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WA Perinatal Mental Health Unit presents

2009 Symposium

Embracing the Bigger Picture More than Postnatal Depression 7 October 2009 The Boulevard Centre, Floreat Contents:

Page

Welcome 2

Programme 3

Presenters 4

Breakfast presentation 6

Keynote presentations 7

Abstracts

Papers 9

Posters 16

Other information 20

Resource ordering information 22

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Welcome _________________________________________________________________________________________________

On behalf of the State Perinatal Mental Health Reference Group Education

Sub-Committee, welcome to a day of exploring the journey of parenthood from

the eyes of the infant, parents, health professionals, consumers and carers.

The presenters today are highly regarded in their respective fields and reflect

evidence-based research in their presentations and evolving programmes.

The aim of the day is to explore emerging trends such as anxiety and trauma

in the perinatal period, and increase awareness that there are many points

of entry into the perinatal mental health arena.

Thank you and enjoy the day’s events.

Lea Davidson

Education and Training Officer

WA Perinatal Mental Health Unit

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Programme

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Time Programme

7.15 Welcome and breakfast

7.30

Breakfast presentation: “Medication for Depression, Anxiety Disorders & Bipolar Disorders in Pregnancy and Lactation… An Update”

Dr Jonathan Rampono, Head of Department of Psychological Medicine, King Edward Memorial Hospital

8.30 Networking

9.30 Registrations

Welcome morning tea

10.00 Indigenous Welcome and Symposium Opening

10.30

Keynote Address: “Preventing Common Postnatal Health Problems in Primiparous Women: Evidence from an Innovative Approach”

Associate Professor Jane Fisher, Clinical Psychologist, Deputy Director and Coordinator of International Programs, Key Centre for Women's Health in Society, University of Melbourne

11.15 Keynote Address: “Establishing Community-Based Early Intervention Services: The Joining Together Program”

Dr Caroline Goossens, Consultant Psychiatrist, Fremantle Hospital

12.00 Presentation: “Conceptualisation and Measurement of Severe Fear of Childbirth”

Janet Jones, Specialist Clinical Psychologist, Department of Psychological Medicine Consultation Liaison Service, King Edward Memorial Hospital

12.30 Lunch

Poster presentations and agency displays

1.30 Presentation: “Bringing an Attachment Perspective Using Circle of Security Concepts to Working with Women with Postnatal Depression”

Anne Clifford, Clinical Nurse, Raphael Centre, St John of God Healthcare

2.00

Presentation: “The Impact of Sexual Assault and Sexual Abuse on Pregnancy, Birthing and the Perinatal Period”

Gail Buesnel, Coordinator of Counselling Services, Sexual Assault Resource Centre, King Edward Memorial Hospital

2.30 Afternoon tea

3.00 Presentation: “Daddy Don’t Cry”

Pamela Whittaker, Clinical Nurse Manager, Mother Baby Unit, King Edward Memorial Hospital

3.30

Presentation: “Summary of Evaluation Results from the Bouncing Back Program 2003-2007”

Kim Tomlinson, Co-ordinator of Bouncing Back Program Albany, Great Southern Mental Health Service

4.00 Presentation: “Looking After Mums Program (LAMP) Promoting Perinatal Wellness and Early Intervention”

May Doncon, Social Worker, Geraldton, WA Country Health Service

4.30 Evaluations and networking

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Presenters

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Dr Jonathan Rampono is a Consultant Psychiatrist and

Head of Department, WA Perinatal Mental Health Services,

Women and Newborn Health Service. He is responsible for

the Consultation Liaison Department, the Mother and Baby

Unit, the Sexual Assault Resource Centre and the WA

Perinatal Mental Health Unit. He was a GP for 11 years

before entering psychiatry, and now works within the

specialty area of perinatal mental health, covering the whole

range of psychological and psychiatric issues relating to

conception, pregnancy and the postnatal period. Dr Rampono has undertaken

research into the exposure of the foetus and breastfed babies to antidepressants,

mood stabilisers and antipsychotics.

Associate Professor Jane Fisher is Deputy Director at the

University of Melbourne’s Key Centre for Women’s Health in

Society. Her research interests are in the links between

reproductive and mental health, in particular women’s

psychological functioning during pregnancy and early

motherhood. She has been Consultant Clinical Psychologist

to Masada Private Hospital’s Mother Baby Unit since 1996.

Dr Caroline Goossens is an Infant, Child and Adolescent

Psychiatrist working as a consultant in the Fremantle

District. She has been passionate about developing services

to the Under Fives following her training in NSW in models of

perinatal and early intervention. Since her return to Perth in

2005, she has focussed on integrating Fremantle Child and

Adolescent Mental Health Service with other local agencies,

providing liaison and consultation to the Paediatric

Department of Fremantle Hospital, Child Development

Services and Community Health. She is a co-founder of two specific joint

intervention programmes for families who are experiencing struggles in their

relationships with their young children.

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Janet Jones is a Specialist Clinical Psychologist working in Psychological

Medicine at Kind Edward Memorial Hospital (KEMH). She has worked as an

educator and psychologist across a range of health settings and in private

practice. Her special interests are working with anxiety, trauma and the

prevention of mental health disorders. As well as continuing to develop effective

treatments for women’s mental health disorders, she hopes to assist the

promotion of research and education in this area.

Anne Clifford is a Clinical Nurse at the Raphael Centre, St John of God

Hospital, Subiaco. Anne's professional background is in paediatrics, child health,

adult and infant mental health.

Gail Buesnel was trained in the US and has worked in inpatient and outpatient

psychiatric settings. She has a Masters Degree in Clinical and Community

Psychology. She formerly worked for DOCS presenting often on the topic

"Trauma as a Criminogenic Variable". She has long been interested in the multi-

faceted impact of trauma. She currently coordinates the counselling services at

the Sexual Assault Resource Centre.

Pamela Whittaker has worked within mental health for 36 years both in the UK

and Western Australia. Her first exposure to perinatal mental health programmes

was back in the 1970s in the UK, undertaking a clinical placement in a Mother

and Baby Unit. Over the years Pamela has worked in public and private mental

health services in WA gaining broad-based understanding and experience

related to services, service delivery and patient care. Throughout all this,

perinatal treatment services have remained an abiding interest and now Pamela

very happily works as Clinical Nurse Manager for the statewide Mother and Baby

Unit attached to King Edward Memorial Hospital in Subiaco.

Kim Tomlinson is a Social Worker with the Great Southern Community Mental

Health Service based in Albany. She has been Co-ordinator of the Bouncing

Back Program for PND for the last six years and also has a background

in multicultural mental health. She has two children, aged four and six.

May Doncon has been working as a Social Worker for WA Country Health

Service since 2003. Based in Geraldton, she also provides a regular visiting

service to Dongara, Eneabba, Leeman and Mingenew. She is about to start

studying for a Masters Degree in Public Health and has a special interest

in perinatal wellness.

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Breakfast Presentation

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Medication for Depression, Anxiety Disorders & Bipolar Disorders in

Pregnancy and Lactation… An Update

Dr Jonathan Rampono

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Keynote Presentations

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Preventing Common Postnatal Health Problems in Primiparous Women:

Evidence from an Innovative Approach

Associate Professor Jane Fisher

What Were We Thinking! (WWWT!) is an evidence-based mental health

promotion program for first-time parents of newborns. This highly structured

psycho-educational intervention is facilitated by maternal and child health nurses

in local accessible venues.

A controlled before-and-after trial of WWWT! funded by the Australian

Government’s Department of Families, Housing, Community Services and

Indigenous Affairs, was conducted in seven Victorian municipalities. This

presentation will present results of the trial.

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Establishing Community-Based Early Intervention Services: The Joining

Together Program

Dr Caroline Goossens

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Abstracts – Papers

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Conceptualisation and Measurement of Severe Fear of Childbirth

Janet Jones

Although poorly defined, fear of childbirth (FOC) can be viewed on a continuum

from normal to severe (Salomonsson et al., 2008). At the severe/extreme end of

this continuum, it may be useful to conceptualise this fear as an anxiety disorder,

such as childbirth-related post-traumatic stress disorder and/or tokophobia

(phobic fear and avoidance of childbirth).

This presentation examines how fear of childbirth has been measured, its

prevalence and nature. It will further examine clinical conceptualisations and

implications, as well as discussing future directions of research.

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Bringing an Attachment Perspective Using Circle of Security Concepts to

Working With Women With Postnatal Depression

Dr Caroline Zanetti & Anne Clifford

Postnatal depression and anxiety affect between 12 and 15% of mothers (O’Hara

et al., 1984). The harmful effects of maternal depression and anxiety on many

aspects of infant development are well recognised (Cooper & Murray, 1998;

Hammen & Brennan, 2003; Misri et al., 2004; Murray & Cooper, 1997; Steer,

Scholl, Hediger, & Fisher, 1992). These effects are overwhelmingly mediated

through the mother-infant relationship, and tend to persist long after the illness

has been treated (Murray, Cooper, Wilson, & Romaniuk, 2003). Results of

Strange Situation Procedures for six middle-class dyads participating in our

parenting group showed five had disorganised attachment pre-intervention,

with the only identifiable risk factor being a history of postnatal depression

(Zanetti, 2007). Thus, supporting the mother-infant relationship should be

an essential component of any treatment programme for postnatal depression.

In this presentation we will briefly describe how our small perinatal and infant

mental health service has put together a comprehensive approach to treating

postnatal depression and anxiety. We take the position that a perinatal mental

health disorder in the mother profoundly affects all members of the family,

particularly the infant. If we are to support the infant, it is necessary to support

both mother and father, and to consider whether the mother also needs support

in parenting older children.

Within the hierarchy of interventions offered, we will focus on the treatments

directly involving the Circle of Security model.

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The Impact of Sexual Assault and Sexual Abuse on Pregnancy, Birthing

and the Perinatal Period

Gail Buesnel

A mother brings all she is to the pregnancy, birthing and perinatal experience.

If that ‘all’ involves sexual abuse or sexual assault she may experience,

re-experience and misinterpret the experience in part or whole. During the

perinatal period her facial expressions, her gestures, her vocal tone and her

touch plunge the baby into the world of ‘mother’. The quality of these

communications represents prototypical right brain to right brain transactions that

facilitate the experience dependent maturation of the right brain. This interaction

may be essential to the maintenance of synaptic connections at a time that the

brain circuits are actually being established. If the mother is unable to attach,

to communicate, to respond or to organise her life into a caring whole, the child

may be affected for life, beginning at a neonatal cortical level.

The stress and depression that accompanies being reconnected to the abuse,

via pregnancy/birthing/the perinatal period, can look a lot like PND.

Understanding the impact of historic abuse on the mothering experience allows

the informed practitioner to intervene at an early enough stage to benefit both the

mother and child.

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Daddy Don’t Cry

Pamela Whittaker, Dr Philippa Brown, Gillian Ennis & Donna Kristianopulos

Postnatal distress or depression is becoming increasingly recognised as having a

dramatic impact on the newly created parent’s lives in almost every aspect.

Parenting is generally perceived as a rewarding and positive experience but for

some families this is not the case. Commentators have noted that first-time

fathers experience significant disruption and distress in their lives when their

partners are treated for a postnatal condition.

This paper will look at our experience with new dads at the Mother and Baby

Unit, as well as interventions we have used to support them and their families.

A review of current research into this area will be presented, along with a

snapshot of what is available in Perth and Western Australia for fathers.

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Summary of Evaluation Results from the Bouncing Back Program

Kim Tomlinson

This presentation provides a brief summary of the evaluation results of the

Bouncing Back Program. The ‘Bouncing Back’ Program is a manualised group

treatment program aimed at women and their families experiencing postnatal

issues related to depression, anxiety or stress. The program was developed in

Albany WA and has been running continuously for the last 13 years. It is a joint

initiative of the Great Southern Mental Health Service and Great Southern

Population Health. The program in the main involves a 12 session treatment and

prevention group (four groups held each year).

Diagnosed mothers attend 12 group sessions. Their partner or support person

attends three evening group sessions: two sessions together with the mother and

one “men’s only” session. The group is co-facilitated by a mental health

professional and a child health nurse (both women). The partners’ sessions are

co-facilitated by two mental health professionals, one male and one female.

The male worker facilitates the men’s session alone.

An evaluation of the outcomes of the Bouncing Back group over the five year

period 2003-2007 has recently been funded by the WA Perinatal Mental Health

Unit. The evaluation includes clinical data: pre and post EPDS and

Kessler-10 Scale scores over the five year period as well as extensive qualitative

evaluations by mothers and their partners who participated in the program. The

results show both consistent and statistically significant positive outcomes for the

participating families over the five year period.

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“Looking After Mums Program” (LAMP) Promoting Perinatal Wellness

and Early Intervention

May Doncon

LAMP (Looking After Mums Program) is a new initiative by the Social Work

Department to provide early intervention for women at risk of developing PND by

promoting psychological, social and physical wellness.

This service is offered to all women with a new baby up to one year postpartum.

Following the referral, a home visit by a social worker is offered usually within two

weeks. An EPDS will be administered if one has not been completed in the past

week. The services provided include:

debriefing following a traumatic or disappointing birth experience

assistance with addressing immediate housing or financial difficulties or other welfare matters

stress management strategies, problem solving and goal setting

short to medium term counselling using CBT to deal with symptoms of anxiety and depression

working with mum to create a wellness plan which would incorporate exercise, relaxation and access to support

information on all other available counselling services and support groups and assistance with referrals

liaison with GP, child health nurse, midwife and other relevant health workers.

Each mother also receives a “tool kit” containing information on topics such as

physical and psychological wellness, relationships, information on local

resources, phone services and useful websites. They also receive a relaxation

CD and a “Healthy Food Fast” cookbook.

This program started in Geraldton in March 2009 and will be introduced to other

areas in the Midwest following evaluation at the end of 2009.

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Abstracts – Posters

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The Value of Auditing Records in Relation to EPDS Screening Rates

Roslyn West

In 2006 the child health records of all babies born in April and May of 2005 were

audited for EPDS screening rates, outcomes and referral avenues. Information

on ethnicity and past history of depression was also recorded. This information

was used to not only give an indication of possible PND rates in the area but also

as a discussion point for the child health nurses, who had attended EPDS

training sessions. Misinformation was able to be corrected, e.g. the

recommended screening times. Barriers to screening were also discussed. Two

years later the same audit was conducted. Screening rates and referrals showed

a marked increase. This was attributed to the one-to-one session that the

researcher had with each nurse.

Supporting the Transition to Parenthood: The Expanding Role of

Community Child Health Nurses in Western Australia

Margaret Abernethy & Susan Bradshaw

There is an established body of evidence which demonstrates that antenatal

engagement of women can improve maternal and child health outcomes.

Risk factors including mental health issues, alcohol and other drug usage and

a range of social issues have been positively impacted by antenatal

interventions. The research has also confirmed that child health nurses can play

an integral role in the delivery of antenatal services.

Whilst child health nurses have traditionally engaged families through the offer of

a universal contact early in the postnatal period, they are also well placed to

provide interventions within the antenatal period. A community health perinatal

project was established to develop a model of antenatal service provision by

child health nurses, which was subsequently piloted and evaluated in four sites

across Western Australia. The project recruited pregnant women over a 16 week

period from August 2008 and followed them until eight weeks post delivery.

Universal antenatal contact was offered to women in the four sites, providing the

opportunity for early engagement with child health nurses and psychosocial

assessment. Women identified with additional needs were offered further home

visits and/or external referral as required. Data was collected on client contacts,

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psychosocial risks and the interventions undertaken. A semi-structured staff

interview and a postnatal client questionnaire were also used.

The evaluation processes demonstrated a high client satisfaction level. Clients

also reported the antenatal contact had a strong positive impact on a range of

elements.

Dispensing ‘Wellness’: More than Just Medications

Stephanie Wai Khuan Teoh & Judith Kristensen

Pregnant and breastfeeding women are sometimes prescribed medicines to treat

acute or chronic medical conditions including psychiatric illnesses. These women

are often concerned about the safety of medications in pregnancy and the effects

of the medicine on their breastfed babies.

The Pharmacy Department at King Edward Memorial Hospital (KEMH) conducts

an Obstetric Drug Information Service providing data on medicines for women

and neonates, with an emphasis on the safe use of medicines in pregnant and

breastfeeding women. From January to March 2009, 651 calls were received.

14.5% (n=96) of these calls were enquiries involving antidepressants (n=83) and

antipsychotic drugs (n=13). Of the 96 calls regarding psychoactive drugs, 37.5%

related to pregnancy and 58.3% to breastfeeding. Most phone calls were made

by the public (47.9%), followed by doctors (30.2%), nurses (11.5%) and

pharmacists (10.4%).

The Pharmacy Department is dedicated to and participates in research projects

and clinical trials involving the use of medicines in obstetrics resulting in

numerous peer-reviewed journal publications, books and presentations at

scientific meetings. Studies published include the transfer into human milk of

antidepressants (such as venlafaxine, citalopram and reboxetine), antipsychotics

(including olanzapine and quetiapine) and psychostimulants (methylphenidate

and dexamphetamine).

The Pharmacy Department also provides a wide range of services to the Mother

and Baby Unit (MBU) and to women suffering from postnatal mental illness.

These include medication history and management reviews, therapeutic drug

monitoring, provision of medication lists upon discharge, specific counselling

on drugs and breastfeeding, and co-ordinating drugs in breast milk studies

involving MBU inpatients.

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Sing & Grow: Encouraging Mental Wellness and Social Connectedness

Through Music Therapy

Catherine Wilmot

Following the birth of a child, support from peers and a sense of ‘social

connectedness’ has as much a role to play as the intervention of health

professionals. Sing & Grow is a national music therapy programme funded

by the Commonwealth Government and auspiced by Playgroup Queensland,

targeting marginalised parents and their children aged 0-3 years. Independent

evaluation of the project has been undertaken, with main study data revealing

statistically significant improvements for parent-reported irritable parenting,

educational activities in the home and parent mental health, as well as positive

outcomes for child development.

Sing & Grow provides music therapy groups for families with children up to the

age of three years. Music provides an enjoyable and non-threatening

environment which allows parents to come together with their children and share

in a common experience, which in turn encourages social networking among

families. Sing & Grow programmes are held in collaboration with community

organisations that have existing relationships with families. Attendance at Sing &

Grow sessions facilitates parents’ engagement with the organisations and

in particular assists parents in developing positive relationships with professional

staff who can provide additional support as needed.

This paper will describe the Sing & Grow programme and discuss how providing

Sing & Grow in collaboration with community organisations helps to support

parents in the postnatal period in developing and maintaining mental wellness.

Self Management as a Guiding Philosophy in Perinatal Psychiatry:

The Mother Baby Unit Perspective

Dr Philippa Brown, Professor Anne Passmore, Professor Tanya Packer

& Pamela Whittaker

One of the key national priority areas identified to refocus the health system is

‘to encourage active patient self-management of chronic conditions’. The Shared

Care Initiative announced by the Commonwealth Government in 1999 was the

first step for Australia. In 2006 the WA Statewide Chronic Disease

Self-Management Implementation and Evaluation model was produced. Since

then seminars, workshops and several projects have been implemented.

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The Mother Baby Unit opened in WA in June 2007. All staff members received

initial training in self-management theory and were keen to introduce concepts

into the everyday working of the unit.

In 2008, the first pilot study was completed and a poster presented to the Marce

Conference.

The presentation will include a background of the history and development of self

management, how the theory is being used in the inpatient unit and our plans for

further development in the future.

The Mother Baby Unit works in collaboration with Prof. Anne Passmore,

Prof. Tanya Packer and the Centre for Research into Disability and Society,

School of Occupational Therapy, Curtin University of Technology.

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Other information

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Certificate of attendance

If you require a certificate of attendance as evidence of professional

development, please collect one from the Registration Desk at the end of the

day.

Evaluation forms

Please take the time to complete an evaluation form (enclosed in your

symposium bag) and place in the designated box on the Registration Desk at the

end of the day.

Any questions?

If you have any further queries about the ‘Embracing the Bigger Picture’

symposium or about perinatal mental health, please contact the WA Perinatal

Mental Health Unit.

Phone: (08) 6458 1786

Email: spimhp@health.wa.gov.au

Web

https://wnhshealthpoint.hdwa.health.wa.gov.au/directory/WHGMH/Pages/Perinat

al-and-Infant-Mental-Health.aspx

Thank you for your attendance and participation!

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WA Perinatal Mental Health Unit – Resource Ordering Information

Catalogue number Resource name Resource type Target audience To order, contact:

OA 003962 Boodjarri Business: Yarning about feelings after baby

DVD WA Aboriginal communities

Email: wapmhu@health.wa.gov.au Phone: (08) 9340 1795

OA 003963 Boodjarri Business: Working with Aboriginal mums, babies and families

DVD Health professionals only Email: wapmhu@health.wa.gov.au Phone: (08) 9340 1795

OA 003964 You are not alone: Emotional health for mothers

DVD (in Amharic) Ethiopian communities Email: wapmhu@health.wa.gov.au Phone: (08) 9340 1795

OA 003965 You are not alone: Emotional health for mothers

DVD (in Arabic) Iraqi communities Email: wapmhu@health.wa.gov.au Phone: (08) 9340 1795

OA 003966 You are not alone: Emotional health for mothers

DVD (in Dinka) Sudanese communities Email: wapmhu@health.wa.gov.au Phone: (08) 9340 1795

OA 003968 Using the EPDS: translated into languages other than English

Resource file Health professionals only Email: wapmhu@health.wa.gov.au Phone: (08) 9340 1795

HP 010125 Edinburgh Postnatal Depression Scale (EPDS)

A4 2-sided sheet Health professionals only Email: wapmhu@health.wa.gov.au Phone: (08) 9340 1795

HP 011329 EPDS Wheel Pin wheel Health professionals only Email: wapmhu@health.wa.gov.au Phone: (08) 9340 1795

HP 011310 Becoming A Parent: Emotional Health and Wellbeing

Quarto booklet All WA consumers Website: www.health.wa.gov.au/ordering Phone: 1300 135 030

OA 003959 Where to Find Help Pocket / wallet

booklet All WA consumers

Website: www.health.wa.gov.au/ordering Phone: 1300 135 030

OA 003960 Mum's Guide DL brochure WA Aboriginal communities

Website: www.health.wa.gov.au/ordering Phone: 1300 135 030

OA 003961 Dad's Guide DL brochure WA Aboriginal communities

Website: www.health.wa.gov.au/ordering Phone: 1300 135 030

HP 003073 Postnatal Anxiety Stress & Depression

DL brochure All WA consumers Website: www.health.wa.gov.au/ordering Phone: 1300 135 030

HP 011328 More than the Blues DVD All WA consumers Website: www.health.wa.gov.au/ordering Phone: 1300 135 030