Supporting depressed mothers at home: their views on an innovative relationship-based intervention
This Introduction is advance text extracted from the accepted manuscript. For edited full text in PDF format see http://pubs.e-contentmanagement.com/
Chris Rossiter
Centre for Research in Learning & Change, University of Technology, Sydney NSW
Cathrine Fowler
Centre for Midwifery, Child and Family Health, University of Technology, Sydney, Sydney; Tresillian Chair in Child and Family Health, Tresilian Family Care Centres, Belmore NSW
Catherine McMahon
Senior Lecturer, Centre for Emotional Health, Psychology Department, Macquarie University, North Ryde, NSW
Nick Kowalenko
Deputy Chair, Infant, Child, Adolescent and Family Mental Health Association (AICAFMHA), Northern Clinical School, University of Sydney; Department of Child & Adolescent Psychiatry, Royal North Shore Hospital, St Leonards NSW
PP: 90 - 100
Abstract
This study explored the responses of a group of 111 mothers who experienced distress and/or depression in the early months after childbirth and who received an innovative home visiting service until their child's first birthday. The current study reports a thematic content analysis of the qualitative questionnaire responses returned by the mothers after completing the intervention. The mothers valued the home visiting program for its capacity to increase their parenting confidence and to enhance their bond to their infants. They attributed this to the reassurance provided by the program and the skills and qualities of the home visitors. Their responses complement the benefits identified in quantitative analysis of the program and demonstrate its impact from participants' viewpoint.
Keywords
Home visiting, qualitative research, postnatal mood disorders, satisfaction surveys, mothers, child and family health nursing
Article Text
Home visiting has a long history in Australian child and family health services as an adjunct to centre-based care (O'Connor 1989). Yet, only during the past twenty years have these programs been acknowledged as effective in their own right for families with young children. This has coincided with a shift in focus from surveillance and imparting parenting skills to a more intensive and programmatic approach to supporting families with identified complex and multiple vulnerabilities (e.g. NSW Health 2009; Children Youth and Families Division 2010).
In 2001 an Australian early parenting organisation developed and implemented a home visiting program (HVP). The HVP aimed to provide innovative, non-institutional support to mothers with moderate to severe postnatal depression (PND). The program consisted of 10 home visits from a Child and Family Health (CFH) nurse to the mothers and their infants who were aged 4-6 months at admission. A key component of the intervention was the 'Seeing is Believing' technique from the University of Minnesota (Erickson, 1999), which involves a short video recording of a mother and infant interacting. The mother and nurse then review the interaction in a process of joint inquiry. They reflect together about how the infant and mother are experiencing the interaction. The nurse facilitates the mother identifying her own and her infant's strengths, and recognizing her infant's cues and attempts at communication. Using this knowledge they jointly consider how to enhance current mother/infant interactions and to equip the mother to anticipate and meet future parenting challenges. Additional components of the HVP intervention included supportive counseling, problem solving, identifying community supports, monitoring mood and anxiety, and supporting the development of infant development and behavior knowledge and parenting skills.
The current study examined the mothers' perspectives on the program, to understand how mothers experienced the intervention and which aspects they found particularly valuable. We were also eager to explore any aspects of the program that did not meet the mothers' expectations. Some findings were as anticipated at the HVP's establishment, given its aims to increase maternal confidence and the quality of their relationships with their infants.
By exploring mothers' perspectives and experiences, we hoped to gain further insights into valued elements to help enhance the effectiveness and acceptability of future service delivery. This is vital given the long-term negative outcomes for children of mothers experiencing ongoing depression (e.g. Lectourneau, Salmani & Duffett-Leger 2010), and the need to provide support that is acceptable for participants and tailored to their needs, given considerable evidence of low treatment uptake in mothers with postnatal depression (McCarthy & McMahon, 2008).
This study is based on satisfaction questionnaire data from 111 mothers who were diagnosed as depressed and admitted to the HVP, over a seven-year period. It focuses on thematic analysis of the qualitative responses. We identified four major themes within these data.
References
Authors (2004). Home visiting intervention project: project evaluation. xxxxx.
Barlow J, Davis H, McIntosh E, Jarrett P, Mockford C, & Stewart-Brown S (2007). Role of home visiting in improving parenting and health in families at risk of abuse and neglect: results of a multicentre randomised controlled trial and economic evaluation. Archive of Disease of Childhood, 92: 229-233.
Bartu A, Sharp J, Ludlow J, & Doherty D (2006). Postnatal home visiting for illicit drug-using mothers and their infants: A randomised controlled trial. Australian and New Zealand Journal of Obstetrics and Gynaecology, 46: 419-426.
Berlin L, Zeanah C & Lieberman A (2008). Prevention and Intervention Programs for promoting early attachment security in Cassidy J & Shaver P (eds.) Handbook of Attachment Second Edition: Theory, research and clinical applications, pp. 745-761, Guilford Press, New York.
Caldera D, Burrell L, Rodriguez K, Crowne S, Rohde C & Duggan A (2007). Impact of a statewide home visiting program on parenting and on child health and development. Child Abuse & Neglect 31: 829-852.
Children, Youth and Families Division (2010). Supporting parents, supporting children: A Victorian early parenting strategy, Victorian Government Department of Human Services, Melbourne.
Cox J, Holden J & Sagovsky R (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Depression Scale. British Journal of Psychiatry, 150: 782-786.
Dixon L, Browne K, & Hamilton-Giachritsis C. (2009). Patterns of risk and protective factors in the intergenerational cycle of maltreatment. Journal of Family Violence, 24: 111-122.
Donovan E, Ammerman R, Besl J, Atherton H, Khoury J, Altaya M, Putnam FW & van Ginkel J (2007). Intensive home visiting is associated with decreased risk of infant death. Pediatrics, 119: 1145-1151.
Duggan A, Caldera D, Rodriguez K, Burrell L, Rohde C, & Crowne S (2007). Impact of a statewide home visiting program to prevent child abuse. Child Abuse & Neglect 31: 801-827.
Erickson M, Endersbe J & Simon J (1999) Seeing is believing: Videotaping families and using guided self-observation to build on parenting strengths. Harris Centre University of Minnesota, Minnesota.
Erickson M & Kurz-Riemer K (2002). Infants, Toddler & Families: A Framework for Support & Intervention. Guilford Press, New York.
Fraser J, Armstrong K, Morris J, & Dadds M (2000). Home visiting intervention for vulnerable families with newborns: Follow-up results of a randomized controlled trial. Child Abuse & Neglect, 24(11): 1399-1429.
Gerkensmeyer J, Austin J, & Miller T (2006). Model testing: Examining parent satisfaction. Archives of Psychiatric Nursing, 20(2): 65-75.
Glick P (2009). How reliable are surveys of client satisfaction with healthcare services? Evidence from matched facility and household data in Madagascar. Social Science & Medicine, 68: 368-379.
Kilpatrick S, Barlow J, Stewart-Brown S, & Davis H (2007). Working in partnership: User perceptions of intensive home visiting. Child Abuse Review, 16: 32-46.
Kitzman H, Olds D, Sidora K, Henderson C, Hanks C, Cole R, Luckey D, Bondy J, Cole K & Glazner J (2000). Enduring effects of nurse home visitation on maternal life course: a 3-year follow-up of a randomized trial. JAMA, 283(13): 1993-1989.
Lectourneau N, Salmani M, & Duffett-Leger L (2010). Maternal depressive symptoms and parenting of young children from birth to 12 years. Western Journal of Nursing Research, 32(2): 662-685.
Liptak G, Orlando M, Yingling J, Theurer- Kaufman K, Malay D, Tompkins & Flynn J (2006). Satisfaction with primary health care received by familes of children with developmental disabilities. Journal of Pediatric Health Care, 20(4): 245-252.
McCarthy M & McMahon C (2008) Acceptance and experience of treatment for postnatal depression in a community mental health setting, Health Care for Women International, 29(6): 618-637.
McMahon C, Barrnett B, Kowalenko N, & Tennant C (2006). Maternal attachment state of mind moderates the impact of postnatal depression on infant attachment. Journal of Child Psychology and Psychiatry, 47(7): 660-669.
Murray L, Cooper P & Hipwell A (2003) Mental health of parents caring for infants.Mental health of parents caring for infants. Archives of Women's Mental Health, 6 (Supplement 2): s71-s77.
Nievar A, van Egeren L, & Pollard S. (2010). A meta-analysis of home visiting programs: Moderators of improvements in maternal behaviour. Infant Mental Health Journal, 31(5): 499-520.
NSW Health (2009). NSW Health / Families NSW supporting families early package NSW Health, Sydney.
O'Connor K (1989). Our babies the state's best asset: A history of 75 years of baby health services in New South Wales. NSW Health Department, Sydney.
Schaffer P, Vaughn G, Kenner C, Donohue F & Longo A (2000). Revision of a parent satisfaction survey based on the parent perspective. Journal of Pediatric Nursing 15(6): 373-377.
Thorne S (2008). Interpretive Description, Left Coast Press, Walnut Creek, CA.
van Doesum K, Riksen-Walraven J, Hosman C & Hoefnagels C (2008). A randomized controlled trial of a home-visiting intervention aimed at preventing relationship problems in depressed mothers and their infants. Child Development 79(3): 547-561.
Zeanah P, Larrieu J, & Boris N (2006). Nurse home visiting: perspectives from nurses. Infant Mental Health Journal, 27(1): 41-54.
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