Perinatal and Infant Mental Health

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Perinatal and Infant Mental Health overview of
NCSS activity examples of good practice by
region.

• David Goodban, CAMHS Regional Development Worker
• PIMH lead, National CAMHS Support Service

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NCSS PIMH programme - Network

• Creation of a national electronic network for
  PIMH in 2009
• 900 members nationally and internationally
• Managed by Janet Cobb, but in transition to new
  arrangement with another overall service provider
  as part of sustainability arrangements
• Free monthly mailings to members
• Circulation of information about upcoming
  conferences and events

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http//www.cypf.org.uk/camhs/perinatal-and-infant-
mental-health.html
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NCSS PIMH programme development of e-learning
course

• Expert reference group 2 seminars
• Facilitation and background work from Yvonne
  Anderson of Cernis (previously with HASCAS)
• Jane Sedgwick, NCSS training lead developed the
  software package with OCB media
• http//learning.camhs.org.uk

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• 4 sections to the PIMH course
• Becoming a parent
• When things go wrong
• Ways of working to promote positive mental health
• Attachment the language of relationships.
• The courses are for everyone parents, people
  working in Childrens or Adult services, social
  care, health, or education. There is e-moderation
  so that people who are not learning as part of a
  local group can be facilitated through the
  course.

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NCSS PIMH programme infant mental health
outcome measures

• Supported by the CAMHS Outcome Research
  Consortium at the Anna Freud Institute
• Expert reference group meeting
• Trial measures agreed
• Visit

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NCSS PIMH programme infant mental health
outcome measures

• Parent/Child interaction measures
• CARE Index (video taping)
• KIPS (Keys to Interactive Parenting Scale)(video
  taping)
• Emotional Availability Scale (parent completed
  measure)
• Measures based on the child
• ASQ-SE (Ages Stages Questionnaires
  Social-Emotional) (parent completed measure)
• Measures based on the mother/parent
• Extreme end measures
• Edinburgh Postnatal Depression Scale
  (EPDS)(mother rated measure)
• Brief Psychiatric Rating Scale (BPRS)
  (practitioner rated measure)
• Mild end measures of general adult mental health
• Kessler-10 (parent completed measure)
• Everyday Feeling Questionnaire (EFQ) (parent
  completed measure) (N.B. EFQ was brought forward
  after the think tank was held)
• Link to CORC advice sheet

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NCSS PIMH programme mapping

• This years Child Health Mapping should deliver
  some answers to a range of questions about
  perinatal and infant mh provision from a
  childrens and community childrens health
  perspective.
• But will not answer questions about AMH
  provision, which are not covered by AMH mapping,
  and therefore gaps remain.
• This reflects an ongoing lack of join up at
  policy and guidance level which still sometimes
  occurs.
• New Horizons indicates the direction of travel as
  being away from a single client group perspective
  to a more integrated approach to commissioning
  and provision.

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Examples of good practice

• Managed Care Networks and Care Pathway
  development
• Integrated delivery of mother and infant services
• AMH with Childrens Services including CAMHS
• CAMHS with Childrens Centres and AMHS
• Common training models underpinning service
  delivery

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Examples of good practice - Care pathway
development

• South West
• NHS SW has commissioned work from SWDC to develop
  and trial a maternal mental health care pathway
  in a local area, with rollout by all areas of a
  care pathway expected.
• Local areas will be expected to have their own
  models in place utilising this work to ensure
  that the care pathways deliver quality care in
  every area and that these meet prescribed
  standards. Attachment and relationship work will
  form part of these standards, as will
  safeguarding.
• Somerset and Bournemouth already have worked
  through care pathways (but without reference to
  the mental health of infants).

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Examples of good practice Integrated service
delivery

• Hard to find. Services tend to be integrated on
  one side of the fence or the other but not both.
• Basingstoke and Bristol good examples of Mother
  and Baby units doing parent baby interaction
  work, but no commissioning from Childrens
  services Bristol has links to IMH PMHWs
• Surrey Childrens services have an integrated
  CAMHS, Health Visiting and Childrens Services
  provision, but not clear what links there are to
  AMH services or commissioning

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Examples of good practice Integrated service
delivery

• Gloucestershire
• 2gether trust provides an IMHS for up to 2 year
  olds in targeted childrens centres funded by the
  PCT with an injection of about 250K this year.
• This new development builds on the success of our
  Secure Start programme in Cheltenham which has
  been running for 5 years.
• Programme includes therapeutic interventions with
  families and a training programme for
  professionals on attachment, the importance of
  brain development and research into the early
  years.
• It also links with the Perinatal services
  provided by 2gether in WAA.

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Examples of good practice Common training models

• CAMHS Antenatal consultation service offered by
  a clinical psychologist to Heartlands and
  Solihull hospitals. The service sits alongside
• the Solihull Approach training strategy for all
  professionals working in Solihull,
• the Solihull Approach Antenatal Parenting
  Programme,
• the Solihull Approach Antenatal Education
  Programme, and
• the CAMHS Consultation Services to Health
  Visitors.
• The CAMHS also offers a support service to
  Childrens Centres in Solihull which includes
• drop in sessions,
• support and supervision to staff,
• advice,
• parenting groups,
• audit and risk assessment.
• The consultation is supported by a draft
  protocol.

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A Model for Infant Mental Health Provision within
Childrens Centres
Possible Providers Possible Provision
Specialist residential family assessment centres Mother and baby units Specialist Child and Adolescent Mental Health Services (CAMHS) Specialist provision-Community or Residential based Residential parent/child assessment Inpatient parental psychiatric treatment Intensive community support
CAMHS specialist within Childrens Centres CAMHS Family Therapist Childrens Centre Specialists or Adult Mental Health Team Childrens Centre Staff together with CAMHS Specialist provision-Community based Parent/Infant psychotherapy Family Therapy Individual Parent support Specialist Parenting Group eg. Mellow Parenting, Growing Together
Childrens Centre Staff Targeted Provision Home visits Family support Being Together (with your baby) Play Link Watch Wait and Wonder group
Childrens Centre midwife, community midwife and Childrens Centre Community Psychiatric Nurse Health Visitors, IMH specialist in Childrens Centre Childrens Centre staff Midwives and trained community based staff Universal Provision Ante and post natal screening for mental health difficulties Post natal support for relationship difficulties Parent support, education and advice eg. Parenting group, nursery matters, welcome to nursery, childhood matters, baby café, breastfeeding support Crèche facilities Play Stay Baby Massage