The prenatal maternal representations of mothers at risk of recurrent care proceedings in the Family Drug and Alcohol Court: A thematic analysis.

BACKGROUND: A substantial number of birth mothers experience repeat removals of their infants and children due to child protection concerns. The perspectives of mothers going through repeat removals and their experiences of pregnancy are insufficiently researched. AIMS AND METHODS: The current qualitative study aimed to explore the maternal representations of five pregnant mothers at risk of recurrent care proceedings. A thematic analysis of these mothers' responses to the Pregnancy Interview focused on their representations of themselves as mothers, of their babies, and of the mother-baby relationship. RESULTS: Seven key themes were identified: (1a) "Uncertainty and fear of losing the baby," (1b) "Uncertainty but hope of becoming a mother," (2) "Not wanting to be like their own mother," (3) "Experiencing recovery and pregnancy as two interdependent processes," (4) "Struggling to imagine the baby," (5) "The omnipresence of previous children," (6) "Pleasure at starting to have a connection with the baby," and (7) "Noting the baby's dependency." CONCLUSION: The results are clinically relevant as they highlight grief, maternal self-identity, recovery from substance abuse, and ability to manage uncertainty as critical areas of intervention for these mothers.

Trasfondo: Un número considerable de madres que dan a luz experimentan la repetida separación de sus infantes y niños debido a las preocupaciones de protección infantil. Las perspectivas de las madres que pasan repetidamente por el proceso de separación y las experiencias de su embarazo no están suficientemente investigadas. Metas y Métodos: El presente estudio cualitativo se propuso explorar las representaciones maternas de cinco madres embarazadas bajo riesgo de un proceso recurrente relacionado con el cuidado. Un Análisis Temático de las respuestas de estas madres a la Entrevista del Embarazo (Slade, 2007) se enfocó en las representaciones sobre ellas mismas como madres, de sus bebés, así como de la relación madre-bebé. Resultados: Se identificaron siete temas claves: (1a) 'Incertidumbre y temor de perder el bebé,' (1b) 'Incertidumbre, pero con la esperanza de llegar a ser madre,' (2) 'No querer ser como su propia madre,' (3) 'Experimentar el recobro y el embarazo como dos procesos interdependientes,' (4) 'Dificultad en imaginarse al bebé,' (5) 'La omnipresencia de niños anteriores,' (6) 'Comenzar a tener una conexión con el bebé que trae alegría,' y (7) 'Notar la dependencia del bebé.' Conclusión: Los resultados son clínicamente relevantes ya que ellos subrayan el hecho de que la aflicción de estas madres, la auto-identidad materna, el recobro del abuso de sustancias, así como la habilidad para arreglárselas con la incertidumbre constituyen áreas críticas de intervención. Palabras claves: procedimientos relacionados con el cuidado, madres biológicas, relación madre-bebé, Entrevista de Embarazo, representaciones maternas prenatales.

Contexte: Un nombre important de mères ayant donné naissance font l'expérience du retrait répété de leurs nourrissons et de leurs enfants à cause d'inquiétudes liées à la protection de l'enfant. Les perspectives de ces mères faisant face à des retraits répétés et leurs expériences de leur grossesse n'ont pas fait l'objet d'assez de recherches. Buts et Méthodes: Cette étude qualitative s'est donné pour but d'explorer les représentations maternelles de cinq mères enceintes à risques de procédures de soins récurrents. Une Analyse Thématique des réponses de ces mères durant l'Entretien de Grossesse (Slade, 2007) a porté sur leurs représentations d'elles-mêmes en tant que mères, et de leurs bébés, et de la relation mère-bébé. Résultats: Sept thèmes clés ont été identifiés: (1a) 'L'incertitude et la peur de perdre le bébé', (1b) 'L'incertitude mais l'espoir de devenir mère', (2) 'Ne pas vouloir être comme leur propre mère', (3) 'Faire l'expérience du rétablissement de la toxicomanie et de la grossesse comme deux processus interdépendants', (4) 'Le fait d'avoir des difficultés à imaginer le bébé', (5) 'L'omniprésence des enfants précédents', (6) 'Commencer à avoir une connexion avec le bébé qui apporte une joie', et (7) 'Le fait de notre la dépendance du bébé'. Conclusion: Les résultats sont cliniquement importants dans la mesure où ils mettent en évidence que le deuil de ces mères, leur auto-identité maternelle, leur rétablissement de toxicomanie, et leur capacité à gérer l'incertitude constituent des domaines critiques d'intervention. Mots clés: procédure de prise en charge, mère biologique, relation mère-bébé, Entretien de Grossesse, représentations maternelles avant la naissance.

TIGA-CUB-manualised psychoanalytic child psychotherapy versus treatment as usual for children aged 5-11 with treatment-resistant conduct disorders and their primary carers: results from a randomised controlled feasibility trial.

BACKGROUND: Parenting programmes are recommended for conduct disorders in 5-11 year olds, but ineffective for 25-33%. A feasibility trial was needed to determine whether a confirmatory trial of second-line, manualised short-term psychoanalytic child psychotherapy (mPCP) versus treatment as usual (TaU) is practicable. METHOD: This was a two-arm, pragmatic, parallel-group, multi-centre, individually-randomised controlled feasibility trial with blinded outcome assessment. Child-primary carer dyads were recruited from National Health Service Child and Adolescent Mental Health Services and mPCP delivered by routine child psychotherapists. RESULTS: Thirty-two dyads (50% of eligible, 95% CI 37 to 63%) were recruited, with 16 randomised to each arm. Eleven (69%) completed ≥50% of 12 week mPCP and 13 (81%) . Follow-up was obtained for 24 (75%) at 4 months and 14/16 (88%) at 8 months. Teacher follow-up was 16 (50%) ≥1 session. Manual adherence was good. Baseline candidate primary outcomes were 37.4 (SD 11.4) and 18.1 (SD 15.7) on the Child Behaviour Checklist/Teacher Report Form externalising scale and 102.8 (SD 28.4) and 58.8 (SD 38.9) on the total score. Health economics data collection was feasible and the trial acceptable to participants. CONCLUSION: Recruitment, teacher follow-up and the manual need some refinement. A confirmatory trial is feasible, subject to funding of research child psychotherapists.

TIGA-CUB - manualised psychoanalytic child psychotherapy versus treatment as usual for children aged 5-11 years with treatment-resistant conduct disorders and their primary carers: study protocol for a randomised controlled feasibility trial.

BACKGROUND: The National Institute for Health and Care Excellence (NICE) recommends evidence-based parenting programmes as a first-line intervention for conduct disorders (CD) in children aged 5-11 years. As these are not effective in 25-33% of cases, NICE has requested research into second-line interventions. Child and Adolescent Psychotherapists (CAPTs) address highly complex problems where first-line treatments have failed and there have been small-scale studies of Psychoanalytic Child Psychotherapy (PCP) for CD. A feasibility trial is needed to determine whether a confirmatory trial of manualised PCP (mPCP) versus Treatment as Usual (TaU) for CD is practicable or needs refinement. The aim of this paper is to publish the abridged protocol of this feasibility trial. METHODS AND DESIGN: TIGA-CUB (Trial on improving Inter-Generational Attachment for Children Undergoing Behaviour problems) is a two-arm, pragmatic, parallel-group, multicentre, individually randomised (1:1) controlled feasibility trial (target n = 60) with blinded outcome assessment (at 4 and 8 months), which aims to develop an optimum practicable protocol for a confirmatory, pragmatic, randomised controlled trial (RCT) (primary outcome: child's behaviour; secondary outcomes: parental reflective functioning and mental health, child and parent quality of life), comparing mPCP and TaU as second-line treatments for children aged 5-11 years with treatment-resistant CD and inter-generational attachment difficulties, and for their primary carers. Child-primary carer dyads will be recruited following a referral to, or re-referral within, National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) after an unsuccessful first-line parenting intervention. PCP will be delivered by qualified CAPTs working in routine NHS clinical practice, using a trial-specific PCP manual (a brief version of established PCP clinical practice). Outcomes are: (1) feasibility of recruitment methods, (2) uptake and follow-up rates, (3) therapeutic delivery, treatment retention and attendance, intervention adherence rates, (4) follow-up data collection, and (5) statistical, health economics, process evaluation, and qualitative outcomes. DISCUSSION: TIGA-CUB will provide important information on the feasibility and potential challenges of undertaking a confirmatory RCT to evaluate the effectiveness and cost-effectiveness of mPCP. TRIAL REGISTRATION: Current Controlled Trials, ID: ISRCTN86725795 . Registered on 31 May 2016.

Evidence-Based Parenting Interventions to Promote Secure Attachment: Findings From a Systematic Review and Meta-Analysis.

Various interventions are used in clinical practice to address insecure or disorganized attachment patterns and attachment disorders. The most common of these are parenting interventions, but not all have a robust empirical evidence base. We undertook a systematic review of randomized trials comparing a parenting intervention with a control, where these used a validated attachment instrument, in order to evaluate the clinical and cost-effectiveness of interventions aiming to improve attachment in children with severe attachment problems (mean age <13 years). This article aims to inform clinicians about the parenting interventions included in our systematic review that were clinically effective in promoting secure attachment. For completeness, we also briefly discuss other interventions without randomized controlled trial evidence, identified in Patient Public Involvement workshops and expert groups at the point our review was completed as being used or recommended. We outline the key implications of our findings for clinical practice and future research.