Listening Visits Research Articles

Implementation of Listening Visits with Parents of Preterm Infants in an Italian Neonatal Intensive Care Unit.

To assess the feasibility of implementing Listening Visits (LV) in an Italian neonatal intensive care unit (NICU). This feasibility implementation of LV included empathic listening and problem-solving sessions provided by a psychologist to 26 parents of hospitalized preterm newborns. Using the RE-AIM implementation framework, three facets of feasibility were assessed: reach, adoption, and implementation. It is feasible to integrate LV into the NICU: 76% of families were willing to try LV (reach). Listening Visits recipients reported high satisfaction. Twelve of the 16 families (75%) received six or more LV sessions (adoption), with mothers attending more sessions. Implementation fidelity, defined here as the percentage of LV recipients that received at least four sessions, was 94% among mothers and 30% among fathers. The LV intervention for parental support during the NICU stay is feasible and deemed helpful by parents. Parents were motivated to participate even though their levels of depression, stress, and anxiety were not high. In addition to the use of standardized screening questionnaires, parental requests and clinical team indications should be included in the decision-making for the provision of parental support services.

Telehealth Listening Visits for emotionally distressed mothers of hospitalized newborns: Proof-of-concept.

Newborn admission to the neonatal intensive care unit (NICU) is stressful. Yet in clinical practice, at best, NICU mothers are screened for depression and if indicated, referred to a mental-health specialist. At worst, no action is taken. Listening Visits, an empirically supported nurse-delivered intervention addressing emotional distress, can be conveniently provided by a NICU nurse. Prompted by the need to minimize face-to-face contacts during the pandemic, the primary purpose of this small pilot trial was to assess the feasibility of having nurses provide Listening Visits to NICU mothers over Zoom. Secondarily, we assessed pre-to post-Listening Visits depression symptom scores as a preliminary evaluation of the effectiveness of this type of support. Nine NICU mothers with mildly to moderately severe depression symptoms received up to six Listening Visits sessions from a NICU nurse via Zoom. Participants completed the Inventory Depression and Anxiety Symptoms-General Depression scale (IDAS-GD) at study entry and 4- and 8-weeks post enrollment. They completed the Client Satisfaction Questionnaire (CSQ) at the 8-week assessment. Using an intent-to-treat approach, the effect of time from the mixed model analysis of IDAS-GD was statistically significant (F(2,26) = 10.50, p < 0.001), indicating improvement in IDAS-GD scores from baseline to follow-up. The average CSQ score was high (M = 29.0, SD = 3.3), with 75% of participants rating the quality of help they received as "excellent". In this pilot trial, we learned it is feasible to provide Listening Visits over Zoom, that this mode of delivery is associated with a significant decrease in depression symptom scores, and that women value this approach. [https://clinicaltrials.gov/], identifier [#201805961].

Using the TIDieR checklist to describe health visitor support for mothers with mental health problems: Analysis of a cross-sectional survey.

At least half of the 20% of mothers who experience mental health problems (MHPs) during pregnancy or after birth are not receiving the help they need that will lead to recovery. In order to identify where improvements need to be made, it is necessary to describe exactly what is being done and the barriers and facilitators that compromise or enhance optimal care. The majority of mothers experience mild to moderate anxiety or depression. The expectation is that primary care professionals, such as health visitors (HVs), can provide the support they need that will lead to recovery. The aim of this study was to explore the views of HVs regarding the content and purpose of an intervention to support mothers with MHPs, described as 'listening visits' (LVs). A link to an online survey was offered to the members and champions of the Institute of Health Visiting (n=9,474) March-May 2016. The survey was completed by 1,599 (17%) of the target population, of whom 85% were offering LVs. The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a framework to describe commonalities and variations in practice. There appeared to be a shared understanding of the rationale for LVs but a lack of agreement about what the intervention should be called, the techniques that should be used and the duration, frequency and expected outcomes of the intervention. Contextual factors such as staff shortages; conflicting priorities; the needs and circumstances of mothers; the capability and motivation of HVs; inadequate training and supervision; and the absence of clear guidance contributed to variations in perceptions and practice. There are many ways in which the HV contribution to the assessment and management of mothers with MHPs could be improved. The intervention delivered by HVs needs to be more clearly articulated. The contextual factors influencing competent and consistent practice also need to be addressed.

Moving beyond depression screening: integrating perinatal depression treatment into OB/GYN practices.

In 2015, the American College of Obstetricians and Gynecologists issued a recommendation to screen women for depression and anxiety symptoms at least once during the perinatal period. Nevertheless, many identified women will not receive care from a behavioral health specialist. Listening Visits (LV), developed for delivery by nurses and validated in the United Kingdom, have recently been evaluated in a US-based randomized controlled trial (RCT) which recruited research participants from three home-visiting programs and an urban OB/GYN practice. RCT results indicated clinically and significant improvement in depression symptoms. To bridge the gap between evidence and practice, and based on experiences garnered at the OB/GYN site during the RCT, this development paper proposes a strategy for implementing depression screening and LV into routine clinical care in this practice setting.

Depression Management by NICU Nurses: Mothers' Views.

The purpose of this article was to evaluate attitudes of mothers of newborns hospitalized on the neonatal intensive care unit (NICU) toward nurse-delivered depression screening and counseling. NICU mothers (N = 200) completed questionnaires assessing their views toward being screened for depression by nurses, treatment provider preference, and interest in learning about Listening Visits (LV), a nurse-delivered intervention. The views of 23 LV recipients were also assessed. Most mothers were receptive to depression screening by nurses, two thirds would see a nurse for counseling, and half were interested in learning more about LV. Among LV recipients, half readily embraced the idea and the remaining recipients were skeptical but opted to try. After receiving LV, recipients unanimously rated LV and the skill of the LV provider highly. Screening and counseling by NICU nurses could increase detection of depression and treatment use among at-risk women. Assessing nurses' perspectives about implementing this model of care is an important future research direction.

Depression treatment for impoverished mothers by point-of-care providers: A randomized controlled trial.

Depression in low-income, ethnic-minority women of childbearing age is prevalent and compromises infant and child development. Yet numerous barriers prevent treatment delivery. Listening Visits (LV), an empirically supported intervention developed for delivery by British home-visiting nurses, could address this unmet mental health need. This randomized controlled trial (RCT) evaluated the effectiveness of LV delivered at a woman's usual point-of-care, including home visits or an ob-gyn office. Listening Visits were delivered to depressed pregnant women or mothers of young children by their point-of-care provider (e.g., home visitor or physician's assistant), all of whom had low levels of prior counseling experience. Three quarters of the study's participants were low-income. Of those who reported ethnicity, all identified themselves as minorities. Participants from 4 study sites (N = 66) were randomized in a 2:1 ratio, to LV or a wait-list control group (WLC). Assessments, conducted at baseline and 8 weeks, evaluated depression, quality of life, and treatment satisfaction. Depressive severity, depressive symptoms, and quality of life significantly improved among LV recipients as compared with women receiving standard social/health services. Women valued LV as evidenced by their high attendance rates and treatment satisfaction ratings. In a stepped model of depression care, LV can provide an accessible, acceptable, and effective first-line treatment option for at-risk women who otherwise are unlikely to receive treatment. (PsycINFO Database Record

Implementation of an Innovative Nurse-Delivered Depression Intervention for Mothers of NICU Infants

Depression affects approximately 19% of all postpartum women, and mounting evidence indicates increased risk for mothers of preterm infants, with prevalence estimates ranging from 28% to 67%. The current approach to management of maternal symptoms related to postpartum depression in the neonatal intensive care unit (NICU) ranges from no intervention to depression screening and referral. For depressed mothers of NICU infants, obtaining treatment is especially difficult and usually becomes a secondary priority; thus, we looked to a nurse-delivered counseling model. Listening visits (LV) are an empirically supported nurse-delivered intervention that focuses on relationship building and exploration of a mother's problems through active reflective listening and collaborative problem solving. An LV open trial in the NICU has been conducted to evaluate the effectiveness of this intervention for mothers of hospitalized infants. Results indicate that LV are associated with a reduction in both maternal depressive and anxiety symptoms. This case study following the description of the intervention demonstrates how the authors used the experiences from the NICU open trial to expand the application of LV to this new setting.

Emotional distress in mothers of preterm hospitalized infants: a feasibility trial of nurse-delivered treatment

ObjectiveMothers of preterm infants in a hospital neonatal intensive care unit (NICU) are at risk for clinically significant depression and anxiety but, for these women, their own treatment is likely a secondary priority. This study evaluated the feasibility, acceptability, and effectiveness of an evidence-based, nurse-delivered, on-site depression treatment: Listening Visits.Study DesignTherapeutic Listening Visits were delivered on site to 23 distressed mothers of NICU infants. The intervention was conducted by a neonatal nurse practitioner; and the outcome examined in an open-trial, pre-post evaluation.ResultsA part-time nurse practitioner delivered six Listening Visits to each participant within a one-month timeframe. Listening Visits were associated with significantly improved mood and well-being in mothers. The majority of eligible women took advantage of Listening Visits and felt satisfied with their care.ConclusionsThis open trial provides “proof of concept”, with results that warrant further evaluation in a multisite randomized controlled trial.

Implementation of an Evidence-Based Depression Treatment Into Social Service Settings: The Relative Importance of Acceptability and Contextual Factors

Listening Visits (LV), an empirically supported depression treatment delivered by non mental health specialists, were implemented into two distinctly structured programs. The relative importance of providers' views and organizational context on implementation were examined. Thirty-seven home visitors completed pre- and post-LV training surveys assessing their views toward implementing LV. Implementation rates markedly differed in the two organizations (73.9% vs. 35.7%). Logistic regression results showed that when predicting the implementation rate, the impact of the organizational setting outweighed home visitors' personal views. These results underscore the importance of organizational context in the implementation of empirically supported treatments.

Women's experiences of health visitor delivered listening visits as a treatment for postnatal depression: A qualitative study

Objective To explore women's experiences of health visitor delivered listening visits as a treatment for postnatal depression. Methods In-depth interviews with 22 women who had received listening visits as a treatment for postnatal depression. Results All the women reported the visits as beneficial, although many of them had required additional intervention to manage their symptoms. Women who had a previous history of depression and women whose depression was not attributed to events in the postnatal period perceived the listening visits to be less beneficial. Receiving visits from a research health visitor, rather than their practice health visitor, was felt to be advantageous. Conclusion Women with postnatal depression may report listening visits as helpful but insufficient to manage their depression. The extent to which women report listening visits as beneficial appears to be linked to the causes of their depression, the way in which the visits are delivered and by whom. Practice implications Practitioners managing women with postnatal depression should discuss possible causes and previous episodes of depression before suggesting listening visits as a treatment. They need to explain what the visits will entail, ensure that additional types of treatment remain available and encourage women to utilise other forms of support.

How do women with postnatal depression experience listening visits in primary care? A qualitative interview study

Background: Listening visits are a routine intervention offered to women with postnatal depression. Objectives: To explore the experiences of women who have received listening visits for postnatal depression. Methods: An in‐depth qualitative interview study involving a purposive sample of 39 postnatal women from patients of 22 general practices within Oxford City PCG area. This paper addresses the question: What factors affected women's experience of listening visits for postnatal depression? A qualitative thematic analysis was used. Results: Sixteen women reported receiving listening visits. The factors that made listening visits a positive experience were: (1) agreeing with a medical model for postnatal depression; (2) a good relationship with the health visitor; (3) being offered choices and options; (4) a clear and flexible process for the visits. Conclusions: This study showed that there certain conditions that needed to be met if women with postnatal depression were to view listening visits as a positive experience. These results need to be evaluated in a larger study since this intervention is already so widespread.