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

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Example ESI Results report

10. 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)

11. 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

12. 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)

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

14. 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 (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.

15. Thank you for listening!
Any Questions