​With the theme of attachment in mind, the pPOD team were delighted to be joined together with over one hundred enthusiastic professionals in the latest in the series of the ‘Healthy Conversations’ conferences. Highly influential Professors in the field of attachment and child development were key speakers at the event which was hosted by The Healthy Start, Happy Start study in collaboration with North Central London Research Consortium (Noclor). 

Professor Pasco Fearon from University College London kicked off the event with his fascinating presentation giving an overview of recent findings in the field of attachment.
Pasco discussed two key questions during his presentation:

1. Is there evidence of intergenerational transmission?
2. Does attachment have implications for a child’s long term development?

 
​Bowlby’s and Ainsworth’s Theories were used to describe the nature of attachment that a child can have with their parents.
Pasco covered attachment related constructs and early intervention and how these can have an impact on language, cognition and general development of the child.
Professor Fearon discussed how intergenerational transmission of attachment is weaker in clinical samples he also acknowledged the effect of socio-economic class and psychiatric illness. Further to this, Pasco discussed how attachment affects both externalising and internalising behaviours in young children. He emphasised that a disorganised attachment is most at risk of developing externalising behavioural problems. 

Next to speak was Professor Stephen Scott who is a Professor of Child Health and Behaviour at the Institute of Psychiatry at Kings College London. Attachment Beyond Infancy effectively proceeded Pasco’s insight into the earlier ages of attachment.
Stephens’s presentation gave contemporary viewpoints on parentings relationships; including how parenting habits can have an effect on other presentations of the child. Poor parenting can lead to changes in behaviour and emotions. These include decreased social and learning skills and emotional dysregulation.  Poor parenting can also lead to developments of unhealthy habits in children such as intoxicant abuse and even heightened physiological responses in cortisol.

​Marinus van IJzendoorn and Marian Bakermans-Kranenburg gave an insightful overview of the Video-feedback Intervention to promote Positive Parenting (VIPP-SD), which is an attachment- based, home-based programme developed in the Netherlands to enhance parental sensitivity and discipline strategies. The programme is currently used in the Healthy Start, Happy Start study.
The programme is based upon Bowlbys/Ainsworth’s attachment theories and Patterson parent child coercive cycle theory.  VIPP-SD is both standardised and individualised as interveners use the same manual. Video clips are taken of the parent and child; this enables parents to practice their observational skills and to reinforce parental sensitive behaviour.
VIPP has also been adapted to suit other target groups, such as VIPP-FC for children in foster care, VIPP-Auti for children with Autism and VIPP-Infant (for children under 12 months of age. 

Author: Emily Pearson

It’s been an amazing couple of weeks in Queensland. I’ve had the chance to visit lots of services, as well as meeting with many health professionals around the state and finding out about how they manage to provide services for a population spread over 1.8 million square kilometres (nearly seven times bigger than the UK). This really is an enormous task. There are many remote communities, places where the staff turnover is high and the nearest birthing hospital is a full day’s travel away.
Despite these challenges there are some incredible services being delivered for parents and their infants. Many of these services are linked in to and supported by the Queensland Centre for Perinatal and Infant Mental Health (QCPIMH), a statewide hub of expertise in this area. The centre is based in a cottage on a residential street in North Brisbane and from the outside looks a lot like a nursery or children’s centre. However, inside, the centre is providing something unique to Queensland residents.

On one side of the building QCPIMH has a clinical unit which provides a 0-4 years infant mental health service. This is a small multidisciplinary team who provide assessment and treatment for struggling families where the infant’s mental health is compromised. This might be because parents have their own mental health difficulties, making it hard for them to respond to the baby’s needs, or sometimes because they had bad experiences of being parented themselves and so don’t have a good model of parenting to draw on. The service is similar to 0-5 CAMHS (child and adolescent mental health) services in the UK, where staff have specialist training and knowledge in infant development and attachment, and work to improve early relationships which are such an important foundation for healthy child development. However, there are few of these around and at the moment only 1% of the CAMHS budget in the UK is spent on under 2s.
On the other side of the building QCPIMH have something a little different going on. Alongside the clinical unit, they have a Strategy and Service Development Unit. This is a statewide service providing leadership, consultation and support to perinatal and infant mental health services across the whole of Queensland. The unit employs two Service Development Leaders, both clinicians themselves, whose aims are to achieve change in four priority areas: service development and implementation, workforce development, mental health promotion and prevention, and evaluation and research.
What this translates to is a whole range of different functions, including providing centralised leadership across different sectors involved in the perinatal period; supporting a focus on the emotional well-being of the whole family within primary care and the non-government sector; consulting on and leading PIMH service development and implementation across sectors; delivering training and education for workforce development; and contributing to the evidence-base for cost-effective best practice by conducting evaluation and research activities. As well as this, staff at QCPIMH are members of a range of mental health networks and committees across the state where they promote and advocate for the needs of infants and families during the perinatal period.
This part of the centre provides a focal point for strategic and service development within this specialist area, ensuring that services are family centred, culturally sensitive and evidence-based. They are helping to establish comprehensive and sustainable perinatal and infant mental health services at a range of levels across Queensland which reflect the needs of local communities. This is a big task and the centre is continuing to expand and develop in order to try and meet the growing need for their expertise. They are about to complete their new strategic plan for the next 5 years as well as launching a new website, and hope to employ more staff to support the current team going forward.
Having this kind of centre, funded by the health service, seems to give some real momentum and focus to the service developments in this area. Staff can help to ensure better integration and communication across different services and have a statewide overview of gaps and areas of best practice. It’s been wonderful observing their work over the last week, learning how they overcome challenges and drive changes in this enormously important area.

Author: Jill Domoney

Talks in the themed presentations ‘Paternal perinatal mental health’ were of key interest to the pPOD team so we were really enthused to hear presentations from Dr Zoe Darwin, University of Leeds, and PhD student Holly Rominov, Australian Catholic University, on their work with fathers.
​
Zoe shared findings from qualitative interviews with dads in the postnatal period, highlighting how fathers felt conflicted that naturally - maternity services needed to focus on the mother, but they often felt excluded by services and didn’t feel there was a specific place to go to for support. Fathers felt under greater stress during this period, especially during this time when they were supporting their partner. As paternal mental health can influence child outcomes,  fathers felt resources and support were needed, but would prefer them to be focused on fatherhood, rather than mental health specifically. In the post presentation discussion ideas about where men could get support included online forums.

Holly’s presentation echoed similar themes about the relationship between paternal mental health and child outcomes and shared a systematic review highlighting interventions, which effectively targeted expectant and new fathers mental health. Based on qualitative interviews also, fathers expressed their desire for fathers’ voices to be involved in shaping these services to identify their specific support needs.
 
Themes presentation ‘Peer support for perinatal illness’
Fiona Cust (Staffordshire University) shared powerful research into the effects of peer support workers in a postnatal depression PND services. After an overwhelming number of applications to be a peer support worker, women were employed and given the appropriate safeguarding and confidentiality training, and developed their own program of support to provide to mums who were currently experiencing PND. This RCT compared six 1-2-1 sessions with the peer support worker to six usual health-visiting sessions had an extremely high completion and acceptability rate. Mothers found it valuable to talk to someone who had previously experienced PND and described their peer support worker as a confident and expert and importantly a positive inspiration. Mood was improved in the mothers who had the peer support compared to the usual health visiting services with a key strength of the research was that the support was peer led.

Key note lecture - day 2

Professor Louise Howard presented preliminary findings from two pieces of research.

The WENDY trial. As part of general health screening, NICE guidelines are to consider asking Whooley questions at first antenatal contact. These questions include:
During the past month have you been bothered by – feeling down, depressed or hopeless? Having little interest or pleasure in doing things? Also consider asking about anxiety.
Louise presented preliminary findings of a cross sectional study comparing the Whooley questionnaire and the Edinburgh Postnatal Depression Scale EPDS against a diagnostic assessment in identifying depression in pregnancy. This trial aimed to identify the prevalence of mental health disorders across the sample. As this research is not yet published, we wont go into too much detail but the answering positively to the Whooley questions was a good indicator of a participant reaching a diagnosis on the clinical interview SKID, particularly in this complex sample. A key message was that it was also very important how the questions were asked.
 

The Stacey study explores the experiences of postnatal services. In the context that often women and their significant others are fearful of the implications of seeking help due to concerns about their baby being taken away from them, it is important to then see what their experiences are once they access treatment. Some preliminary themes from the interviews included:

• Participants feeling professionals are not confident in identifying mental health needs
• Some services are not tailored for the perinatal period.
• Some services could be intrusive
• Mothers who had an acute ward experience sometimes helpful to have a break from baby whereas some mothers really wanted baby there. Some services lacked family friendly rooms and resources, as there was sometimes a strong focus on medication but not in a perinatal context. Mothers said they really valued it when staff remembered they were mothers.
• Specialist mother and baby units were experienced to be helpful and generally found supportive. They had knowledgeable and helpful staff but the environment was sometimes difficult to adjust to. Mothers found that it was good to also meet other mothers
• Another key experience was difficulties once the mother had been discharged. 

​Another fantastic key note lecture which was a highlight of day 2!

Written by Rachael and Leonie

Leonie and Rachael have attended the SRIP conference  at Hinsley Hall, Leeds.
Day 1 



The conference was opened by keynote speaker Olga can den Akker, Professor of Health Psychology, Middlesex University. The tone was set with hearing about new advances in third party assisted conception and importantly the impact/consequences for the parents, the third party who is assisting and crucially the child. The success rate of IVF has recently risen to 25% and so lots of families now have experienced this non-traditional and challenging way of bringing life into the world. Whilst highlighting the emotional effects of surrogacy for example, there were thoughts as to how the birth method may affect the parent-child relationship and the child’s feelings of identity as they learn of their heritage. Key research highlighted by Olga, was that when individuals are born through anonymous donor sperm/eggs, individuals have the right and often want to know whom their biological parents are. With countries having different legislation, attributing responsibility to either birth parents or genetic parents, it creates difficulty in monitoring how people are registered, there can be huge difficultly for people to find out their genetic heritability. Third party conception can introduce a new set of difference and equalities and so health planning for this way of reproducing should be a priority.

The rest of the day was filled with themed presentations. In ‘Infants: Child development, interactions and feeding’ we heard research from Leonardo De Pascalis (University of Reading) who presented findings that infants born with a cleft lip/palate CLP developed typically compared to controls in self recognition tasks at 18 months old, but when looking in a mirror, infants with CLP stood further away from the mirror, displayed less positive emotion and showed less communicative cues to their parents. This coupled with previous research finding mothers of babies don’t look at their babies face as much as control mother-infant dyads posed an interesting discussion about maternal responsiveness and sensitivity to children with CLP
 
Janet McNally, University of Leeds presented her interesting qualitative PhD findings from mothers who either weaned their baby by the traditional method of spoon feeding in comparison to the newly popular baby led weaning. Her findings suggested it was a highly emotive subject with all mothers feeling the approach they selected was best for their baby, ease of approach but ultimately the approach needs to be matched with the babies characteristics of how they feed and the evidence base needs adding to. 

The final presentation in this theme was by Dr Netalie Shloim (University of Leeds)  sharing results that mothers of breast fed infants were more sensitive and responsive to their infants cues in compared to mothers who bottle fed their infants. Generally mothers who breast fed had more positive mealtime interactions with less distractions such as TV etc. strengthening the idea that it is not only important what infants are eating but also how mothers and infants communicate during a feed.

We attended some fascinating themed talks about ‘Development and validation of measures: birth satisfaction, birth trauma, postpartum specific anxiety'. One of the presenters included Professor Susan Ayers (City University London) who presented her work developing the Birth Trauma Scale, which is a measure of child birth related PTSD. Professor Ayers discussed that the Birth Trauma Scale was developed due to the lack of self-report measures of postpartum PTSD based on DSM-V criteria. Peers in perinatal research reviewed the questionnaire, in addition to postpartum women who had experienced birth-related PTSD.  Overall, the research presented reminded us that the developing and using the valid and reliable scales measuring postpartum mental health is incredibly important for screening purposes and assessing the effects of treatment.


Leonie also did a flash presentation of the qualitative findings from the ACORN study. The aim the flash presentation was to present your research project in 3 minutes using one PowerPoint slide. Despite the tight time restrictions Leonie, alongside the other flash presenters, managed to state their research project within the time limit! ​

Rachael and Leonie also had the opportunity to present their posters in the poster viewing galleries, which facilitated an excellent opportunity to discuss the pPOD research which fellow peers.

Rachael and Leonie attended the SRIP conference dinner last night, which was held at the Thackray Medical Museum. The Thackray Museum has a grand and impressive exterior that holds a number of different galleries presenting the world of medicine from the Victorian age to present day. Following the short ‘after hours’ tour of the museum, a three-course meal was served, and opened up a fantastic opportunity to socialize with others who are attending the SRIP conference.


The first day of the conference was an amazing experience and we are looking forward to seeing what the second day holds in store for us!