POSTER AND POSTER WORKSHOPS – Concurrent Sessions
The David P. Derham Theatre
Ethics, Parents and the Infant in Families Assisted by Reproductive Technology (ART)
Chair: Ms Beulah Warren
Ms Ornella Care
Background: Research shows the mental health of parents can influence infant mental health. An estimated 1 in 8 women experience perinatal depression, the importance of supporting women’s emotional wellbeing during and after birth is important not only for the mental health of women, but also their babies.
mummatters is a free online mobile health tool that enables women to self-assess for symptoms of depression or the presence of psychosocial risk factors, and supports them to seek help if needed.
The tool targets women who are pregnant or have recently had a baby with the purpose of preventing or mitigating the impact of perinatal depression. mummatters also encourages women to create a tailored wellness plan and to regularly ‘check-in’ to monitor their emotional health. Summary reports can be generated directly from mummatters for women to share with their health care provider.
An external evaluation is being conducted by the University of NSW. The mummatters evaluation will examine the impact of this online tool on women’s health. Data will be collected from consenting women at 1-month, 3-months, and 6-months after completion of the mummatters self-assessment measures.
Data from the first 200 women enrolled in the evaluation will be showcased.
Preliminary results are:
-In the six months since mummatters has been ‘live’, over 2,000 women have signed up and are receiving monthly support.
-50% of users are antenatal and 50% are postnatal.
Over half of the users either have symptoms or risk factors of depression. Thirty-six percent of these women report having seen a health care provider after being prompted by mummatters.
Ms Sharon Cooke & Ms Sue Coleson
The naked newborn enters the world exposed; subject to a sudden sensory feast of milk, medical procedures and expectations. Simultaneously a new mother is birthed; a role with big responsibilities, wherein new hopes, fears and longings are stirred.
Mother-Baby Nurture is a 10-week targeted support group for infants 0-6 months and mothers struggling to connect with their baby. It offers a safe holding space to recuperate and reflect on the new relationships that are in formation. The group is slow and spacious, providing opportunity to reflect on birth experiences, expectations and disappointments, family roles, self-care and support. The baby is an active participant of the group. Each week there is silent space dedicated to observation followed by reflection, where the mother is supported to wonder about her baby’s behaviour and experiences, considering the mind of her infant, as distinct from her own. Time is taken to move between each member of the group, babies included, delighting in shared interests as well as differences, honouring the unique internal world of the other.
Each Mother-Baby Nurture group is hosted by two facilitators. A senior facilitator specialised in infant mental health and the other a peer facilitator who offers her unique story of lived experience and recovery. As the facilitators work in an unhurried pace, thinking aloud about the processes encountered in the group whilst holding each member in mind, they attempt to embody the qualities found in a nurturing parent-child relationship for the members to experience.
Dr Finbar Hopkins
The relationship between a pregnant woman and her midwife is based on values of respect, trust and the dignity for all pregnant women. This relationship can be impacted upon if the midwife has to refer the pregnant woman to another professional because she suspects the woman is disengaged from her unborn baby.
The midwife is aware that pregnancy is a unique series of new bodily changes and new mental imaginings or maternal representations about self as-a-mother and of her unborn baby as well as her partner and significant others in her life.
Recently, midwives in the UK have been tasked with exploring maternal representations of pregnant women in order to build mother-infant attachment during pregnancy (The Royal College of Midwives 2012, Maternal Emotional Wellbeing and Infant Development A Good Practice Guide for Midwives). The Guide also suggests midwives refer women to psychologists if midwives consider women are disengaged from their unborn.
While the Guide aims to boost maternal-fetal attachment the context in which maternal representations are explored at present need further discussion if the values of the midwife- woman relationship are to be upheld. The ethics of informed consent, the right to privacy and the use of judgement when sharing this information with others needs discussion.
This presentation will discuss the potential ethical dilemmas that midwives could face when working with the concept of maternal representations during routine antenatal care. Recommendations to enable midwives to work ethically with maternal representations will also be addressed.
Dr Lia Laios, Dr Emma Symes
Introduction: We explore the case of a first-time mother who conceived using a known egg donor.
Method: Salient features of the case are highlighted: alongside the often-lengthy time to conceive, the uncertainty of successful implantation, and the risk of miscarriage, assisted conception using donor gametes poses additional anxieties for the recipient mother. It is largely unchartered territory and can trigger complex emotional responses around ownership of fetus and family composition. We describe this motherâ€™s fears, conflicts, attachment with her unborn baby, relationship with the egg donor, and how this all manifest in her experience of motherhood. We also outline the mental health care and interventions that this mother received.
Results: Joan Raphael-Leff described egg donation between live women as marking a profound alteration in social exchange. An egg is not merely a generous altruism, but materialization of one’s own baby through another’s gestation. For the recipient it can be a mixed blessing. This mother’s anxieties negatively affected her attachment with her unborn baby to the extent that she struggled to ‘own’ him and sought reassurance from the egg donor. She became preoccupied with her baby’s lack of resemblance to her, as if he was ‘alien’ and unfamiliar. She would look at her baby but not really see him. By three months of age, baby had also begun to avert his gaze from his mother which, perceived as rejection, intensified her anxieties.
Conclusions: Antenatal psychotherapy and a postnatal mentalisation-focussed group intervention provided the mother with space to consider and reflect on her anxieties, as well as develop a more positive attachment with her baby.
Ms Belinda Lequertier, Dr Gabrielle Simcock, Dr Vanessa Cobham, Prof Sue Kildea, Prof Suzanne King
Maternal mind-mindedness (MM) refers to a mother’s tendency to view her infant as an independent psychological agent. Although higher levels of this quality have been associated with more optimal child social and emotional development, the nature of maternal MM remains to be fully understood, including the prenatal conditions and maternal characteristics that may best explain individual differences in this caregiving quality. The current study investigated the predictors of maternal MM in 110 mothers pregnant during the Queensland floods in January 2011. At recruitment, mothers completed measures of adult attachment style and flood-related objective hardship and posttraumatic stress (PTS) symptoms. At 16 months postpartum, mothers completed measures of anxiety and depression symptoms. Maternal MM was assessed during a lab visit as the frequency of appropriate mind-related comments made by mothers when playing with their infants. Preliminary regression analyses indicated that mothers with higher MM reported lower attachment avoidance and higher attachment anxiety. No influence of flood-related objective hardship, PTS symptoms or concurrent maternal depression or anxiety was evident. Results are consistent with a view of maternal MM as a stable relational construct, extending on the existing literature by suggesting that this caregiving quality may be unaffected by stress during pregnancy, and concurrent anxiety and depression. Findings will be discussed in relation to the existing literature concerning the nature and predictors of maternal MM and similar constructs, together with implications for clinical practice.
Ms Jessica Little, Mr Allen Jeffress
As social change and advances in reproductive technology progress, more people are having children outside the hetero-normative frame. We wish to illuminate modern family making-and-living through understanding the experiences of LGBTIQ+ people negotiating the desire and the decision to have children and navigating the medical and social systems inherent to reproduction and parenting; and exploring how infant health professionals work with LGBTIQ+ families. We will focus on the fundamental first days, weeks, months and years of the infant’s life, where experiences common to all families play out.
This project begins with a literature review of current infant mental health research and professional engagement with non-traditional families. This exploration is motivated by our experience as practitioners and anecdotal reports of blind-spots – and even exclusion – in current practice.
We will establish how well these families are currently being met, listened to and understood by the infant mental health community. We will ask: how successfully are the needs and experiences of rainbow families being represented in current research in the area of infant mental health; and how well are the babies in these families being recognised within infant mental health practice? As the project continues, qualitative data will be collected via interviews with people making families outside of the hetero-normative model, and with professionals in the field of infant mental health. Participants will be invited to reflect on fertility privilege; the wonderings and decisions included in the journey to parenthood and in working with these families; and the hopes, dreams and fears for infants in rainbow families. We wish to investigate the infant’s experience of being born into families who survive ‘othering’ and prejudice in the current political climate of contemporary Australia.
This presentation will illuminate research-in-process, and seek to engage with the infant mental health community to assess and enrich the current state of keeping the infants-in-rainbow-families in mind.
Ms Anne-Marie Maxwell, A/Prof Catherine McMahon, Dr Anna Huber, Dr Rebecca Reay, Dr Erinn Hawkins, Prof Bryanne Barnett
“In the field of perinatal mental health, the wellbeing of the mother is typically the primary focus of interventions. However, there is growing recognition of the importance of working from a relational framework, given the reciprocal influences mothers and infants have on each other. In Australian perinatal and infant mental health settings, the Circle of Security Parenting program (COS-P) is a widely used approach to supporting parenting through a focus on the parent-child attachment relationship, To date, more than 10 000 Australian practitioners have been trained to facilitate COS-P, with significant investment by government departments and non-profit organisations alike. Dissemination has dramatically outpaced evaluation, however, and evidence is limited regarding effectiveness of COS-P with families of different risk profiles. In particular, evidence is needed regarding the impact of COS-P 1) on parenting capacities likely to influence infant social and emotional development, and 2) indirectly on parent mood. This presentation documents the development of a collaborative evaluation of COS-P. Four organisations (including two designated perinatal mental health services) are working with researchers from Macquarie University to evaluate COS-P in these complex real-world settings. Using the newly developed Composite Caregiving Questionnaire, the Circle of Security Interview and a videotaped parent-infant interaction, this research aims to explore whether parents attending COS-P groups over 8 weeks show improved parent efficacy, capacity to tune in to infant cues, and representations of their infant, compared with a group receiving treatment as usual. The study design and measures will be outlined, and some pilot data presented.”
Ms Mia Mclean, Dr Vanessa Cobham, Dr Gabrielle Simcock, Prof Sue Kildea, Prof Suzanne King
Greater displays of negative emotionality (reactivity e.g. irritability, withdrawal behaviours) and poorer attentional control during toddlerhood have been found to uniquely and interactively predict greater anxiety symptom development during childhood. Researchers are yet to examine whether this developmental trajectory, may be impacted by maternal stress during the prenatal period (prenatal maternal stress; PNMS).
Following exposure to the Queensland January 2011 floods, we assessed mothers’ (N = 230) self-reported objective hardship due to the floods; subjective stress; and cognitive appraisal of the floods impact. Mothers reported on their toddlers’ temperament (16 months); and child internalising behaviours and specific anxiety symptoms at 4 years (N =105). Preliminary mediation analyses suggest that for girls, higher levels of prenatal maternal subjective stress predicted greater toddler withdrawal behaviours, which in turn contributed to the development of greater specific anxiety symptoms and internalising behaviours at 4 years. Greater maternal objective exposure to the flood led to greater childhood internalising behaviours mediated by increased toddler negative reactivity (less cooperation, irritability). Attentional control did not mediate the effects of pregnancy stress on anxiety symptom development nor did it moderate the effects of reactivity or approach tendencies on anxiety, following PNMS. Results are independent of maternal mood, throughout development.
Our findings suggest that greater PNMS exposure impacts the development of toddler negative emotionality (reactivity, withdrawal), associated with increased internalising and anxiety symptoms in childhood. Our results underscore the importance for greater clinical practitioner understanding and consideration of prenatal neurobehavioral development.
Ms Dianne Zalitis
This paper will present an innovative service provision model delivered completely within the digital multimedia environment, utilising telephone, video, website and Facebook to communicate, provide advice and support to families, without direct face to face contact. Healthdirect Australia conducted social media and health seeking behaviour research that, along with analytics data shows how such a digital service reaches and engages with Australian parents.
Our data shows 82% of women access this service via their mobile device with the main age group, 24 to 35, using social media as their first choice for information and peer validation. Multichannel research confirmed Facebook as the most utilised social site by 24 to 35-year-old females, and found those with children under 15 the highest use of smartphones (97%) and tablets (76%) when searching for health and care of infant information.
The similarity between birthing age groups and social media users provides services focused on infant mental health an opportunity to engage parents, address access concerns and encourage an infant centered focus. We found Facebook forums with their ability to form supportive social networks for isolated and vulnerable families successful in reaching our national consumer audience.
This presentation explores the multichannel environment from the consumers’ expectations and how healthcare providers may operate in this environment. This digital solution enables a focus on infants through support and advice to their parents. Our multichannel approach of social media, video, telephone and online channels fundamentally puts the family, their needs and aspirations at the centre of our service provision.
Law Room 101
The Infant Needing Protection
Chair: Dr Ben Goodfellow
Dr Winnie Goh, Ms Rajni Parasurum, Ms Valerie Goh
Kids Integrated Development Service 0-3 (KIDS0-3) is a pilot secondary level preventive early intervention program. Its primary objective is to deliver, through a key-worker framework, a home visiting program to low income families with multiple risk factors. These multiple risk factors are assessed accordingly to the Family Advocacy and Support Tool (FAST) that helps communicate the complexity of the cases. After which, a trans-disciplinary team comprising paediatricians, social workers, nurses, community health visitors and allied health professionals support the key worker. Service delivery is based on the Abecederian approach with the aim of optimizing child development while protecting the child from toxic stress. The trans-disciplinary skilled worker, with the support of professionals on a multidisciplinary team, is well placed to detect early the presence of any signs of infant emotional and physical neglect. KIDS 0-3 collaborate with Child Protection Services (CPS) in using a common tool, Sector Specific Screening Guide (SSSG) and Child Abuse Reporting Guide (CARG) for assessing risk factors in the family environment. By applying this tool, CPS is able to take appropriate action and work with the KIDS0-3 team or community supporting agencies to step up infant protection strategies.
In this poster, we illustrate on how the key worker trans-disciplinary practice is implemented to support home visitors in skills required for early detection and assessment of child at risk of neglect and abuse. The use of common tool for assessment of family at risk is an important component and efficient approach to child protection.
Ms Emily Kostos
Freud’s statement that the ego is first and foremost a bodily ego is well known. The integrity of this body ego is particularly under threat for infants in statutory care who have experienced severe neglect and traumatization. Often these infants experience little psychological and physiological containment, disrupting their capacity to feel at home in their own skin and their internalisation of a containing relationship. Systemic complexities in out-of-home-care, including placement instability, reinforce this experience as infants lack the security of a stable external dwelling and consistent caregiver. Infants are often left feeling as though they are in a perpetual ‘waiting area’ with no home in their own body, in anyone’s mind or in any consistent external environment. This experience will be explained using a de-identified case vignette of psychoanalytically informed psychotherapy with a three-year-old boy. The phenomenological method of inquiry which underpins the presenter’s training as an art therapist will be used to understand the infant’s presentation. Winnicott’s theory of transitional phenomena and Bick’s writings on the experience of skin in early object-relations will help the presenter elucidate the child’s presentation and therapeutic process. The contribution of the waiting area as a treatment space will also be discussed. The waiting room became a ‘transitional space’ for this infant to express his anxieties, guilt, grief and loss but also develop a capacity for imaginative and symbolic play. Small changes were observed in how the child held themselves in the physical space, as well as emotionally in his psychic world.
Ms Lee Meredith & Ms Susan Clarke
Women experiencing long term psychotic illness such as Schizophrenia face unique challenges with regards to pregnancy and parenting an infant. Evidence suggests over half of women with schizophrenia experience a relapse in symptoms postnatally. Women at highest risk are those who experience active symptoms immediately preceding conception and women who have been hospitalised for extended periods at any time in their life. Women with a diagnosis of schizophrenia are statistically more likely than the general population to have intervention from statutory child protection services and more likely to have their infants placed in out of home care. They often have complex psychosocial issues and limited social supports.
In NSW, women with long term severe mental illness are predominately managed by community case management services and during pregnancy/postnatally may have access to specialist Perinatal and Infant Mental Health (PIMH) Clinicians. If required postnatally, admissions to psychiatric care occur in public acute mental health units with limited services for mother and infant or to private mother and baby unit.
This poster explores the ethical issues arising for PIMH Clinicians holding the mother and infant dyad in mind whilst navigating health and child protection services. It will use a de- identified case study to illustrate the complicated systemic issues faced by the infant, mother and services. It will highlight reflections of an established PIMH service exploring the impact of attachment issues, potential trauma for the mother and infant, vicarious trauma for clinicians and opportunities for reflection on improving care for consumers and infants.
Ms Alma-Jane O’Donnell
Research supports the vital role early childhood education environments play in providing secure and nurturing environments for infants exposed to trauma. To provide an optimum transition into early learning services for infants who are experiencing or have experienced trauma, it is important the trauma needs of each individual infant entering early learning are considered and that there is a clear process for communication between the child protection service and early learning service.
In the past, there has been limited communication between child protection services and the early learning sector. Further, the normal practice of centre orientation (including short visits over a period of few days) that supports infants’ smooth transition into centres, would typically be missed, if infants were enrolled in centres over the phone by child protection agencies with a request of immediate placement due to high risk child protection concerns. Educators would have no knowledge of who was dropping off and picking up the infants, details of access visits, or other important information such as the infants’ sleep, settling and feeding routines.
To meet the needs of their most vulnerable infants, Goodstart Early Learning have developed trauma informed policies, procedures and practices to be implemented nationally. Emotional Support Plans are now completed before any infant in the child protection system transitions into a Goodstart centre. Evidence of the success of these procedures will be shared through two case studies of infants who both made successful transitions.
Dr Nicole Milburn & Mr Ric Pawsey
The Take Two Program is an intensive therapeutic service for Child Protection clients in Victoria that is provided by Berry Street Victoria in partnership with the Victorian Aboriginal Child Care Agency (VACCA), La Trobe University and Mindful. Take Two has had a dedicated infant mental health strategy for almost ten years that has aimed to promote the mental health needs infants in the Child Protection System and prioritise their needs for both early in life and early in problem intervention. This poster will present an overview of the internal and external capacity building activities under the Strategy. External activities have included attendance at Child Protection high risk infant panels, annual four-day training in the mental health of high risk infants that has been developed in partnership with the Royal Children’s Hospital Mental Health Service and the Austin Perinatal Mental Health Service, and secondary consultation to the sector. The internal capacity building strategy began with a monthly Communities of Practice, being a state-wide case based discussion group facilitated by the Infant Mental Health Consultant in person and via video conference. Primary and secondary consultations occurred outside the Communities of Practice as a further capacity building strategy. The support and development network was used to leverage the development of an infant clinic model that is being implemented across all Take Two Teams in Victoria. Outcomes of the strategy for internal and external capacity building and referrals will be presented.
Ms Catherine McQueen
Infant Child Protection clients have by definition suffered trauma and usually separation from primary attachment figures. They are a priority for clinical intervention to address existing distress and difficulties and to intervene early to prevent difficulties becoming embedded in development. This presentation will explore the clinical challenges in working with infant Child Protection clients, including securing referrals and working with the complexity of fostercarers as well as biological parents. The Take Two approach to infant mental health privileges the baby’s experience as the first port of entry into the complex system. The tension of urgency of need within a seemingly glacial systemic process at times is addressed through a framework of brief, targeted infant-parent intervention using interaction guidance (McDonagh, 2000). Ongoing therapeutic interventions are described via a case study to demonstrate clinical decision making regarding length of involvement.
Dr Allison Cox & Dr Nicole Milburn
A key component of clinical work is a focus on the outcomes for the client. Measuring outcomes for infants and young children can be challenging due to the pace of development in the infant and the complexity of measuring change due to interventions whilst controlling for maturation and/or environmental factors. Nonetheless, measuring outcomes is a core part of service delivery that is both helpful to clinical practice and forms a key platform for quality assurance and advocacy to government. The Berry Street Take Two Program has grappled with the complexities of measuring outcomes for infants and has developed a suite of measures specific to infants that measure change from multiple perspectives. This presentation will describe the outcomes framework and present via a case example, tracking change within an individual. Aggregated results from 13 years of clinical practice will also be presented that show strengths and challenges from a measurement perspective. Program wide implementation strategies will also be presented, illustrating the progress of the outcomes framework over the years from the establishment of the program in 2004 along its own maturational pathway to the situation as it stands today.
Dr Allison Cox & Dr Nicole Milburn
Infants and young children who have experienced significant abuse and trauma are particular vulnerable to the development of maladaptive self-regulatory strategies. Occupational therapy assessment of these children’s sensory processing can add valuable information to the care team to inform intervention planning. This poster will present findings from a research project that investigated the association between the pattern of sensory processing and earlier experiences, as well as other clinical outcome measures, for 70 randomly selected Take Two clients aged between birth and eight years. There were significant differences between male and female toddlers as well as Aboriginal children and non-aboriginal children. Results also found increasing clinicians and carers’ understanding of traumatized children’s sensory processing patterns enabled greater specificity in intervention planning and opportunities for co-regulation with these children. Where significant abuse, neglect and trauma has occurred, it is clear infants and children can demonstrate complex and idiosyncratic sensory responses and needs, negatively impacting their capacity to heal and to develop relationships with others. If these sensory experiences are understood by their workers and carers, interventions can be developed that greatly assist development and recovery.
Law Room 102
The Infant Observed
Chair: Ms Libby Morton
Ms Kim Bellingham, Ms Janet Annor, Ms Mary Milne, Ms Jodie Williams, Ms Jyoti Sing, Ms Minh Tran
Sustaining NSW Families (SNF) is a nurse-led sustained and integrated health home visiting program. The posture is an illustration of the journey of a mother during the antenatal period and continues until the child’s second birthday. SNF Nurses build a professional relationship based on partnership, trust, honesty and transparency. The program promotes mothers to have a positive and healthy attachment with their baby.
Dr Peter Brann, Dr Nick Kowalenko, Dr Gordana Culjak
The HoNOS family of clinician measures has been settled for a long period of time in Australia and New Zealand. Quite rightly, there has been concerted efforts to facilitate structures that provide a routine system for the voices of consumers and parents and carers. One lingering blind spot though in the array of clinician perceptions has been for infants and pre-schoolers. Prior to, and supported by the strategic review of the Australian Mental Health National Outcomes and Classification Collection (NOCC) in 2013, there has been ongoing work to provide a vehicle for infants and pre-schoolers mental health to become part of the routine outcomes conversation. Focussing on infants, a HoNOSCA type instrument for the 0-47 month age group has been developed and undergone the first round of pilot face validity testing. Modifications have been made to the instrument, and a current study is examining aspects of validity and inter-rater reliability across Australia. This presentation will discuss the developments to date. Waiting for the perfect instrument to emerge is difficult and time consuming. Yes, (with apologies to all those we have previously asked to wait) a take away version is anticipated to be available at this conference.
Dr Christine Hill
In 2014 three experienced infant mental health practitioners volunteered to offer a playgroup to babies and their parents in a Melbourne immigration detention centre. When it was pointed out to the Department of Immigration that many of the parents were depressed and that babies benefit from play, our group was approved. Detention centre management, however, was less than enthusiastic, and frequently made access and continuity very difficult. The effect of this was to create a potential split in the working group, one that needed to be thoughtfully contained in the actual work (play). Despite much initial good will, the growing despair of the families who wanted to play challenged our thinking and our way of working. At times, like the families themselves, we felt helpless and hopeless. The tendency to retreat into the protective safety of theory and familiar professional roles was understandable but inappropriate. We had no contract for therapy; we were volunteers who came to play. These families needed us to keep our minds alive and thinking, to be adaptable, hopeful, and kind.
This paper explores the ethical considerations for healthcare professionals who volunteer in complex situations.
Dr Jane Kohlhoff, Ms Sue Morgan, Dr Sarah Mares, Dr Sarah Woodgate
Parent-Child Interaction Therapy (PCIT) is a popular parent-training program shown to effectively treat behavioral disorders in children aged between 2 and 7 years (Eyberg, 1988; Thomas & Zimmer-Gembeck, 2007). Direct parental coaching of parent-child interactions, usually through a one-way mirror and ‘bug-in-the-ear’ technology, is a unique feature of the program. PCIT has a stated aim of improving the quality of the parent-child relationship and has theoretical underpinnings in attachment theory (pcit.org), but in the PCIT literature to date, the model of change and focus of outcome measures for PCIT have predominantly been behavioral.
Recent studies have highlighted the efficacy of Parent Child Interaction Therapy for Toddlers (PCIT-T), an adapted version of PCIT designed to meet the specific developmental needs of infants and toddlers aged 12-24 months with disruptive behaviors (e.g., Kohlhoff & Morgan, 2014, Dombrowski et al, 2005). Given that the toddler period is characterized by such significant neural plasticity and the consolidation of the child’s internal working models of relationships, we propose that a complete explanation for the effectiveness of PCIT in this age group requires an emphasis on relational and developmental factors.
This presentation will have two major aims. The first aim will be to articulate an attachment-focused model of change for PCIT-T, illustrated with case study material including clinical observations and details obtained from the Adult Attachment Interview (Main, Kaplan, and Cassidy, 1985) and Strange Situation Procedure (SSP; Ainsworth, 1978). The second aim will be to report preliminary results from a wait-list controlled study examining attachment-related outcomes associated with PCIT-T in a sample of 35 families using the Emotional Availability scales (Biringen, 2008), the SSP and the Child-Behaviour Checklist (Achenbach, 2000). Preliminary study results show PCIT-T to be associated with positive outcomes across attachment and behavioral domains, supporting an attachment-focused model of change.
Ms Helen Stevens, Ms Lindy Parsons, Ms Christine Hoyne
By linking psychodynamic, neurobiology, infant mental health and behavioural management theories to practice, the Solihull Approach measured outcomes have identified increased emotional communication in both practitioners and parents. Incorporating Bion’s 1970 concept of containment and Brazelton’s notion of reciprocity to promote behaviour management /recognition and change, in the Solihull Approach adults’ area freed to be more responsive in meeting the dynamic and diverse needs of the infant. The poster will provide an overview of the Australian Solihull Approach training (Helen Stevens).
Inspired by the potential of the approach, two trained practitioners, with management support, introduced the Solihull Approach training concepts at team meetings. Clinicians seemed to relate to the non-threatening framework and within months the concepts were creeping into everyday language and drawing clinicians into reflecting on the experience of the infant. It has seamlessly become a way of thinking, or ‘reflection in action’ while simultaneously opening up a common language with the local regional Parent and Infant Unit. The component of the poster will review the shift in emotional thinking and expression; giving the infant ‘a voice’. (Lindy Parsons)
The Solihull Approach was embedded into the model of care from the inception of the ‘Agnes Unit’, five bed parent and infant Unit, in the Gippsland region in 2014. The part of the poster will include a discussion of how the infant focused model has been used in a residential unit where the adult is the admitted patient . A case study illustrates the practical application of the Solihull Approach (Christine Hoyne).
Ms Helen Stevens, A/Prof Wendy Middlemiss, Ms Lael Ridgway, Prof Susan McDonald, Ms Michelle Kousa
It is unquestioned that infants benefit from consistent, predictable and contingent caregiving to ultimately achieve a self-regulated state, such as sleep. Society often expects infants to be able to separate and self-regulate for sleep and if they do not, considers them as having sleep problems. Struggling families often seek help for infant sleep problems, which often sees them being offered a ‘solution’ of behavioural sleep interventions such as modified controlled comforting or modified controlled crying. These interventions train infants to settle to sleep without caregiver attention. Although successful in extinguishing infant’s signalling at sleep time, research has shown that although quiet, the infant continues to have increased stress markers such as salivary cortisol. (Middlemiss, Granger, Goldberg, & Nathans, 2012).
Infant sleep patterns can be changed without compromising the infant’s rights to parental care. Rather than focussing on interventions to extinguish behaviours, caregivers can be encouraged to consider the infant experience and contingently respond to the infant behaviours at sleep time. In this presentation, infant needs and abilities surrounding sleep will be examined as well as the rationale behind response-based sleep interventions. These focus on helping caregivers understand normative sleep patterns, identify sleep signs, and to learn responsive approaches to help infants achieve a healthy sleep, all without extinction based programs. By respecting and responding the infant communication, infant total sleep time can be increased and psychological stress indicators decreased without needing to be exposed to controlled crying, or modifications of interventions that promote increasing parental absence from the infant at sleep time.
Mrs Vera Toniolo, Mrs Pauline Cox, Dr Christine Hill
Asylum seekers who come to Australia by boat are detained indefinitely. The negative mental health consequences of prolonged immigration detention have been well documented. Babies born and raised in detention are more likely to have parents who have suffered trauma. Post-natal depression is common, interfering with infant-parent communication and play, thus putting healthy infant development at risk.
This paper tells the story of a reflective space where two baby boys discovered the joy of play and showed their troubled mother how to join and enjoy them.
Ms Kate Forbes
Set in the context of a small village of a developing country with a tropical climate, harsh physical environment, limited infrastructure, low staff: child ratio, strong cultural values and norms and rare connections to the rest of the world.
Princess, aged one year begins her day at 4am wrapped to her mother’s back as she completes home chores of sweeping and preparing breakfast before she sets out to sell second hand clothes on the main street of their village by 6am. The crowded and noisy school bus will arrive sometime within the hour, a place for Princess waiting on the front seat with the other infants under one year loosely strapped in. On arrival at school, any one of the school staff carry her inside and place her on the floor of the nursery as they unload the other children and bags from the bus and direct them to assembly to begin the school day. She is surrounded by 40 essentially unsupervised infants and toddlers fighting with each other for attention and searching for objects to hold as prized possessions; a straw, an empty cereal packet, a piece of thread from a mat. Princess sits alert, with eyes wide open, also searching for an object to hold, perhaps a piece of cardboard to chew or a shoe that has slipped off already to tap on the ground; all the while trying to stay balanced amidst the hard knocks and chaos of the room.
From Melbourne, Australia to Ghana, West Africa, Mental Health Social Worker, Kate Forbes shares observations from her first twelve months of working in the role of Assistant Principal in a Nursery school with 80 children aged three months to seven years. She explores how her learning from young Ghanaian children as they ready their lives ahead has helped her to ready her infant mental health practice within a developing country.
Law Room 104
Keeping the Infant Safe: Observing and Thinking
Chair: Dr Raylene Lewis
Ms Lyn Doherty & Mr Hone Fowler
A feasibility and effectiveness study of a culturally adapted Mellow Dads programme has been completed in South Auckland, New Zealand. Over thirty fathers – indigenous and Pacific, participated and were available at three months follow up. The results are in line with a growing body of research that shows positive involvement of fathers impacts positively on subsequent development of their children.
Māori and Pacific families with infants and young children (0-4 yrs old), living in the Counties Manukau District Health Board area who were experiencing complex health and social care needs that impacted on parent child relationships, were recruited. The 14 week programme is based on attachment, social learning and CBT theories, with facilitators modelling and encouraging personal reflection, using video feedback and parenting workshops.
The General Health Questionnaire (GHQ-30), Parenting Daily Hassles Scale (PDH), Ages and Stages (ASQ-SE) and Strengths and Difficulties Questionnaires (SDQ) were administered at pre, post programme and at three months follow up. Pre and post programme videos were coded.
Results of the fathers’ evaluation will be shared, including focus group feedback with ethical issues raising the voice of infants and young children within the context of access and custody, being presented.
Ms Lyn Doherty & Ms Maia Fowler
Many parents who have had hard times or negative experiences may lead chaotic lives moving between highs and lows. Studies have showed how trauma impacts infants, young children and adults in ways that can have lifelong effects.
Megan Gunnar (2009), et al have demonstrated how ongoing exposure to trauma can have long-term impact on brain development and the health of young children. Zaneta Thayer (2015), has evidenced the transmission of stress between New Zealand mothers-to-be in their third trimester, and their new born babies. Discrete stressful events have been differentiated from ongoing or toxic stress. Children’s development can be severely impacted by environments of toxic stress, and parents who are traumatized transmit much of their own anxieties and fears to their children (Shonkoff, 2000).
This poster describes an investigation by Mangere East ACCESS & Ohomairangi Trusts into the needs of parents who have had their children removed from their care (or were under this threat), and were required to attend parenting courses alongside parents who had their children in their care.
Both trusts were interested to find out how parents without the care of their children (a) experienced the parenting programmes, (b) thought about the process they had been through, (c) understood the future options that lay ahead for them and their children.
Insights gained from this co design process led to improved understanding that enabled responsiveness to better meeting parents needs, alongside the needs of infants and young children.
Ms Lyn Doherty & Ms Tawera Ormsby
The number of risk factors a child is exposed to increases their vulnerability.
Strategic investment in the wellbeing of pregnant women and young children can change the trajectory of children’s lives. In order to build resilience in our children and families, we need to look at both promoting protective factors and alleviating risk factors
The social, health and economic benefits extend into adulthood and potentially inter-generationally. This investment can help to avoid less effective and more expensive attempts to fix problems as they emerge later in life.
Mellow Bumps is a 6 week attachment based ante-natal parenting programme that focusses on the importance of relationships and attachment. It is designed to be offered at 20 to 30 weeks gestation and aims to help vulnerable and hard to reach expectant parents.
The results in our programmes suggest that an attachment based antenatal intervention such as Mellow Bumps which is focused on relationships, infant mental health and stress management, can have a positive impact on an expectant parents emotional wellbeing and therefore can change the trajectory of these children’s lives.
Ms Rebecca Eberle
The High Risk Infant (HRI) Visits with Child Protection Practice Leader project was developed in the Ovens Murray area to provide an opportunity for Child Protection Practitioners to learn about the specifics of HRI home visiting in the Child Protection context. The process of planning for the home visit, conducting the home visit using the Statewide HRI Checklist and then reflecting on the visit will hopefully improve practice and lead to safer outcomes for infants.
The Practice Leader provides live supervision in a curious and non-judgemental manner that helps the practitioners to understand their role, focus on what they are doing and to participate in a wider purpose of evaluating the HRI Checklist in action The practitioners in Ovens Murray are asked for their opinion and advice about the practical use of the HRI Checklist during and after home visits. The data collected has been used as a learning tool for reflective practice sessions and to identify further training and support needs for staff. It is hoped that this research will help to inform Statewide HRI practice from the ground level.
Practitioners and the Practice Leader go through a four step process for each visit that could then be applied to any child protection home visit or meeting to ensure that all interventions and interactions are meaningful and purposeful. The process is based on Kolb’s reflective learning cycle.
The aim of presenting this project at the AAIMHI conference is to share the learning from the Child Protection Practitioners in Ovens Murray and to highlight the complexity of Child Protection’s role when working with infants and their families. It also highlights the benefit of live supervision and a focus on quality work and learning experiences that provide opportunities for professional development within the workplace.
Mr Raquib Ibrahim
Key findings from the latest Child Protection Australia report (2015â€“16) corroborate the urgent need for intensive and culturally appropriate family support programmes targeted at early developmental stages, in order to prevent further interpersonal, family, societal and economic costs. Prevention and early interventions have a central role in this national action plan.
Mellow Parenting (MP) is a Scottish based NGO that uses theory, research and best practice to develop targeted early interventions that improve parent-child relationships. MP programmes have developed a strong evidence-based and are regularly tested for cultural appropriateness as they are offered to families in UK, New Zealand, Tajikistan and across Europe. The foundation of these programmes is attachment theory with particular emphasis on the transmission of attachment and relationship styles across generations. Targeted at families with a range of complex health and social care needs living in low social economic status or with poor mental health, domestic abuse, drug & alcohol misuse, social isolation and child protection.
This poster will provide delegates with the opportunity to learn more about the MP approach and its evidence of effectiveness in various cultures; how it can support professionals in Australia to address the need for a relationship and development focused early parenting intervention and can pave the way for child behaviour management interventions. Experience and best practice will be shared to illustrate how MP has been instrumental in influencing and shaping current and future research, policy and practice within the field of infant mental health, child protection and family social support.
Mr Raquib Ibrahim
Increasingly the importance of early father involvement in his child’s life is receiving international recognition. Research has shown the positive involvement of fathers is linked to subsequent development of fewer behaviour problems and improved cognitive and social emotional outcomes for children. A lack of father responsiveness is also associated with indicators of poor child outcome, including social and academic impairments.
Mellow Dads (MD) programme is a preventative early attachment-based parenting intervention, designed to improve parent-child relationship. Fathers and their infant with a range of complex health and social care needs living in low social economic status or with poor mental health, domestic abuse, drug & alcohol misuse, social isolation and with child protection concerns are the target group for the programme. A variety of techniques are used during the intervention including, personal reflection, video feedback and parenting workshops. MD is underpinned by the psychological theories of attachment, social learning and CBT.
MD programme has been implemented across Scotland using a model of partnership working. Using qualitative and quantitative techniques, an impact evaluation of the programme has been carried out. Data from participants and facilitators was collected pre/post-group and at follow up. The Adult Well-being Scale, Karitane Parenting Confidence Scale, Strength & Difficulties Scale and Parental Hassles Scale were used to measure parent, child and relationship-focused outcomes.
The poster will provide delegates with the opportunity to learn more about the intervention and will share evaluation findings, with results showing improvement in paternal wellbeing, confidence, child outcomes and qualitative evidence of parent-child interaction.
The authors have developed an innovative, in-house perinatal and infant reflective supervision group program for private practice psychologists belonging to the Centre for Perinatal Psychology, where psychologists not only seek to restore maternal perinatal wellbeing but value the concurrent development of infant emotional wellbeing.
Keeping the infant in focus amid the pressures and isolation of the private practice setting, especially when mothers often present without their babies, can be supported by a dedicated quarantined time and a safe supportive group of minds to wonder about the challenges for the clinician with this family with this infant.
Clinicians are encouraged to experience the enriching benefits of reflective group supervision. Provision of a safe reflective space that prioritizes precious time to wonder about each mother and their baby and the presence of the father or sibling as well as the presence of any ghosts or angels in the nursery, allows clinicians time to reflect on their own practice and what may be enhancing or hindering their therapy and whether they need a new lens or merely minor adjustments in focus. Additionally, we seek to create a holding experience for clinicians which becomes experiential learning of the concept of the parallel process where the clinician feels held, (and therefore can be reflective) which enables the parent to feel held which enables the infant to feel held.
Groups are offered for 60-minutes, fortnightly, and hold 2-3 participants with one facilitator. Participants sign up for a 10-session block to ensure predictability and cohesion within the group.
Ms Katie Lindeberg
Referencing Simon Olshansky, this presentation provides comparative overview of chronic sorrow against traditional grief and clinical depression relevant to clinicians working with parents of infants with chronic illness in the tertiary paediatric health setting.
Exploring the complexities of grief and the impact on psychological wellbeing at a time of great vulnerability is crucial to promoting positive engagement and collaboration in the medical management of chronic illness.
Within the medical model, parents displaying adverse reactions or behaviours connected to grief are often labelled ‘depressed’ or ‘difficult’, when in many cases we are observing a normal response to a living grief. Pervasive, cyclical and devastatingly normal. For many, the grief experience is compounded by the need to rapidly adjust to new parenting roles. High expectation on parents to cope and ‘keep up’ with medical education, compliance, navigating the healthcare system and providing caregiving in a situation that has no predictable end poses additional challenges. Understanding this cyclical grief provides a useful lense with which to view families and to promote understanding and compassionate practice across disciplines.
By placing a focus on normalising this grief experience for parents of infants with chronic illness and promoting compassion for clinicians working in this space, we advocate for the individualised needs of the infant and parents and promote positive working relationships within the medical system with a view of longevity. Based on theory and practice wisdom, this presentation also provides a model of practice for clinical staff to identify and support parent carers experiencing this cycle of grief and to practice with compassion and kindness.
Ms Anne Lowagie
The Mirrabooka Circle of Security Parenting (COS-P) project
The Circle of Security Parenting project started mid-2015 in Mirrabooka and surrounding suburbs north of Perth, Western Australia. It has reached 203 families so far. It is building the capacity of family support workers to facilitate the Circle of Security Parenting (COS-P) – DVD course, with the aim to meet the demand in their multicultural local community and provide follow-up support to parents who have completed the course.
Intensive collaboration between service providers, mentoring of newly trained co-facilitators, reflective supervision, culturally sensitive practice and flexibility are key elements of this challenging 4-year project.
The poster will illustrate the collaboration between local organisations and the work with families from diverse cultures and backgrounds including teen parents, Karen-speaking Burmese mothers, fathers and Aboriginal parents to promote the secure attachment of their children through a range of universal and targeted COS-P groups.
We will discuss the project’s achievements, stories and learnings through the lens of reflective conversations and supervision. We aim to demonstrate the crucial role of reflective supervision in enabling the various levels of ‘holding’ (being the COS ‘hands’) for new co-facilitators and mentors so they, in turn, can hold the many stories of the parents who participate in COS-P.