Perinatal and infant mental health programme: evaluability assessment

1. Women with perinatal mental health issues, including those at risk of self-harm, are identified as early as possible and offered prompt and equitable access to specialist care provided by professionals with the appropriate skills and experience for the stage of pregnancy and/or infant development, at the level needed wherever they live.

1. Are women with perinatal mental health issues identified early and offered prompt appropriate care?

1.1 What understanding do professionals have about risks to mental health in perinatal period?

None - can be gained from survey/interview

Professionals

1.2 What understanding do women and their families about the risks to mental health in perinatal period?

Possibly Maternity Care Survey.

Can be gained from survey/interview

Women and their families

1.3 Are all women regularly and appropriately assessed throughout the perinatal period? Including:

• Routinely at booking?
• Later bookers?
• Pre-existing mental health conditions?
• At risk groups?

Booking data

Clinical notes

Routine Data collections

Staff survey/interviews

Health Boards

Mat/Neo Hub

1.4 Are appropriate screening tools used?

Booking Data

Clinical notes

Health Boards

Mat/Neo Hub

Mental Health Workers

1.5 Are all professionals aware of where to refer women and are they aware of the range of appropriate interventions? Including those for women with

• Pre-existing mental health issues
• Mild to moderate mental health issues

Health Visitor data

Clinical notes

Staff survey/interviews

Professionals

1.6 Do all women have access to appropriate services throughout Scotland, at the most appropriate time? Including:

• Time from referral to access
• Do services respond timeously and appropriately?

Clinical notes

Booking data

Data from mental health services e.g. Psychological Therapies Service

Maternity Care Survey

Health Boards

Mat/Neo Hub

ISD (Information Service Division Scotland)^[6] for MBUs and Inpatient data

1.7 Are all the staff fully and appropriately skilled and are services appropriately resourced with multidisciplinary teams to meet demand?

Training courses

Workforce survey

NES

Health Boards

Professionals

2. Women at additional risk of perinatal mental health problems, self-harm and suicide are identified and appropriately supported through preventative measures.

2. Are women at risk of perinatal mental health problems and suicide identified and appropriately supported?

2.1 What understanding do professionals have about risks to mental health in perinatal period?

None - can be gained from survey/interview

Professionals

2.2 What understanding do women and their families about the risks to mental health in perinatal period?

Possibly Maternity Care Survey

Can be gained from survey/interview

Women and their families

2.3 Are all women regularly and appropriately assessed throughout the perinatal period? Including:

• Routinely at booking?
• Later bookers?
• Pre-existing mental health conditions?
• At risk groups?

Booking data

Clinical notes

Health Boards

Mat/Neo Hub

2.4 Are appropriate screening tools used?

Booking Data

Clinical notes

Health Boards

Mat/Neo Hub

Mental Health Workers

2.5 Are all professionals aware of where to refer women and are they aware of the range of appropriate interventions? Including those for women with

• Pre-existing mental health issues
• Mild to moderate mental health issues

Health Visitor data

Clinical notes

Staff survey/interviews

Professionals

2.6 Do all women have access to appropriate services throughout Scotland, at the most appropriate time? Including:

• Time from referral to access
• Do services respond timeously and appropriately?

Clinical notes

Booking data

Data from mental health services e.g. Psychological Therapies Service

Maternity Care Survey

Health Boards

Mat/Neo Hub

ISD for MBUs and Inpatient data

2.7 Are all the staff fully and appropriately skilled and are services appropriately resources with multidisciplinary teams to meet demand?

Training courses

Workforce survey

NES

Health Boards

Professionals

2.8 Do women feel able to be open about their thoughts for suicide and/or self-harm with relevant professionals?

None - can be gained from survey/interviews

Women

2.9 What has been the impact of suicide awareness campaigns?

Suicide patterns in perinatal women

None - women's survey/interviews

NRS

Women and their families

3. Barriers associated with perinatal mental health, including stigma, are reduced so that women feel able to disclose issues to professionals they are in contact with, family, friends and their community.

3. What barriers do women face in disclosing perinatal mental health difficulties?

3.1 What understanding do women and their families have about the risks to mental health in perinatal period?

None - can be gained from survey/interview

Women and their families

3.2 What stops women talking about their mental health?

• Stigma?
• Certain groups?
• Professional behaviour

None - can be gained from survey/interview

Women

3.3 Are appropriate screening tools used?

Booking Data

Clinical notes

Health Boards

Mat/Neo Hub

Mental Health Workers

3.4 Do all women have access to appropriate services throughout Scotland, at the most appropriate time?

• Time from referral to access
• Do services respond timely and appropriately?

Clinical notes

Booking data

Data from mental health services e.g. Psychological Therapies Service

Maternity Care Survey

Health Boards

Mat/Neo Hub

ISD for MBUs and Inpatient

MBRRACE-UK

4. Infants at risk of mental health problems are identified early and prompt support is offered to their primary care-giver.

4. Are infants at risk of mental health problems identified early and support offered to their care-giver?

4.1 What understanding do professionals have about risks to infant mental health?

None - can be gained from survey/interview

Professionals

4.2 What understanding do women and families have about risks to infant mental health?

None - can be gained from survey/interview

Women and their families

4.3 Are women whose infant may be at risk of poor infant mental health identified in the perinatal period?

Health Visitor data

FNP Data

Paediatrician Clinical notes

ISD

Health Board

4.4 How, by whom and at what time points are infants assessed before the age of 3 years?

Child Health Surveillance Programme (CHSP)

ISD

4.5 Are infants at risk of poor mental health identified as soon as possible, irrespective of their social circumstances?

HV clinical notes

Paediatrician Clinical Notes

Survey of women

Health Boards

Women

4.6 Is there an appropriate pathway in response to poor mental health (based on GIRFEC principles) and is this used appropriately?

HV clinical notes

FNP data

ISD

Health Boards

4.7 Are infants at risk of poor mental health referred and offered appropriate and prompt support nationally?

HV notes

FNP data

Paediatric Clinical notes

CHSP 'Future Actions'

ISD

Health Boards

4.8 What is the impact of support (i.e. services and/or intervention) in response to poor infant mental health on the long term outcomes for the child?

HV notes and CHSP

FNP data

ISD

Health Boards

5. Women and their partners/significant other family members are supported to form and maintain a healthy (i.e., a warm, secure and attuned) relationship with their child/children.

6. Women and their partners/significant other family members are supported to meet the physical, social, emotional and cognitive needs of their child/children and to develop sensitive attuned parenting.

5. Are primary care givers and their families supported to form and maintain a healthy relationship with their child/children?

6. Are primary care givers and their families supported to meet the needs of their child/children?

5/6.1 What understanding, knowledge and skills do professionals have about healthy relationships between infant and care-giver?

• Including assessing

None - can be gained from survey/interviews

Professionals

5/6.2 What understanding do women and their families have about what constitutes a healthy relationship with their infant?

None - can be gained from surveys/interviews

Women and their families

5/6.3 What support is available for all parents to encourage a healthy relationship between them and their child?

• Timely?
• Who is providing?

Service mapping

"Wellbeing for Wee Ones" - Mapping of parent-infant intervention and support services in Scotland

Study of Local Authorities, Health Boards, Registered charities, Third sector organisations etc.

MCN/NSPCC

5/6.4 Are all professionals aware of what support is available both nationally and locally?

None - can be gained from survey/interviews

Professionals

5/6.5 Do all women and significant care givers have access to appropriate support throughout Scotland, at the most appropriate time?

• − Awareness?
• − Enablers?
• − Barriers?

None - can be gained from survey/interviews

Women and significant care givers

5/6.6 Are there pathways to guide the identification of families in need of support to develop healthy relationships with their infant?

None - can be gained from survey/interviews

Training content

Professionals

NES