Characteristics and changes in characteristics of women and babies admitted to residential parenting services in New South Wales, Australia in the first year following birth: a population-based data linkage study 2000-2012

Parenting interventions targeting early parenting difficulty: A scoping review

Parent and child wellbeing are reciprocal. Attentive, responsive parenting, is contingent on parental wellbeing. Insights into mechanisms of early parenting interventions that seek to improve parent and child outcomes are needed. This scoping review aimed to systematically map research reporting on parenting interventions for parents experiencing early parenting difficulty. A secondary aim was to synthesise existing research using a realist lens, to provide context, mechanism and outcome insights into elements of early parenting interventions. A systematic search was conducted across six databases within the publication period of 2010-2020, to identify evidence on interventions targeting early parenting difficulty. Using pre-determined inclusion criteria, fifteen studies were selected for review. Deductive reflexive thematic analysis identified three themes: conceptual disparities in early parenting difficulty, early parenting intervention diversity and an absence of theory to explain interventions or outcomes. Neither early parenting difficulty nor the theoretical basis for early parenting interventions were well defined. Identification of contexts, mechanisms and outcomes of early parenting interventions is a unique contribution of this study. These insights may be used to inform planning, implementation and evaluation activities to promote context-focused, early parenting interventions targeting a critical phase of child development.

Prospective evaluation of parent and child outcomes following admission to a 'virtual' early parenting residential programme

OBJECTIVES

Australian early parenting residential services provide interventions for families experiencing complex early parenting issues. Many services have recently shifted to virtual care models but the clinical effectiveness of such programmes is currently unknown. This study sought to test outcomes of a 'virtual' early parenting residential programme and to compare these with those of an in-person programme.

DESIGN

Prospective cohort study; self-report questionnaires on admission, at discharge and 6-week follow-up.

SETTING

An early parenting residential unit in Sydney, Australia.

PARTICIPANTS

Consecutive series of parent-child dyads admitted to the unit virtually (n=56) or in person (n=44) between August 2021 and January 2022.

INTERVENTIONS

Participants in both groups received a 4-night/5-day intervention programme involving access to 24-hour support from a multidisciplinary team of health professionals. The in-person programme was delivered at a residential unit; the virtual programme involved provision of support via video calls, phone calls, SMS and emails.

PRIMARY AND SECONDARY OUTCOME MEASURES

Infant sleep, parenting self-efficacy (primary outcomes); parenting empathy, emotion, hostility, helplessness, mentalisation and stress (secondary outcomes).

RESULTS

Parents who received the virtual programme reported improvements from admission to discharge, and from admission to 6-week follow-up, in a range of areas including parenting self-efficacy, empathy, mentalisation, hostility, helplessness, stress and infant sleep resistance (ps<0.05). At 6 weeks, they also reported improvements in emotion and understanding related to their child (p<0.05). In contrast to expectation, outcomes at discharge and 6 weeks were not superior in the in-person group. In fact, at 6 weeks, parents who attended the virtual residential group reported significantly lower levels of parenting hostility and parenting stress, and greater levels of parenting confidence compared with those in the in-person group (ps<0.05).

CONCLUSIONS

Virtual early parenting residential interventions may be effective in bringing positive changes for families, and there is no evidence to suggest that outcomes are inferior to those of in-person programmes.

Birth related PTSD and its association with the mother-infant relationship: A meta-analysis

OBJECTIVE

There is a growing body of research showing that birth related posttraumatic stress disorder (PTSD) symptoms may impact the mother-infant relationship. The present study assessed the strength of the association between birth related PTSD symptoms and the mother-infant relationship.

METHOD

A total of twelve studies (5,572 participants) were included based on database searches using PubMed, EBSCO and ProQuest.

RESULTS

The findings showed that greater levels of birth related PTSD symptoms were associated with poorer mother-infant relationship, r = -0.36, 95% CI: [-0.43 - -0.28], random effects model. The outcomes appeared to be heterogeneous (Q(11) = 81.63, p <.001, tau2 = 0.0123, I2 = 80.73%), despite all outcomes being in the same direction as the overall outcome.

CONCLUSIONS

The results indicated that birth related PTSD symptoms are negatively associated with the mother-infant relationship. Further investigation into the prevention of birth related trauma is suggested. Improving birthing experiences for mothers is likely to contribute to improved infant mental health, thereby reducing overall social and economic costs.

Characteristics and co-admissions of mothers and babies admitted to residential parenting services in the year following birth in NSW: a linked population data study (2000-2012)

Background

There is a tiered healthcare system in Australia to support maternal and child health, including, non-psychiatric day stay and residential parenting services (RPS) such as Tresillian and Karitane (in New South Wales [NSW]). RPS are unique to Australia, and currently there is limited information regarding the healthcare trajectory of women accessing RPS and if they are more likely to have admissions to other health facilities within the first-year post-birth. This study aimed to examine differences in hospital co-admissions for women and babies admitted to RPS in NSW in the year following birth compared to non-RPS admitted women.

Methods

A linked population data study of all women giving birth in NSW 2000–2012. Statistical differences were calculated using chi-square and student t-tests.

Results

Over the 12-year timeframe, 32,071 women and 33,035 babies were admitted to RPS, with 5191 of these women also having one or more hospital admissions (7607 admissions). The comparator group comprised of 99,242 women not admitted to RPS but having hospital admissions over the same timeframe (136,771 admissions). Statistically significant differences between cohorts were observed for the following parameters (p ≤ .001). Based upon calculated percentages, women who were admitted to RPS were more often older, Australian born, socially advantaged, private patients, and having their first baby. RPS admitted women also had more multiple births and labour and birth interventions (induction, instrumental birth, caesarean section, epidural, episiotomy). Their infants were also more often male and admitted to Special Care Nursery/Neonatal Intensive Care. Additionally, RPS admitted women had more admissions for mental health and behavioural disorders, which appeared to increase over time. There was no statistical difference between cohorts regarding the number of women admitted to a psychiatric facility; however, women attending RPS were more likely to have mood affective, or behavioural and personality disorder diagnoses.

Conclusion

Women accessing RPS in the year post-birth were more socially advantaged, had higher birth intervention and more co-admissions and treatment for mental health disorders than those not accessing RPS. More research is needed into the impact of birth intervention and mental health issues on subsequent parenting difficulties.

'Stretched thin with little children' - smoking perceptions and experiences of families seeking help with parenting

Cigarette smoking is the leading preventable cause of poor pregnancy outcomes. Pregnancy is a trigger for smoking cessation yet, up to 50% of parents will relapse in the early years of their child's life. This study explored the smoking-related perceptions and experiences of 11 parents seeking professional help with the care and parenting of babies and toddlers using semi-structured interviews. Inductive thematic analysis identified three themes: parenting as a change catalyst, smoking as a parenting challenge and smoking as a coping strategy. Becoming a parent is a catalyst to reduce the associated risks and stigma associated with smoking, but maintaining rules and boundaries can be perceived as a further burden for parents who are struggling to care for their infant. When faced with difficulties with parenting, parents may revert to smoking as a coping strategy. Based on these study findings, interventions targeting gender norms may be useful in addressing smoking cessation.