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

Research output: Contribution to journalReview articlepeer-review


  • Joanna Garstang
  • Debbie Watson
  • Anna Pease
  • Catherine Ellis
  • Peter S. Blair
  • And 1 others
  • Peter Fleming

Colleges, School and Institutes


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.

Bibliographic note

Funding Information: This work was funded by the Department for Education to support the National Child Safeguarding Practice Review of SUDI in families with children at risk of significant harm. The funder had no role in the design, analysis or interpretation of results. The views expressed are those of the authors and not necessarily of the Department for Education or National Child Safeguarding Practice Review Panel. Publisher Copyright: © 2021 The Authors. Child: Care, Health and Development published by John Wiley & Sons Ltd.


Original languageEnglish
JournalChild: Care, Health and Development
Early online date30 Apr 2021
Publication statusE-pub ahead of print - 30 Apr 2021


  • Sudden Infant Death Syndrome, Sudden Unexpected Death in Infancy, child protection, engagement