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Eið RC, Strøyer de Voss S, Wilson P, Overbeck G. Collaboration between general practitioners and health visitors about children of concern in Denmark: a qualitative study. J Interprof Care 2024:1-9. [PMID: 38813754 DOI: 10.1080/13561820.2024.2357118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
Primary health care services are responsible for preventive measures to optimize child development in the first years of life. In Denmark, these services are shared between general practitioners and municipality health visitors. National guidelines mandate collaboration between these professionals but in reality, they work in parallel. We aimed to explore how professionals experience collaboration and communication regarding children with professional concern about their wellbeing. Seventeen semi-structured interviews were conducted with general practitioners, and health visitors. Both professions considered closer collaboration to be important in meeting children's needs. Barriers to collaboration and communication included differing legal obligations, Information Technology-systems (IT), lack of financial incentives, lack of mutual professional acknowledgment and respect, and absence of routines for sharing knowledge. The traditional division of responsibilities between physicians and nurses in which all professionals involved in preventive child health care are acculturated seems to impede collaboration based on unequal professional status. IT infrastructure needs to support information sharing and structures to support informal meetings between professionals are warranted to support more collaborative practice.
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Affiliation(s)
- Rebekka Consuelo Eið
- Centre for General Practice, Institute of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Sarah Strøyer de Voss
- Centre for General Practice, Institute of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Philip Wilson
- Centre for General Practice, Institute of Public Health, University of Copenhagen, Kobenhavn, Denmark
- Centre for Rural Health, University of Aberdeen, Aberdeen, UK
| | - Gritt Overbeck
- Centre for General Practice, Institute of Public Health, University of Copenhagen, Kobenhavn, Denmark
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Jackson L, Fallon V, Harrold JA, De Pascalis L. Psychosocial predictors of post-natal anxiety and depression: Using Structural Equation Modelling to investigate the relationship between pressure to breastfeed, health care professional support, post-natal guilt and shame, and post-natal anxiety and depression within an infant feeding context. MATERNAL & CHILD NUTRITION 2024; 20:e13558. [PMID: 37752680 PMCID: PMC10750005 DOI: 10.1111/mcn.13558] [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: 01/05/2023] [Revised: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 09/28/2023]
Abstract
High perceived pressure to breastfeed and poor perceived quality of health care professional support have been associated with early breastfeeding cessation, guilt, and shame. This is problematic because guilt and shame significantly predict post-natal anxiety and depression. No previous attempts have been made to provide quantitative evidence for relationships mapped between the post-natal social context, infant feeding method and post-natal emotional well-being. The current study aimed to empirically investigate aforementioned pathways. Structural equation modelling was applied to survey data provided online by 876 mothers. Guilt and shame both significantly predicted anxiety and depression. Poor health care professional support and high pressure to breastfeed increased anxiety and depression, and these effects were explained by indirect pathways through increases in guilt and shame. Formula feeding exclusivity was negatively correlated with post-natal anxiety symptoms. This finding may be explained by feelings of relief associated with observed infant weight gain and being able to share infant feeding responsibilities others e.g., with one's partner. This relationship was counterbalanced by an indirect pathway where greater formula feeding exclusivity positively predicted guilt, which increased post-natal anxiety score. While guilt acted as mediator of infant feeding method to increase post-natal depression and anxiety, shame acted independently of infant feeding method. These identified differences provide empirical support for the transferability of general definitions of guilt (i.e., as remorse for having committed a moral transgression) and shame (i.e., internalisation of transgressive remorse to the self), to an infant feeding context. Recommendations for health care practitioners and the maternal social support network are discussed.
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Affiliation(s)
- Leanne Jackson
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolMerseysideUK
| | - Vicky Fallon
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolMerseysideUK
| | - Joanne A. Harrold
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolMerseysideUK
| | - Leonardo De Pascalis
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolMerseysideUK
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3
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M Moran P, Coates R, Ayers S, Olander EK, Bateson KJ. Exploring interprofessional collaboration during the implementation of a parent-infant mental health service: A qualitative study. J Interprof Care 2023; 37:877-885. [PMID: 36440978 DOI: 10.1080/13561820.2022.2145274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/01/2022] [Indexed: 11/30/2022]
Abstract
We examined interprofessional working in a newly implemented parent-infant mental health service team supporting families experiencing bonding and attachment difficulties. The aim was to identify forms of interprofessional work undertaken, barriers and facilitators of this work, and families' and healthcare professionals' perceptions of it. Semi-structured interviews were carried out with 21 stakeholders (5 parents, 4 team clinicians, 9 service referrers, 3 service commissioners) and were analyzed thematically. Interprofessional activities identified included building the service team's cohesion and shared practice, building partner networks, interagency communication, coordination of roles, and raising awareness of infant mental health and parent-infant relationship needs. Enablers and barriers to interprofessional working were broadly consistent with findings from previous studies of related services, but with additional emphasis on consultative work as an enabler. Healthcare professionals reported benefiting from the case consultations and training on infant mental health provided by the service team. Parents reported that good interprofessional working enhanced satisfaction and engagement with the service. Findings indicate the centrality of interprofessional working for parent-infant mental health teams, with implications for future service implementation, service development, and understanding of mechanisms by which such services may influence family outcomes.
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Affiliation(s)
- Patricia M Moran
- Department of Midwifery and Radiography, Centre for Maternal and Child Health Research, School of Health & Psychological Sciences, City, University of London, London, UK
| | - Rose Coates
- Department of Midwifery and Radiography, Centre for Maternal and Child Health Research, School of Health & Psychological Sciences, City, University of London, London, UK
| | - Susan Ayers
- Department of Midwifery and Radiography, Centre for Maternal and Child Health Research, School of Health & Psychological Sciences, City, University of London, London, UK
| | - Ellinor K Olander
- Department of Midwifery and Radiography, Centre for Maternal and Child Health Research, School of Health & Psychological Sciences, City, University of London, London, UK
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Moran E, Noonan M, Mohamad MM, O'Reilly P. Women's experiences of specialist perinatal mental health services: a qualitative evidence synthesis. Arch Womens Ment Health 2023:10.1007/s00737-023-01338-9. [PMID: 37351664 DOI: 10.1007/s00737-023-01338-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
PURPOSE Specialist perinatal mental health services identify and treat women experiencing mental health conditions during pregnancy and up to one year post birth. There is limited knowledge about women's experiences of care from specialist services. Evaluation and optimisation of service delivery requires knowledge of women's care experiences. This review aimed to systematically identify, appraise, and synthesise qualitative evidence exploring women's experiences of specialist perinatal mental health services. METHODS A systematic literature search of five databases: Medline (OVID), EMBASE (Elsevier), PsycINFO (EBSCO), CINAHL (EBSCO) and Scopus (Elsevier), grey literature searching, and backward citation, identified a total of 1035 papers of which sixteen met inclusion criteria. Methodological quality of the included studies was assessed using the Critical Appraisal Skills Program (CASP) tool. RESULTS Thematic synthesis identified three themes: connected relationships; new beginnings; and meaningful service delivery. Findings identified that relationships developed with clinicians were significant to women and their experience of care. Women valued continuity of care from dedicated non-judgemental clinicians. Peer support from other mothers was perceived as meaningful to women. Through service interventions women gained new insights into their infant's needs and grew in confidence as a mother. CONCLUSIONS Women require provision of flexible and accessible specialist services with clinicians who are sensitive to their individual psychosocial needs and preferences. Examining discharge practices and continuing care needs is essential to ensure the best outcomes for women and their families.
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Affiliation(s)
- Emma Moran
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.
- The Department of Nursing and Healthcare, Technological University of the Shannon, Athlone, Co Westmeath, Ireland.
| | - Maria Noonan
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Mas Mahady Mohamad
- Specialist Perinatal Mental Health Services, University Maternity Hospital Limerick, Limerick, Ireland
| | - Pauline O'Reilly
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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Khan N, van Mook W, Dave S, Ha S, Sagisi J, Davi N, Aftab C, Tiwari S, Hickman M, Gilliar W. Learner perspectives of professionalism: a mixed method systematic review protocol (Preprint). JMIR Res Protoc 2022; 11:e37473. [PMID: 36006688 PMCID: PMC9459844 DOI: 10.2196/37473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/04/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Professionalism has come to be associated with competence in medical education, with the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served. Recent studies indicate students should have the opportunity to observe the application of knowledge and skills by their mentors to improve patient health and safety. A noticeable detail that needs implementation into the curriculum is the inclusion of student perspectives. This review will explore students’ understanding and experience of professionalism in undergraduate medical education (UME). Objective This paper presents the protocol for a review that aims to develop an integrated synthesis of qualitative and quantitative studies resulting in recommendations for medical school curricula to incorporate the learners’ perspectives in teaching professionalism in UME. Methods We will take an integrated approach to synthesis. Data will be extracted from the included studies, and quantitative data will be “qualitized.” PubMed (Medline), Embase, PsycInfo, and ERIC (Education Resources Information Center) will be searched for studies published in English from 2010 to 2021. Studies will be screened and critically appraised for methodological quality using the Mixed Methods Appraisal Tool by 2 researchers, with disagreements resolved by a third researcher. Qualitative, quantitative, and mixed methods studies will be considered. Our population of interest is undergraduate medical students; hence, studies on medical residents and graduate medical students will be excluded. We will consider studies that explore how concepts of professionalism are understood, experienced, and taught in undergraduate medicine and on how medical students understand and develop the identified constructs of professionalism. Results This study is in the screening phase; therefore, no results are available at this time. However, we had initiated the searches, screening, and are currently in the critical appraisal stage. We will commence preparation to clean and convert the data for coding in July 2022, and analysis will be ongoing from the end of July 2022 until submission for publication in November 2022. Conclusions This research will contribute to the student perspectives on professionalism in medical education literature. The findings will aid in the creation of a checklist to guide the development of a curriculum on professionalism in UME. International Registered Report Identifier (IRRID) PRR1-10.2196/37473
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Affiliation(s)
- Nagina Khan
- Department of Osteopathic Medicine, Touro University Nevada, Henderson, NV, United States
- Association of University Teachers of Psychiatry, London, United Kingdom
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School of Health Professions Education, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
- Maastricht UMC+ Academy, Maastricht, Netherlands
| | - Subodh Dave
- Department of Osteopathic Medicine, Derbyshire Healthcare NHS Foundation Trust, Derbyshire, United Kingdom
- Department of Osteopathic Medicine, University of Bolton, Bolton, United Kingdom
- Royal College of Psychiatrists, London, United Kingdom
| | - Sohyun Ha
- Department of Osteopathic Medicine, Touro University Nevada, Henderson, NV, United States
| | - Joshua Sagisi
- Department of Osteopathic Medicine, Touro University Nevada, Henderson, NV, United States
| | - Nicole Davi
- Department of Osteopathic Medicine, Touro University Nevada, Henderson, NV, United States
| | - Chantel Aftab
- Department of Osteopathic Medicine, Touro University Nevada, Henderson, NV, United States
| | - Sucheta Tiwari
- East London NHS Foundation Trust, London, United Kingdom
| | - Marie Hickman
- Department of Osteopathic Medicine, Derbyshire Healthcare NHS Foundation Trust, Derbyshire, United Kingdom
| | - Wolfgang Gilliar
- Department of Osteopathic Medicine, Touro University Nevada, Henderson, NV, United States
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Klatter CK, van Ravesteyn LM, Stekelenburg J. Is collaborative care a key component for treating pregnant women with psychiatric symptoms (and additional psychosocial problems)? A systematic review. Arch Womens Ment Health 2022; 25:1029-1039. [PMID: 36163596 PMCID: PMC9734206 DOI: 10.1007/s00737-022-01251-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/23/2022] [Indexed: 12/14/2022]
Abstract
Mental disorders during pregnancy are common, with long-lasting negative effects on mother and child. Treatment of these women is challenging, because of the high incidence of additional psychosocial problems and barriers on population and healthcare level. Collaborative care, collaboration between mental health and obstetric care professionals, may help to overcome these problems. The aim of this review is to review antenatal mental health interventions and analyse the impact of collaborative care. Two independent reviewers searched for RCT's in PubMed, Embase and PsycINFO. Trials studying the effect of psychological or pharmacological interventions on the mental health of pregnant women with psychiatric symptoms (and psychosocial problems) were eligible for inclusion. Two reviewers independently abstracted data and assessed study quality and risk of bias. Each study was scored on collaborative care criteria: multi-professional approach to patient care, structured management plan, scheduled patient follow-ups and enhanced interprofessional communication. Thirty-five studies were included. Most trials studied the effect of cognitive behavioural therapy and interpersonal psychotherapy on antenatal depression. Almost all interventions met at least one collaborative care criteria. Interventions were mostly provided by multiple professionals, but interprofessional communication rarely took place. Interventions that met more criteria did not more often show a positive effect on maternal mental health. There is lack of research on antenatal psychiatric disorders other than depressive and on long-term treatment outcomes. Collaborative care is partly implemented in most current interventions, but more trials (including interprofessional communication) are needed to be conclusive whether collaborative care is a key component in antenatal mental healthcare.
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Affiliation(s)
- Celine K Klatter
- Department of Global Health, Medical Sciences, University of Groningen/University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands.
| | - Leontien M van Ravesteyn
- Department of Global Health, Medical Sciences, University of Groningen/University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Jelle Stekelenburg
- Department of Global Health, Medical Sciences, University of Groningen/University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
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Jia S(S, Wu B. Topic modelling and opinion mining of user generated content on the internet using machine learning: An analysis of postpartum care centres in Shanghai. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2021. [DOI: 10.3233/jifs-189726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In order to reach a compromise between adhering to the traditional culture and embracing the modern lifestyle, more and more Asian moms are heading towards postpartum care centres for postpartum recovery. However, research regarding the quality of care of these postpartum care centres is nearly missing from the literature. This paper investigated the status quo of the postpartum care centres in Shanghai, China from mothers’ perspectives by means of analysing the 34280 pairs of ratings and reviews posted by postpartum care centre customers on the internet with machine learning and text mining. Results show that the mothers are generally satisfied with the studied care centres. Meanwhile, the 13 major topics in the customer online reviews were identified, which provide an overview of the interaction between a mother and a care centre. In addition, weight of topic analysis suggests that the studied care centres can further improve in the areas of support team, environment, and facility.
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Affiliation(s)
- Susan (Sixue) Jia
- School of Finance and Business, Shanghai Normal University, Shanghai, China
| | - Banggang Wu
- Business School, Sichuan University, Chengdu, Sichuan, China
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D'haenens F, Van Rompaey B, Swinnen E, Dilles T, Beeckman K. The effects of continuity of care on the health of mother and child in the postnatal period: a systematic review. Eur J Public Health 2021; 30:749-760. [PMID: 31121019 DOI: 10.1093/eurpub/ckz082] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Continuity of care (COC) is essential for high-quality patient care in the perinatal period. Insights in the effects of COC models on patient outcomes are important to direct perinatal healthcare organization. To our knowledge, no previous review has listed the effects of COC on the physical and mental health of mother and child in the postnatal period. METHODS A search was conducted in four databases (PubMed, Web of Knowledge, CENTRAL and CINAHL), from 2000 to 2018. Studies were included if: participants were healthy mothers or newborns with a gestational age between 37-42 weeks; they covered the perinatal period and aimed to measure breastfeeding or any outcome related to the maternal/newborn physical or mental health. At least one of the three COC types (management, informational and relationship) was identified in the intervention. The methodological quality was assessed. RESULTS Ten articles were included. COC is mostly present in the identified care models. The effects of COC on the outcomes of mother and child in the postnatal period seem mostly to be positive, although not always significant. The relation between COC and the outcomes can be influenced by confounding factors, like the socio-economic status of the included population. Interventions with COC during pregnancy appear to be more effective for all the studied outcome factors. CONCLUSION COC as management, relational and informational continuity starting antenatal has the most impact on the postnatal outcomes of mother and child.
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Affiliation(s)
- Florence D'haenens
- Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus University College Brussels, Brussels, Belgium
| | - Bart Van Rompaey
- Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
| | - Eva Swinnen
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tinne Dilles
- Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
| | - Katrien Beeckman
- Nursing and Midwifery Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel and University Hospital Brussel, Brussels, Belgium
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Kohlhoff J, Cibralic S, Tooke S, Hickinbotham R, Knox C, Roach V, Barnett B. Health professional perspectives on an antenatal mental health screening program in a private hospital. Aust N Z J Obstet Gynaecol 2021; 61:891-897. [PMID: 34121178 DOI: 10.1111/ajo.13394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/11/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perinatal mental ill-health is a global health priority. Mental health screening during pregnancy is a routine part of clinical practice in many public hospital obstetric services across Australia, but implementation in the private hospital system has lagged. AIMS This study explored health professionals' perspectives on the Pre-admission Midwife Appointment Program (PMAP), an antenatal mental health screening program at the Mater Hospital, Sydney. MATERIALS AND METHODS Nine midwives and three medical specialists participated in focus groups or individual interviews; key themes were determined using thematic qualitative analysis. RESULTS Five major themes and three sub-themes were identified: immediate benefits to women (identifying women at risk; referrals to support services; supporting and educating women); enhanced overall quality of care at the hospital; the dilemma of partners attending; factors that make the program successful; and recommendations for improvement. CONCLUSIONS Results will inform the implementation of antenatal mental health screening programs at other private hospitals across Australia.
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Affiliation(s)
- Jane Kohlhoff
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Karitane, Sydney, New South Wales, Australia
| | - Sara Cibralic
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarah Tooke
- The Mater Hospital, Sydney, New South Wales, Australia
| | - Rachael Hickinbotham
- North Shore Private Hospital and the Mater Hospital, Sydney, New South Wales, Australia
| | | | - Vijay Roach
- North Shore Private Hospital and the Mater Hospital, Sydney, New South Wales, Australia
| | - Bryanne Barnett
- Gidget Foundation Australia, Sydney, New South Wales, Australia
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Johnson A, Stevenson E, Moeller L, McMillian-Bohler J. Systematic Screening for Perinatal Mood and Anxiety Disorders to Promote Onsite Mental Health Consultations: A Quality Improvement Report. J Midwifery Womens Health 2021; 66:534-539. [PMID: 34032002 DOI: 10.1111/jmwh.13215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/28/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Perinatal mood and anxiety disorders are the most common complication during pregnancy and postpartum. Screening, diagnosis, and treatment for these disorders are inhibited by limited mental health resources for patients and health care providers, lack of provider training, and time constraints. Systematic screening combined with onsite mental health consultation is an evidence-based method to increase timely diagnosis and treatment. The purpose of this quality improvement project was to promote and improve onsite mental health consultations through the implementation of a systematic screening guideline. PROCESS The systematic screening guidelines included administration of the Patient Health Questionnaire-9 at the perinatal intake visit, the Edinburgh Perinatal Depression Scale between 28 and 32 weeks' gestation and again between 2 and 8 weeks postpartum. The guidelines included onsite mental health consultations for eligible women. Screening rates, attended onsite mental health consultations, and health care provider satisfaction and feedback surveys were collected over a 3-month period, before and after guideline implementation. OUTCOMES Perinatal mood and anxiety disorder screening rates were significantly increased from 24.9% to 64.2% (P < .001) at the perinatal intake visit and in the third trimester from 0.3% to 32.8% (P < .001) with the implementation of a systematic screening guideline. Onsite mental health consultations significantly increased from 7.2% to 15.2% (P < .001). Perinatal care providers (n = 9, 100%) were satisfied with the screening guideline and reported that it added 5 minutes or less to their office visits. DISCUSSION The implementation of a systematic perinatal mood and anxiety disorder screening guideline increased completed screenings in the perinatal period and increased the number of attended onsite mental health consultations. Systematic screening combined with onsite mental health consultation is a successful way to identify at-risk women and offer critical and convenient maternal mental health care without increasing the burden on perinatal care providers.
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Affiliation(s)
- Amber Johnson
- Duke University School of Nursing, Duke University, Durham, North Carolina
| | - Eleanor Stevenson
- Duke University School of Nursing, Duke University, Durham, North Carolina
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Abstract
The complexities of providing quality perinatal care within rural communities provide significant challenges to providers and policy makers. Provision of healthcare in rural communities is challenging on individual as well as community-based levels. A quality improvement lens is applied to consider key challenges that pertain to patients, providers, place, and policy. Potential solutions from a provider perspective include nurse-midwifery care and inclusion of advanced practice providers in a variety of specialties in addition to creating care models for registered nurses to practice at the top of their scope. To enhance access in the rural place, telehealth and coordination activities are recommended. Finally, policy approaches such as Perinatal Care Collaboratives, Area Health Education Centers, and enhanced financial resources to eliminate socioeconomic disparities will enhance perinatal care in rural communities.
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Affiliation(s)
- Amy J Barton
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora (Drs Barton and Anderson)
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Taylor Salisbury T, Atmore KH, Nhambongo I, Mintade M, Massinga L, Spencer J, West J, Mandlate F. Integrating human-centred design into the development of an intervention to improve the mental wellbeing of young women in the perinatal period: the Catalyst project. BMC Pregnancy Childbirth 2021; 21:183. [PMID: 33673826 PMCID: PMC7936480 DOI: 10.1186/s12884-021-03675-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Mental wellbeing during pregnancy and the year after birth is critical to a range of maternal and infant outcomes. Many mental health interventions fail to incorporate stakeholder perspectives. The Catalyst Project aimed to work with key stakeholders in Mozambique to develop interventions and delivery strategies which were in-line with existing evidence and the needs, goals, and priorities of those both directly and indirectly involved in its success. Methods A qualitative, human-centred design approach was utilised. Focus-group discussions, individual interviews, and observations with young women (aged 16–24 years), their families, community leaders, service providers and government were used to better understand the needs, priorities and challenges to mental wellbeing of young women. These findings were triangulated with the literature to determine priority challenges to be addressed by an intervention. Stakeholder workshops were held to identify potential solutions and co-develop an intervention and delivery strategy. Results The 65 participants comprised 23 young pregnant women or new mothers, 12 family members, 19 service providers and 11 staff from the Ministry of Health. Participants highlighted significant uncertainty related to living situations, financial status, education, social support, and limited knowledge of what to expect of the impact of pregnancy and parenting. Family and community support were identified as an important need among this group. The Mama Felíz (Happy Mama) programme was developed with stakeholders as a course to strengthen pregnancy, childbirth and child development knowledge, and build positive relationships, problem-solving and parenting skills. In addition, family sessions address wider cultural and gender issues which impact adolescent maternal wellbeing. Conclusions We have developed an intervention to reduce the risk of poor maternal mental health and gives young mothers hope and skills to make a better life for them and their children by packaging information about the risk and protective factors for maternal mental disorders in a way that appeals to them, their families and service providers. By using human-centred design to understand the needs and priorities of young mothers and the health and community systems in which they live, the resulting intervention and delivery strategy is one that stakeholders view as appropriate and acceptable.
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Affiliation(s)
- Tatiana Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, SE5 8AF, London, UK.
| | - Katie H Atmore
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, SE5 8AF, London, UK
| | - Inocencia Nhambongo
- Centro de Investigação em Saude de Manhiça (CISM), Manhiça Office, Rua 12, Cambeve, CP 1929, Manhiça, Mozambique
| | - Muanacha Mintade
- Centro de Investigação em Saude de Manhiça (CISM), Manhiça Office, Rua 12, Cambeve, CP 1929, Manhiça, Mozambique
| | - Luciana Massinga
- Centro de Investigação em Saude de Manhiça (CISM), Manhiça Office, Rua 12, Cambeve, CP 1929, Manhiça, Mozambique.,Departamento de Saude Mental, Ministerio da Saude, Av Edurado Mondlane nr 1008, CP 264, Maputo, Mozambique
| | - Jak Spencer
- Helen Hamlyn Centre for Design, Royal College of Art, SW11 4AN, London, UK
| | - Jonathan West
- Helen Hamlyn Centre for Design, Royal College of Art, SW11 4AN, London, UK
| | - Flavio Mandlate
- Departamento de Saude Mental, Ministerio da Saude, Av Edurado Mondlane nr 1008, CP 264, Maputo, Mozambique.,Faculdade de Medicina da Universidade Eduardo Mondlane, Avenida Salvador Allende nr 702 CP 257, Maputo, Mozambique
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Health care practitioners' views of the support women, partners, and the couple relationship require for birth trauma: current practice and potential improvements. Prim Health Care Res Dev 2020; 21:e40. [PMID: 33004100 PMCID: PMC7576522 DOI: 10.1017/s1463423620000407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM To examine health care practitioners' views of the support women, partners, and the couple relationship require when affected by birth trauma, barriers to gaining such support, and potential improvements. BACKGROUND Ongoing distress following psychologically traumatic childbirth, also known as birth trauma, can affect women, partners, and the couple relationship. Birth trauma can lead to post traumatic stress symptoms (PTSS) or disorder (PTSD). Whilst there is a clear system of care for a PTSD diagnosis, support for the more prevalent experience of birth trauma is not well-defined. METHOD An online survey of health care practitioners' views of the support parents require for birth trauma, barriers to accessing support, and potential improvements. Practitioners were recruited in 2018 and the sample for the results presented in the article ranged from 95 to 110. RESULTS Practitioners reported differing needs of support for women, partners, and the couple as a unit. There was correlation between practitioners reporting having the skills and knowledge to support couples and feeling confident in giving support. The support most commonly offered by practitioners to reduce the impact on the couple relationship was listening to the couple. However practitioners perceived the most effective support was referral to a debriefing service. Practitioners observed several barriers to both providing support and parents accessing support, and improvements to birth trauma support were suggested. CONCLUSIONS Practitioners indicate that some women, partners, and the couple as a unit require support with birth trauma and that barriers exist to accessing effective support. The support that is currently provided often conflicts with practitioners' perception of what is most effective. Practitioners indicate a need to improve the identification of parents who need support with birth trauma, and more suitable services to support them.
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A Realist Synthesis of Interprofessional Collaboration in the Early Years; Becoming Familiar with Other Professionals. Int J Integr Care 2020; 20:16. [PMID: 33041733 PMCID: PMC7528689 DOI: 10.5334/ijic.5482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Research into interprofessional collaboration (IPC) has predominantly focused on health care and specialized care settings, but there is an increasing interest in interprofesssional 'teams around the child' in community-based settings. We conducted a realist synthesis of empirical studies into IPC between youth professionals, often in regular community settings, to explore barriers and facilitators of IPC. Included studies were coded with an elaborated scheme to chart the focus of studies and to identify moderators and context-mechanism-outcome configurations of IPC. Professional and normative integration was the main focus of the included studies. Most studies emphasized the challenges of IPC in practice, like unclear roles of self and others, lack of trust and inadequate communication. Other perceived barriers are excluding others in the planning of interventions, taking ownership of plans (vs. sharing) and different modes of communication. Interprofessional education, co-location of staff, acting as a mediator in the team, organising formal and informal meetings, conflict resolutions, self-sacrifice, and conceptualizing practice were perceived as facilitators of IPC. Future IPC research into community-based settings should include all professional stakeholders and the children and their families to evaluate outcomes at both interprofessional and clinical level.
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Croteau MO, Dufour S. Qualitative assessment of interorganisational partnership at a perinatal and family substance abuse centre: stakeholders' perceptions of quality and development of their collaboration. J Interprof Care 2020:1-11. [PMID: 32838603 DOI: 10.1080/13561820.2020.1803227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 06/25/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
Partnerships are required in health and social care services to meet the increasingly complex needs of vulnerable populations. It is essential to assess these partnerships to ensure partners are supported as they strive to improve their practices. This qualitative study assessed the quality and development of the partnership of an integrated service centre for pregnant women and substance-abusing parents and their young children aged 5 and under. The data were gathered over a period of three years, by means of group and individual interviews. Twenty respondents (practitioners and managers) shared their perceptions of the interagency collaboration at the beginning, the midpoint and the end of the project funding period. Their responses were examined by means of thematic analysis. Conditions facilitating or hindering implementation of the partnership included (a) partners' participation and engagement; (b) nature of the project and its functioning (aspects of governance); (c) partners' joint work with families; and (d) social and political issues. The study highlights critical elements to consider for the development and success of a partnership project. Participants reported a number of barriers to effective collaboration; the main ones, the importance of thorough planning of project implementation, as well as the challenges relating to communication and shared leadership, are discussed.
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Affiliation(s)
| | - Sarah Dufour
- School of Psychoeducation, University of Montreal, Montreal, Canada
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Lever Taylor B, Kandiah A, Johnson S, Howard LM, Morant N. A qualitative investigation of models of community mental health care for women with perinatal mental health problems. J Ment Health 2020; 30:594-600. [DOI: 10.1080/09638237.2020.1714006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Abiramy Kandiah
- Division of Psychiatry, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Louise M. Howard
- Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
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Liang LL. Impact of integrated healthcare: Taiwan’s Family Doctor Plan. Health Policy Plan 2019; 34:ii56-ii66. [DOI: 10.1093/heapol/czz111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Integration of health services has been pursued worldwide. Diversity in integration approaches and in the contexts in which integrated programmes operate, however, hinders comparative analysis of care integration in both high-income countries (HICs) and low- and middle-income countries (LMICs). This study evaluates an HIC programme implemented in a delivery system resembling those of LMICs, especially its weak primary care system. The programme, Taiwan’s Family Doctor Plan (FDP), targets high-cost and chronic patients, incorporating key elements of integrated care, viz., case management, multidisciplinary teams and care pathways. This study estimates the effects of shifting from usual to integrated care and locates contextual factors that may distort programme implementation. To estimate programme effects, difference-in-differences analysis is applied to a balanced panel comprising >160 000 patients over 2009–13. Because physician participation is voluntary, a propensity score matching method is used to match providers. The research findings reveal that introduction of the FDP has not reoriented the model of care from fragmented towards integrated health services. It reduces continuity of care and has no effect on co-ordination of care. Regarding quality of care, the FDP is shown to have no effect on avoidable admissions and increases drug injections and emergency department visits. Several contextual factors may serve as barriers that impede elements of FDP from generating desirable outcomes. These include absence of registration and gatekeeping systems; limited capacities of clinics; and preponderance of fee-for-service remuneration. These findings suggest that HIC design elements may not be directly transferrable to settings with weak primary care systems, as is typical of LMIC healthcare. Changes at the system level, such as establishing regular sources of care, may be necessary before elements of integrated care are introduced to a weaker primary care system.
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Affiliation(s)
- Li-Lin Liang
- Department of Business Management, National Sun Yat-sen University, 70 Lienhai Road, Kaohsiung, Taiwan
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Silverwood V, Nash A, Chew-Graham CA, Walsh-House J, Sumathipala A, Bartlam B, Kingstone T. Healthcare professionals' perspectives on identifying and managing perinatal anxiety: a qualitative study. Br J Gen Pract 2019; 69:e768-e776. [PMID: 31548296 PMCID: PMC6758931 DOI: 10.3399/bjgp19x706025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/11/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Perinatal mental health problems are those that occur during pregnancy or up to 12 months postpartum, and affect up to 20% of women. Perinatal anxiety (PNA) is at least as common as depression during the perinatal phase and can adversely impact on both mother and child. Despite this, research into anxiety has received less attention than depression. The National Institute for Health and Care Excellence guidance on perinatal mental health has identified PNA as a research priority. AIM To explore the perspectives and experiences of healthcare professionals (HCPs) in the identification and management of PNA. DESIGN AND SETTING This was a qualitative study in primary and secondary care set in the West Midlands from February 2017 to December 2017. METHOD Semi-structured interviews (n = 23) with a range of HCPs. Iterative approach to data generation and analysis, using principles of constant comparison. Patient and Public Involvement and Engagement (PPIE) group was involved throughout the study. RESULTS Twenty-three HCPs interviewed: 10 GPs, seven midwives, five health visitors, and one obstetrician. Four themes were uncovered: PNA as an 'unfamiliar concept'; reliance on clinical intuition and not clinical tools; fragmentation of care; and opportunities to improve care. CONCLUSION Awareness and understanding of PNA among HCPs is variable, with debate over what is 'normal' anxiety in pregnancy. HCPs suggested that PNA can be challenging to identify, with mixed views on the use and value of case-finding tools. Opportunistic identification was noted to be significant to aid diagnosis. Care for women diagnosed with PNA was reported to be fragmented and interprofessional communication poor. Potential solutions to improve care were identified.
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Affiliation(s)
- Victoria Silverwood
- School of Primary, Community and Social Care, Keele University, Staffordshire
| | - Annabel Nash
- Midlands Partnership NHS Foundation Trust, St George's Hospital, Stafford
| | - Carolyn A Chew-Graham
- School of Primary, Community and Social Care, Keele University, Staffordshire; honorary professor of primary care mental health, Midlands Partnership NHS Foundation Trust, St George's Hospital, Stafford
| | | | - Athula Sumathipala
- School of Primary, Community and Social Care, Keele University, Staffordshire; honorary consultant psychiatrist, Midlands Partnership NHS Foundation Trust, St George's Hospital, Stafford
| | - Bernadette Bartlam
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore; honorary research fellow, School of Primary, Community and Social Care, Keele University, Staffordshire
| | - Tom Kingstone
- School of Primary, Community and Social Care, Keele University, Staffordshire; research associate in mental health, Midlands Partnership Foundation Trust, St George's Hospital, Stafford
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Coates D, Foureur M. The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e389-e405. [PMID: 30900371 DOI: 10.1111/hsc.12740] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
Perinatal mental health problems are linked to poor outcomes for mothers, babies and families. Despite a recognition of the significance of this issue, women often do not receive the care they need and fall between the gap of maternity and mental health services. To address this, there is a call for reform in the way in which perinatal mental healthcare is delivered. This paper responds to this by exploring the role and competence of midwives in delivering mental healthcare. Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question 'what is the nature of the evidence relevant to the provision of mental health interventions by midwives?' To identify studies, the databases PubMed, Maternity and Infant Care, Science Citation Index, Social Sciences Citation Index, Medline, Science Direct and CINAHL were searched from 2011 to 2018, and reference lists of included studies were examined. Studies relevant to the role of midwives in the management and treatment of perinatal mental health issues were included; studies focussed on screening and referral were excluded. Thirty papers met inclusion criteria, including studies about the knowledge, skills, and attitudes of midwives and student midwives; the effectiveness of educational interventions in improving knowledge and skills; the delivery of counselling or psychosocial interventions by midwives; and barriers and enablers to embedding midwife-led mental healthcare in practice. Synthesis of the included studies indicates that midwives are interested in providing mental health support, but lack the confidence, knowledge and training to do so. This deficit can be addressed with appropriate training and organisational support, and there is some evidence that midwife-led counselling interventions are effective. Further research is needed to test midwife-led interventions for women with perinatal mental health problems , and to develop and evaluate models of integrated perinatal mental healthcare.
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Affiliation(s)
- Dominiek Coates
- Faculty of Health, Centre for Midwifery and Child and Family Health, University of Technology, Sydney, New South Wales, Australia
| | - Maralyn Foureur
- Faculty of Health, Centre for Midwifery and Child and Family Health, University of Technology, Sydney, New South Wales, Australia
- Hunter New England Nursing and Midwifery Research Centre, Newcastle, Australia
- University of Newcastle, Faculty of Health and Medicine, Newcastle, Australia
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Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. Understanding new models of integrated care in developed countries: a systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06290] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BackgroundThe NHS has been challenged to adopt new integrated models of service delivery that are tailored to local populations. Evidence from the international literature is needed to support the development and implementation of these new models of care.ObjectivesThe study aimed to carry out a systematic review of international evidence to enhance understanding of the mechanisms whereby new models of service delivery have an impact on health-care outcomes.DesignThe study combined rigorous and systematic methods for identification of literature, together with innovative methods for synthesis and presentation of findings.SettingAny setting.ParticipantsPatients receiving a health-care service and/or staff delivering services.InterventionsChanges to service delivery that increase integration and co-ordination of health and health-related services.Main outcome measuresOutcomes related to the delivery of services, including the views and perceptions of patients/service users and staff.Study designEmpirical work of a quantitative or qualitative design.Data sourcesWe searched electronic databases (between October 2016 and March 2017) for research published from 2006 onwards in databases including MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index, Social Science Citation Index and The Cochrane Library. We also searched relevant websites, screened reference lists and citation searched on a previous review.Review methodsThe identified evidence was synthesised in three ways. First, data from included studies were used to develop an evidence-based logic model, and a narrative summary reports the elements of the pathway. Second, we examined the strength of evidence underpinning reported outcomes and impacts using a comparative four-item rating system. Third, we developed an applicability framework to further scrutinise and characterise the evidence.ResultsWe included 267 studies in the review. The findings detail the complex pathway from new models to impacts, with evidence regarding elements of new models of integrated care, targets for change, process change, influencing factors, service-level outcomes and system-wide impacts. A number of positive outcomes were reported in the literature, with stronger evidence of perceived increased patient satisfaction and improved quality of care and access to care. There was stronger UK-only evidence of reduced outpatient appointments and waiting times. Evidence was inconsistent regarding other outcomes and system-wide impacts such as levels of activity and costs. There was an indication that new models have particular potential with patients who have complex needs.LimitationsDefining new models of integrated care is challenging, and there is the potential that our study excluded potentially relevant literature. The review was extensive, with diverse study populations and interventions that precluded the statistical summary of effectiveness.ConclusionsThere is stronger evidence that new models of integrated care may enhance patient satisfaction and perceived quality and increase access; however, the evidence regarding other outcomes is unclear. The study recommends factors to be considered during the implementation of new models.Future workLinks between elements of new models and outcomes require further study, together with research in a wider variety of populations.Study registrationThis study is registered as PROSPERO CRD37725.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maxine Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res 2018; 18:350. [PMID: 29747651 PMCID: PMC5946491 DOI: 10.1186/s12913-018-3161-3] [Citation(s) in RCA: 317] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/29/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION Prospero registration number: 42016037725 .
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Maxine Johnson
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Duncan Chambers
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Anthea Sutton
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Elizabeth Goyder
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
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Vignato J, Georges JM, Bush RA, Connelly CD. Post-traumatic stress disorder in the perinatal period: A concept analysis. J Clin Nurs 2017; 26:3859-3868. [PMID: 28295746 PMCID: PMC5599312 DOI: 10.1111/jocn.13800] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To report an analysis of the concept of perinatal post-traumatic stress disorder. BACKGROUND Prevalence of perinatal post-traumatic stress disorder is rising in the USA, with 9% of the U.S. perinatal population diagnosed with the disorder and an additional 18% being at risk for the condition. Left untreated, adverse maternal-child outcomes result in increased morbidity, mortality and healthcare costs. DESIGN Concept analysis via Walker and Avant's approach. METHODS The databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Academic Search Premier and PsychINFO were searched for articles, written in English, published between 2006-2015, containing the terms perinatal and post-traumatic stress disorder. RESULTS Perinatal post-traumatic stress disorder owns unique attributes, antecedents and outcomes when compared to post-traumatic stress disorder in other contexts, and may be defined as a disorder arising after a traumatic experience, diagnosed any time from conception to 6 months postpartum, lasting longer than 1 month, leading to specific negative maternal symptoms and poor maternal-infant outcomes. Attributes include a diagnostic time frame (conception to 6 months postpartum), harmful prior or current trauma and specific diagnostic symptomatology defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Antecedents were identified as trauma (perinatal complications and abuse), postpartum depression and previous psychiatric history. Consequences comprised adverse maternal-infant outcomes. CONCLUSIONS Further research on perinatal post-traumatic stress disorder antecedents, attributes and outcomes in ethnically diverse populations may provide clinicians a more comprehensive framework for identifying and treating perinatal post-traumatic stress disorder. RELEVANCE TO CLINICAL PRACTICE Nurses are encouraged to increase their awareness of perinatal post-traumatic stress disorder for early assessment and intervention, and prevention of adverse maternal-infant outcomes.
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Affiliation(s)
- Julie Vignato
- College of Nursing, University of Iowa, Iowa City, IA, USA
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, CA, USA
| | - Jane M Georges
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, CA, USA
| | - Ruth A Bush
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, CA, USA
| | - Cynthia D Connelly
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, CA, USA
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Madden D, Sliney A, O'Friel A, McMackin B, O'Callaghan B, Casey K, Courtney L, Fleming V, Brady V. Using action research to develop midwives' skills to support women with perinatal mental health needs. J Clin Nurs 2017; 27:561-571. [PMID: 28557236 DOI: 10.1111/jocn.13908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aim of the research was to identify and develop midwives' skills to support women with mental health needs during pregnancy, using an action research approach. BACKGROUND A review of perinatal mental health services in a large Dublin maternity unit revealed a high number of referred women who 'did not attend' the perinatal mental health service with few guidelines in place to support midwives in identifying and referring women for specialist help. DESIGN Action research using cooperative inquiry involved a mental health nurse specialist and a team of midwives, who were drawn to each other in mutual concern about an area of practice. METHODS Data were gathered from three Cooperative Inquiry meetings, which incorporated one main Action Research Cycle of constructing, planning, taking and evaluating action. Data were analysed using a thematic content analysis framework. RESULTS Participants experienced varying levels of uncertainty about how to support women with perinatal mental health needs. Cooperative inquiry supported participants in making sense of how they understood perinatal mental health and how they managed challenges experienced when caring for women with perinatal mental health issues. Participants developed a referral pathway, highlighted the significance of education to support women with perinatal mental health issues and identified the value of using open questions to promote conversation with pregnant women about mental health. CONCLUSIONS Midwives value education and support to identify and refer women at risk of perinatal mental health issues. Cooperative inquiry, with a focus on action and shared reflection, facilitated the drawing together of two professional groups with diverse knowledge bases to work together to develop practice in an area of mutual concern. RELEVANCE TO CLINICAL PRACTICE Perinatal mental health is a significant public health issue and midwives need support to make psychosocial assessments and to negotiate access to specialist services where available and when required.
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Affiliation(s)
| | | | | | | | | | - Kate Casey
- National Maternity Hospital, Dublin, Ireland
| | | | | | - Vivienne Brady
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
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Schmied V, Langdon R, Matthey S, Kemp L, Austin MP, Johnson M. Antenatal psychosocial risk status and Australian women's use of primary care and specialist mental health services in the year after birth: a prospective study. BMC Womens Health 2016; 16:69. [PMID: 27782825 PMCID: PMC5078921 DOI: 10.1186/s12905-016-0344-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 09/16/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Poor mental health in the perinatal period can impact negatively on women, their infants and families. Australian State and Territory governments are investing in routine psychosocial assessment and depression screening with referral to services and support, however, little is known about how well these services are used. The aim of this paper is to report on the health services used by women for their physical and mental health needs from pregnancy to 12 months after birth and to compare service use for women who have been identified in pregnancy as having moderate-high psychosocial risk with those with low psychosocial risk. METHODS One hundred and six women were recruited to a prospective longitudinal study with five points of data collection (2-4 weeks after prenatal booking, 36 weeks gestation, 6 weeks postpartum, 6 months postpartum and 12 months postpartum) was undertaken. Data were collected via face-to-face and telephone interviews, relating to psychosocial risk factors, mental health and service use. The prenatal psychosocial risk status of women (data available for 83 of 106 women) was determined using the Antenatal Risk Questionnaire (ANRQ) and was used to compare socio-demographic characteristics and service use of women with 'low' and 'moderate to high' risk of perinatal mental health problems. RESULTS The findings indicate high use of postnatal universal health services (child and family health nurses, general practitioners) by both groups of women, with limited use of specialist mental health services by women identified with moderate to high risk of mental health problems. While almost all respondents indicated that they would seek help for mental health concerns most had a preference to seek help from partners and family before accessing health professionals. CONCLUSION These preliminary data support local and international studies that highlight the poor uptake of specialist services for mental health problems in postnatal women, where this may be required. Further research comparing larger samples of women (with low and psychosocial high risk) are needed to explore the extent of any differences and the reasons why women do not access these specialist services.
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Affiliation(s)
- Virginia Schmied
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia.
| | - Rachel Langdon
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia
- Centre for Applied Nursing Research (a joint facility of the South Western Sydney Local Health District and Western Sydney University, Liverpool, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, Sydney, NSW, Australia
| | - Stephen Matthey
- School of Psychology, University of Sydney and Research Director, Infant, Child & Adolescent Mental Health Service, South West Sydney Local Health District, Sydney, Australia
| | - Lynn Kemp
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia
| | - Marie-Paule Austin
- Chair, Perinatal Mental Health Unit University of New South Wales & St John of God Health Care, Burwood , Sydney, Australia
- The Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, Sydney, NSW, Australia
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Rossiter C, Schmied V, Kemp L, Fowler C, Kruske S, Homer CSE. Responding to families with complex needs: a national survey of child and family health nurses. J Adv Nurs 2016; 73:386-398. [PMID: 27624334 DOI: 10.1111/jan.13146] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2016] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to explore the extent to which Australian child and family health nurses work with families with complex needs and how their practice responds to the needs of these families. BACKGROUND Many families with young children face challenges to their parenting capacity, potentially placing their children at risk of poorer developmental outcomes. Nurses increasingly work with families with mental health problems, trauma histories and/or substance dependence. Universal child health services must respond effectively to these challenges, to address health inequalities and to promote the best outcomes for all children and families. DESIGN The descriptive study used cross-sectional data from the first national survey of child and family health nurses in Australia, conducted during 2011. METHODS Survey data reported how often, where and how child and family health nurses worked with families with complex needs and their confidence in nursing tasks. FINDINGS Many, but not all, of the 679 respondents saw families with complex needs in their regular weekly caseload. Child and family health nurses with diverse and complex caseloads reported using varied approaches to support their clients. They often undertook additional professional development and leadership roles compared with nurses who reported less complex caseloads. Most respondents reported high levels of professional confidence. CONCLUSION For health services providing universal support and early intervention for families at risk, the findings underscore the importance of appropriate education, training and support for child and family health professionals. The findings can inform the organization and delivery of services for families in Australia and internationally.
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Affiliation(s)
- Chris Rossiter
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith South DC, New South Wales, Australia
| | - Lynn Kemp
- School of Nursing and Midwifery, Western Sydney University, Penrith South DC, New South Wales, Australia
| | - Cathrine Fowler
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Sue Kruske
- Maternal Child Health, Institute of Urban Indigenous Health, Bowen Hills, Queensland, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
| | - Caroline S E Homer
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Broadway, New South Wales, Australia
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Yu M, Sampson M. Closing the Gap between Policy and Practice in Screening for Perinatal Depression: A Policy Analysis and Call for Action. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:549-556. [PMID: 27254263 DOI: 10.1080/19371918.2016.1160337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Although perinatal depression (PND) is one of the most common maternal morbidities, it is frequently undetected. Screening for early detection and intervention has the potential to prevent depressive symptoms from worsening. In the United States, five states have enacted legislation in relation to screening for PND, but a gap remains between policy and practice in providing continuum of care for mothers who may be suffering from depressive symptoms. From the perspective of policy formation, the reasons for this gap include a discrepancy between policy and practice goals, lack of regulations on capability building among perinatal care providers, and few pathways for establishing collaborations between medical providers and mental health professionals. The authors recommend involving social workers in the process to promote a better continuum of care after screening through comprehensive policy that explicitly states goals to effectively screen women in the perinatal period.
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Affiliation(s)
- Miao Yu
- a Graduate College of Social Work, University of Houston , Houston , Texas , USA
| | - McClain Sampson
- a Graduate College of Social Work, University of Houston , Houston , Texas , USA
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Olley H, Psaila K, Fowler C, Kruske S, Homer C, Schmied V. 'Being the bridge and the beacon': a qualitative study of the characteristics and functions of the liaison role in child and family health services in Australia. J Clin Nurs 2016; 26:91-102. [PMID: 27647750 DOI: 10.1111/jocn.13373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This article explores the characteristics and functions of the liaison role in child and family health services in Australia. BACKGROUND Liaison roles are increasingly being used to improve communication between health services and professionals and to facilitate access to support for individuals and families in need. Nurses are commonly, although not always, the professionals who undertake these roles. Research on the role and outcomes of liaison positions in child and family health services is limited in Australia and internationally. DESIGN A qualitative interpretive design informed this study. Interviews and focus groups were conducted with 40 liaison and other health professionals, primarily nurses, working with families with newborn and young children in two Australian States. Data were analysed thematically. RESULTS Three major themes were identified reflecting the importance of defining the role and tasks which included building bridges between services and professionals, supporting families during transition between services and supporting clinicians. Several facilitators and barriers were identified, including concerns about sustainability of the roles. CONCLUSIONS Professionals working in a liaison role in child and family health services emphasise that these positions have the potential to link services and professionals, thereby providing more effective care pathways for children and families especially for those with complex and multiple vulnerabilities. While a few children and family health services in Australia provide liaison services, the extent of liaison support and the outcomes for families in Australia is unknown. RELEVANCE TO CLINICAL PRACTICE Nurses working with children and families are the most likely health professionals to undertake a liaison role. In many nursing contexts, liaison roles are relatively new and those in the role have the responsibility to define the key purpose of their role. Liaison roles are multifaceted requiring the nurse to have excellent communication and negotiation skills to effectively link diverse professionals and services, while simultaneously engaging with and supporting vulnerable families and children. Nurses in these roles also support and educate clinical colleagues.
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Affiliation(s)
- Hannah Olley
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Kim Psaila
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Cathrine Fowler
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Sue Kruske
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
| | - Caroline Homer
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
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Myors KA, Cleary M, Johnson M, Schmied V. A mixed methods study of collaboration between perinatal and infant mental health clinicians and other service providers: Do they sit in silos? BMC Health Serv Res 2015; 15:316. [PMID: 26260057 PMCID: PMC4531515 DOI: 10.1186/s12913-015-0977-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/24/2015] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Karen A Myors
- School of Nursing and Midwifery, University of Western Sydney, Parramatta Campus, Penrith South, DC, NSW 1797, Australia.
| | - Michelle Cleary
- School of Nursing and Midwifery, University of Western Sydney, Parramatta Campus, Penrith South, DC, NSW 1797, Australia.
| | - Maree Johnson
- School of Nursing and Midwifery, University of Western Sydney, Parramatta Campus, Penrith South, DC, NSW 1797, Australia.
- Centre for Applied Nursing Research, Affiliated with the Ingham Institute of Applied Medical Research, Sydney South West Local Health District, Liverpool, NSW, 2170, Australia.
| | - Virginia Schmied
- School of Nursing and Midwifery, University of Western Sydney, Parramatta Campus, Penrith South, DC, NSW 1797, Australia.
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O'Donnell M, Maclean MJ, Sims S, Morgan VA, Leonard H, Stanley FJ. Maternal mental health and risk of child protection involvement: mental health diagnoses associated with increased risk. J Epidemiol Community Health 2015; 69:1175-83. [DOI: 10.1136/jech-2014-205240] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 06/24/2015] [Indexed: 11/04/2022]
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Myors KA, Johnson M, Cleary M, Schmied V. Engaging women at risk for poor perinatal mental health outcomes: a mixed-methods study. Int J Ment Health Nurs 2015; 24:241-52. [PMID: 25521937 DOI: 10.1111/inm.12109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Karen A Myors
- School of Nursing and Midwifery, The University of Western Sydney, Sydney, New South Wales, Australia
| | - Maree Johnson
- School of Nursing and Midwifery, The University of Western Sydney, Sydney, New South Wales, Australia.,Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, South West Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michelle Cleary
- School of Nursing and Midwifery, The University of Western Sydney, Sydney, New South Wales, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, The University of Western Sydney, Sydney, New South Wales, Australia
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Jenkinson B, Young K, Kruske S. Maternity services and the discharge process: A review of practice in Queensland. Women Birth 2014; 27:114-20. [DOI: 10.1016/j.wombi.2013.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/02/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
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Myors KA, Schmied V, Johnson M, Cleary M. 'My special time': Australian women's experiences of accessing a specialist perinatal and infant mental health service. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:268-277. [PMID: 24224792 DOI: 10.1111/hsc.12079] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2013] [Indexed: 06/02/2023]
Abstract
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.
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Affiliation(s)
- Karen A Myors
- School of Nursing and Midwifery, The University of Western Sydney, Penrith South DC, New South Wales, Australia
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Myors KA, Schmied V, Johnson M, Cleary M. Therapeutic interventions in perinatal and infant mental health services: a mixed methods inquiry. Issues Ment Health Nurs 2014; 35:372-85. [PMID: 24766172 DOI: 10.3109/01612840.2013.873100] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Perinatal mental health disorders potentially have long-term negative sequelae for women, their infants and their families. Multidisciplinary perinatal and infant mental health (PIMH) services are an emerging specialty in mental health designed to improve mother-infant outcomes. This mixed methods study explored the characteristics of women referred to a specialist PIMH service and the therapeutic interventions that PIMH clinicians use. Women referred to the service were identified with multiple and complex risk factors. Perinatal and infant mental health clinicians use a range of interventions, dependent upon their training, such as family of origin work/genograms, non-directive counseling, and strategies to manage anxiety and depression. Clinicians also emphasized the therapeutic relationship and the interventions they use within an attachment-based framework, which warrants further research.
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Thornton C, Schmied V, Dennis CL, Barnett B, Dahlen HG. Maternal deaths in NSW (2000-2006) from nonmedical causes (suicide and trauma) in the first year following birth. BIOMED RESEARCH INTERNATIONAL 2013; 2013:623743. [PMID: 24024205 PMCID: PMC3760299 DOI: 10.1155/2013/623743] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/18/2013] [Accepted: 07/18/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Trauma, including suicide, accidental injury, motor traffic accidents, and homicides, accounts for 73% of all maternal deaths (early and late) in NSW annually. Late maternal deaths are underreported and are not as well documented or acknowledged as early deaths. METHODS Linked population datasets from births, hospital admissions, and death registrations were analysed for the period from 1 July 2000 to 31 December 2007. RESULTS There were 552,901 births and a total of 129 maternal deaths. Of these deaths, 37 were early deaths (early MMR of 6.7/100,000) and 92 occurred late (late MMR of 16.6/100,000). Sixty-seven percent of deceased women had a mental health diagnosis and/or a mental health issue related to substance abuse noted. A notable peak in deaths appeared to occur from 9 to 12 months following birth with the odds ratio of a woman dying of nonmedical causes within 9-12 months of birth being 3.8 (95% CI 1.55-9.01) when compared to dying within the first 3 months following birth. CONCLUSION Perinatal services are often constructed to provide short-term support. Long-term identification and support of women at particular risk of maternal death due to suicide and trauma in the first year following birth may help lower the incidence of late maternal deaths.
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Affiliation(s)
- Charlene Thornton
- University of Western Sydney, Locked Bag 1797, Penrith South, NSW 2751, Australia
| | - Virginia Schmied
- University of Western Sydney, Locked Bag 1797, Penrith South, NSW 2751, Australia
| | - Cindy-Lee Dennis
- University of Toronto, 155 College Street, Toronto, ON, Canada M5T 2P8
| | - Bryanne Barnett
- University of New South Wales, High Street, Kensington, NSW 2050, Australia
| | - Hannah Grace Dahlen
- University of Western Sydney, Locked Bag 1797, Penrith South, NSW 2751, Australia
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