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In 2006 in north Somerset we launched the Postnatal pathway for - - PowerPoint PPT Presentation
In 2006 in north Somerset we launched the Postnatal pathway for - - PowerPoint PPT Presentation
In 2006 in north Somerset we launched the Postnatal pathway for maternal mental health and early attachment . Ref: Milford R. Community practitioner Aug 2006 Hospit pital l Anxie iety ty Sca cale (HAD) This is divided into two aspects
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Hospit
pital l Anxie iety ty Sca cale (HAD)
This is divided into two aspects depression and anxiety. Depressi
ession
- n
A score of 7 or lower is low concern A score of 8-9 is moderate concern A score of 10 or more is high concern Anxiety
ety
A score of 7 or lower is low concern A score of 8-9 is moderate concern A score of 10 or more is high concern
SLIDE 4
Mother
ers s Objec ect t Re Rela latio ions ns Sc Scale les s (MORS RS)
Warmth and Invasion scores Warmth
h scale le
A score of 11 and lower is high concern A score of 15 - 10 is moderate concern A score of 16 and above is low concern Invasi
asion
- n scale
le
A score of 17 and above is of high concern A score of 12 -16 is of moderate concern A score of 11 and below is of low concern
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No concern rn Moderat rate concern rn High concern rn Routine Health Visiting service Up to 6 listening visits (review) GP & Mental Health specialists (NICE Guidance) Refer to Mental Health Specialist for consultation Additional appropriate services offered from a menu
- f complementary care
packages including
BABY MASSAGE FOR ALL
* GP (NICE Guidelines) Counselling IAPT Referral to Adult Mental Health Team Wait, watch and wonder/ Theraplay based Attachment group No further action
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We no longer use the HAD and now use PQ9 GAD 7 We have commenced a pilot for the complimentary antenealt
care pathway which aims to pick up women with mental health concerns at the first booking clinic
SLIDE 7
A secure attachment relationship between mother and infant is recognised as
a protective factor and a key component in increasing the likelihood of children developing positive mental health in adulthood (Oates et al., 2007).
Recent research suggests 23% of non-clinical mothers have insecure-dismissive attachment, 19% insecure-preoccupied attachment and 58% secure attachment (Bakermans-Kranenburg and Van IJzendoorn, 2009). By considering a possible links between maternal attachment style and the
dyadic relationship with the infant, this study looked at the effectiveness of infant massage in promoting improved mother-infant attachment and dyadic attunement.
cure attachment relationship between mother and infant is recognised as a protective factor and key component in children developing positive mental health in adulthood (Oates et al., 2007).
Recent research suggests 23% of non-clinical mothers have insecure-dismissive attachment, 19% insecure-preoccupied attachment and 58% secure attachment (Bakermans- Kranenburg and Van IJzendoorn, 2009). Acknowledging these links between maternal attachment style and the dyadic relationship with the infant, this study looked at the effectiveness of infant massage in promoting improved mother-infant attachment and dyadic attunement.
SLIDE 8
NICE guidance for planning and commissioning children’s
services suggests that health visitors and midwives should consider evidence-based interventions, such as baby massage, as part of provision for the social and emotional well-being of new mothers and the under 5’s.
Robust evidence of the effectiveness of baby massage courses
would give confidence to decision makers about funding these resources within perinatal services.
Cut in local offer- lack of research used as a reason.
SLIDE 9
A Systematic review was conducted using 4 databases,
including publications from January 1980 to May 2016.
The criteria included massage or touch, when used as an
intervention on more than one occasion.
Two reviewers screened the extracted data for eligibility and
quality, using standardised forms.
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STUDY M ethod Participants Intervention Outcome M easures Data Collection Process Data Items Author's Judgment of Bias/Limitations Summary of M easures 232 Fujiki 279 Hart 392 Lee 520 O’Higgins 49 Beyer 1 1 5 Clarke 685 Watanabe 662 Underdown 523 Onozawa 264 Gurol Very small sample size. High drop out rate. Differing lengths
- f sessions. Short period of
intervention. data was analysed by non parametric methods due to sample size and M ann-Whitney U-test (two tailed) or Fisher's prbability test as appropriate Quasi- experimental design. Randomised Controled 1 1 7 (3 excluded) Breastfeeding singleton M others of healthy babies living in a specific city and with a minimum of highschool level of education. Baby massage taught at 5-7 days by IAIM instructor, CD given and technique checked at 1 5 and 38 days). 1 5 minute massage given daily for 48 days Implementation of M other-Infant Identifier Poll. M aternal Attachment Inventory Test between 24-48 hours after birth in hospital and on the last day
- f the study at home.
M aternal Affectionate Attachment M AI conducted in different
- environments. All mothers well
educated. Analysis used SPSS. Percentiles and means. Chi-square test. One- way analysis of varience. Paired sample t-test Randomised Controled 25 (9 dropped out) M others scoring >1 3 on the EPDS at 4 weeks postpartum, with healthy
- babies. 1
2 took part in a massage group and 1 3 took part in a support group 5 weekly sessions (1 hour for massage group and 1 hour for support group). Edingburgh Postnatal Depression Scale, Video's coded using Global Ratings for mother-infant Interactions at 2 months by Fiori- Cowley and M urray First and Last Sessions mother's given EPDS and videoed playing with their child for 5 mins. Depression status. M aternal contribution to interaction. Infant contribution to
- interaction. Quality of
interaction. No author comment but we could consider limitations regarding number, shortness of the interval between outcome measures (no follow up). Unknown care to control group. T-test Critical Realist research design (mixed method - quantative and qualatative) 39 mothers attending a six week infant massage programme in a group (six did not complete). 72% were white-British and 28% were other ethnic minorities. A five week massage course (group) led by the International Association of Infant M assage (IAIM ) Working model of the child interview (WM CI), the Edinbrugh Post- Natal Depression scale (EPDS) and the care index. Interviews (unknown environment).
- Videos. Pre and post intervention
Parental response classified into one of three broad attachment classifications: balanced, disengaged and
- distorted. EPDS scores for
levels of depression and Care Index (CI)measuring three aspects of maternal behaviour (sensitivity, covert and overt hostility and unresponsiveness). Four aspects of infant behaviour (cooperativeness, compulsive compliance, difficultness and passivity). Diverse range of infant practices
- bserved between parents and
- infants. They had a high
proporiton of white British which may impact on the contextual generalisation. Possible bias in recruitment e.g 1 /4 of participants had degrees, meaning they may have been more motivated to attend having heard of the offer of high quality infant massage programmes. High level of low risk women meaning that no significant change was likely. Quantative data was entered directly into SPSS as well as demographic details, WM CI classifications and EPDS and CI
- scores. Appropriate statistical
t-test were performed to compare the means for quantative data collected before and after the
- programme. Qualatative data
was also entered into NVIVO whcih is a qualatative data analaysis computer-software packaged and analysed thematically. Intervention research - Non- equivalent Control First time mums, three months post natal who attended infant massage
- classes. Full term infants.
20 1 0-1 5 minutes massage per day over four
- weeks. Control group
received normal care. The Profile of M ood States and the Postpartum Bonding
- Questionnaire. Pre and
post intervention. Unknown Tension-anxiety, depression, anger-hostility, vigour, fatigue and confusion. Very small sample size. No control group. Not randomised in design. All participants were married, proffessional and had existing social support
- networks. There were no high
levels of risk for stress or relationship difficulty. Recruitment via poster. Visual comparison of Pre and Post stress scores. Post Intervention Evaluation 94 (52 dropped out) Parents who had completed IAIM baby massage courses. 60 (1 40 dropped out) Parents who had not taken part in the massage courses
Unspecified 5 week programme
- f baby massage.
Control group did not attend this programme.
Programme Evaluation Questionairre, Infant Social Interaction Questionairre, Focus group Interviews. Post interaction questionairre by mail, requiring mailing back and Focus Group Interview. Items about the baby, Parent's Competancy Scale, Items about the parents, breastfeeding, reading, chatting. Impact of Social Interaction and Parenting. Post intervention data only. M ost of the data was from the focus group and just used one
- trainer. Short length of time so
unknown longer term effects. Sensitivity of tools was limited. Non intervention group was not well matched to intervention group so comparisons are limited. Qualitative data entered into SPSS and analysed using standard non parametric non statistical tests. Tapes were transcribed and analysed using Open Coding and Thematic Analysis. Single Pretest- Posttest Design 4 (3 dropped out) M others of healthy 1
- 3
months old infants responding to a poster advert. One off training session in non specific massage and parental
- sensitivity. Applied 5 x
weekly for 1 5-30 mins per day. Journal
- completion. Contacted
at midpoint to discuss progress and concerns. Parenting Stress Index - Short Form Pre and post questionairres. Narrative analysis was done on the journals. Total Stress Score. Parent's ratings of Infant's temperament, parental competancy, attachment, social support and role habit disturbance. Sensitivity to infant cues and
- ther themes (eg. Time of day).
Not fully randomised in design. Limited collection of physiological parameters. All babies lived with their families. t-test and chi-square test Prospective Block - Controled Randomised design 62 M others scoring 1 3+
- n the EPDS at 4 weeks
post partum. Control Group - 34 (56 dropped
- ut) scoring less than 9 on
the EPDS at 4 weeks post
- partum. Both groups were
split equally between 2
- interventions. M other's
attending 4 or more sessions were included. 6 Sessions of either IAIM Infant M assage
- r a support group
Edinburgh Post Natal Depression Scale, Spielberg State Anxiety Inventory, Infant Characteristics Questionairre, Video interactions using the Global Ratings for M other-Infant
- interactions. Social
economic questions. 9 to 1 2 weeks Questionairres and Videos in Clinic. Repeated at 1 9 weeks in clinic. Social ecomomic profile questions asked at the beginning. Depression and Anxiety State M aternal Sensitivity in Interaction, Infant Performance in Interaction, Overall Interaction, Fussiness/Difficulty Scale. The group were well educated with no socio economic stress. Participants were predominantly white and married. No treatment for depression group was not included for ethical reasons. Initial fall in EPDS scores may be attributed to anticipated support (Appleby, et al. 1 997). ANOVA with post hoc Bonferroni Tests. Non-equivalent Control Group Pretest- Posttest Design 1 29 (1 3 dropped out) M others of Full term, healthy 2-6 month old babies, recruited at M assage programme or Well Baby Clinic. 26 M others agreed to the massage programme and 1 03 took part as the control group. Non specific Baby M assage course and written checklist. Applied 4 x weekly at home for 4 weeks. M other's Perception of Infant's Temperament Scale (modified), Weight, Height, M other- Infant Interaction (M IPIS Walker and Thompson 1 982) Questionairre - not specified how
- given. Video recordings of M other-
Infant interaction in the health centre, Weight -Cas electronic scales, Height - collected in triplicate and averaged. Social demographics and feeding information - questions were also collected at time of selection. M other's Perception of Infant's Temperament (defined as the individual's emotional reactivity and behavioural style in interacting with the environment), M other-Infant Interactions, Height, Weight. Wilcoxon rank sum test, Student t-test. The level of significance was set at 0.05. Cortisol Levels determined by enzyme-linked immnuosorbent assay. Non-equivalent Control Group Pretest- Posttest Design 94 (52 didn't respond) Parents usually presenting with a perceived problem (eg. Crying). 60 (1 40 didn't respond) Parents with no perceived
- problems. No selection -
voluntary participation. IAIM 5 week course. 1 5 courses in a variety of
- settings. 1
2 parents at each course. Infant Social Interaction Questionairre, Edingburgh Postnatal Depression Scale, Programme evaluation
- Questionairre. Focus
group interviews Questionairres mailed to participants before and after
- intervention. Interviews conducted
at focus group. Parenting sense of competancy, Self Esteem, Breast Feeding, Reading to child, Chatting, General health of parent and child, Depression status. Health action zone funding Not fully randomised in design. Study focuses on one trainer. Short period of intervention requiring participants to mail back questionairres. Long term benefits can only be conjecture. Indicitive of future research
- Percentages. Significance not
- specified. Detailed results from
the report are reported elsewhere in a further study. Clarke, C et al. Social Interaction in Parenting study: Project Report, Newcastle upon Tyne: university of Northumbria @ Newcastle 2000. STUDY DESIGN Randomised controlled 39 (1 8 dropped out) full term, singleton M others @ 6 weeks postnatal with no complications Field's M ethod of Baby M assage (did not attend a course). Applied 1 0 mins per day until 3 months Cortisol in saliva, Profile of M ood States Cortisol taken between 1 0am and 3 pm at the start and end of the study (in hospital and at home), Questionairres were completed at home before and after intervention. All mothers were mailed the questionairres. Tension, Depression, Anger, Vigour, Fatigue, Confusion,Concentration of Cortisol Levels determined by enzyme-linked immnuosorbent assay Short period of intervention, requiring participants to mail back responses, The second Cortisol samples were delayed until 6 weeks after the intervention ended and taken in different environments. Indicative
- f further research.
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Of 732 papers identified, 72 were included for consideration
- f the full paper.
10 papers met the criteria for inclusion in the systematic
review.
Synthesis of the papers showed some evidence that baby
massage has a positive effect on the dyadic relationship.
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There was moderate evidence for short term improvement in
infant attachment, no long term conclusions could be made from the review.
Longitudinal research would be needed to support the current
findings and careful consideration given to the use of appropriate outcome measures.
Two papers suggested that further research should focus on
using infant massage programmes to improve the mental wellbeing of mothers with previously recognised moderate mental health concerns.
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We propose to complete further research by following up on
the findings from Underdown et al.
The review they carried out suggested of possible link
between women with mild to moderate mental health concerns have improved outcomes following the completion
- f a structured baby massage programme.
Focus will be on the elements that may or may not be
important in this improvement.
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