Study protocol for a comparative effectiveness trial of two models of perinatal integrated psychosocial assessment: The PIPA project

Background: Studies examining psychosocial and depression assessment programs in maternity settings have not adequately considered the context in which psychosocial assessment occurs or how broader components of integrated care, including clinician decision-making aids, may optimise program delivery and its cost-effectiveness. There is also limited evidence relating to the diagnostic accuracy of symptom-based screening measures used in this context. The Perinatal Integrated Psychosocial Assessment (PIPA) Project was developed to address these knowledge gaps. The primary aims of the PIPA Project are to examine the clinical- and cost-effectiveness of two alternative models of integrated psychosocial care during pregnancy: \u27care as usual\u27 (the SAFE START model) and an alternative model (the PIPA model). The acceptability and perceived benefit of each model of care from the perspective of both pregnant women and their healthcare providers will also be assessed. Our secondary aim is to examine the psychometric properties of a number of symptom-based screening tools for depression and anxiety when used in pregnancy. Methods: This is a comparative-effectiveness study comparing \u27care as usual\u27 to an alternative model sequentially over two 12-month periods. Data will be collected from women at Time 1 (initial antenatal psychosocial assessment), Time 2 (2-weeks after Time 1) and from clinicians at Time 3 for each condition. Primary aims will be evaluated using a between-groups design, and the secondary aim using a within group design. Discussion: The PIPA Project will provide evidence relating to the clinical- and cost- effectiveness of psychosocial assessment integrated with electronic clinician decision making prompts, and referral options that are tailored to the woman\u27s psychosocial risk, in the maternity care setting. It will also address research recommendations from the Australian (2011) and NICE (2015) Clinical Practice Guidelines

Miller Early Childhood Sustained Home-visiting (MECSH) trial: design, method and sample description

<p>Abstract</p> <p>Background</p> <p>Home visiting programs comprising intensive and sustained visits by professionals (usually nurses) over the first two years of life show promise in promoting child health and family functioning, and ameliorating disadvantage. Australian evidence of the effectiveness of sustained nurse home visiting in early childhood is limited. This paper describes the method and cohort characteristics of the first Australian study of sustained home visiting commencing antenatally and continuing to child-age two years for at-risk mothers in a disadvantaged community (the Miller Early Childhood Sustained Home-visiting trial).</p> <p>Methods and design</p> <p>Mothers reporting risks for poorer parenting outcomes residing in an area of socioeconomic disadvantage were recruited between February 2003 and March 2005. Mothers randomised to the intervention group received a standardised program of nurse home visiting. Interviews and observations covering child, maternal, family and environmental issues were undertaken with mothers antenatally and at 1, 12 and 24 months postpartum. Standardised tests of child development and maternal-child interaction were undertaken at 18 and 30 months postpartum. Information from hospital and community heath records was also obtained.</p> <p>Discussion</p> <p>A total of 338 women were identified and invited to participate, and 208 were recruited to the study. Rates of active follow-up were 86% at 12 months, 74% at 24 months and 63% at 30 months postpartum. Participation in particular data points ranged from 66% at 1 month to 51% at 24 months postpartum. Rates of active follow-up and data point participation were not significantly different for the intervention or comparison group at any data point. Mothers who presented for antenatal care prior to 20 weeks pregnant, those with household income from full-time employment and those who reported being abused themselves as a child were more likely to be retained in the study. The Miller Early Childhood Sustained Home-visiting trial will provide Australian evidence of the effectiveness of sustained nurse home visiting for children at risk of poorer health and developmental outcomes.</p> <p>Trial registration</p> <p>ACTRN12608000473369</p

Using the Edinburgh Postnatal Depression Scale for women and men\u2014some cautionary thoughts

The objective of the study was to critically consider some of the possible limitations in the Edinburgh Depression Scale (EDS), given that great emphasis is put on the results of this measure within both clinical and research fields. Using findings and discussion points from other studies, as well as from a critical analysis of issues by the authors based upon their clinical and research experience, possible limitations with the scale in nine areas are discussed. Possible limitations include the following: (1) ambiguous items, (2) exclusion of certain types of distress, (3) scoring difficulties, (4) low positive predictive value, (5) frequent use of incorrect cut-off scores, (6) a vast array of validated cut-off scores, (7) validation against a questionable gold-standard, (8) limited anxiety detection and of depressive symptoms in men, and (9) many screen positive women only have transient distress. While the EDS has unquestionably been an extremely valuable instrument in aiding in the recognition of the importance of perinatal mental health, users of the scale should be aware that it, like other measures, has limitations. We discuss possible strategies to overcome these limitations and describe a recent scale that has been developed to surmount these shortcomings more effectively

The effectiveness of Group Triple P and the impact of the four telephone contacts

The aim of this study was to determine the efficacy of the four telephone contact sessions that are prescribed as an integral component of the Group Triple P parenting program, and to compare the efficacy of Group Triple P to a waitlist control group. Parents of children aged 2 to 8 years were randomly assigned to one of three conditions: the usual Group Triple P program, consisting of four group sessions and four telephone calls (n = 16); a modified Group Triple P condition, consisting of just the four group sessions (n = 17); or a waitlist control condition (n = 16). Pre- and post-intervention assessments were conducted using the Eyberg Child Behavior Inventory (ECBI), the Depression Anxiety Stress Scales (DASS) and the Parenting Scale (PS). Statistically and clinically significant main effects were found for attending either the full Triple P or the modified Triple P program on both the DASS and the ECBI, but not on the participant’s perception of their parenting style (PS). We conclude that (a) the four telephone sessions are not an essential component for the initial effectiveness of the Group Triple P program (though further research needs to explore whether they impact on maintenance of gains), and (b) that Group Triple P is effective in bringing about change, as measured using these self-report instruments

Comparison of two strategies to improve infant sleep problems, and associated impacts on maternal experience, mood and infant emotional health : a single case replication design study

Background: Infant sleep problems (ISP) are common and have known effects on parental mood. There is debate as to whether treatment strategies may impact on the infant's emotional health. Aims: To compare the effectiveness of two treatment strategies for ISP on the infant's sleep, maternal mood, and the infant's emotional health. The two strategies are 1) systematic ignoring with minimal check ('. SI-mc': commonly known as 'controlled crying'), and 2) a new, but similar, method where parents feign sleep inside the infant's room before intervening (parental presence with minimal check: '. PP-mc'). Design: Participants were randomised to one of the two conditions. Measures were taken at baseline, then three weeks and four months post-intervention. Subjects: Data were collected from 16 families with infants aged 6-18. months who were seeking professional help with their infant's sleep difficulties. Outcome measures: Measures of infant sleep, maternal experiences and mood, and infant emotional health were collected. Results: Both treatments were effective, with a third to a half of families reporting decreased ISP by 3. week post intervention, and nearly all reporting decreased ISP by follow-up. Similarly, most mothers in both treatments reported improvements to their experiences or mood, and there was no discernable disruption to infant emotional health. Conclusions: These findings support previous research into the effectiveness of SI-mc. The study also expands the research into the effectiveness of parental presence by showing that with the inclusion of the minimal check component, which may be preferred by both parents and clinicians over non-responding to the crying infant, the strategy is as effective as SI-mc

The impact of behavioural parent training on fathers' parenting: a meta-analysis of the Triple-P Positive Parenting Program

Behavioural parent training programs have been developed to address child behaviour problems through improvement in parenting practices. Ideally, programs would demonstrate effectiveness with all parents. The Triple P-Positive Parenting Program is widely reported as an effective, evidence-based program for parents. However, in this meta-analysis we demonstrate that there are significant differences in program effectiveness for mothers and fathers. We show that while Triple P has a large positive effect on mothers’ parenting practices, it has a smaller effect on fathers’ parenting practices. Considering that fathers make a significant and unique contribution to child development, we argue that it is important for parenting programs to assess their effectiveness with fathers as well as mothers

Repeat testing on the Edinburgh Depression Scale and the HADS-A in pregnancy : differentiating between transient and enduring distress

Background: The Edinburgh Depression Scale (EDS/EPDS) is routinely used in many clinical services to screen for probable distress in antenatal and postnatal women. Typically a single administration of this scale results in a referral to a specialist mental health service if the woman scores above the service's cut-off score on the measure - that is, scores 'high'. A few postnatal studies have shown, however, that many women when re-tested just a few weeks later no longer score 'high'. This study explored this phenomenon in a sample of pregnant women, using both the EDS and an anxiety self-report measure (Hospital Anxiety and Depression Scale - Anxiety subscale: HADS-A). Method: 164 English-speaking pregnant women attending a local public hospital's antenatal clinic for their first appointment participated. At this appointment they completed the EDS and the HADS-A, and predicted how they might be feeling in about two-week time. Approximately two weeks later they were interviewed by phone and again completed the EDS and the HADS-A, and answered questions about possible mood changes. Results: Regardless of which of several cut-off scores on the EDS or HADS-A was used to define 'high' scorers, approximately 50% (± 6%) of women scoring high at their first appointment on either measure no longer scored 'high' two weeks later. Common reasons given for their mood improvement included reduced morning sickness, reassuring results from routine tests (e.g., ultrasounds), fear of miscarriage subsiding, and a sense of reassurance following their hospital visit. Many of the women were accurate in predicting at their first appointment that they would be feeling better within a few weeks. Limitations: The administration procedure for completion of the measures on the two occasions was different. Women initially completed the measures by hand, and on the second occasion over the phone. Conclusion: Half the women screened as having emotional distress - that is, scoring 'high' on self-report mood measures (i.e., EDS and HADS-A) - during their first hospital visit in pregnancy are likely to have transient distress for predictable reasons. Referring women to specialist mental health services based upon just one administration of these measures will therefore result in a large number of unnecessary referrals, thus possibly overstretching the resources available. We therefore believe that when women score high on a self-report mood measure, enquiring as to why this is the case, and about whether the woman expects to feel differently in a few weeks time, together with a second administration of the measures in a few weeks is a better practice, unless there are good clinical reasons to do otherwise. In addition, studies reporting prevalence rates of perinatal distress should not simply use a one-off administration of a self-report mood scale to state the probable rate of disorders or distress