Perinatal continuity of care for mothers with depressive symptoms: perspectives of mothers and clinicians.

Background: Mothers with mild to moderate depression in pregnancy are at risk of developing postpartum depression. Midwife-led continuity of care may support maternal mental health throughout the perinatal period. Research is needed to better understand how continuity of care may support mothers experiencing depression in pregnancy. This study aimed to investigate the perspectives of mothers with mild to moderate depression and clinicians regarding continuity of care in the perinatal period. Method: Fourteen mothers and clinicians participated in individual interviews or a focus group. Analysis was conducted using inductive reflexive thematic analysis with a constructivist orientation. Results: From the perspectives of mothers and clinicians, continuity of care during the antenatal period benefitted mothers' mental health by providing connection and rapport, information about pregnancy and referral options, and reassurance about whether pregnancy symptoms were normal. The experience of seeing multiple clinicians was noted by mothers to increase distress while participants discussed the value of extending continuity of care into the postpartum period, including having someone familiar checking in on them. The importance of having a second opinion and not always relying on a single provider during pregnancy was highlighted by some mothers and clinicians. Mothers also described how multiple modes of communication with a midwife can be helpful, including the ease and accessibility of text or email. Conclusion: Mothers and clinicians perceived benefits of continuity of care for maternal mental health. Offering midwife-led continuity of care to mothers with mild to moderate depression during the perinatal period is recommended.

Screening tools for autism in culturally and linguistically diverse paediatric populations: a systematic review.

BACKGROUND: Autism Spectrum Disorder (ASD) has varying prevalence rates worldwide, often higher in culturally diverse populations. Cultural differences can affect autism symptom recognition. Language barriers and differing healthcare attitudes may delay diagnosis and intervention. Most autism screening tools were developed in Western, predominantly Caucasian populations, and their appropriateness in culturally and linguistically diverse (CALD) contexts remains uncertain. There is a lack of comprehensive data on the accuracy of these tools in identifying autism in culturally and linguistically diverse groups. Consequently, it is unclear whether current screening tools are culturally sensitive and appropriate. METHODS: A research protocol was registered in PROSPERO (CRD42022367308). A comprehensive search of literature published from inception to October 2022 was conducted using the following databases: PubMed, Medline Complete, Scopus, PsychInfo and CINAHL Complete. The articles were screened using pre-determined inclusion and exclusion criteria. Data extracted included participant demographics, screening tool psychometric properties (validity, reliability, accuracy) and acceptability. A narrative synthesis approach was used. RESULTS: From the initial retrieval of 2310 citations, 51 articles were included for analysis. The studies were conducted in 32 different countries with screening tools in the following languages: Chinese, Spanish, Korean, Turkish, Arabic, Kurdish, Persian, Serbian, Italian, French, Sinhala, Taiwanese, Finnish, Northern Soho, Albanian, German, Japanese, Vietnamese, Farsi, Greek and English. There was no data on acceptability of the screening tools in CALD populations. Validity, reliability, and accuracy ranged from poor to excellent with consistently high performance by screening tools devised within the populations they are intended for. CONCLUSIONS: The review evaluated autism screening tools in culturally diverse populations, with a focus on validity, reliability, and acceptability. It highlighted variations in the effectiveness of these tools across different cultures, with high performance by tools devised specifically for the intended population, emphasizing the need for culturally sensitive screening tools. Further research is needed to improve culturally specific, reliable autism screening tools for equitable assessment and intervention in diverse communities.

A mixed-methods evaluation of a state-wide outreach perinatal mental health service.

BACKGROUND: Access to perinatal mental health services in rural and remote areas is scarce, particularly perinatal psychiatry services. Telehealth, together with psychiatry consultation-liaison services are one way to improve access to areas of need. The New South Wales State-wide Outreach Perinatal Services - Mental Health (SwOPS) program is a Sydney-based program, offering specialist perinatal consultation-liaison services to rural and remote community mental health clinicians caring for perinatal women with significant mental health problems. This study aimed to evaluate healthcare practitioners' perceptions of the SwOPS program. METHOD: Healthcare practitioners (N = 31) were purposely recruited to participate in the study. Data were analysed using a mixed-methods cross-sectional design. RESULTS: Most participants reported being familiar with and satisfied with the service. As a result of accessing the service, participants reported an increase in knowledge and confidence regarding caring for women with moderate-to-severe or complex mental health conditions. Qualitative comments highlight the participant's perceptions of the program. CONCLUSION: This study provides useful insights about a state-wide telehealth psychiatry consultation-liaison service from the perspective of practitioners. It highlights the benefits, facilitators, and barriers associated with implementing such services.

Adapting the 'First 2000 Days maternal and child healthcare framework' in the aftermath of the COVID-19 pandemic: ensuring equity in the new world.

The purpose of this perspective article is to emphasise the importance of the 'First 2000 Days' policy of life from conception to age five, and to propose new directions in which the policy's implementation could be extended for the benefit of children and families. The proposed approach highlights principles of responsiveness, integration, sustainability and equity, specifying initiatives that embody the kind of innovation each principle aspires to. The article also proposes innovations in data collection and linkages that would strengthen the implementation of first 2000 days policies and frameworks. This perspective proposes a framework that could improve health systems implementation of services in the first 5 years of life, by proposing a well-coordinated continuum of services with integrated physical and digital solutions. This has the potential to transform how the health system monitors and responds to children and families' needs in the critical early years of life during and beyond the current pandemic.

The impact of midwifery continuity of care on maternal mental health: A narrative systematic review.

BACKGROUND: Systematic reviews have shown that midwifery continuity of care programs lead to improvements in birth outcomes for women and babies, but no reviews have focused specifically on the impact of midwifery continuity of care on maternal mental health outcomes. OBJECTIVE: To systematically review the available evidence on the impact of midwifery continuity of care on maternal mental health during the perinatal period. METHOD: A systematic search of published literature available through to March 2021 was conducted. A narrative approach was used to examine and synthesise the literature. RESULTS: The search yielded eight articles that were grouped based on the mental health conditions they examined: fear of birth, anxiety, and depression. Findings indicate that midwifery continuity of care leads to improvements in maternal anxiety/worry and depression during the perinatal period. CONCLUSION: There is preliminary evidence showing that midwifery continuity of care is beneficial in reducing anxiety/worry and depression in pregnant women during the antenatal period. As the evidence stands, midwifery continuity of care may be a preventative intervention to reduce maternal anxiety/worry and depression during the perinatal period.

Developmental Screening Tools Used with First Nations Populations: A Systematic Review.

Developmental surveillance and screening is recommended for all children under five years of age, especially for those from at-risk populations such as First Nations children. No review to date has, however, evaluated the use of developmental screening tools with First Nations children. This review aimed to examine and synthesise the literature on developmental screening tools developed for, or used with, First Nations populations children aged five years or younger. A PRISMA-compliant systematic review was performed in the PsychInfo, PubMed, and Embase databases. Additional searches were also undertaken. In total 444 articles were identified and 13 were included in the final review. Findings indicated that several developmental screening tools have been administered with First Nations children. Most tools, however, have only been evaluated in one study. Results also found that no studies evaluated actions taken following positive screening results. More research evaluating the accuracy, acceptability, and feasibility of using developmental screeners with First Nations children is required before widespread implementation of developmental screening in clinical settings with First Nations children is recommended.

Attachment-Based Parenting Interventions and Evidence of Changes in Toddler Attachment Patterns: An Overview.

There is strong evidence to show links between attachment security in young children and a range of positive outcomes in social, emotional, and psychological domains. The aims of this review were to provide a narrative summary of (1) the attachment-based interventions currently available for caregivers of toddlers aged 12-24 months and for which research about the impact of the program on child attachment patterns has been reported, and (2) the empirical effectiveness of these interventions at improving attachment security. A number of interventions were shown to be associated with shifts to secure and/or organized attachment, with Child-Parent Psychotherapy and Attachment and Biobehavioral Catch-Up emerging as the interventions with the strongest evidence bases. For most interventions, evidence came from just a single research study, and in some cases from studies that were not randomized controlled trials. In order for clinicians to make informed decisions about the interventions they use with parents and toddlers, it is vital that further research be conducted to test the efficacy of all available attachment-based parenting programs using randomized controlled trial designs, in a range of settings and clinical and cultural groups, and with longitudinal follow-ups.

Watch me grow integrated (WMG-I): protocol for a cluster randomised controlled trial of a web-based surveillance approach for developmental screening in primary care settings.

INTRODUCTION: The increasing prevalence of developmental disorders in early childhood poses a significant global health burden. Early detection of developmental problems is vital to ensure timely access to early intervention, and universal developmental surveillance is recommended best practice for identifying issues. Despite this, there is currently considerable variation in developmental surveillance and screening between Australian states and territories and low rates of developmental screening uptake by parents. This study aims to evaluate an innovative web-based developmental surveillance programme and a sustainable approach to referral and care pathways, linking primary care general practice (GP) services that fall under federal policy responsibility and state government-funded child health services. METHODS AND ANALYSIS: The proposed study describes a longitudinal cluster randomised controlled trial (c-RCT) comparing a 'Watch Me Grow Integrated' (WMG-I) approach for developmental screening, to Surveillance as Usual (SaU) in GPs. Forty practices will be recruited across New South Wales and Queensland, and randomly allocated into either the (1) WMG-I or (2) SaU group. A cohort of 2000 children will be recruited during their 18-month vaccination visit or opportunistic visit to GP. At the end of the c-RCT, a qualitative study using focus groups/interviews will evaluate parent and practitioner views of the WMG-I programme and inform national and state policy recommendations. ETHICS AND DISSEMINATION: The South Western Sydney Local Health District (2020/ETH01625), UNSW Sydney (2020/ETH01625) and University of Queensland (2021/HE000667) Human Research Ethics Committees independently reviewed and approved this study. Findings will be reported to the funding bodies, study institutes and partners; families and peer-reviewed conferences/publications. TRIAL REGISTRATION NUMBER: ANZCTR12621000680864.

Utility of screening for adverse childhood experiences (ACE) in children and young people attending clinical and healthcare settings: a systematic review.

OBJECTIVE: To examine and synthesise the literature on adverse childhood experience (ACE) screening in clinical and healthcare settings servicing children (0-11) and young people (12-25). DESIGN: A systematic review of literature was undertaken. DATA SOURCE: PsycInfo, Web of Science, Embase, PubMed and CINAHL were searched through June 2021. Additional searches were also undertaken. ELIGIBILITY CRITERIA: English language studies were included if they reported results of an ACE tool being used in a clinical or healthcare setting, participants were aged between 0 and 25 years and the ACE tool was completed by children/young people or by parents/caregivers/clinicians on behalf of the child/young person. Studies assessing clinicians' views on ACE screening in children/young people attending health settings were also included. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed for risk of bias using the Mixed Methods Appraisal Tool. Results were synthesised qualitatively. RESULTS: Initial searches identified 5231 articles, of which 36 were included in the final review. Findings showed that the most commonly used tool for assessing ACE was the ACE questionnaire; administering ACE tools was found to be feasible and acceptable; there were limited studies looking at the utility, feasibility and acceptability of assessing for ACE in First Nations people; and while four studies provided information on actions taken following ACE screening, no follow-up data were collected to determine whether participants accessed services and/or the impact of accessing services. CONCLUSION: As the evidence stands, widespread ACE screening is not recommended for routine clinical use. More research is needed on how and what specific ACE to screen for and the impact of screening on well-being. PROSPERO REGISTRATION NUMBER: University of York Centre for Reviews and Dissemination (CRD42021260420).

Oxytocin receptor gene (OXTR) polymorphisms and social, emotional and behavioral functioning in children and adolescents: A systematic narrative review.

This study systematically reviewed available evidence regarding associations between polymorphisms of the oxytocin receptor (OXTR) gene and socio-emotional and behavioral functioning in children and adolescents. The search yielded 69 articles, which were grouped into nine categories: depression, anxiety, and internalizing symptoms, alcohol abuse, borderline personality disorder, conduct disorder symptoms or diagnosis, autism spectrum disorder, attention deficit hyperactivity disorder, early childhood attachment and behavior, pro-social skills, and resilience. Direct and/or gene x environment interactions were identified in over half of the studies. ASD and conduct disorder (including callous unemotional traits) were the diagnoses that were most studied and for which there was the strongest evidence of direct links with OXTR polymorphisms. In most studies identifying gene x environment interactions, the candidate OXTR polymorphism was rs53576. Results suggest that OXTR polymorphisms are associated with social, emotional or behavioural functioning in children and adolescents. The mixed findings do, however, highlight the need for further research.

Outcomes for infants whose mothers had an eating disorder in the perinatal period: A systematic review of the evidence.

OBJECTIVE: To establish any health outcomes for infants to age one, associated with their mother having a diagnosis of an active eating disorder during pregnancy or the 12-month postnatal period. METHOD: A qualitative systematic literature review of numerous databases (Medline, PsycINFO, CINAHL, Scopus, Cochrane Library, MedNar, PsycExtra, National Institute for Health and Care Excellence and Open Grey) was performed examining any infant health outcomes. RESULTS: This resulted in 22 included studies (17 cohort, 3 cross-sectional, 1 case controlled and 1 mixed methods study). A range of adverse infant outcomes including poor birth, growth and interactional feeding outcomes were identified. DISCUSSION: Antenatal identification and treatment for women with an eating disorder during the perinatal period and their infants are vital. Optimizing pregnancy nutrition, maternal eating disorder symptoms and feeding interactions appear particularly important.

OBJETIVO: Establecer cualquier resultado de salud para los lactantes hasta la edad de un año, asociado con que su madre tenga un diagnóstico de un trastorno de la conducta alimentaria activo durante el embarazo o en el período postnatal de 12 meses. MÉTODO: Se realizó una revisión cualitativa sistemática de la literatura de numerosas bases de datos (Medline, PsycINFO,CINAHL,Scopus, Cochrane Library, MedNar, PsycExtra, National Institute for Health and Care Excellence y Open Grey) que examinó cualquier resultado de salud infantil. RESULTADOS: Esto dio lugar a 22 estudios incluidos (17 de cohorte, 3 transversales, 1 estudio de caso controlado y 1 estudio de métodos mixtos). Se identificaron una variedad de resultados adversos para los lactantes, incluidos los resultados deficientes al nacimiento, el crecimiento y en la interacción con la alimentación. DISCUSIÓN: La identificación prenatal y el tratamiento para las mujeres con un trastorno de la conducta alimentaria durante el período perinatal y sus infantes son vitales. La optimización de la nutrición del embarazo, los síntomas del trastorno alimentario materno y las interacciones alimentarias parecen particularmente importantes. PALABRAS CLAVE: Trastornos de la Conducta Alimentaria y de la Ingestión de Alimentos; Anorexia nerviosa; Bulimia Nerviosa; Trastorno por Atracón; Embarazo; Parto; Período posparto; Infante, Recién Nacido; Bienestar Infantil; Desarrollo Infantil; Pronóstico; Madre.

Antenatal psychosocial assessment and depression screening in an Australian Private Hospital setting: A qualitative examination of women's perspectives.

BACKGROUND: In Australia, clinical practice guidelines have been developed to support the implementation of antenatal psychosocial assessment and depression screening in routine clinical obstetric care. While there has been widespread uptake of such programs in Australian public hospitals, implementation in private hospitals has been slower. However, the situation in this regard may be changing, with the emergence of examples of midwife delivered screening programs in a number of private hospital settings. At present, patient experiences of these programs are largely unknown. AIM: The aim of this study was to gain feedback from women who participated in the 'Pre-admission midwife appointment' program at an Australian private hospital about their experiences of, and perspectives about, the program. METHODS: Semi-structured interviews were conducted with 20 women (Mage 36.04 years, range 30-48) who had given birth to a child between 9 and 14 months prior to the interview (M = 11.87 months, SD = 1.76) and who had attended the Pre-admission midwife appointment program during the pregnancy. Interviews were transcribed and analysed using an inductive thematic analysis approach with an essentialist-realistic theoretical framework. FINDINGS: Data analysis revealed five major themes: 'increased awareness and support for perinatal mental health issues', 'enhanced quality of care provided at the hospital', 'experience with the midwife impacts perceptions of the program'; 'partners', and 'preparation for the program'. DISCUSSION: This study provides useful information from the perspective of consumers, about a psychosocial assessment and depression screening program at an Australian private hospital. It highlights a number of program benefits for pregnant women, their partners, and the hospital, as well as factors facilitating program success.

Health professional perspectives on an antenatal mental health screening program in a private hospital.

BACKGROUND: Perinatal mental ill-health is a global health priority. Mental health screening during pregnancy is a routine part of clinical practice in many public hospital obstetric services across Australia, but implementation in the private hospital system has lagged. AIMS: This study explored health professionals' perspectives on the Pre-admission Midwife Appointment Program (PMAP), an antenatal mental health screening program at the Mater Hospital, Sydney. MATERIALS AND METHODS: Nine midwives and three medical specialists participated in focus groups or individual interviews; key themes were determined using thematic qualitative analysis. RESULTS: Five major themes and three sub-themes were identified: immediate benefits to women (identifying women at risk; referrals to support services; supporting and educating women); enhanced overall quality of care at the hospital; the dilemma of partners attending; factors that make the program successful; and recommendations for improvement. CONCLUSIONS: Results will inform the implementation of antenatal mental health screening programs at other private hospitals across Australia.

Increasing partner communication and understanding during pregnancy: evaluation of 'The Great Pregnancy Quiz'.

OBJECTIVE: To evaluate a Quiz designed to enhance communication and understanding in expectant parents. BACKGROUND: A supportive and understanding relationship is associated with better maternal mental health outcomes. Many services therefore advocate that couples should communicate openly with each other, particularly about worries or concerns either have. To facilitate this a quiz (The Great Pregnancy Quiz) was developed and evaluated in this project. METHOD: English-speaking women (N = 442) and men (N = 146) were recruited from antenatal clinics or classes and were given the 'Great Pregnancy Quiz' to complete at home. Approximately 2-4 weeks (T2) later they participated in either a phone interview, an online survey, or a face-face interview, still during the pregnancy, concerning the impact of the Quiz. Data were available from 90 women and 46 men. Data were analysed using a mixed-methods single group post-test only design. RESULTS: Most women (78 of the 90: 87%) and men (35 of the 46: 76%) reported that the Quiz had positively impacted either their understanding or knowledge of each other. For 30 of the 90 women (33%) and 3 of the 46 men (7%) one or other had implemented some new supportive behaviour due to the Quiz. Qualitative comments highlight the impacts of the Quiz. CONCLUSION: Most couples who did the Quiz reported positive impacts on their communication and understanding. While the issue of low T2 contact rates may have skewed the results, the benefits associated with the quiz make this resource an inexpensive and easily implemented health promotion strategy.

A randomized controlled trial comparing parent child interaction therapy - toddler, circle of security- parenting™ and waitlist controls in the treatment of disruptive behaviors for children aged 14-24 months: study protocol.

BACKGROUND: It is common for toddlers to display disruptive behaviors (e.g., tantrums, aggression, irritability) but when these become severe and persistent they can be the start of a trajectory towards poor outcomes in childhood and adolescence. Parent Child Interaction Therapy - Toddler is an intervention model designed to meet the specific developmental needs of toddlers aged 12-24 months presenting with disruptive behaviors. METHODS: This study will use a randomized controlled design to evaluate the efficacy of the Parent Child Interaction Therapy - Toddler intervention for children aged 14-24 months with disruptive behaviors. Ninety toddlers with parent-reported disruptive behavior will be randomly allocated to either Parent Child Interaction Therapy - Toddler, Circle of Security- Parenting™ or a waitlist control group. Key parenting capacity outcome variables will include positive and negative parenting, parenting sensitivity, parental sense of competence in managing negative toddler emotions, parent sense of caregiving helplessness, parent mentalizing about the child, parent emotion regulation, child abuse potential and parental stress. Key outcome variables for children will include child social-emotional functioning (initiative, relationship functioning, self-regulation), child emotion regulation, child attachment security, and child behavior. DISCUSSION: Delivered in the early intervention period of toddlerhood, Parent Child Interaction Therapy - Toddler has the potential to bring about significant and lasting changes for children presenting with early onset behavioral issues. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR), 12618001554257 . Registered 24 September 2018 - retrospectively registered.

Development and validation of the Karitane Family Outcomes Tool.

PURPOSE: The purpose of this study was to develop the Karitane Family Outcomes Tool (KFOT), a brief parent-report questionnaire to measure outcomes of Australian Early Parenting Centres (EPCs) and similar programmes worldwide. DESIGN AND METHODS: The study was conducted in two stages. In Stage One, an initial item pool (80 items) was developed via focus group discussions with clinical experts and parents. In Stage Two, three samples of parents were recruited (online community sample: n = 849, clinical sample 1: n = 141, clinical sample 2: n = 109). The online community sample completed the 80-items and then non-normally distributed items were culled, leaving a total item pool of 57 items. The online community sample was then split into two subsamples (subsample 1: n = 650, subsample 2: n = 199). Exploratory factor analysis (EFA) was then conducted on online community subsample 1 and confirmatory factor analysis (CFA) on online community subsample 2 and clinical sample 1. Using clinical sample 2, concurrent validity was assessed by examining correlations between KFOT factor scores with scores on the Parenting Stress Index. Finally, discriminant validity was assessed by examining the KFOTs sensitivity to change following EPC intervention and by comparing KFOT scores of clinical and community samples. RESULTS: EFA revealed 13 items loading onto three factors: "Parental feelings," "Reading cues & meeting the child's needs" and "Perceptions of child behaviour." The factor structure was confirmed using CFA in both the community and clinical samples. Significant differences on all three KFOT factors and on the total score were found between the clinical and community samples, suggesting that the scale is able to discriminate between clinical and nonclinical groups. Significant differences were also found between pre- and postintervention scores, and between pre- and follow-up scores, on all three KFOT factors, providing further indication of discriminant validity. The KFOT factors correlated in the expected direction with scores on the Parenting Stress Index, showing concurrent validity. PRACTICAL IMPLICATIONS: Results indicate that the KFOT is a brief, valid and reliable parent-report scale that can be used by nurses to evaluate outcomes of EPC and similar parenting programmes.

Feasibility and acceptability of internet-delivered parent-child interaction therapy for rural Australian families: a qualitative investigation.

INTRODUCTION: Parent-child interaction therapy (PCIT) is an evidence-based parent management training program for the treatment of childhood disruptive behaviour disorders (DBDs). In Australia, however, due to a lack of services in regional, rural and remote areas, the program is not accessible to all families who might benefit. Preliminary evidence demonstrates that telehealth technologies can be leveraged to deliver PCIT via internet (I-PCIT) to urban families. It is not known, however, to what extent I-PCIT is acceptable and effective for regional and remote families, who are traditionally underserved and face a range of stressors unique to living outside major cities. The present study represents the first qualitative investigation into the experience of I-PCIT for rural or regional Australian families. METHODS: Qualitative interviews were conducted with 10 parents who were living in regional, rural and remote areas of New South Wales (NSW), Australia, and who were referred to an I-PCIT program for treatment of DBD in a child aged 2-4 years. RESULTS: Thematic analysis yielded two pre-treatment themes: motivation for seeking treatment and barriers to previous service access. Three overarching themes were identified in post-treatment interviews: positive outcomes, valuable program components and challenges and acceptability of internet delivery. Results demonstrate that consumers from regional, rural and remote NSW view I-PCIT as an acceptable and effective treatment of childhood DBD, bolstering preliminary evidence about the utility of internet technologies to deliver the high-quality results of PCIT. While internet connection issues were a hindrance to treatment for some participants, all parents reported meaningful positive outcomes for both child and parents. CONCLUSION: The study highlights that I-PCIT effectively expands the reach of mental health services to Australian communities that previously could not access clinic-based parenting services.