Implementing the Maternal Postnatal Attachment Scale (MPAS) in universal services: Qualitative interviews with health visitors

Abstract

Background: A secure parent-infant relationship lays the foundations for children’s development, however there are currently no measurement tools recommended for clinical practice. We evaluated the clinical utility of a structured assessment of the parent-infant relationship (the Maternal Postnatal Attachment Scale, MPAS) in a deprived, multi-ethnic urban community in England. This paper answers the question: what are health visitors’ views on the parent-infant relationship, and experiences of piloting the MPAS? It explores the barriers and facilitators to implementation, and complements the paper on psychometric properties and representativeness reported in Dunn et al (2022). Methods: Semi-structured interviews were conducted with 11 health visitors and data were analysed using thematic analysis. Results: Health visitors saw identification and support of the parent-infant relationship as an important part of their role, and reported benefits of the MPAS, including opening conversation and identifying and reporting concerns. Challenges included timing and workload, the appropriateness of language, perceived intrusiveness and understanding of the questions, and the length of the tool. Suggestions for improvements to the tool were put forward. Conclusions: The experiences, benefits and challenges identified help to explain results in Dunn et al, and the wide-ranging challenges identified would hinder assessment of the parent-infant relationship in routine practice. Further work with health professionals and parents has been undertaken to co-produce an acceptable, feasible and reliable tool for clinical practice.

Study Protocol for a Randomized Controlled Trial of the Parent Child Assistance Program: A Case Management and Home Visiting Program for People Using Substances During Pregnancy

“…The SAS was developed by the investigator team, drawing primarily upon standardized scales and measures used in addictions research and related sub elds that have solid psychometric properties. The SAS elicits information from participants along several dimensions covering a wide range of participant behavior metrics and social psychological concepts important for addiction research, including criminal justice involvement, additional adverse childhood experiences (ACEs) from an expanded ACEs instrument, 30 social support, 31 maternal attachment (antenatal 32 and postnatal 33 ), mental health (PTSD 34 and psychological distress 35 ), self-esteem 36 and self-e cacy, 37 addiction beliefs, 38, 39 parenting practices, 40 and parent/child experiences 41 and child development. 42 These measures allow us to examine both predictors of success, as well as additional secondary outcomes stemming from the intervention.…”

Study protocol for a systems evaluation of an infant mental health service: Integration of ‘Little Minds Matter’ into the early years system

“…Whilst National Institute for Health and Care Excellence (NICE) guidance highlights the importance of assessing the relationship parents have with their children, there are no assessment tools recommended for use in the critical first 12 months after birth, and those recommended for pre-school children require clinical expertise to complete [ 13 ]. Consequently, healthcare professionals working in universal settings with families with young children may lack the confidence and/or ability to assess this relationship [ 14 , 15 ].…”