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.
Highlights
A secure parent-infant relationship lays the foundations for children’s socio-emotional development (Cassidy et al, 2013; Fearon et al, 2010; Fernald et al, 2013; Stams et al, 2002)
1) Health visitors’ role and the parent-infant relationship During the interviews, health visitors stressed the importance of a healthy parent-infant relationship
Some of the respondents felt that health visitors have a unique opportunity to assess and support the parent-infant relationship, as home visits help understand the wider family context: I think we have lots of influence because when we go into the family home, we’re not just assessing what that parent-infant relationship is in isolation, we’re looking at everything
Summary
A secure parent-infant relationship lays the foundations for children’s socio-emotional development (Cassidy et al, 2013; Fearon et al, 2010; Fernald et al, 2013; Stams et al, 2002). This is increasingly recognised in policy and service provision guidelines in the UK and internationally (NICE, 2012; NICE, 2015; NICE, 2020). A secure parent-infant relationship lays the foundations for children’s development, there are currently no measurement tools recommended for clinical practice. Results: Health visitors saw identification and support of the parentinfant relationship as an important part of their role, and reported benefits of the MPAS, including opening conversation, and identifying and reporting concerns. Conclusions: The experiences, benefits and challenges identified help version 1
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