Promoting Attachment Through Healing (PATH): Results of a retrospective feasibility study providing trauma‐and‐violence‐informed care to pregnant women

Abstract

Aim To evaluate the impact of a trauma and violence‐informed cognitive behavioural therapy (TVICBT) intervention, compared with standard care on mental health, coping, bonding and maternal‐infant attachment among pregnant women with a history of intimate partner violence and who displayed symptomatology consistent with anxiety, depression or post‐traumatic stress disorder (PTSD). Design A mixed‐methods case study design was employed, where women either received standard perinatal care or were referred to a specialized TVICBT program. Methods Data were collected through a retrospective obstetric medical chart audit in 2017 at an Ontario hospital in a large urban centre. Multiple choice and ‘yes/no’ questions were analysed using measures of central tendency and dispersion, in addition to frequency counts. Qualitative data from clinical notes were subjected to an inductive content analysis approach to identify key concepts. Results In total, 69 women participated (intervention group = 37, standard care group = 32). Prevalence of mental illness between groups was consistent, apart from the TVICBT group having a significant increase in PTSD. In the TVICBT group, 83.8% of women (n = 31) expressed perinatal concerns, compared with only 37.5% (n = 12) of the standard care group. More women in the intervention group (94.6%, n = 35) coped successfully in the intrapartum period than the standard care group (78.1%, n = 25). However, more women in the standard care group (97.0%, n = 31) exhibited appropriate bonding behaviours than the TVICBT group (88.6%, n = 31). Conclusion The TVICBT intervention was effective in assisting women to identify triggers during their pregnancy journey, develop appropriate coping strategies and advocate for their needs to best cope. Impact TVICBT offers an effective, individualized, trauma and violence‐informed approach to optimize the health outcomes of perinatal women and their infants by promoting positive coping and maternal‐infant bonding, thus filling an existing practice gap of a lack of individualized, trauma‐informed care.

Advancing nursing's response to the wicked problem of intimate partner violence

“…Researchers in nursing and health services are actively engaged in developing and evaluating new interventions to address the health effects associated with violence exposure. For pregnant women who have experienced IPV, the provision of 12 sessions of trauma-and violence-informed cognitive behavioural therapy by a clinical nurse specialist is showing promise as an intervention to identify potential triggers in pregnancy, develop appropriate coping strategies and advocate for their needs to best cope with their stressors and pain (Mantler et al, 2023). Similarly, for nurses working with perpetrators of violence, a nurse-led, 15-session videoconference-delivered cognitive behavioural group therapy is also showing promise as an intervention where participants report high levels of satisfaction and completion (Nesset et al, 2023).…”

Child Abuse during the Pandemic and Trauma-Informed Care: A Review of Evidence-Based Literature

“…Authors of the Promoting Attachment through Healing (PATH) study employed a different programmatic approach using cognitive behavioral therapy (CBT) and trauma-and-violence-informed care during the perinatal time [26].…”

“…As an example, more women in the TVICBT group indicated that they "prefer no males" before receiving care. During the intrapartum period, researchers reported that 94.6% of TVICBT (35/37) women coped successfully compared to 78.1% (25/32) of women who received standard care [26].…”

Interventions for intimate partner violence during the perinatal period: A scoping review

“…A wide variety of therapeutic approaches have been used to provide support to survivors of perinatal IPV, such as cognitive behavioral therapy (CBT) (Mantler et al, 2022 ), motivational interviewing (Sapkota et al, 2022 ), and problem‐solving therapy (Nakku et al, 2021 ). Counseling sessions are often integrated into pre‐existing prenatal care visits or added as a supplementary program.…”