PANJO Presentation
Everything you need to know about the PANJO program, designed to help expectant parents living in challenging psychosocial circumstances build a strong bond with their newborn
Contact
For any questions or additional information, please contact: evalpanjo@santepubliquefrance.fr
The PANJO Initiative: Early Prevention, Evidence-Based Practices, and Maternal and Child Health Services
The quality of the relationship that develops between a parent and their newborn is crucial for the child’s future development and health. However, the living conditions in which parents welcome their babies vary and do not offer the same opportunities to everyone. This is why Santé publique France developed and piloted the PANJO early prevention intervention. It is offered to expectant parents living in an unfavorable psychosocial environment to promote the development of secure attachments.
The Attachment Bond
A toddler’s need for emotional security is a fundamental need, just like eating or sleeping. The quality of the baby’s attachment bonds with their parent will impact their psycho-emotional development in both the short and long term. The attachment bond is formed through daily interactions between a caregiver and the baby, particularly when the child is in distress and turns to the adult to regain a sense of security. The establishment of secure baby-parent attachment bonds fosters the child’s autonomy, flexibility, and self-confidence as well as trust in others, thereby contributing to their overall development.
PANJO’s strategy is based on supporting parents from pregnancy through the child’s first 12 months. Midwives and pediatric nurses from the PMI make 6 (minimum) to 12 home visits to expectant and new parents. What sets PANJO home visits apart is that they systematically devote significant time to observing the baby and parent-baby interactions, which helps foster secure attachments. The professional’s role is to support the parent in developing their sensitivity, closeness, commitment, and ability to foster reciprocity with their child. These interventions are conducted exclusively by PMI staff who have received PANJO training, use PANJO intervention tools, and receive supervision.
Since 2020: PANJO 3, the pilot program
The third phase of the project aims to establish partnership frameworks between departments, ARS, and Santé publique France to enable the large-scale and sustainable deployment of an optimized PANJO intervention. The lessons learned from this PANJO intervention deployment pilot will help define the guidelines for a deployment strategy for the rest of France.
Supporting the changes in preventive practices necessary for implementing PANJO
In PANJO 3, ARS and PMI supervisors receive methodological and scientific support provided by Santé publique France or one of its partners, such as the Institut de la parentalité.
Midwives and pediatric nurses receive training to better master attachment theory, the PANJO intervention protocol, and to familiarize themselves with the tools. Supervisors and mentors are welcome to participate in this training. Home-based practitioners take part in about ten group supervision sessions per year to provide long-term support for integrating professional practices based on attachment and collaboration with families.
Managers and practitioners participate in deployment monitoring and evaluative studies regarding the integration of PANJO practices.
Milestones of the pilot rollout
More than 15 PMI services are participating in the pilot rollout. The rollout may be department- or region-wide, as is the case with initiatives by the ARS Bretagne and ARS Nouvelle Aquitaine.
From 2022 to 2024, 750 PMI home-visit providers were trained in PANJO, and 863 families agreed to receive support.
Training and supervision for midwives and pediatric nurses were co-funded by the ARS’s FIR, the “First 1,000 Days of a Child’s Life” policy, and contracts signed under the National Strategy for Child Prevention and Protection.
The second phase made it possible to assess the suitability of the implementation strategies for this innovative intervention and to measure its effectiveness. To this end, Santé publique France signed a research and development agreement with the Agency for New Social and Health Interventions (ANISS).
Method
The Panjo 2 efficacy study included 330 women pregnant with their first child who reported feeling lonely during pregnancy. The 159 women supported using the PANJO method constitute the exposed cohort. The control cohort consists of 171 women receiving standard care available in France during the perinatal period. Participants were interviewed once at the end of pregnancy at the time of recruitment, once when the child was six months old, and a final time at twelve months.
The data collected are intended to measure the effectiveness of PANJO home visits in terms of promoting a sense of parental efficacy (primary outcome), reducing coercive parenting behaviors, promoting health-protective behaviors, and improving the appropriate use of medical and social services. These short-term effectiveness criteria are, in fact, predictors of the intervention’s long-term effectiveness on the child’s physical, cognitive, and psycho-emotional development.
Partners
Santé publique France and ANISS were able to rely on the commitment of some twenty PMI teams spread across eleven departments to pilot the intervention with families in the exposed cohort. Eight maternity wards facilitated the recruitment of families for the control cohort. Other partners joined the project. Thus, we were able to rely on the Université du Québec à Montréal for scientific support, child psychiatry services to provide supervision for the practitioners, the federation of perinatal networks, and certain Regional Health Agencies to support the local implementation of the study.
Results
Quantitative and qualitative implementation evaluations highlight the relevance of the professional practice support system and identify certain challenges that must be addressed to ensure the intervention’s sustainability beyond the experimental period.
The results of the effectiveness evaluation show that, at six months of age, the Panjo intervention has favorable effects on parent-infant interactions for certain groups of more vulnerable women: fewer hostile reactions toward the infant and fewer dysfunctional interactions. Positive effects were also observed regarding access to healthcare and preventive services: fewer emergency room visits for babies, fewer instances of mothers foregoing care, and greater satisfaction with the support received from maternal and child health centers (PMI). However, no effect was observed on the sense of parenting competence, the study’s primary outcome measure.
An initial presentation of the results was given at the French Public Health Society Congress in October 2021. It is available here.
The first phase of PANJO, implemented by INPES (the National Institute for Prevention and Health Education, which became Santé publique France in May 2016), aimed to develop and test the acceptability of the PANJO intervention among professionals in maternal and child health services and beneficiary families in three departments. This initial phase confirmed the program’s high level of acceptance among professionals and families and allowed for its optimization.
References
Taymi S., Popineau B., Estebanez L-A., Quéruel N., “Panjo Home Visits: Support Tailored to the Family and Newborn.” Health in Action. Supporting the Formation of Early Parent-Child Bonds. May 2024, No. 466, pp. 24–26
Sempé S., et al., “Early Prevention: Results of the Efficacy Study on the PANJO Intervention Tested by Eleven Maternal and Child Health Centers.” Public Health, 2022/HS1 (Vol. 34),
Saïas T. “The Panjo Project: Managing the First 1,000 Days of Life Based on Professional Practices.” Cahiers de la puéricultrice – Vol. 59 – No. 356 – April 2022
Mercerat C. et al, “The Panjo Program in France: A Qualitative Evaluation of Implementation and Changes in Professional Practices.” Revue Francophone Internationale de Recherche Infirmière – 2021 – No. 7
Sempé S., “Panjo: Home Visits to Strengthen the Mother-Child Bond.” Health in Action, Children’s Basic Needs, March 2019, No. 447, pp. 44–45.
Saïas T. et al. “Supporting the skills of early prevention workers in France: uses and effects of the Panjo program.” Revue Francophone Internationale de Recherche Infirmière – 2019 – No. 5
Lagarde C. “The experience of containment in supervisory work with PMI childcare workers within the PANJO program.” Enfances et Psy – 2018 – No. 77
Le Nestour A. “The PANJO program: intensifying network-based work.” Enfances et Psy – 2016 – No. 69
