Improving antenatal risk assessment in women exposed to high risks

Abstract

Antenatal substance use and related psychosocial risk factors are known to increase the likelihood of child protection involvement; less is known about the predictive nature of maternal reflective functioning (RF) in this population. This preliminary study assessed psychosocial and psychological risk factors for a group of substance dependent women exposed to high risks in pregnancy, and their impact on child protection involvement. Pregnant women on opiate substitution treatment (n = 11) and a comparison group (n = 15) were recruited during their third trimester to complete measures of RF (Pregnancy Interview), childhood trauma, mental health and psychosocial assessments. At postnatal follow-up, RF was reassessed (Parent Development Interview - Revised Short Version) and mother-infant dyads were videotaped to assess emotional availability (EA). Child protection services were contacted to determine if any concerns had been raised for infant safety. Significant between-group differences were observed for demographics, psychosocial factors, trauma and mental health symptoms. Unexpectedly, no significant differences were found for RF or EA between groups. Eight women in the 'exposed to high risks' group became involved with child protection services. Reflective functioning was not significantly associated with psychosocial risk factors, and therefore did not mediate the outcome of child protection involvement. Women 'exposed to high risks' were equally able to generate a model of their own and their infants' mental states and should not be seen within a deficit perspective. Further research is required to better understand the range of risk factors that predict child protection involvement in high risk groups.

Mentalizing Makes Parenting Work: A Review about Parental Reflective Functioning and Clinical Interventions to Improve It

“…In addition, findings by Stacks et al (2014) showed that maternal reflective functioning was associated with parenting sensitivity which, in turn, was associated with infant attachment security, thus replicating previous findings (Grienenberger et al, 2005). Only Perry et al (2015) did not find any significant relationship between PI-RF, PDI-RF and maternal emotional availability in a study that, however, had some methodological flaws concerning, above all, sample size and significant delay in follow-up regarding some mother-child dyads.…”

Prenatal Reflective Functioning in Primiparous Women With a High‐risk Profile

“…These findings are in line with the majority of existing studies indicating that the presence of risk factors negatively affects mothers’ RF ability, with HR women have lower RF and more negative mental representations (Huth‐Bocks et al., ; Leigh, ; Seng & Prinz, ; Theran et al., ). An exception to the rule is a study by Perry et al (), who found similar prenatal RF levels for both HR and LR women. However, their sample size was limited and consisted mainly of multiparous women.…”

“…These factors could affect prenatal maternal RF. Maternal characteristics that have been negatively related to RF include psychiatric illness (Fonagy & Luyten, ; Levinson & Fonagy, ; Perry, Newman, Hunter, & Dunlop, ; Toth, Rogosch, & Cicchetti, ), substance use during pregnancy (Pajulo et al., ), single parenthood (Huth‐Bocks, Levendosky, Bogat, & Von Eye, ), unavailability of support from family and friends (Larney, Cousens, & Nunn, ; Sadler et al., ; Smith, ), scarcity of material resources (e.g., regarding housing or financially), and low educational attainment (Pajulo, Helenius, & Mayes, ; Rosenblum, McDonough, Sameroff, & Muzik, ; Sadler et al., ; Theran et al., ; Vrieze, ). These factors also have been used to define risk status with respect to child sociobehavioral outcomes (World Health Organization, ).…”

Maternal-fetal bonding among pregnant women at psychosocial risk: The roles of adult attachment style, prenatal parental reflective functioning, and depressive symptoms

“…In one study, pregnant woman at high risk (defined as mental health problems, substance use, or social problems) had lower P-PRF than did pregnant women at low risk, and the presence of multiple risk factors was associated with lower P-PRF scores [40]. In contrast, another study found that prenatal PRF was not associated with psychosocial risk factors or involvement with child protection services among women on opiate substitution treatment or in the comparison group [41]. To inform our understanding of potential similarities and differences between the concepts of MFB and prenatal parental reflective functioning, more evidence is needed.…”