'Modelling a Secure-Base' for Women with Complex Needs: Attachment-Based Interventions Used by Perinatal and Infant Mental Health Clinicians.

Infant well-being is intrinsically linked to maternal physical and emotional well-being. Internationally health services have implemented policies to identify women at risk of mental health problems and developed effective care pathways. The aim of this paper is to describe how perinatal and infant mental health clinicians perceive their role and the attachment-based interventions they use in their work. The study comes from a larger mixed methods study, which examined two specialist perinatal and infant mental health services in New South Wales (Australia). Two hundred and forty-four medical records were reviewed, and six perinatal and infant mental health clinicians participated in in-depth semi-structured interviews. Data were analysed by content and thematic analysis. One overarching theme, modelling a secure base and three supporting themes, enhancing reflective capacity, enhancing emotional regulation and enhancing empathy emerged from the analysis. These findings demonstrate how perinatal and infant mental health clinicians use attachment theory to inform practice by modelling "holding" and being a secure-base for women. They also provide a clearer understanding of perinatal mental health practice and can be used to inform educational programs for multidisciplinary mental health professionals particularly those working with women and infants.

A mixed methods study of collaboration between perinatal and infant mental health clinicians and other service providers: Do they sit in silos?

BACKGROUND: Women at risk of poor perinatal mental health benefit from coordinated approaches to care. Perinatal and infant mental health (PIMH) services have been established to support women with social and emotional needs. This paper examines the nature and extent of collaboration within two PIMH services in Australia. METHODS: A convergent, embedded, mixed methods design was used. Two hundred and forty four medical records were reviewed, 13 professionals (six PIMH clinicians, two PIMH service managers, and five key stakeholders) and 11 women service-users participated in semi-structured interviews. RESULTS: Three broad themes were drawn from the data, Theme 1: We don't sit in silos … but they do, Theme 2: We need to enhance communication, and Theme 3: Collaboration is hard work. Perinatal and infant mental health clinicians believe they work collaboratively with other service providers. Key stakeholders and documentation in the medical records reveal that collaboration is nominal. CONCLUSIONS: Professionals believe that collaboration is essential for women with complex needs. Perinatal and infant mental health clinicians are skilled at building relationships with women, however further support is needed to build trusting relationships with other service providers. Women service-users also need to be involved in the collaborative process to become equal partners in their care.

Engaging women at risk for poor perinatal mental health outcomes: a mixed-methods study.

Risk factors for poor perinatal mental health are well known. Psychosocial assessment and depression screening during the perinatal period aim to identify women at risk for poor perinatal outcomes. Early intervention programmes are known to improve the mental health outcomes of women and infants. Key to any intervention is initial and ongoing engagement in the therapeutic process. This mixed-methods study reports the proportion of women who engage/do not engage with services and their characteristics, as well as the strategies clinicians use to engage women. Data were collected by reviewing medical records, interviewing perinatal and infant mental health (PIMH) clinicians, their managers, key stakeholders, and women service users. Analyses identified that most (71.3%) women referred engaged with the PIMH service. Themes related to non-engagement are 'time to rethink' and 'stigma'. Themes reflecting the engagement strategies used by PIMH clinicians are initial engagement: 'back to basics' and 'building trust', therapeutic engagement: 'making myself useful', engagement at discharge: 'woman or clinician led', and models that facilitate engagement.

'My special time': Australian women's experiences of accessing a specialist perinatal and infant mental health service.

Women who have few social supports, poor health and a history of stressful life events are at risk of poor mental health during the perinatal period. Infants of parents whose parenting capacity is compromised are also at risk of adverse outcomes. Specifically, poor perinatal mental health can impact maternal-infant attachment. To identify women at risk of poor perinatal mental health, psychosocial assessment and depression screening in the antenatal and early postnatal periods are recommended. This qualitative study is part of a larger mixed methods study, which explored two specialist perinatal and infant mental health (PIMH) services in New South Wales (Australia). Eleven women who had accessed and been discharged from a PIMH service participated in either face-to-face or telephone interviews. Data were transcribed verbatim and analysed thematically. One overarching theme, 'my special time' and three sub-themes, 'there is someone out there for me', 'it wasn't just a job' and 'swimming or stranded: feelings about leaving the service', were identified. The themes describe the women's experiences of being a client of a PIMH service. Overall, women reported a positive experience of the service, their relationship with the clinician being a key component. Findings from this study highlight the importance of the relational aspect of care and support; however, women need self-determination in all therapeutic processes, including discharge, if recovery and self-efficacy as a mother are to be gained. Importantly, further research is needed about how clinicians model a secure base and how mothers emulate this for their infants.

Child and family health nurses working with families of preschool-aged children.

AIMS AND OBJECTIVES: To examine child and family health nurses' perceptions of and practices related to working with families of preschool-aged children about their child's behaviour. BACKGROUND: Emotional and behavioural problems in young children are of increasing concern. Child and family health nurses are well placed to support parents and provide education about behavioural concerns. DESIGN: A qualitative interpretive study informed by ethnography was used. METHODS: Forty-eight nurses participated in focus groups. Of these nurses, 11 participated in observations of clinical interactions with 23 mothers. Eight managers were interviewed. RESULTS: Three themes and two subthemes emerged from the data: Parents as deficit and nurse as expert; Parents have strengths and nurse as partner; Shaping practice - Time pressures and Wanting respect and to be valued. CONCLUSIONS: Child and family health nurses enjoy working with preschool-aged children; however, complex issues and tensions are evident. Nurses need support at all levels within the health service if they are to negotiate an environment of ongoing change and to be enabled to work in partnership with parents and families and thereby promote the emotional and behavioural development of preschool-aged children. RELEVANCE TO CLINICAL PRACTICE: The universal role of child and family health nurses provides unique opportunities to support parents about child behaviour concerns. Without appropriate support, nurses continue to work within an expert model that may alienate parents and families from using this service.

Collaboration and integrated services for perinatal mental health: an integrative review.

BACKGROUND: An integrative review was undertaken to synthesise the research related to professionals' perceptions and experiences of working in collaborative and integrated models of perinatal care for women with mental health problems. METHOD: A search of the databases CINAHL, Medline, PubMed, Psychinfo and Scopus was conducted. Studies were limited to English language papers published from 2000 to 2010. Fourteen papers were included in the review. RESULTS: The overarching theme identified in the review related to the process of 'making it happen'. Eight key elements were identified as central components of this process: funding and resources for collaboration; shared vision, aims and goals; pathways and guidelines; continuity of care; building relationships and trust; role clarity; training and education of staff and support to work in new ways. CONCLUSION: Perinatal mental health is an emerging field that is particularly challenging as it requires professionals to work across disciplines and timeframes, where there is a risk of dichotomising care, compounding existing barriers to service uptake. Professionals need resources and to feel supported to change clinical practice and work in more collaborative ways. The voices of women and families are missing in the literature.