Art-based interventions during pregnancy to support women's wellbeing: An integrative review.

BACKGROUND: The transition to motherhood is a dynamic experience. Antenatal care and education are designed to support women during pregnancy, however childbearing women often report a further need for emotional and social support beyond preparation for birth. Broadening routine antenatal care to included art-based interventions may offer women an opportunity to explore important aspects of the transition to motherhood. AIM: The aim of this integrative review is to synthesise research regarding the use of art-based interventions with women during pregnancy. METHOD: A systematic integrative review of the current evidence-base was conducted. A multi-database keyword search was implemented, and a total of six articles met inclusion criteria. Results were analysed using an inductive thematic analysis framework. FINDINGS: Six studies met the inclusion criteria. Three major themes were generated: art-based engagements supported women to express complex emotion, fostered a sense of connection and strengthened personal resourcefulness. DISCUSSION: Creative expression provided an opportunity to explore important aspects of the motherhood experience including, complex emotion, identity and bonding with the unborn child. Being in a group enhanced the health effects of art-making and the social connection felt supportive when role and identity was evolving. CONCLUSIONS: Whilst research on the current topic is emergent, preliminary results suggest that facilitated art-based programs are valuable for pregnant women. Art-based experiences offer women a unique opportunity to explore the full dimensionality of the transition to motherhood which can contribute to improved health and wellbeing. These findings suggest that art-based programs may serve to complement existing antenatal care models.

Barriers and facilitators in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs: A qualitative study of midwives' experience.

BACKGROUND: Screening pregnant women for substance use is highly recommended in antenatal care settings. Although midwives provide routine screening for substance use and referral for treatment in pregnancy, little is known about the barriers and facilitators they experience. AIM: The study explored barriers and facilitators experienced by midwives in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs. DESIGN/SETTING: A semi-structured interview was adopted to explore barriers and facilitators experienced by midwives in screening and referring pregnant women for alcohol or other drugs specialised services. Eighteen midwives were recruited from urban, regional and rural antenatal settings in Victoria. Interviews were tape recorded and transcribed verbatim. Themes were generated by thematic analysis, the process of identifying patterns within the data. FINDINGS: Of the seven themes identified under barriers, five could be categorised as "institution and provider-related", namely: (i) lack of validated screening tool, (ii) inadequate support and training, (iii) discomfort in screening, (iv) lack of multidisciplinary team and specialised treatment in regional and rural areas, and (v) workload and limited consultation time. Conversely, two themes could be classified as 'client-related', namely (i) non- or partial-disclosure of substance use, and (ii) reluctance and non-adherence to referrals. All five themes under facilitators were "institution and provider-related." They are (i) a woman-centred philosophy of care, (ii) evidence of harms from substance use on neonates, (iii) experience and training, (iv) continuity of care, and (v) availability of multidisciplinary team and funding. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: To the best of our knowledge, this is the first study of its kind conducted in Victoria. This study not only adds to the limited body of knowledge on barriers experienced by midwives but also identifies facilitators in antenatal settings that promote screening and referral of pregnant women who use substance. Most of the barriers and facilitators are interrelated. Despite midwives' willingness to screen all pregnant women for substance use and provision of referral, they often felt limited in their capacity. Availability and accessibility to validated screening tool(s), in addition to regular, ongoing training for all midwives to maintain clinical competence and provide effective communication are imperative. Availability of a multidisciplinary team, funds and specialised care facilities such as detoxification and mental health services, especially in regional and rural areas, are necessary to effectively support at-risk pregnant women.

Scoping review of claimants' experiences within Australian workers' compensation systems.

Objective The aim of this scoping review was to map the literature on the lived experiences of injured workers in Australia in order to better understand the factors that inhibit the transition back to work and improved health. The ultimate aim of the study was to identify areas for further research into workers' compensation systems and practices that are associated with improved occupational rehabilitation outcomes. Methods PubMed, ProQuest, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for eligible articles published in English in peer-reviewed journals from 2001 to 2017. Narrative data synthesis was used to analyse the data collected from included articles. Results Twelve articles examining injured workers' experiences within Australian workers' compensation systems were identified. Injured workers reported similar experiences across states and territories in Australia. Four common themes and three subthemes were noted, namely: (1) relationships and interactions; (2) injured workers' perceptions (subthemes: mental health effects, social effects and financial effects); (3) the workers' compensation process; and (4) independent medical evaluations. Conclusions There are common difficulties that injured workers experience within Australian workers' compensation systems that are reported to impede rehabilitation and return to work. A less harmful, more cooperative approach to worker rehabilitation and compensation is needed. What is known about the topic? Different workers' compensation systems exist throughout Australia. Little is known about injured workers' perceptions of their experiences within these systems in Australia and whether these experiences are similar or different across systems. What does this paper add? This scoping review synthesises available evidence showing that injured workers report negative experiences of workers' compensation systems, and that this experience is similar across the different systems. This review also identified a clear need for future research on workers' compensation systems in order to promote evidence-based approaches to best support the occupational rehabilitation of injured workers. What are the implications for practitioners? Evidence suggests a more holistic, biopsychosocial approach is required by practitioners when facilitating an injured worker's recovery and return to work. This approach is also vital when considering legislative reforms, such as workers' compensation systems, processes and practices.

A THERAPEUTIC PLAYGROUP FOR DEPRESSED MOTHERS AND THEIR INFANTS: FEASIBILITY STUDY AND PILOT RANDOMIZED TRIAL OF COMMUNITY HUGS.

Symptoms of depression negatively impact on mother-infant relationships and child outcomes. We evaluated a novel, 10-session mother-infant therapeutic playgroup-Community HUGS (CHUGS)-which combines cognitive and experiential components through psychoeducation, play, music, and movement. Participants were mothers experiencing a range of postnatal mental health difficulties, including depression, with infants ≤12 months of age. However, the aim was not to treat maternal depression but to ameliorate associated problems in the mother-infant interaction. In the feasibility study, all participants received CHUGS. In the pilot randomized controlled trial (RCT), participants were randomized between intervention and a wait-list. Outcomes were the Parenting Stress Index (PSI; R.R. Abidin, 1995), Parenting Sense of Competency Scale (Self-Efficacy subscale; J. Gibaud-Wallston & L.P. Wandersman, 1978), and the Depression, Anxiety, Stress Scales (P.F. Lovibond & S.H. Lovibond, 1995). In the feasibility study (n = 74), PSI scores dropped on all subscales, all ps < .01. Depression, p < .001, anxiety, p = .01, stress, p = .01, and self-efficacy, p < .001, all showed improvements, as did observer-rated mother-infant interactions, p < .001. In the RCT, depression, p < .001, anxiety, p = .005, and stress, p < .001, symptoms were significantly reduced for intervention participants (n = 16), as compared to wait-list participants (n = 15). The CHUGS program had high participant satisfaction and produced improvements in self-efficacy, depression, anxiety, stress, and mother-infant interactions that supported the program's acceptability and the utility of further rollout.

Equine-Assisted Psychotherapy for adolescents experiencing depression and/or anxiety: A therapist's perspective.

Animal-Assisted Interventions (AAIs) are thought to overcome some of the limitations of traditional therapies as they do not rely exclusively on language as a medium for change. One such Animal-Assisted Therapy (AAT) approach involves horses as a therapeutic medium. Equine-Assisted Psychotherapy (EAP) comprises a collaborative effort between a licensed therapist and a horse professional working with clients to address treatment goals. The purpose of the present Australian-based qualitative study was to examine EAP facilitators' perspectives on the biospychosocial benefits and therapeutic outcomes of EAP for adolescents experiencing depression and/or anxiety. The findings suggest a range of improvements within adolescent clients, including increases in confidence, self-esteem and assertiveness, as well as a decrease in undesirable behaviours. The effectiveness of the therapy was thought to be due to the experiential nature of involving horses in therapy. The lack of understanding in the wider community about EAP was seen as a barrier to recognition and acceptance of EAP as a valid therapeutic intervention.

A holistic programme for mothers with postnatal depression: pilot study.

AIM: This paper is a report of a pilot study to identify women's perceptions of participation in a holistic intervention for postnatal depression. BACKGROUND: Approximately 10-15% of women suffer from postnatal depression following childbirth. Most programmes for women with postnatal depression include pharmaceutical interventions; however, evaluation of women's perceptions of participation in holistic programmes for those suffering from postnatal depression show that non-pharmaceutical programmes can also be effective. METHOD: In-depth interviews were conducted in 2004 with a self-selected sample of 10 women prior to and after an intervention to treat postnatal depression. FINDINGS: The intervention seemed capable of encouraging and facilitating a positive mother-infant relationship while also effectively reducing the mother's anxiety levels. Participants commented on the supportive environment of other mothers and said that they found playing with their babies difficult and needed guidance and facilitation to do this. CONCLUSION: The pilot programme was well accepted and could easily be used by midwives, maternal and child health nurses and other appropriately trained allied health professionals.