Providing Evidence to commissioners about the effectiveness of VIG with mums and babies
OUR AIM • It is possible to provide compelling evidence with limited budget and time • Overview of whole pilot with a case example • VIG with mothers and babies is AMAZING.
Context • Step2 Early intervention CAMHS • Bid for Community Perinatal Team • No parent –infant work • Opportunity to bid for CAMHS transformation fund
Is it possible? • 4 months to complete pilot- recruitment of participants, intervention, evaluation • Only maximum of £10,000 available initially • Assumption of average of 7 appointments per intervention and 2.5 appointments per day. • Bid for one clinician 2 days a week for 4 months, aiming to work with 10 parent –infant dyads
Referral criteria • Baby is 0- 18 months old • Difficulties are present in parent infant relationship for example -parent feels their baby does not like them or see them as special -parent feels they are not good enough/ lacks confidence -parent feels numb or feels negative about having a baby -There are concerns about the parent – infant interaction • Or there is a risk of difficulties developing in the parent infant relationship due to vulnerability factors such as parental mental health difficulties, history of unresolved loss/ trauma, difficulties parenting older children.
Evaluation methods All needed to be quick, easy and free Quantitative - PHQ9 and GAD7 ( maternal depression and anxiety - MORS ( mother’s perception of relationship with baby) - Karitane parenting confidence scale - Individualised goals for VIG
Evaluation methods Qualitative - Referrer feedback questionnaire - Modified VIG traject plan - Audiotaped feedback of mother’s experience of VIG - Case examples with video evidence - Not possible to have evaluation of quality of interaction
Challenges • Getting enough referrals but not too many! • Calculations based on appointments attended not appointments offered • Families with ongoing need at the end of the pilot • Short time scale • Calculations did not include time for meetings
Results • The results of the pilot were so well received by the commissioners they provided funding to continue the pilot for a further 7 months ( 2 clinicians one day a week each).
Quantitative results combining phase 1&2 (25 participants)
Referrer feedback • “ I have noticed that Mum does appear to have a much better bond with baby now. When she came into clinic with him, she was smiling and kissing him lots and interacting with him as she got him dressed and undressed .”
Referrer feedback • “I have referred several mothers for VIG. Each of them has had an extremely positive experience, and has benefitted clinically. One mother was ready to give her twins up for adoption when I started working with her, she felt the children would be better off without her and that life was not worth living. VIG was one of the treatments we arranged for her, but specifically I think it directly contributed to her increased confidence to see that she is a good mother that she is of great importance and value to her children and that they need her and enjoy her. She has developed a much more positive and happy relationship with them, she has more purpose to carry on.”
Referrer feedback “I have had a couple of listening visits. Mum is feeling much happier now, so much so I have closed the referral. Mum greatly benefited from the VIG and found it very interesting. Mum’s confidence in caring for her child has increased a great deal. She appeared less fraught and calmer following the VIG.”
Mother’s feedback from Traject plan My relationship with my baby - “It’s helped so much in how I bond with him and play with him. It’s like a completely different relationship” - “I have become more relaxed with my baby . A result of which means that I enjoy him more” - “I feel like I appreciate how much of a bond we have. I feel a lot closer to her.”
My development as a parent • “I have got more patience with my baby. I have started understanding him better than before. I am more confident that I am a good mum” • “I feel like I understand her a lot more. I feel like I understand what I’m doing with her – I know what I’m doing.” • “I can now go out with my babies to play groups and know that I look normal and people aren’t judging me or thinking there’s something wrong with me. I’m not as bad a mum as I thought I was.”
The development of my baby • “People kept commenting on how much my baby started to become more vocal and the music lady said my daughter was like a completely different child. She often comes and cuddles me and wants to play with me, which she never did before.” • “My baby has started to play more with me and tell me what he wants with his actions”
Other relationships within the family • “I felt like my husband got the best of my daughter. Now I feel like we are more equal. It’s helped me in my relationships with my daughter and my husband” • “It has encouraged me to share more with my partner and help him understand the benefits of the small things we do” • “My partner is glad he doesn’t have to keep convincing me I’m doing a good job anymore.”
My relationship with extended family/ friends/ wider community • “I go out with him more often and engage in various groups as I’m not worried about not being able to handle him correctly if he’s unsettled outside the comfort of the home.” • “I don’t have to rely on my family anymore. I now know I can cope and I can do this!”
Case study • First time Mum and her 3 month old baby • Previous and current mental health difficulties • Feeling unable to connect with her baby • Scared to be on her own with her baby • Mum felt she had no maternal instincts and that her baby preferred other family members
Goals • 1. To feel more confident as a mum Pre score 4 • 2. To enjoy being with my baby Pre score 2 • 3. To know my baby loves me Pre score 1
Goals • 1. To feel more confident as a mum Pre score 4 Post score 8 • 2. To enjoy being with my baby Pre score 2 Post score 8 • 3. To know my baby loves me Pre score 1 Post score 9
Pre/ post measures
Results • Commissioners convinced about the effectiveness of VIG with mums and babies • 0.5 WTE permanent post for VIG therapist created within the Community Perinatal Team.
We hope you agree VIG with mums and babies is AMAZING Any Questions? Natasha.gray4@nhs.net Emma.custance@nhs.net
Recommend
More recommend
