Provide specific care with well-formed and supervised professionals PERINATAL AMBULATORY CARE: PREVENTIVE AND THERAPEUTIC INTERVENTIONS IN VULNERABLE FAMILIES J. Le Foll (a). A. Guedeney (a). a) - Service de pédopsychiatrie, Pr. A. Guedeney, Hôpital Bichat-Cl. Bernard, AP-HP, Paris BACKGROUND Vulnerability factors, especially as they accumulate, expose the unborn child to a higher risk of somatic disorders and increase the risk of delayed psychomotor development, learning difficulties, and child abuse. Vulnerable mothers are also known to be more frequently depressed, which may have an impact on parent-child bonding and attachment and subsequently influence the child’s development. In terms of perinatal prevention and early interventions, it is therefore essential for vulnerable families to be detected in order to be supported. Which are the key points of a relevant perinatal preventive and therapeutic intervention in vulnerable families CHALLENGES FOR PREVENTION AND INTERVENTION Vulnerable parents rarely request help and babies at psychosocial risk therefore remain difficult to access by professionals. Caught up in their relational insecurity, vulnerable parents find it more difficult to accept help and support, in the fear to be judged and to have their children put in foster care. Perinatal period is probably one of the best one to build a strong and trusting relationship and use it as a tool for change by modifying negative relationship models or by increasing the family’s trust in care. KEY POINT: early identification and treatment can be used to reduce the likelihood of serious developmental failure and relationship disturbance in vulnerable families MAIN OBJECTIVES Identify families at risk and carry out early, continuous and prolonged multidisciplinary care Early identification of families cumulating psychosocial risk factors such as precarious situation, lack of social support, neglect or emotional deprivation during childhood, unresolved trauma, drug addiction… Early care, starting as far as possible during pregnancy Continuous and prolonged care: same professionals from pregnancy to early childhood (avoiding interchangeable professionals who break their word and are not completely involved) Multidisciplinary care: partnership between all medico-social workers; creation and use of Perinatal Networks; combination of day-to-day support (social and family workers) and more specific psychological support. Provide specific care with well-formed and supervised professionals Specific care based on different intervention strategies, often used in combined ways: emotional support, developmental guidance, parent-infant therapy, early assessment of child development… The professional has to identify and enhance parental capacities to provide care to the child and encourage positive interactions and playful exchanges. Home-based interventions: care institutions must change and adapt to the functioning of these vulnerable families; professionals must be fully committed and patient, and propose more flexible approach, such as home-based care. Specific training, regular analysis of practices and supervision represent an absolute necessity for all practitioners, whatever their level of seniority or experience, in particular when they have to provide home-based care. References: Dozier M, Lomax L, Tyrrell C, et al. (2001) The challenge of treatment for clients with dismissing states of mind. Attachment and human development. 3: 62 – 76 Fraiberg S, Adelson E, Shapiro V. (1975) Ghosts in the Nursery: A Psychoanalytic Approach to the Problems of Impaired Infant-Mother Relationships. Journal of the American Academy of Child Psychiatry. 14(3), 387–421 Greenspan S, Wieder S, Lieberman A, & al. (1987) Infants in multirisk families: case studies in preventive intervention. International Universities Press McDonough, S. (1993) Interaction guidance: Understanding and treating early infant-caregiver relationship diturbances. In C. ZEANAH, Handbook of infant mental health (pp. 414-426). New-York: Guilford Press. Olds D, Kitzman H, Cole R, Robinson J, Sidora K, Luckey DW, et al. (2004) Effects of nurse home-visiting on maternal life course and child development: age 6 follow-up results of a randomized trial . Pediatrics.114: 1550 - 9.