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 evaluate 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 (submitted). 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 forwards. 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.

Born in Bradford’s Better Start (BiBBS) interventional birth cohort study: Interim cohort profile

“…Whilst assessment of, and support for, perinatal mental health is a key priority for universal midwifery and health visiting, the data systems do not support documentation of the assessments that are undertaken, with national systems unable to report on the prevalence of perinatal mental health. We have undertaken steps to improve this situation locally, including the assessment of an existing measure of the mother-child relationship 27 , 28 and the co-production and validation of a new measure for this outcome 29 , development of a proxy measure for perinatal mental health 30 , as well as additional data collection within the cohort and use of data collected within the existing interventions.…”

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 subfields 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 [ 34 ], social support [ 35 ], maternal attachment (antenatal [ 36 ] and postnatal [ 37 ]), mental health (PTSD [ 38 ] and psychological distress [ 39 ]), self-esteem [ 40 ] and self-efficacy [ 41 ], addiction beliefs [ 42 , 43 ], parenting practices [ 44 ], and parent/child experiences [ 45 ] and child development [ 46 ]. These measures allow us to examine both predictors of success, as well as additional secondary outcomes stemming from the intervention.…”

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.…”