Perinatal Services Research Articles

Conceptual framework on barriers and facilitators to implementing perinatal mental health care and treatment for women: the MATRIx evidence synthesis.

Perinatal mental health difficulties can occur during pregnancy or after birth and mental illness is a leading cause of maternal death. It is therefore important to identify the barriers and facilitators to implementing and accessing perinatal mental health care. Our research objective was to develop a conceptual framework of barriers and facilitators to perinatal mental health care (defined as identification, assessment, care and treatment) to inform perinatal mental health services. Two systematic reviews were conducted to synthesise the evidence on: Review 1 barriers and facilitators to implementing perinatal mental health care; and Review 2 barriers to women accessing perinatal mental health care. Results were used to develop a conceptual framework which was then refined through consultations with stakeholders. Pre-planned searches were conducted on MEDLINE, EMBASE, PsychInfo and CINAHL. Review 2 also included Scopus and the Cochrane Database of Systematic Reviews. In Review 1, studies were included if they examined barriers or facilitators to implementing perinatal mental health care. In Review 2, systematic reviews were included if they examined barriers and facilitators to women seeking help, accessing help and engaging in perinatal mental health care; and they used systematic search strategies. Only qualitative papers were identified from the searches. Results were analysed using thematic synthesis and themes were mapped on to a theoretically informed multi-level model then grouped to reflect different stages of the care pathway. Review 1 included 46 studies. Most were carried out in higher income countries and evaluated as good quality with low risk of bias. Review 2 included 32 systematic reviews. Most were carried out in higher income countries and evaluated as having low confidence in the results. Barriers and facilitators to perinatal mental health care were identified at seven levels: Individual (e.g. beliefs about mental illness); Health professional (e.g. confidence addressing perinatal mental illness); Interpersonal (e.g. relationship between women and health professionals); Organisational (e.g. continuity of carer); Commissioner (e.g. referral pathways); Political (e.g. women's economic status); and Societal (e.g. stigma). These factors impacted on perinatal mental health care at different stages of the care pathway. Results from reviews were synthesised to develop two MATRIx conceptual frameworks of the (1) barriers and (2) facilitators to perinatal mental health care. These provide pictorial representations of 66 barriers and 39 facilitators that intersect across the care pathway and at different levels. In Review 1 only 10% of abstracts were double screened and 10% of included papers methodologically appraised by two reviewers. The majority of reviews included in Review 2 were evaluated as having low (n = 14) or critically low (n = 5) confidence in their results. Both reviews only included papers published in academic journals and written in English. The MATRIx frameworks highlight the complex interplay of individual and system level factors across different stages of the care pathway that influence women accessing perinatal mental health care and effective implementation of perinatal mental health services. These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to perinatal mental health care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services; and quality training for health professionals with protected time to do it. Further research is needed to examine access to perinatal mental health care for specific groups, such as fathers, immigrants or those in lower income countries. This trial is registered as PROSPERO: (R1) CRD42019142854; (R2) CRD42020193107. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR 128068) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.

Perinatal Mood and Anxiety Disorder and Reproductive Justice: Examining Unmet Needs for Mental Health and Social Services in a National Cohort.

Perinatal Mood and Anxiety Disorders (PMADs) are the most common complications during the perinatal period. There is limited understanding of the gaps between need and provision of comprehensive health services for childbearing people, especially among racialized populations. The Giving Voice to Mothers Study (GVtM; n=2700), led by a multistakeholder, Steering Council, captured experiences of engaging with perinatal services, including access, respectful care, and health systems' responsiveness across the United States. A patient-designed survey included variables to assess relationships between race, care provider type (midwife or doctor), and needs for psychosocial health services. We calculated summary statistics and tested for significant differences across racialized groups, subsequently reporting odds ratios (ORs) for each group. Among all respondents, 11% (n=274) reported unmet needs for social and mental health services. Indigenous women were three times as likely to have unmet needs for treatment for depression (OR [95% confidence interval, CI]: 3.1 [1.5-6.5]) or mental health counseling (OR [95% CI]: 2.8 [1.5-5.4]), followed by Black women (OR [95% CI]: 1.8 [1.2-2.8] and 2.4 [1.7-3.4]). Odds of postpartum screening for PMAD were significantly lower for Latina women (OR [95% CI]=0.6 [0.4-0.8]). Those with midwife providers were significantly more likely to report screening for anxiety or depression (OR [95% CI]=1.81 [1.45-2.23]) than those with physician providers. We found significant unmet need for mental health screening and treatment in the United States. Our results confirm racial disparities in referrals to social services and highlight differences across provider types. We discuss barriers to the integration of assessments and interventions for PMAD into routine perinatal services. We propose incentivizing reimbursement schema for screening and treatment programs; for community-based organizations that provide mental health and social services; and for culture-centered midwife-led perinatal and birth centers. Addressing these gaps is essential to reproductive justice.

BARRIERS FACED BY REFUGEE WOMEN AND BIRTHING PEOPLE ACCESSING UK PERINATAL MENTAL HEALTH SERVICES

Refugee women and birthing people are at much higher risk of perinatal mental health disorders compared to the general population. Numerous barriers to accessing perinatal mental health services exist for this population, on individual, sociocultural, organisational and structural levels, contributing further to the risk of perinatal illness. Changes to care are crucial to reducing already widening perinatal mental health inequalities between refugee and host country service users.

Psychological intervention priorities according to perinatal women who experienced suicidal thoughts and perinatal mental health professionals: a Q-methodology study.

Suicide is the leading direct cause of maternal death in the year following birth and the second leading cause during pregnancy, in the UK and Ireland. Currently no evidence-based psychological interventions exist specifically designed to reduce mothers' suicidal experiences during the perinatal period. Reducing suicidal ideation and behaviour in mothers is a priority to prevent deaths and lessen the distress felt by mothers and their families. As Q-methodology measures the consensus and disagreement between individuals on a given topic, the current study used Q-methodology to elicit the priorities for a future psychological intervention aimed at reducing suicidal ideation and behaviour during the perinatal period, from the collective perspectives of both mothers and professionals. As part of this Q-methodology study, we developed a Q-set of 75 statements pertaining to possible elements of a psychological intervention that might help reduce a mother's suicidal ideation and behaviour during the perinatal period. Mothers and professionals were recruited via perinatal mental health services and social media advertisements. Twenty-one mothers and 11 perinatal mental health professionals ranked each Q-set statement depending on its perceived importance in developing a new intervention. A centroid factor analysis was conducted and two factors, which accounted for 42% of the overall variance, were identified: Factor 1 "supporting the mother to create distance between herself and the appeal of suicide" and Factor 2 "establishing positive connections with the therapist, the baby and motherhood." All participants believed that developing plans to keep the mother safe from suicide was the most important aspect for inclusion in a future intervention. Participants who loaded onto Factor 1 also prioritised supporting mothers to learn more about triggers for their suicidal ideation and behaviour. Ensuring a robust therapeutic alliance was more important for those who loaded onto Factor 2. This is the first study using Q-methodology to explore the psychological intervention priorities of mothers and professionals. Findings indicate clear priorities in terms of planning and coping during a crisis, endorsed by all participants, and provide an initial step in the development of a new perinatal suicide prevention intervention.

California's Comprehensive Perinatal Services Program and birth outcomes.

California's Medicaid (Medi-Cal) sponsors Comprehensive Perinatal Services Program (CPSP), a program with enhanced perinatal care for women (more education, nutritional supplements, and psychosocial counseling/support). Past evaluations of CPSP's effectiveness in birth outcomes were limited to pilot programs and yielded mixed results. We used 2012-2016 California's statewide data about singleton live births with any receipt of prenatal care (N = 2,385,811) to examine whether Medi-Cal with CPSP enrollment was associated with lower odds of preterm birth (PTB), spontaneous PTB, and low birthweight (LBW) than non-CPSP births. With three binary variables of PTB, spontaneous PTB, and LBW as the response variables, three multilevel logistic models were used to compare the outcomes of participants enrolled in Medi-Cal with CPSP against those with private insurance, adjusting for maternal factors and county-level covariates. Logistic models showed that participants enrolled to Medi-Cal with CPSP [n (%) = 89,009 (3.7)] had lower odds of PTB, spontaneous PTB and LBW, respectively, as compared with those with private insurance [n (%) = 1,133,140 (47.2)]. Within the Medi-Cal sub-population, the CPSP enrollment was associated with lower odds of PTB, SPTB and LBW than Medicaid beneficiaries without CPSP [n (%) = 967,094 (40.3)]. With statewide data, these findings revealed a robust link between CPSP enrollment and better birth outcomes. Expanding access to comprehensive prenatal services could be an important strategy to improve birth outcomes.

Compassion focused therapy for women in the perinatal period: a summary of the current literature.

Compassion focused therapy (CFT) is emerging as an effective psychological intervention to treat those experiencing mental health difficulties. CFT was adapted for women who are mothers during the perinatal period (from conception to 2 year postpartum). Although CFT is being delivered in NHS perinatal mental health services in the United Kingdom (UK), its current evidence-base for the treatment of women's mental health problems is unclear. As part of this Mini Review, we aimed to identify the current findings relating to CFT for women in the perinatal period (with or without a mental health condition) in order to identify any associated future research and clinical implications. A systematic search of two databases was undertaken. Included studies were required to meet the following criteria: (1) offered an intervention using CFT or perinatal CFT (P-CFT), (2) participants were women in the perinatal period, and (3) studies used a pre- and post-intervention study design. No language restrictions were used. A narrative synthesis was then conducted. Five studies, dating from 2018 to 2023, met the inclusion criteria. A total of 1,258 participants were included across those studies. Significant improvements in compassion-based outcomes (i.e., self-compassion, self-criticism/self-reassurance) were observed. However, these findings were primarily derived from non-clinical samples (n = 4) and could only be seen as preliminary. Although these results are encouraging for mothers presenting with sub-clinical mental health symptoms, further research is clearly warranted to determine whether CFT/P-CFT may benefit mothers, including those presenting with more significant perinatal mental health difficulties.

Screening for perinatal depression and stress: a prospective cohort study.

There is currently a heightened need for perinatal medical services to timely recognize and accurately meet the psychological needs of pregnant women. Psychological disturbances a mother experiences during pregnancy, such as depression and anxiety, can be later associated with inadequate maternal capacity for antenatal care for herself and the baby, and may lead to subsequent mental health problems later in the mother's life. Routine prenatal assessment could significantly benefit from being proactively enriched with early prevention mental health screening tools to assess, appropriately manage vulnerable populations, and subsequently implement preventive actions. 178 pregnant women, under routine prenatal medical assessment, were measured regarding depressive symptomatology and stress, through the use of two validated psychometric tools (the Edinburgh Postnatal Depression Scale (EPDS) and the Perceived Stress Scale (PSS-14)). Heightened perceived stress and depressive symptomatology levels were associated with younger maternal age, an obstetrical record of more than one births and a history of abortion. Results additionally showed a connection between the requirement for a psychiatric referral-based on the levels of symptomatology recorded through the psychometric assessment and a clinical interview-and currently running the earlier stages (weeks) of pregnancy. Our revised proposed prenatal screening protocol for depression and stress suggests an amplified follow-up assessment including all pregnant women scoring high in both depression and in perceived stress, regardless of previous history of prenatal depression or of suicidality, to detect earlier or less manifest expressions of distress during pregnancy, in vulnerable perinatal populations.

The Better Start Bradford Perinatal Support Service Peer – Support Changing Lives

Better Start Bradford (BSB) is one of five ‘A Better Start’ programmes in England set up and funded by The National Lottery Community Fund. Sister sites are in Southend, Blackpool, Lambeth and Nottingham. Our aim is to improve the life chances of babies and very young children in the three most deprived wards in Bradford by changing the way services are commissioned and delivered, involving parents as equal partners. In partnership with parents, we are developing and testing ways to improve children’s diet and nutrition, social and emotional development, speech, language and communication. As well as this, we aim to bring about systems change – change, for the better, the way that local health, public services and the voluntary and community sector work together with parents to improve outcomes for children. We are finding out what works so we can share it to promote wider change. To do this we have commissioned and set up over 20 individual projects during the eight years which the programme has run and we are evaluating their impact with colleagues at Born In Bradford. The perinatal support service is one of these projects.

Specialist perinatal mental health services: future developments to meet the needs of families.

Specialist perinatal mental health services: future developments to meet the needs of families.

Qualitative Study of Perinatal Mental Health Services: Experiences and Perspectives of Health Workers and Patients

The perinatal period is a transitional period that is vulnerable to changes in women's relationships with partners, family, friends, and wider social networks. This study aims to determine how perinatal mental health services are based on the experiences of health workers and patients. This research is qualitative research with a case study design. The informants in this study were 6 informants, namely 2 health workers and 4 patients with a history of perinatal mental health disorders. The instruments used in this study were structured interview guidelines, interviews were conducted in health facilities and patients' homes. Thematic data analysis using the Collaizi protocol. Qualitative data from this study raised six themes, namely "symptoms of perinatal mental health disorders", "causes of perinatal mental health disorders", "management of mental health disorders", "prevention of perinatal mental health disorders", "barriers to perinatal mental health services", and "support". Pregnant, maternity and postpartum women are vulnerable to mental health problems, especially if a woman is faced with family neglect and lack of husband's support during pregnancy. It is important for health workers, especially midwives, to examine women's problems more comprehensively during antenatal care.

Revisiting the Mackey Childbirth Satisfaction Rating Scale: Spanish adaptation, factor analysis, and sources of construct validity.

Women's dissatisfaction with perinatal health care services is associated with poor postpartum outcomes for the mother and the baby. The Mackey Childbirth Satisfaction Rating Scale is a frequently used measure of women's childbirth satisfaction. However, its factor structure has been inconsistent across investigations. The goal of this study was to evaluate the psychometric properties of the scale (i.e., factor structure and sources of validity evidence). This study is a descriptive prospective investigation. Participants included 106 pregnant women (mean age = 31.86, SD = 4.12) recruited from a public university hospital situated in South Madrid. Sources of construct validity of the Mackey were explored with the Women's View of Birth Labor Satisfaction Questionnaire. Sources of criterion validity were investigated with measures of pain (labor, delivery, and just after birth) and post-traumatic stress symptoms. Minor adaptations in item distribution resulted in an adequate fit of the original six-factor solution of the Mackey scale (i.e., oneself, the partner, the baby, the nurse, the physician, and overall satisfaction). Sources of validity evidence supported the construct and criterion validity of the scale. Obtaining a psychometrically and conceptually sound factor solution is fundamental when validating a scale. With the present study, researchers and clinicians (e.g., midwives) will be able to measure women's childbirth satisfaction in a more robust manner. Both antecedents and consequences of satisfaction were found to correlate with several satisfaction subscales, which might help guide prevention programs in mother care in a more efficient way.

Implementing a National Navigation Service for Perinatal and Infant Mental Health: Early Learnings from the ForWhen Model.

ForWhen is an Australia-based national navigation service aimed at helping parents and carers navigate the perinatal mental health service landscape and connect them with appropriate support and clinical services. The current study forms part of a mixed-methods evaluation of the ForWhen program. Semi-structured interviews were conducted with ForWhen navigators during the early design and implementation phases of the service. Results were used to characterise the ForWhen navigator activities and responsibilities, identify navigator core competencies, and examine facilitators and barriers to successful implementation of a large-scale navigation program for perinatal and infant mental health. Further research will be crucial for evidencing the utility and potential of navigation models in addressing identified issues with access to treatment for perinatal and infant mental health issues.

Participatory research with women in the perinatal period: Considerations for reflexive, community-oriented and power-sensitive research practices

This article provides an account of using reflexive participatory methods including study advisory group membership to evaluate a perinatal wellbeing service in an economically deprived area of Scotland. There is little qualitative research that explores the experiences of women accessing perinatal mental health services. This article draws on feminist values and narrative theory to explore the practice, process and ethics of using participatory methods with women in the perinatal period. We explore the blurring of intervention and research group boundaries to consider the service and study advisory group as a space which provided the conditions for collective care and re-storying the self. We explore the study advisory group as an extension of the intervention itself, highlighting the role of community in research practices and in interventions, for women who experience perinatal mental health difficulties. We reflect on the ‘sticky’ practice of navigating epistemic and decision-making power in participatory research, including the dual positionalities of being two academic researchers who come to research with therapeutic training in counselling, psychotherapy and social work. We call for reflexive, community-oriented and flexible approaches when using participatory methods with populations that might be considered vulnerable, marginalised or stigmatised.

Mixed-methods evaluation of home visiting workforce wellbeing and telework in Florida

ObjectivesTo examine the impact of telework on the well-being and quality of life of Florida’s perinatal home visiting workforce. MethodA mixed-methods follow-up evaluation of telework experiences and practices among Florida home visitors during the COVID-19 pandemic was conducted. Data was collected via a 22-question statewide survey and 30 questions from the Professional Quality of Life Measure (ProQOL). ResultsStaff felt supported by their organizations in working from home (telework) during the pandemic, and quality of life indicators suggest that many were thriving. Some staff reported that additional technological and emotional support is needed. Virtual home visiting services were reported as convenient, comfortable, and timesaving, although barriers such as lack of client engagement and difficulty maintaining work-life balance were mentioned. ConclusionsThis evaluation provided an update on telehealth perinatal support services and the overall wellbeing of home visiting employees during the COVID-19 pandemic. Our findings suggest that virtual or hybrid services may be appropriate for some home visitors and families, although more evaluation of families’ perspectives is needed. Policy implicationsFlexible telework arrangements, with corresponding flexibility in virtual or hybrid services delivery, should be considered to support home visits and families following the COVID-19 pandemic.

A71Evaluation of a co-produced Simulation Based Perinatal Mental Health Programme

NHS England’s Long-Term Plan for Mental Health highlights need to develop PNMH services and train staff ensuring service user involvement [1]. Women experiencing PNMH disorders often initially present to non-specialist healthcare professionals (NSHCP), meaning that they need specific training in assessment and management of PNMH disorders. A co-produced and co-facilitated simulation-based training programme in perinatal mental health was developed in 2019 by Sussex Partnership Specialist Perinatal Service in conjunction with University Hospital’s Sussex Simulation team. Primary Aim: Evaluate self-reported changes in confidence and competence of learners attending perinatal mental-health (PNMH) simulation training across multiple domains relating to assessment and management of PNMH problems. Secondary Aims: Evaluate impact of service user co-facilitation on PNMH simulation training; Assess whether participant demographics reflect training’s target professional groups. Service User Consultants (SUCs) were employed as faculty members and trained in simulation facilitation alongside professional faculty. Scenarios were developed in a multidisciplinary workshop, and aligned to the Health Education England (HEE) Competency framework in PNMH. Courses were co-facilitated by a Perinatal Psychiatrist and SUC. Data on participants’ confidence and knowledge across the competency framework domains was collated using a survey monkey questionnaire, pre and post-course. 242 responses were collected from participants from more than ten different staff groups e.g. junior doctors, (18%), health visitors (17%) & midwives (26%). Participant confidence improved significantly across all training domains. 93.5% of participants graded contribution of SUCs either useful or very-useful. 99.2% found the simulation training useful or very-useful, with all participants agreeing their future practice would consequently change. The simulation-based training programme increased confidence and understanding of NSHCPs from across the PNMH care pathway, on a number of domains set by HEE PNMH competency framework. Participants were overwhelmingly in support of SUC involvement in the provision of valuable training which resembled real-life clinical encounters via scenarios.

A systematic review of clinical psychological guidance for perinatal mental health

BackgroundGuidelines on psychological and/or psychosocial assessment and intervention in the perinatal period can provide beneficial practice guidance for healthcare professions to reduce maternal distress and potential mortality. As little is known about the similarities in recommendations across guidelines, which could impact the quality of therapeutic intervention women receive, this systematic review was conducted to draw out the consistent guidance for perinatal psychological and/or psychosocial therapeutic input.MethodEight literature and two guideline databases were searched alongside guideline development institutions, and organisations of maternity or perinatal mental health care. All relevant guidance was searched for and extracted before guideline quality was assessed using the AGREE-II instrument. Included guidelines had a primary or secondary focus on psychological assessment and therapeutic intervention for perinatal mental health difficulties. Using a narrative synthesis approach, recommendation consistencies and inconsistencies were outlined.ResultsFrom the 92 records screened, seven guidelines met the inclusion criteria. Only two guidelines were rated high (> 80%) across all assessed domains, with the other guidelines scoring between poor and excellent across domains. Highest rated domains across all seven guidelines were clarity of presentation (75%) and scope and purpose (70%). Recommendations for structured psychological assessment and intervention were most commonly reported in the guidelines; however, the level of detail and depth of information varied across guidelines. Whilst assessment and intervention recommendations for mother-infant dyad and partners were considered, research into working therapeutically with these client groups in perinatal mental health services is only just emerging. Hence, guideline recommendations for working with the mother-infant dyad and partners were based on consensus of expert opinion.ConclusionPerinatal mental health guidelines were consistent in scope but showed considerable variability in quality and depth of recommendations, which could have implications for standards of clinical practice. However, there is still a need to improve the evidence underpinning recommendations in perinatal mental health guidelines to advance the implementation of psychological and/or psychosocial interventions. High quality interventions in the perinatal period could improve outcomes for women and their families.

Fifty years of evidence on perinatal experience among refugee and asylum-seeking women in Organization for Economic Co-operation and Development (OECD) countries: A scoping review.

Members of the Organization for Economic Co-operation and Development (OECD) play a significant role in hosting and supporting refugees. Refugees and asylum seekers in OECD countries may face unique challenges in accessing perinatal healthcare. These challenges can impact their use of and experience with perinatal health services leading to poor maternal and infant outcomes. This scoping review describes the general trends in perinatal health research among refugees/asylum seekers in OECD countries over the past fifty years (1970 to 2021) as well as summarizes their perinatal experience. Databases including Embase and Medline were searched using relevant key words for "refugee/ asylum seeker", "perinatal ", and " OECD countries.". Articles were excluded if they only involved economic migrants or internally displaced persons, conducted in non-OECD countries, only assessed health behaviors and practices during pregnancy (e.g., smoking), or were published in a language other than English. The final list of articles included 82 unique studies. In the 40 years between 1970 and 2009, very few studies (n = 9) examined perinatal health among refugees/ asylum seekers in OECD countries. However, an increasing trend was observed over the past decade. Early studies (1980 to 2009) focused more on traditional perinatal outcomes; however, from 2010 onwards, studies related to perinatal experience were more likely to emerge in the global health literature. Access to timely prenatal care remains a challenge with failure to address the root causes of the problem in several OECD countries including those with a long history of hosting refugees. The limited availability of interpretation services and the lack of a patient-centered approach to care have also interfered with the perceived quality of care. In addition, perceived isolation and the limited social support experienced by this vulnerable population have negatively impacted their perinatal experiences in several OECD countries. Refugee/asylum seekers in OECD countries face a number of challenges during the perinatal period. Policy changes and further research are needed to address access barriers and identify specific interventions that can improve their well-being during this critical period.

How do patient and care experience data inform policy and practice? Insights from the Irish National Care Experience Programme

Abstract Issue Patient experiences are central to the delivery of quality, person-centred care and an important predictor of outcomes. Prior to 2017, there was no unified, national approach to the collection of care experience data in Ireland. Description of the problem The National Care Experience Programme is a partnership between a regulator, policy makers and the Irish public health service, with a suite of surveys of inpatient, maternity, nursing home and end of life care. The surveys aim to learn from people's feedback on health and social care services to identify areas of good experience and areas requiring improvement. Results Findings have informed national policies, including a healthcare communication programme to support staff to develop communication skills with patients and families. Survey data provide a key input to the Irish health quality indicator framework and the Health Systems Performance Assessment Framework, which assess the overall performance of the Irish health system. National Maternity Experience Survey results informed the allocation of funding for post-natal supports and new lactation consultant posts, and supported the implementation of a specialist perinatal mental health services model of care, leading to increased diagnosis and vigilance of mental health issues ante- and postnatally. National Nursing Home Experience Survey findings supported legislative amendments, including provision for the delivery of in-person advocacy awareness campaigns and the strengthening of complaints processes within nursing homes. Lessons In order to maximise the use of survey findings and ensure the voices of people using health and social care services are acted on, routine surveying of care experiences is required to track the impact of policy and practice initiatives. The programme is currently expanding to include people's experiences of cancer care and mental health services, in addition to exploring options for continuous, local care experience surveys.

Psychometric properties of the European Portuguese version of the modified perinatal PTSD questionnaire (PPQ-II)

Childbirth-related posttraumatic stress symptoms (CB-PTSS) are prevalent and have pervasive consequences for the entire family. The development and validation of tools for screening CB-PTSS are deemed necessary to maximize prevention and intervention efforts. This study aims to examine the psychometric properties of the modified perinatal PTSD questionnaire (PPQ-II) in a sample of European Portuguese mothers. Four hundred and fifty-one women, from 1 to 18 months postpartum, participated in an online cross-sectional study that was conducted between February and March 2020. Participants completed the PPQ-II and the Depression Anxiety Stress Scales – 21 (DASS-21). Factor structure was estimated through an Exploratory (EFA; n = 229) and Confirmatory factor analysis (CFA; n = 222). Convergent and known-groups validity and internal consistency of the scale were also computed. The EFA suggested a 2-structure factor (Factor 1 “Arousal”, containing 7 items; and Factor 2 “Avoidance and Intrusion”, containing 4 items), accounting for 48.3% of the total variance of the scale. This factor structure was supported by the CFA, showing an adequate fit to the data. Convergent validity was shown by significant associations between the PPQ-II and DASS-21 subscales. Overall, the scale discriminated between at-risk and low-risk mothers. The McDonald’ omega coefficients attested the high reliability of the PPQ-2 (ranging from 0.78 to 0.89). The PPQ-II is a valid and reliable instrument to routinely screen for CB-PTSS in perinatal health services. It also adds to prior studies demonstrating its cross-cultural validity.

O082 A Survey to explore the Knowledge and Education needs of Perinatal Health Professionals to support the Provision of Inclusive Care to Transgender people in Aotearoa New Zealand

Abstract Background International literature shows that transgender teens and young adults are more likely to report insomnia compared to cis-gendered individuals of the same age – often linked with discrimination or minority stress. Trans people often encounter health providers with limited knowledge of gender diversity. Objective to understand the education needs, knowledge, and attitudes of the perinatal health workforce in New Zealand when providing care for trans people. Methods Interviews with trans people who had engaged with perinatal services, informed the development of a workforce survey, alongside extensive consultation with Māori, health professionals and trans community groups. The survey was shared with perinatal care providers via their professional organisations and social media. It included questions about strategies utilised in their clinical practice towards trans inclusion, previous education opportunities and current needs, as well as attitudes towards gender diversity. Results Survey participants (n=476) reported using multiple strategies when providing inclusive practice for trans people. Gaps in knowledge to support inclusive practice were identified, along with support needs to ensure perinatal care providers are resourced to provide culturally safe and affirming care for trans people and whānau/families. Most respondents had not received education on gender-inclusive care but three quarters of them reported they would access this if available. Conclusions Survey results identified strategies for inclusive care as well as knowledge gaps, in relation to meeting trans people’s perinatal care needs. Findings led to recommendations for education, practice and policy which could readily apply to those supporting trans people to improve their sleep health.