Improving mother-infant interactions and parenting in a mother and baby mental health unit: A service evaluation Belinda Williams

Background The efficacy of assessments and interventions with mothers diagnosed with mental health problems in the perinatal period is currently unknown (NICE, 2017). Need for robust assessment and evidence-based interventions (RCP, 2016; NICE,2017). Minimising the impact of the mother’s mental health on mother-infant bonding (Tickell, 2011; Department of Health, 2011; NICE, 2017; PHE, 2016). Team in the mother and baby unit had difficulty assessing and documenting individual problems and outcomes. The Evaluation of Social Interaction (ESI) is validated for use within a mental health population.

Evaluation of Social Interaction (ESI) Only standardised observation based measure of quality of social interaction Standardised on over 14,791 persons worldwide Can be used with anyone, with or without a diagnosis, aged 2 years and over Client-centred assessment tool using actual social exchanges with real social partners Observations occur within real environments using typical daily occupations Can evaluate any relevant social exchange accounting for cultural expectations Fisher & Griswold, 2018

Social Interaction: A chain of small actions Looks at partner Approaches Partner Shakes hands Asks a question Talks before partner is finished answering Laughs inappropriately Turns away from Places hand on arm Says “Goodbye” Looks back at partner Links in a chain of actions performed one by one as the person “constructs” the social exchange

The 27 Social Interaction Skills (ESI Items) included in the ESI Shaping content of social interaction Questions Replies Discloses Expresses emotion Disagrees Thanks Maintaining flow of social Interaction Transitions Times Response Times Duration Takes Turns Verbally supporting social Matches Language Clarifies Acknowledges/Encourages Empathises Adapting social interaction Heeds Accommodates Benefits The 27 Social Interaction Skills (ESI Items) included in the ESI Initiating and terminating social interaction Approaches/Starts Concludes/Disengages Producing social interaction Produces Speech Gesticulates Speaks Fluently Physically supporting Turns Toward Looks Places Self Touches Regulates

Aim To find a standardised assessment that captures mothers’ social interactions in order to better meet NICE recommendations To introduce the ESI into the team’s assessment routine and evaluate its usefulness

Procedures ESI used during first week of admission for baseline assessment of social interaction – as part of usual treatment Mothers observed during parenting occupations and other relevant occupations of their choice. e.g. changing nappy, bathing baby, preparing bottle, catching bus, buying goods, finding out about local resources. Observations undertaken within the natural context e.g. on the ward, local community. Two ESI observations scored and reports generated

Goal Setting and Intervention ESI results and reports discussed with each mother Goals were agreed collaboratively and focussed on occupations that each mother wanted to achieve Interventions delivered by OT focussed specifically on social occupations as well as care of self and baby MDT interventions included play, baby massage, role modelling Following interventions or before discharge the ESI was used again The ESI can also be used as an outcome measure

Example ESI Results report

Interventions Each mothers goals determined the focus of interventions Encouraging good quality social interaction with social partners including baby (Adaptive) Grading, practicing and developing social interaction skills (Acquisitional) Providing feedback to increase awareness of social interaction strengths and challenges (Restorative) Work with partners, health visitors, grandparents to increase understanding of how best to support good quality social interactions (Educational)

Outcomes Baseline assessments completed with 12 mothers (n=12). Goal setting and intervention programmes with 12 mothers 8 mothers were re-assessed following interventions. Seven (88%) demonstrated statistically significant change (p≤0.15), [two ESI measures differed by at least the sum of the SE for each ESI measure (Fisher & Griswold, 2018). Three mothers were discharged before the re-evaluation could be completed. One mother chose not to participate in the re-assessment

Example ESI Progress report Time 1: 0.2 logits Time 2: 0.7 logits Change: 0.5 logits Minimum change needed to be significant 0.33 logits (based on the sum of SE of both ESI scores (Fisher & Griswold, 2018)

Implications for Practice Individual social interaction strengths and limitations identified Targeted and specific goal directed interventions for OT and MDT Individual outcomes Team outcomes

References Department of Health. (2011). Health visitor implementation plan – A call to action. London: Stationery Office. Fisher, AG (2014) Occupation-centred, occupation-based, occupation-focused: Same, same or different? Scandinavian Journal of Occupational Therapy, 21 (Suppl. 1), 96 – 107. Fisher, AG & Griswold, LA (2018). Evaluation of Social Interaction 4th Edition. Fort Collins, Colorado: Three Star Press Inc. NHS Commissioning Board (2016). C06/S/a Perinatal Mental Health, NHS Standard Contract for Specialised Perinatal Mental Health Services (In-patient Mother and Baby Units and linked outreach teams). London: National Health Service England National Institute for Health and Clinical Excellence. (2017). Antenatal and postnatal mental health: clinical management and service guidance CG192. London: NICE. Public Health England (2016). Health matters: giving every child the best start in life. Available at https://www.gov.uk/government/publications/health-matters-giving-every-child-the-best-start-in-life/health-matters-giving-every-child-the-best-start-in-life (Accessed 11 May 2018) Royal College of Psychiatry (2016). Perinatal Quality Network for Perinatal Mental Health services Service Standards for Mother and Baby Units: Fifth Edition. London: Royal College of Psychiatry. Tickell C. (2011). The early years: Foundations for life, health and learning. London: The Stationery Office.

Thank you for listening! Any Questions belinda.williams@lavender-ot.co.uk