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Branjerdporn G, Healey L, Hudson C. Understanding care plans in a psychiatric mother-baby unit. J Reprod Infant Psychol 2023; 41:566-581. [PMID: 35171736 DOI: 10.1080/02646838.2022.2041187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/06/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Care plans outline collaborative goals and strategies for recovery. While care planning is recommended across international mental health guidelines, scant attention has examined the unique nature of care planning within psychiatric mother-baby units. This retrospective audit aims to explore the content of care planning goals, compare against the World Health Organisation's (WHO) International Classification of Functioning, Disability, and Health (ICF), and devise a care plan framework to support development of admission goals. METHODOLOGY A total of 63 care plans across admission, mid-admission and discharge were analysed. Using deductive content analysis, care plan goals were compared to the WHO ICF codes. Inductive content analysis was used to generate a framework for care plans. RESULTS When compared to the WHO ICF codes, care plans were most commonly coded against d570 (looking after one's health) and d7600 (parent-child relationships). Care plans covered six main themes: mental health recovery, physical health, connecting with baby, caring for baby, relationships, and community supports. DISCUSSION This study is the first to examine the nature of recovery goals in care plans within a mother-baby unit. The results inform a framework to support care planning and thereby facilitate holistic well-being and recovery for a mother with mental illness.
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Affiliation(s)
- Grace Branjerdporn
- Mental Health and Specialist Services, Gold Coast and Health Service, Gold Coast, Australia
| | - Lyndall Healey
- Mental Health and Specialist Services, Gold Coast and Health Service, Gold Coast, Australia
| | - Carly Hudson
- Mental Health and Specialist Services, Gold Coast and Health Service, Gold Coast, Australia
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Roca-Lecumberri A, Torres A, Andrés S, López C, Naranjo C, Roda E, Garcia-Esteve L, Gelabert E. Treating postpartum affective and/or anxiety disorders in a mother-baby day hospital: preliminary results. Int J Psychiatry Clin Pract 2023; 27:344-350. [PMID: 37530780 DOI: 10.1080/13651501.2023.2236169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/28/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Women experiencing perinatal mental-health illness have unique needs. The present study analyzes preliminary data about the effectiveness of MBDH in treating postpartum women with affective and anxiety disorders. METHODS We analysed 33 mothers with affective and/or anxiety disorders treated at the MBDH with their babies between March 2018 and December 2019. All women were assessed at admission, discharge and three months after discharge. Outcomes included symptoms of depression (EPDS) and anxiety (STAI-S), mother-infant bonding (PBQ) and functional impairment (HoNOs). We also assessed the clinical significance of changes in patients' scores on these scales and patient satisfaction. RESULTS At discharge, no patients still met the full criteria for the main diagnosis. Between admission and discharge, symptoms of depression and anxiety, mother-infant bonding, functional impairment and autonomy in caring for babies improved significantly. These gains were maintained at three months follow-up. Patient satisfaction was high. CONCLUSIONS These preliminary results suggest that multidisciplinary intervention for postpartum women with affective or anxiety disorders at the MBDH improves maternal psychopathology, mother-infant bonding and mothers' ability to care for their babies. MBDHs are a promising approach for delivering specialised perinatal mental-health care for mother-baby dyads.
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Affiliation(s)
- Alba Roca-Lecumberri
- Perinatal Mental Health Unit, Hospital Clínic Barcelona, Barcelona, Spain
- Psychiatry and Clinical Psychology Department, Institute of Neuroscience Hospital Clínic Barcelona, Barcelona, Spain
| | - Anna Torres
- Perinatal Mental Health Unit, Hospital Clínic Barcelona, Barcelona, Spain
- Psychiatry and Clinical Psychology Department, Institute of Neuroscience Hospital Clínic Barcelona, Barcelona, Spain
| | - Susana Andrés
- Perinatal Mental Health Unit, Hospital Clínic Barcelona, Barcelona, Spain
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neuroscience Hospital Clínic Barcelona, Barcelona, Spain
| | - Cristina López
- Perinatal Mental Health Unit, Hospital Clínic Barcelona, Barcelona, Spain
- Psychiatry and Clinical Psychology Department, Institute of Neuroscience Hospital Clínic Barcelona, Barcelona, Spain
| | - Carmen Naranjo
- Perinatal Mental Health Unit, Hospital Clínic Barcelona, Barcelona, Spain
- Psychiatry and Clinical Psychology Department, Institute of Neuroscience Hospital Clínic Barcelona, Barcelona, Spain
| | - Ester Roda
- Perinatal Mental Health Unit, Hospital Clínic Barcelona, Barcelona, Spain
- Psychiatry and Clinical Psychology Department, Institute of Neuroscience Hospital Clínic Barcelona, Barcelona, Spain
| | - Lluïsa Garcia-Esteve
- Perinatal Mental Health Unit, Hospital Clínic Barcelona, Barcelona, Spain
- Psychiatry and Clinical Psychology Department, Institute of Neuroscience Hospital Clínic Barcelona, Barcelona, Spain
| | - Estel Gelabert
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
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Branjerdporn G, Hudson C, Sheshinski R, Parlato L, Healey L, Ellis A, Reid A, Finnerty C, Arnott R, Curtain R, McLean M, Parmar S, Roberts S. Evaluation of an Inpatient Psychiatric Mother-Baby Unit Using a Patient Reported Experience and Outcome Measure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095574. [PMID: 35564969 PMCID: PMC9106046 DOI: 10.3390/ijerph19095574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022]
Abstract
Understanding the patient experience of admission to a psychiatric mother-baby unit (MBU) informs service improvement and strengthens patient-centered care. This study aims to examine patients’ experience, satisfaction, and change in mental health status related to MBU admission. At discharge, 70 women admitted to a public MBU completed the Patient Outcome and Experience Measure (POEM), rated the usefulness of therapeutic groups, and provided written qualitative feedback. Paired sample t-tests, correlations, and thematic content analysis were completed. Women were highly satisfied with the level of care and support received, particularly for those who were voluntarily admitted. Women reported an improvement in mental health from admission to discharge. Women appreciated the staff’s interpersonal skills, provision of practical skills, education, advice, support from other women, and therapeutic groups offered. Women suggested improvements such as having greater food choices, more MBU beds, more group sessions, family visitations, which had been restricted due to COVID-19, environmental modifications, and clarity of communication surrounding discharge. This study highlights the benefits of MBUs and the specific aspects of care that are favorable in treating women with mental illnesses who are co-admitted with their baby in an MBU.
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Affiliation(s)
- Grace Branjerdporn
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia; (C.H.); (R.S.); (L.P.); (L.H.); (A.E.); (A.R.); (C.F.); (R.A.); (R.C.); (M.M.); (S.P.); (S.R.)
- Mater Young Adult Health Service, Mater Hospital, South Brisbane, QLD 4101, Australia
- Correspondence:
| | - Carly Hudson
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia; (C.H.); (R.S.); (L.P.); (L.H.); (A.E.); (A.R.); (C.F.); (R.A.); (R.C.); (M.M.); (S.P.); (S.R.)
| | - Roy Sheshinski
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia; (C.H.); (R.S.); (L.P.); (L.H.); (A.E.); (A.R.); (C.F.); (R.A.); (R.C.); (M.M.); (S.P.); (S.R.)
| | - Linda Parlato
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia; (C.H.); (R.S.); (L.P.); (L.H.); (A.E.); (A.R.); (C.F.); (R.A.); (R.C.); (M.M.); (S.P.); (S.R.)
| | - Lyndall Healey
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia; (C.H.); (R.S.); (L.P.); (L.H.); (A.E.); (A.R.); (C.F.); (R.A.); (R.C.); (M.M.); (S.P.); (S.R.)
| | - Aleshia Ellis
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia; (C.H.); (R.S.); (L.P.); (L.H.); (A.E.); (A.R.); (C.F.); (R.A.); (R.C.); (M.M.); (S.P.); (S.R.)
| | - Alice Reid
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia; (C.H.); (R.S.); (L.P.); (L.H.); (A.E.); (A.R.); (C.F.); (R.A.); (R.C.); (M.M.); (S.P.); (S.R.)
| | - Catherine Finnerty
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia; (C.H.); (R.S.); (L.P.); (L.H.); (A.E.); (A.R.); (C.F.); (R.A.); (R.C.); (M.M.); (S.P.); (S.R.)
| | - Rachelle Arnott
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia; (C.H.); (R.S.); (L.P.); (L.H.); (A.E.); (A.R.); (C.F.); (R.A.); (R.C.); (M.M.); (S.P.); (S.R.)
| | - Rebecca Curtain
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia; (C.H.); (R.S.); (L.P.); (L.H.); (A.E.); (A.R.); (C.F.); (R.A.); (R.C.); (M.M.); (S.P.); (S.R.)
| | - Miranda McLean
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia; (C.H.); (R.S.); (L.P.); (L.H.); (A.E.); (A.R.); (C.F.); (R.A.); (R.C.); (M.M.); (S.P.); (S.R.)
| | - Snehal Parmar
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia; (C.H.); (R.S.); (L.P.); (L.H.); (A.E.); (A.R.); (C.F.); (R.A.); (R.C.); (M.M.); (S.P.); (S.R.)
| | - Susan Roberts
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia; (C.H.); (R.S.); (L.P.); (L.H.); (A.E.); (A.R.); (C.F.); (R.A.); (R.C.); (M.M.); (S.P.); (S.R.)
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Soni N, Roberts S, Branjerdporn G. Exploring Discharge Outcomes and Readmission Rates of Mothers Admitted to a Psychiatric Mother and Baby Unit. Psychiatr Q 2022; 93:393-407. [PMID: 34606066 DOI: 10.1007/s11126-021-09956-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
To evaluate change in Health of the Nation Outcome Scale (HoNOS) scores from admission to discharge, readmission rates after 28-day and six months post-discharge, and factors associated with readmission in a Mother and Baby Unit (MBU). An exploratory cohort study was completed of mother-infant dyads admitted to a public psychiatric MBU in Australia between March 2017 and August 2018 (18 months). Admission and discharge scores on the clinician-rated Health of the Nation Outcome Scale (HoNOS) were compared using dependent samples t-tests. The frequency of readmission to any psychiatric inpatient unit within six months of discharge was determined from medical records. Characteristics of mothers who were and were not readmitted were evaluated. Of the 82 mother-infant dyads admissions, 12 (14.63%) women were readmitted within six months, and six (7.31%) were readmitted within 28-days. Total HoNOS scores significantly improved between admission and discharge (t(81)=9.45, p<.000). Descriptive statistics for demographics, diagnoses, Mental Health Act status and discharge supports were computed for women readmitted and not readmitted. While these readmission rates and HONOS scores reflect a successful MBU admission, further research is required with larger sample sizes and more specific maternal and infant mental health outcome measures.
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Affiliation(s)
- Nayan Soni
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Susan Roberts
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.
| | - Grace Branjerdporn
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
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Taylor BL, Sweeney A, Potts LC, Trevillion K, Howard LM. Factors associated with re-admission in the year after acute postpartum psychiatric treatment. Arch Womens Ment Health 2022; 25:975-983. [PMID: 36006457 PMCID: PMC9492555 DOI: 10.1007/s00737-022-01255-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To examine factors associated with being re-admitted in the year after discharge from acute postpartum psychiatric treatment. METHODS Secondary data analysis of information collected from mothers who were admitted to acute psychiatric services in the year after childbirth between 2013 and 2017. We carried out univariable analyses and multivariable hierarchical logistic regression to examine risk factors for women's re-admission to acute psychiatric care (inpatient or community crisis care) in the year following discharge. RESULTS Sixty-seven (24.1%) of 278 women were re-admitted in the year after discharge from acute care; the median number of days to re-admission was 86 (IQR 35-214), and women who were re-admitted accessed a median of two further acute services (IQR 1-3). In adjusted analyses, reporting a history of childhood trauma (aOR 1.02; 95% CI 1.00- 1.03, p = 0.036), a higher level of difficulties in the mother-infant bond (aOR 1.03; 95% CI 1.01-1.06, p = 0.009) and younger age (aOR 0.95; 95% CI 0.90-1.00, p = 0.066) were associated with re-admission. CONCLUSION This study confirms that the role of childhood adverse experiences on mental health is relevant for outcomes in women experiencing acute postpartum psychiatric episodes. Ongoing parent-infant bonding difficulties are also independently associated with re-admission. Perinatal mental health services therefore need to offer evidence-based interventions to address histories of trauma and to support parent-infant bonding to optimise mental health in women following discharge from acute psychiatric services. However, further research is needed to explore what other factors, not measured in our study, are also influential to re-admission.
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Affiliation(s)
- Billie Lever Taylor
- Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.
| | - Angela Sweeney
- grid.13097.3c0000 0001 2322 6764Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Laura C. Potts
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kylee Trevillion
- grid.13097.3c0000 0001 2322 6764Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Louise M. Howard
- grid.13097.3c0000 0001 2322 6764Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
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Wright T, Stevens S, Reed PW, Wouldes TA. Post-discharge outcomes for mothers and the mother-infant relationship following admission to a psychiatric Mother-Baby Unit. Infant Ment Health J 2020; 41:770-782. [PMID: 32573014 DOI: 10.1002/imhj.21870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mother-Baby Unit research has focussed on maternal psychopathology over the course of an admission. Less is known about the baby's well-being, the shared relationship, or the mother's recovery. In an initial sample of 45 women, we describe discharge and post-discharge outcomes for maternal psychopathology (using maternal report and the Global Assessment of Function, GAF) and the mother-infant relationship (using the Child and Adult Relational Experimental Index, CARE Index). Three months post-discharge, one third of women described themselves as "completely recovered," one third were experiencing significant deterioration and 17% were readmitted to inpatient care. Poorer GAF scores were associated with a clinical diagnosis of comorbid personality disorder, antenatal presence of the index illness, partner illicit substance use, maternal perception of her bond, infant social withdrawal, and child protection concern. Post-discharge, the mother-infant relationship results were concerning. Only 17% were regarded as adequate. Improvement was observed across this period in 56% but relational deterioration occurred for 35%. Maternal and relational outcomes were weakly correlated at discharge (r² = 0.29, p = 0.07) but this was lost post-discharge (r² = 0.03, p = 0.89). The shared relationship and infant mental health should both be targets for intervention; both during MBU admission, and post-discharge.
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Affiliation(s)
- Tanya Wright
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Suzanne Stevens
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Peter W Reed
- Starship Child Health, Auckland District Health Board, Auckland, New Zealand
| | - Trecia A Wouldes
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Mutschler C, Lichtenstein S, Kidd SA, Davidson L. Transition Experiences Following Psychiatric Hospitalization: A systematic Review of the Literature. Community Ment Health J 2019; 55:1255-1274. [PMID: 31104176 DOI: 10.1007/s10597-019-00413-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
The period immediately following discharge after inpatient stay for mental illness has been found to be the time of greatest risk for adverse outcomes (e.g., rehospitalization, relapse, suicide). However, the experiences of patients as they transition from the hospital to the community are not well understood. The purpose of the present review was to systematically search and synthesize the literature examining the transition experiences of individuals following inpatient psychiatric stay. A systematic search was conducted for studies examining the experiences of patients as they transition back into their communities, using qualitative or quantitative methods. Qualitative articles were analyzed using thematic content analysis. Quantitative articles were extracted and summarized. The search identified 1614 abstracts, of which 27 (18 qualitative; 9 quantitative) were included in the review. The results of the analysis identified themes necessary for transition including safety, supported autonomy, and the opportunity to engage in a number of reintegration activities. A number of barriers were found that prevent integration, such as poverty, interpersonal difficulties, and stigma. The results highlight the disconnect that occurs for patients as they transition from hospital, pointing to the need for effective transitional interventions that target these challenges.
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Affiliation(s)
- Christina Mutschler
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
| | | | - Sean A Kidd
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Larry Davidson
- Program for Recovery and Community Health, Yale University, 319 Peck Street, New Haven, CT, 06513, USA
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Reilly N, Brake E, Briggs N, Austin MP. Trajectories of clinical and parenting outcomes following admission to an inpatient mother-baby unit. BMC Psychiatry 2019; 19:336. [PMID: 31675945 PMCID: PMC6825337 DOI: 10.1186/s12888-019-2331-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to examine trajectories of clinical and parenting outcomes following admission to a mother-baby unit (MBU), and to explore factors associated with these trajectories. METHODS Women admitted to an MBU completed the Edinburgh Postnatal Depression Scale (EPDS), Depression, Anxiety and Stress Scale (DASS-21), Karitane Parenting Confidence Scale (KPCS) and Maternal Postnatal Attachment Scale (MPAS) at admission, discharge and 3 months following discharge. Questions assessing psychosocial risk and adult attachment style were also completed at admission, and information relating to service engagement in the time since discharge was collected at follow-up. Additional clinical and demographic information was extracted from the patient medical record. RESULTS Seventy-five women participated in the study. Overall, significant improvements in mean scores on measures of anxiety and parenting confidence were maintained 3-months following discharge. However, the majority of women (93.3%) followed trajectories that were characterised by deterioration in self-reported mother-infant attachment following discharge. 62.9 and 34.6% of women followed trajectories of increased symptoms of depression and stress between discharge and follow-up, respectively. Across measures, the least optimal trajectories, or least optimal scores, at follow-up were associated with less secure maternal attachment style (associated with more anxiety symptoms, poorer parenting confidence and maternal-infant attachment), older maternal age (more depressive symptoms) and increased psychosocial risk (more anxiety symptoms). CONCLUSIONS The findings of this study highlight the clinical implications of anxious attachment style for the mental health and parenting outcomes of women admitted to an MBU and the importance of incorporating mother-infant therapy as part of an ongoing management plan. Comprehensive discharge planning and transitional care to help ensure women discharged from an MBU are best supported in the longer term is recommended.
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Affiliation(s)
- Nicole Reilly
- Research Centre for Generational Health and Ageing & School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, 13 Grantham St, Burwood, 2134, Australia.
| | - Elloise Brake
- 0000 0004 4902 0432grid.1005.4Perinatal and Women’s Mental Health Unit, St John of God Health Care and University of New South Wales, 13 Grantham St, Burwood, 2134 Australia
| | - Nancy Briggs
- 0000 0004 4902 0432grid.1005.4Stats Central, Mark Wainwright Analytical Centre, Biological Sciences South Building, UNSW, Sydney, 2052 Australia
| | - Marie-Paule Austin
- 0000 0004 4902 0432grid.1005.4Perinatal and Women’s Mental Health Unit, St John of God Health Care and University of New South Wales, 13 Grantham St, Burwood, 2134 Australia
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Walker SB, Rossi DM, Sander TM. Women's successful transition to motherhood during the early postnatal period: A qualitative systematic review of postnatal and midwifery home care literature. Midwifery 2019; 79:102552. [PMID: 31605940 DOI: 10.1016/j.midw.2019.102552] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/24/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To undertake a systematic review of available qualitative research literature to determine what women need to successfully transition to motherhood during the early postnatal period and whether postnatal home care delivered by midwives supports this process. DESIGN The transition from woman to mother is a significant occurrence, one that requires adjustments on physical, psychological and social levels. A qualitative systematic review design was chosen to ensure both humanistic and interactive concepts related to what women need to successfully transition to motherhood during the early postnatal period were identified. The systematic and structured search uncovered 33 research articles for detailed review. Two team members, using the qualitative research checklist from the Critical Appraisal Skills Programme, appraised the quality of the research articles. A total of 19 articles met the quality criteria and were included in the data evaluation process. SETTING AND PARTICIPANTS Research teams from Asia-Pacific, Europe, Middle East and North America generated the 19 qualitative journal articles. MEASUREMENTS AND FINDINGS Data evaluation included identification of research aim, presence of a research question, type of methodology, data collection processes, sample information, data analysis techniques and study outcomes. Data was analysed using an inductive content analysis approach. Four themes were identified from the qualitative systematic review process including: women and midwives connecting, identification and meeting of women's individual needs, family and cultural influences and, education and support. KEY CONCLUSIONS The ability of women to connect with midwives during the early postnatal period assisted them overcome barriers and to successfully transitioning to motherhood. Although all four themes were determined to be key to effective postnatal transition, overwhelmingly the findings showed postnatal midwifery home care to be important in women's successful transition to motherhood in the early postnatal period. IMPLICATIONS FOR PRACTICE Strategies are needed ensure women have access to midwives in the early postnatal period.
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Affiliation(s)
- Sandra B Walker
- School of Nursing Midwifery and Social Sciences, Central Queensland University, Bruce Highway, Rockhampton, Queensland 4702, Australia.
| | - Dolene M Rossi
- School of Nursing Midwifery and Social Sciences, Central Queensland University, Bruce Highway, Rockhampton, Queensland 4702, Australia.
| | - Teresa M Sander
- Maternity Unit Rockhampton Hospital, Canning Street, Rockhampton, Queensland 4700, Australia
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Bell Scott B, Doss S, Myers D, Hess B. Addressing externalized behavioral concerns in primary care: Listening to the voices of parents. SOCIAL WORK IN HEALTH CARE 2019; 58:14-31. [PMID: 30130473 DOI: 10.1080/00981389.2018.1508114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 06/08/2023]
Abstract
This article presents the perceptions parents have of the causative and curative factors for their child's externalized behaviors and what treatment they prefer to receive from their primary care integrated behavioral health team. This is a qualitative study, using interpretative phenomenological analysis. Semi-structured interviews were conducted with a purposive sample of 12 parents representing 14 patients with a disruptive behavior disorder (DBD) who sought care from their primary care physician for treatment of the DBD. Participants spoke of uncertainty of the cause of the DBD and the desire to find parenting approaches that augment the effectiveness of pharmacological intervention provided by the primary care team. Parents' responses suggest that they are eager for more education about their child's DBD and how to engage at-home management of the symptoms. Discussion focused on the import of considering the voices of these parents when implementing brief parent management training programs in integrated behavioral health primary care programs.
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Affiliation(s)
- Becky Bell Scott
- a Garland School of Social Work , Baylor University , Waco , Texas
| | - Susanna Doss
- a Garland School of Social Work , Baylor University , Waco , Texas
| | - Dennis Myers
- a Garland School of Social Work , Baylor University , Waco , Texas
| | - Burrit Hess
- b Waco Family Medicine Residency Program , Waco , Texas
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Wright T, Jowsey T, Stanton J, Elder H, Stevens S, Wouldes TA. Patient experience of a psychiatric Mother Baby Unit. PLoS One 2018; 13:e0198241. [PMID: 29847584 PMCID: PMC5976160 DOI: 10.1371/journal.pone.0198241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/16/2018] [Indexed: 11/24/2022] Open
Abstract
Background Mothers with severe mental illness are vulnerable and engage with services cautiously due to fears of stigma and custody loss. To develop best practice standards and patient-centred services, the subjective experience of those who use it must inform service improvement and policy. Method This study utilised exploratory concurrent mixed methods design with primarily qualitative data. Women admitted between April 2015 and December 2016 to a newly developed psychiatric Mother Baby Unit (MBU) in New Zealand were invited to participate in this study. Qualitative data were collected in three ways: (i) semi-structured interviews incorporating Māori concepts of health and wellness by research assistants near discharge; (ii) invitation to provide anonymous feedback in writing using an open format; (iii) unsolicited verbal feedback provided during a home visit three months after discharge. Thematic analysis was undertaken. Demographic and clinical information was collected prospectively for mother-infant pairs during the course of admission and three months post-discharge. Results Forty-five people participated in the study. High rates of satisfaction were described. Strengths of the service–as perceived by mothers–included co-admission of mother and infant, staff warmth and availability, transparent practice, inclusion of families, and having a comfortable environment. Mothers described intense distress and confusion, as well as negative self-perceptions when acutely unwell. Infant co-admission and the inclusion of partners and other family members alleviated mothers’ distress. Personal attributes of staff, practical support with caregiving, a range of therapeutic approaches and holistic care were all valued. Feedback collected three months after discharge was the most reflective. Significant inter-ethnic differences were not apparent. Conclusions The experience of inpatient care can have lasting influence on recovery and wellbeing. Employing a Māori model of health broadened the holistic nature of enquiry. The approach and timing taken in seeking the views of participants’ yielded different information, all of which is of value to service evaluation and refinement. The findings suggest that keeping mothers and infants together during health service utilisation such as MBUs should be a priority for policy makers and service designers. This approach is consistent with Māori values, combining the importance of whānau relationships (kinship), wairua (spiritual connectivity), hinengaro (the mind) and tinana (physical health). These findings suggest that ‘holistic care’–in this case following a Māori holistic health model–is important in mental health settings.
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Affiliation(s)
- Tanya Wright
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Child and Family Unit, Starship Hospital, Auckland District Health Board, Auckland, New Zealand
- * E-mail:
| | - Tanisha Jowsey
- Centre for Medical and Health Services Education, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Josephine Stanton
- Child and Family Unit, Starship Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Hinemoa Elder
- Te Whare Wānanga o Awanuiārangi, Whakatane, New Zealand
| | - Suzanne Stevens
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Trecia A. Wouldes
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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A systematic review of research on psychiatric mother-baby units. Arch Womens Ment Health 2017; 20:373-388. [PMID: 28332002 DOI: 10.1007/s00737-017-0718-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
Abstract
Psychiatric mother-baby units (MBUs) are currently viewed as best practice, particularly in the UK, Australia and France, for improving outcomes for mothers and babies when the former are experiencing severe forms of mental illness. A growing number of publications have examined MBUs, but to date, there has not been a comprehensive review of these studies. As such, the systematic review reported in this paper sought to address this gap. A systematic search was conducted for peer-reviewed research and grey literature published in English between 2000 and 2015. A final sample of 44 publications were identified that reported on empirical findings with regard to MBUs. Three quarters of the studies focused on individual MBUs and most studies were quantitative. A thematic analysis of the studies identified three major themes: (1) admissions data, (2) outcomes for mothers, and (3) programmes and interventions. The analysis also identified four secondary themes: (i) follow-up after discharge, (ii) separation of mothers and babies after discharge, (iii) client satisfaction with MBUs, and (iv) partners of women admitted to MBUs. The findings of the review highlight gaps in knowledge about MBUs and provide suggestions for future research.
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