Psychosocial interprofessional perinatal education: Design and evaluation of an interprofessional learning experience to improve students' collaboration skills in perinatal mental health.

BACKGROUND: Perinatal mental health disorders are one of the leading causes of maternal illness and suffering and care and services need to be well coordinated by an interprofessional team who are skilled in working collaboratively. AIM: The aim of this paper is to describe the design and evaluation of an innovative interprofessional education initiative to increase midwives and other health professional students' knowledge and skills in caring collaboratively for women with psychosocial issues in the perinatal period, including women experiencing domestic and family violence. METHODS: The Psychosocial Interprofessional Perinatal Education workshop was designed for midwifery, psychology, social work and medical students. It provided a simulated learning experience with case studies based on real life situations. Students undertook pre and post surveys to measure changes in students' perceptions of interprofessional collaboration and their experiences of participating in the interprofessional simulation-based learning activity. Quantitative survey data were analysed using paired t-tests and a qualitative content analysis was undertaken on the open-ended questions in the survey. FINDINGS: Comparison of pre and post surveys found students from all disciplines reported feeling more confident working interprofessionally following the workshop. The following categories were generated from analysis of the open ended survey data: Greater understanding of each others' roles; Recognising benefits of interprofessional collaboration; Building on sense of professional identity; Respecting each other and creating a level playing field; and Filling a pedagogical gap. CONCLUSION: Through this innovative, simulated interprofessional education workshop students developed skills essential for future collaborative practice to support women and families experiencing psychosocial distress.

Educational programs and teaching strategies for health professionals responding to women with complex perinatal mental health and psychosocial concerns: A scoping review.

BACKGROUND: Mental health and psychosocial concerns such as domestic violence in pregnancy and after birth are significant issues. Maternal health, social and environmental contexts have a direct influence on child development and long-term health. However, midwives, nurses and other health professionals lack confidence and skills in assessing, supporting and referring women with perinatal psychosocial concerns. AIM AND OBJECTIVES: The aim of the scoping review is to review educational innovations and teaching strategies used to build skills and knowledge in health professionals and students to address psychosocial concerns including perinatal mental health, domestic violence and drug and alcohol misuse. DESIGN: A scoping review was undertaken to help identify the breadth of papers reporting educational innovations and strategies particularly to address psychosocial concerns. METHOD: Four databases CINAHL, PsychoInfo, PubMed, OvidMedline and the grey literature were searched using a diverse range of terms for papers published in English between January 2009 and December 2020. This yielded 2509 papers and after review, 34 papers were included in the scoping review. RESULTS: The 34 papers in this review found a diversity of educational initiatives and strategies delivered either face-to-face, online or in a blended mode addressing the learning needs of health professionals working with women with complex psychosocial concerns. The following characteristics in the papers were examined; focus of education, design and development, length, target audience including interprofessional focus, self-care, sensitive topics, debriefing, involving lived experience consumers and evaluation measures. PARTICIPANTS: In the studies indicated that they benefited from hearing about the individuals' lived experiences, opportunities for simulated practice and valued interprofessional learning experiences for both content and teamwork. The emergence of virtual modes offered some innovative and engaging ways to create a safe space for psychosocial education. However, the research does not provide guidance as to the best mode of delivery or length of program CONCLUSION: This scoping review provides a broad overview of innovative and diverse educational methods and strategies being used in the nursing, midwifery and health disciplines to engage students and practitioners in learning in the areas of perinatal mental health and psychosocial care. Involvement of lived experience consumers in the design and delivery of education programs can positively impact learners' knowledge and understandings of sensitive psychosocial topics. These diverse approaches could be used to shape the development and evaluation of future education programs.

Effects of the COVID-19 Pandemic and Telehealth on Antenatal Screening and Services, Including for Mental Health and Domestic Violence: An Australian Mixed-Methods Study.

Introduction: Australian antenatal care includes specific screening and service provision for domestic and family violence (DFV) and mental health. However, the COVID-19 pandemic resulted in major care changes, including greatly expanded telehealth. Given difficulties in a safe assessment and management of disclosures via telehealth, DFV and mental health service provision might be substantially impacted. This study therefore aimed to assess COVID-19 effects on DFV and mental health screening, as well as broader service provision from the perspective of local maternity service providers. Methods: Mixed-methods study of staff surveys and interviews of staff directly involved in pregnancy care (doctors, midwives, and allied health) in three Sydney (Australia) maternity units, from October 2020 to March 2021. Surveys and interviews interrogated perceived effects of the COVID-19 pandemic on delivery (ensuring required services occurred), timeliness, and quality of (a) overall maternity care and (b) DFV and mental health screening and care; and also advantages and disadvantages of telehealth. Surveys were descriptively analyzed. Interviews were conducted online, recorded, and transcribed verbatim prior to thematic analysis. Results: In total, 17 interviews were conducted and 109 survey responses were received. Breakdown of survey respondents was 67% of midwives, 21% of doctors, and 10% of allied health. Over half of survey respondents felt the pandemic had a negative effect on delivery, timeliness, and quality of overall pregnancy care, and DFV and mental health screening and management. Perceived telehealth positives included convenience for women (73%) and reducing women's travel times (69%). Negative features included no physical examination (90%), difficulty regarding non-verbal cues (84%), difficulty if interpreter required (71%), and unsure if safe to ask some questions (62%). About 50% felt telehealth should continue post-pandemic, but for <25% of visits. Those perceived suitable for telehealth were low-risk and multiparous women, whereas those unsuited were high-risk pregnancy, non-English speaking, and/or mental health/psychosocial/DFV concerns. "Change to delivery of care" was the central interview theme, with subthemes of impact on mental health/DFV screening, telehealth (both positive and negative), staff impact (e.g., continuity of care disruption), and perceived impact on women and partners. Discussion: While telehealth may have an ongoing, post-pandemic role in Australian maternity care, staff believe that this should be limited in scope, mostly for low-risk pregnancies. Women with high risk due to physical health or mental health, DFV, and/or other social concerns were considered unsuited to telehealth.

Midwives experiences of removal of a newborn baby in New South Wales, Australia: Being in the 'head' and 'heart' space.

BACKGROUND: A newborn baby is removed from his/her mother into formal care when he/she is considered at risk of serious harm and it is not in the best interests to go home with their parent(s) or carer(s). In New South Wales (NSW), this removal is known as an "assumption of care". This process is challenging for all involved especially when it occurs soon after birth. There is very limited research to inform midwives in this area of practice. AIM: To explore the experiences of midwives who had been involved in the assumption of care of a baby soon after birth or in the early postnatal period. METHOD: A qualitative descriptive approach was used. Ten midwives involved with the assumption of care of a baby were interviewed. A thematic analysis was undertaken. FINDINGS: There were two overarching themes. "Being in the head space" represented the activities, tasks and/or processes midwives engaged in when involved in an assumption of care. "Being in the heart space" described the emotional impact on midwives, as well as their perceptions on how women were affected. CONCLUSION: Midwives described feeling unprepared and unsupported, in both the processes and the impact of assumption of care. They were confronted by this profound emotional work and described experiencing professional grief, similar to that felt when caring for a woman experiencing a stillbirth. In the future, midwives need to be provided with support to ensure that they can effectively care for these women and also manage the emotional impact themselves.