A qualitative inquiry of clinicians’ relational experiences within a perinatal infant mental health service contextualised with quantitative analysis of outcome measures

Abstract

Literature highlights the perinatal period as a time of increased risk for mothers and infants, particularly those who have additional psychological and social risk factors. Enquiry reports underscore poor outcomes and service engagement for mothers from marginalized social contexts wherein relationships with services can be characterized by avoidance, distrust and silencing. Nuanced understandings of these relational processes are lacking and important to explore in the context of research supporting the therapist-parent relationship as a mechanism of therapeutic change. Within a Perinatal Infant Mental Health Service (PIMHS), this research aimed to explore clinicians’ relational experiences with the mothers and infants they work with, and their reflections on therapeutic change, and contextualize this with analysis of quantitative outcomes for mothers and infants engaged in PIMHS interventions. A qualitative inquiry using semi-structured interviews was undertaken with ten clinician participants and analysed using thematic analysis (TA). Quantitative analysis using Reliable and Clinically Significant Change calculations was conducted for six parent-infant dyads using pre and post-intervention scores on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and Mother Object Relationship Scale-Short Form (MORS-SF), alongside descriptive changes according to the Meaning of the Child Interview and safeguarding statuses. TA produced five main themes; ‘the overbearing wider context’, ‘professional positioning’, ‘dyadic/triadic relating’, ‘the self in the work’, and ‘connecting and expanding understanding’. Results highlight the multifaceted nature of experiences of clinicians working within the PIMHS through which wider contextual, inter-professional, dyadic/triadic, and intra-professional factors impact upon the work. Quantitative analyses of outcomes indicated a mixed profile of the extent that parents appeared to benefit from the PIMHS and demonstrated little consistency of change across measures. The discussion raises questions regarding how to measure the impact of the work, and the centrality of inter-disciplinary shared understanding in supporting families. Clinical and research implications are presented in the context of the findings and methodological limitations