles on the NBO in their September issue, the theme of which was Supporting Parents Through Relationship-based Interventions. The first featured article was “The Newborn Behavioral Observations (NBO) system as a form of intervention and support for new parents” (by JKN), while Beth McManus’s article was entitled, “Integrating the NBO into Care Settings for High-Risk Newborns”, and describes the uses of the NBO with at-risk infants. Joanna Hawthorne described how the NBO and NBAS came to be recommended by the National Health Visiting Service in the UK in her article on “Influencing health policy in the antenatal and postnatal period: the UK experience”. Susan Nicolson described their work with the NBO in Australia in “Let’s meet your baby as a person: From research to Preventive Perinatal Practice with the NBO”, while Kari Slinning and Unni Tranaas Vannebo’s article “The Training of Infant Mental Health Professionals: the Norway experience” was based on their experience with NBO training in Norway. (All these articles appeared in the NBONBASInternational November Meeting folder)

Norway: Gunn Kristin Øberg was certified as an NBAS trainer for Norway by Yvette Blanchard. Gunn is an Associate Professor in the Department of Health and Care Sciences, at the University of Tromsø, The Arctic University of Norway. Yvette and Gunn’s article, Physical therapy with newborns and infants: applying concepts of phenomenology and synactive theory to guide interventions, was published in Physiotherapy, Theory and Practice, Early Online, 1-5,
United States: In the same month, Claudia Quigg and Ann Stadtler conducted the first NBO training at the Little Company of Mary Hospital in Chicago, Illinois. Participants included Baby TALK professionals, Touchpoints practitioners, Fussy Baby personnel and occupational/physical therapists among other personnel working with infants and families.

United Kingdom: Topun Austin, Addenbrookes, Cambridge and colleagues received a grant from the Melinda and Bill Gates Foundation to carry out a study about nutrition and cognitive development in the UK and The Gambia, using the NBAS as a measure. The research with George Washington and Cambridge Universities, will select the most malnourished children and compare them with the best-nourished children to explore why the two groups differ despite the same environmental influences. Three researchers on the project received NBAS training from Joanna Hawthorne in Cambridge, England.


World Wide Web: I was invited to be the featured presenter on the first Zero to Three Author Spotlight Webinar and was asked to speak about our work with the NBO. I described the NBO, its content and uses and went on to summarise the content of all five Zero to Three Journal articles. This was followed by questions from the webinar participants.

Spain: A research paper on the NBAS written by our Barcelona colleagues, Alicia Alvarez-Garcia (who, as part of the new generation of trainers, joined us for the November meeting) and long-time NBAS Trainer Carme Costas and their colleagues, entitled, Neurobehavioral conditions and effects of gender, weight and severity in preterm infants according to the Neonatal Behavioral Assessment Scale, was published in the Annals of Psychology, 31, 3 in 2015. The preterm group showed significantly lower scores than the control group on 2 of the 5 clusters, but preterm babies performed better in habituation to disturbing stimuli (light and sound) during sleep. In relation to the influence of sex, premature girls performed better in the Social-Interactive cluster.

United States: Beth McManus and her colleagues had their paper on Identifying infants and toddlers at high risk for persistent delays published in the Maternal Child Health Journal.

Australia: NBO practitioners, Patricia O’Rourke, Lynly Mader and Valerie Aylesbury presented their work at the Australian Marcé Society Meeting in Adelaide from Oct 22-24th. See the NBO Australia Newsletter for more details on the Australia - New Zealand training site activities in 2015.

United Kingdom: An article by Joanna Hawthorne, Learning to observe baby behaviour: Using the NBAS and NBO was published in the International Journal of Birth and Parent Education, London, Vol. 3, (1), 23-28.

Norway: NBAS and NBO Trainer, Inger-Pauline Landsem and her colleagues had their paper, Early intervention influences positively quality of life as reported by prematurely born children at age nine and their parents; a randomized clinical trial, published in Health and Quality of Life Ootcomes, 13, 25. The newborn component of the Tromsø Intervention Study on Preterms was based on the NBAS and the training was provided by NBAS Trainer Emeritus, Jean Cole. This early intervention appears to have generated long-lasting positive effects, improving perceived physical well-being among prematurely born children and parent’s perception of these children’s Quality of Life measures in middle childhood.


United States: The International NBO and NBAS Trainers Meeting, planned by Joanna Hawthorne, Lise Johnson, Beth McManus and myself, was held at Harvard Medical School from Nov 2nd-4th. Over sixty of you from twenty countries attended, many attending for the first time. I know you will agree that we were very fortunate to have had such a brilliant line-up of speakers, to have had Berry Brazelton with us, along with all the eminent long-time serving international Trainers such as Joao Gomes-Pedro, Joanna Hawthorne, Carme Costas, Betty Hutchon, Gherardo Rapisardi, Nittaya Kotchabkhakdi, Shohei Ohgi, Nadia Bruschweiler-Stern, Marie Fabre-Grenet, Yvette Blanchard and Connie Keefer.

But, as the focus is on “firsts”, I would now like to single out the welcome presence of all of you who were participating for the first time: Danielle Atkins from New Zealand, Claudia Regina Lindgren Alves and Livia Magalhaes from Brazil, Regina Elton from Chile, Sui Chen from China, Merethe Vinter from Denmark, Susanne Mudra from Germany, Stefania Arnardottir from Iceland, Luca Migliacco, Fabia Banella and Maria Luce Cioni from Italy, Yukiyo Nagai and Mariko Iwayama from Japan, Alexis Reyes and Rita Vallodolid from the Philippines, Ana-Teresa Brito and Rita Silveira Machado from Portugal, Katherine Frost and Nicky Dawson from South Africa, Alicia Alvarez-Garcia from Spain, Laetitia Chansel from Switzerland, Pat Rojmahamongkol and Pornchanok Wantanakorn from Thailand and Karen Fehringer, Nancy Deacon and Nina Burtchen from the United States. Thank you for honouring us with your presence and for sharing your ideas with us!  For others of you, this was a “second time” as you had attended the Edinburgh meeting and this number included Hu Li, Eiko Saito, Kari Slinning, Campbell Paul, Lise Johnson, Kristie Brandt, Unni Tranaas Vannebo, Inger-Pauline Landsem, Susan Nicolson, Eileen Hayes, Ann Stadtler, Jeanette Appleton, Inge Nickell, Emily Hills, Deanna Gibbs, Jayne Singer, Claudia Quigg, Guillermina Marquine, Rita Al Minwayi and Gaylen Plant.

The organizing committee, which included Joanna Hawthorne, Lise Johnson, Beth McManus and myself, would like to take this opportunity to offer a special word of public thanks to our colleagues who worked behind the scenes to make the November meeting such a success: Ann Stadtler, Mai Nguyen, Gaylen Plant, Aditi Subramaniam, Alisa Serraton and Allison Duarte.

Switzerland: Kari Slinning and I presented the first NBO training in Switzerland at the University of Bern on Nov 19-20th. The training included nurses, psychologists, psychiatrists, physiotherapists and infant specialists from all over Switzerland. The very successful training was hosted and organized by Professor Eva Cignacco Mülller and Natascha Schütz Hämmerli and Nadia Bruschweiler-Stern also participated.

Ireland: I was invited to testify on Infant Mental Health before the National Parliament of Ireland (Oireachtas) Joint Committee on Health and Children, Government Buildings, Leinster House, Dublin, and took the opportunity to speak of the value of the NBO as a form of parent-infant mental health promotion. I also presented the keynote address to the Psychological Society of Ireland Annual Meeting in Galway, Towards science-based interventions in the first years of life: Supporting infant-parent mental health and gave an introductory workshop on the NBO in Dublin. The meeting was hosted by the Psychological Society of Ireland, under the Presidency of Paul D’Alton in partnership with the Irish Association for Infant Mental Health, under the leadership of Catherine Maguire. Plans are in place to present NBO training in Ireland in 2016.

Hong Kong: Campbell Paul presented a workshop on the NBO at the inaugural meeting of the Hong Kong Association for Infant Mental Health.

United Kingdom: The Brazelton Centre UK was invited to train 250 health visitors in Cambridgeshire, UK in the NBO. Another request for NBO training came from Derbyshire where all health visitors will be trained over the next few years.

United States: Two articles by Beth McManus and colleagues appeared this month. Rural/Urban differences in therapy service use among Medicaid children with developmental conditions, ages 0-3, in Colorado, was published in Acta Pediatrica, while, Which Children Are Not Getting Their Needs for Therapy or Mobility Aids Met? Data From the 2009-2010 National Survey of Children With Special Health Care Needs, was published in Physical Therapy in the same month.


United States: “Using The Newborn Behavior Observation (NBO) In An Urban Early Intervention Program With At-Risk Infants” by Gaylen Plant and Aditi Subramaniam was presented at the ZERO TO THREE's 30th National Training Institute (NTI) in Seattle, Washington, December 2-4, 2015. 

Egypt: Joanna Hawthorne was a keynote speaker at the 6th annual Infant Psychiatry Conference, INFANT PSYCHIATRY: From Prevention to Early Intervention, held in Cairo. Her talks were entitled: 'Listening to the Baby's voice: Infant mental health in practice' and 'Influencing health policy in the UK'. NBAS/NBO trainer Rita Al-Minyawi gave a talk entitled: 'Using the NBAS in the Neonatal Unit'. The next day, both Joanna and Rita held a day's workshop attended by 60 practitioners entitled: 'Understanding and supporting parent-baby relationships'.

Australia: Eight NBO training workshops were held in Australia this year. At the end of the year, Susan Nicolson and Campbell Paul published the NBO Australia newsletter, which I am including here. It is a very impressive publication and I am very happy to share it with you as this year of “firsts” comes to an end.

Other significant 2015 events – not “firsts” - but equally notable!

Australia, Belgium, Japan, Norway, Switzerland, Spain, UK & USA: NBO and NBAS Training took place across many NBAS and NBO sites in 2015, which may not have been “firsts” but are equally significant in terms of fulfilling our mission to provide training to researchers and clinicians around the world.

USA: In the United States, NBO and NBAS trainings were conducted at Boston Children’s Hospital as part of our on-going series of offerings at the Brazelton Institute. During the year, we also provided NBO training to three key Infant Mental Health Fellowship programs. In March, we provided training to Kristie Brandt’s Napa UC Davis Infant-Parent Mental Health Fellowship program, as described above, and in the same month, NBO training was presented by Connie Keefer and Kevin Nugent to Ed Tronick’s Infant-Parent Mental Health Fellowship program at the University of Massachusetts at Boston. Then in September Connie Keefer and Kevin Nugent presented NBO training at the University of Wisconsin-Madison Infant Mental Health Fellowship. Participants included Fellows in the University of Wisconsin Infant, Early Childhood and Family Mental Health Capstone Certificate Program and practitioners from many of the Home Visiting Programs in Wisconsin. The training was coordinated by Drs. Roseanne Clark and Linda Tuchmann.

In December, Beth McManus and I received a research grant from the Noonan Family Foundation to test the effectiveness of the NBO as a model of care in a large sample of infants served by Early Intervention programs for infants with developmental disabilities or delays in the State of Massachusetts. The purpose of the study is to determine the effects of the NBO on infant cognitive and social-emotional function and maternal depression. Trainer Yvette Blanchard is a consultant on the grant and Trainer Jayne Singer will be involved in the training of the EI practitioners.

Looking forward to 2016

As we welcome the New Year, I look forward to meeting you in Prague in May, as many of you are presenting symposia and papers at the World Association for Infant Mental Health meeting. In the meantime, we will try to set up a Trainers meeting for even a half day, either before or after the meeting proper. By that time, too, NBO NBAS International will have a more significant and more accessible presence on-line, so that we can communicate and plan for this event together.
As for a new year’s wish or set of wishes for NBO NBAS International, it is my sincere hope that we can
  • Continue to reflect on and refine our theoretical model
  • Further develop our approach to mentoring and training
  • Use on-line technology more effectively as part of our training
  • Commit ourselves to generating more research to support evidence-based practice
  • Promote more research with the NBAS and the NBO
  • Aspire towards consolidating our NBO NBAS International network.

I feel very honoured to be working with you and to be able to call you my colleagues and I look forward to continuing our work together as we move into the future.
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