Perinatal and infant mental health programme: evaluability assessment

1 Introduction

1.1 Perinatal and Infant Mental Health in Scotland

Mental health problems in the perinatal period^[1] affects up to 20% of women in Scotland. While perinatal mental health problems can happen to any woman, some are at increased risk of developing problems. Risk factors include having a history of mental health problems, childhood abuse and neglect and domestic violence.(1) Early identification of problems and prompt appropriate care is important to prevent long lasting effects on women and their families.(2) (3)

In this report, infant mental health is understood to be the same as healthy social and emotional development in the very early years.^[2] As such, infant mental health is fundamentally linked to the quality of the relationship between the infant and their primary care-giver. Significant adversities faced by women and their families, such as perinatal mental health problems, parental substance misuse and domestic abuse, can interfere with a parent's capacity to develop a warm and secure relationship with their infant, as well as hindering the provision of sensitive attuned parenting. (4)

The Perinatal and Infant Mental Health Programme board was established in April 2019 in order to implement the commitments to improving perinatal and infant mental health set out in the 2018/19 Programme for Government and Better Mental Health in Scotland. (5) The programme board will oversee an investment of more than £50 million to be spent on improving perinatal and infant mental health support and treatment for women and their partners in the perinatal period and infants in the very early years who are experiencing poor mental health. (6) The recommendations of the Needs Assessment for Specialist and Universal Perinatal Mental Health Services carried out by the Perinatal and Infant Mental Health Managed Clinical Network will inform the vision and delivery plans of the programme board.

NHS Health Scotland (now part of Public Health Scotland) was commissioned to undertake an evaluability assessment of the Perinatal and Infant Mental Health programme to inform the development of an evaluation plan for the programme.

1.2 Evaluability assessment process

An evaluability assessment (EA) is a systematic approach to prioritising and planning evaluation projects. The process usually involves the following:

• Structured engagement with stakeholders to clarify the intervention or policy goals and how they are expected to be achieved.
• Development and appraisal of a theory of change or programme logic model, which describes how the programme contributes to change in longer-term outcomes, via change in a series of linked short- and medium-term outcomes. It can also identify:
  • the assumptions which underpin the theory/logic model
  • possible unintended consequences of implementing a programme
  • the external factors which will impact on successful implementation and achievement of the intended outcomes.
• Development of evaluation priorities and questions.
• Assessment of existing data sources and data gaps, and consideration of evaluation options.
• Provision of advice on whether an evaluation can be carried out at reasonable cost, or whether further development work on the intervention should be completed first.

A series of three workshops were held with a variety of stakeholders who work in the perinatal and infant mental health care sector including representatives from Scottish Government, health services and the Third Sector.

This paper will present:

• the programme logic model that was developed in collaboration with, and agreed by, the Scottish Government, Perinatal and Infant Mental Health programme board and other stakeholders
• the evaluation questions developed, along with a consideration of possible sources of information to answer the questions posed
• recommendations about the overall evaluation approach