Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Supporting Depressed Mothers at Home: Their Views on an Innovative Relationship-Based Intervention

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Supporting Depressed Mothers at Home: Their Views on an Innovative Relationship-Based Intervention

Article excerpt

Home visiting has a long history in Australian child and family health services as an adjunct to centre-based care (O'Connor, 1989). Yet, only during the past twenty years have these programs been acknowledged as effective in their own right for families with young children. This has coincided with a shiftin focus from surveillance and imparting parenting skills, to a more intensive and programmatic approach to supporting families with identified complex and multiple vulnerabilities (e.g., Children, Youth and Families Division, 2010; NSW Health, 2009).

In 2001, Tresillian, an Australian early parenting organisation developed and implemented a home visiting program (HVP). The HVP aimed to provide innovative, non-institutional support to mothers with moderate to severe postnatal depression (PND). The program consisted of 10 home visits from a child and family health (CFH) nurse to the mothers and their infants who were aged 4-6 months at admission. A key component of the intervention was the 'seeing is believing' technique from the University of Minnesota (Erickson, Endersby, & Simon, 1999), which involves a short video recording of a mother and infant interacting. The mother and nurse then review the interaction in a process of joint inquiry. They reflect together about how the infant and mother are experiencing the interaction. The nurse facilitates the mother identifying her own and her infant's strengths, and recognising her infant's cues and attempts at communication. Using this knowledge they jointly consider how to enhance current mother/infant interactions and to equip the mother to anticipate and meet future parenting challenges. Additional components of the HVP intervention included supportive counselling, problem solving, identifying community supports, monitoring mood and anxiety, and supporting the development of parental knowledge and skills in infant development and behavior.

The current study examined the mothers' perspectives on the program, to understand how mothers experienced the intervention and which aspects they found particularly valuable. We were also eager to explore any aspects of the program that did not meet the mothers' expectations. Some findings were as anticipated at the HVP's establishment, given its aims to increase maternal confidence and the quality of their relationships with their infants.

By exploring mothers' perspectives and experiences, we hoped to gain further insights into valued elements to help enhance the effectiveness and acceptability of future service delivery. This is vital given the long-term negative outcomes for children of mothers experiencing ongoing depression (e.g., Lectourneau, Salmani, & Duffett- Leger, 2010), and the need to provide support that is acceptable for participants and tailored to their needs, and given considerable evidence of low treatment uptake in mothers with PND (McCarthy & McMahon, 2008).

This study is based on satisfaction questionnaire data from 111 mothers who were diagnosed as depressed and admitted to the HVP over a 7-year period. It focuses on thematic analysis of the qualitative responses. We identified four major themes within these data.

BACKGROUND

The difficulties caused by postnatal mood disorders have been well established, in terms of both the immediate distress for the parents and the longer-term consequences for child development and family functioning. Maternal depression, particularly when severe and persistent, has been associated with insecure attachment between mother and infant (McMahon, Barnett, Kowalenko, & Tennant, 2006). Importantly, this study further showed that women with an insecure state of mind about their own childhood attachment experiences were significantly more likely to experience both the onset of PND and recurrent episodes during early parenthood.

Given considerable evidence indicating that treatment of maternal depression alone (either with antidepressant medication, counseling or psychotherapy) does not impact on infant outcomes (Murray, Cooper, & Hipwell, 2003), the HVP utilised a relationship focus at two levels. …

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