Collaborating to improve child and maternal health – PenARC and ARC Yorkshire and Humber
A three-year programme of research to improve children’s and maternity services across England has identified the four most pressing interventions.
The programme, led by ARCs South West Peninsula and Yorkshire and Humber and developed collaboratively with ARCs North East and North Cumbria, North Thames, North West Coast, Northwest London, South London, West and West Midlands has seen a busy first six months.
The programme received 32 suggestions from ARCs across the country who consulted with their networks of providers, commissioners and Patient and Public Involvement and Engagement (PPIE) groups. From these, the programme team shortlisted 14 interventions most likely to meet the aim of the programme.
The team then brought together over 80 members of the public, practitioners, providers and academics for four consultation workshops, chaired by public contributors to draw on a range of voices and perspectives, to discuss the interventions. Participants were asked to give an overall score for each intervention based on its feasibility, acceptability and impact on equity, which were used to rank and prioritise the interventions.
Using rapid but formal reviews of effectiveness for the nine highest rated interventions, a final selection was made and sense-checked against national priorities with the Programme Advisory Board, including PPIE representatives and national leaders in Child Health and Maternity.
Professor John Wright, Director of ARC Yorkshire and Humber, said: “I’ve been involved in many funding and selection panels in my career. The Child and Maternal Health selection programme was one of the best I’ve experienced. Led by public advocates, with a preliminary ranking stage that captured the views of multiple stakeholders, and then a deep dive evidence review and critical appraisal to select the top interventions from a formidable field of proposals”.
The four adopted interventions are:
- Maternal Mental Health Services (MMHS) in multidisciplinary teams
One in five mothers suffer from depression, anxiety or in some cases psychosis during pregnancy or in the first year after childbirth and suicide is the second leading cause of maternal death, after cardiovascular disease. Mental health problems not only affect the health of mothers but can also have longstanding effects on children’s emotional, social and cognitive development. MMHS are funded as part of the NHS Long Term Plan and combine specialist community-based assessment and interventions including maternity, reproductive health, peer support and psychological therapy services for women experiencing mental health difficulties linked to their maternity experience.
- Trauma-focused Cognitive-Behavioural Therapy (TF-CBT) for young people with Post-Traumatic Stress Disorder (PTSD)
PTSD is a type of trauma response to a very stressful or an extremely threatening event that causes adverse mental health outcomes like depression, anxiety, suicidal tendencies and flashbacks. TF-CBT has been expanded from traditional Cognitive-Behavioural Therapy (CBT) to address the distress resulting from trauma and decrease the negative behaviour patterns and emotional responses often developing as a consequence of maltreatment. The treatment goals include providing a process in which the child and their caregivers learn about trauma and develop strategies to reduce related stress and control associated feelings and thoughts; providing structured opportunities for the child to process the trauma and learn to cope with stimuli that may lead to traumatic reactions; and supporting the child in developing and maintaining a secure sense of safety as well as adaptive social skills.
- A tooth-brushing programme for 3-5yr olds targeting deprived areas
Dental cavities are common in young children and many require dental treatment which usually requires general anaesthesia. Tooth extraction is the most common reason for hospital admission in children. There is a strong relationship between deprivation and the likelihood of tooth decay. This intervention is a school/early years (3-5yr olds) tooth brushing programme particularly targeting deprived areas in parts of England. This intervention will involve children brushing their teeth as a class during the school day, supervised by nursery and preschool staff or teaching assistants. The programme includes training for early years and school staff to lead and supervise the tooth brushing and the equipment needed (brushes, toothpaste, brush holders, labels). An implementation toolkit will be developed as part of this project.
- Independent Domestic Violence Advisor’s (IDVAs) in maternity settings
Domestic violence and abuse affects up to 1 in 5 women during pregnancy. It is associated with adverse mental health outcomes, including depression, anxiety and substance misuse. IDVAs are specialist professionals who work with survivors of domestic abuse to provide support and represent their voice at a Multi-agency Risk Assessment Conference (MARAC), as well as helping them to navigate the criminal justice process and working with the different statutory agencies to provide wraparound support. The aim of IDVAs is to secure the safety of those at risk of harm from intimate partners, ex-partners or family members. They work with those affected to assess risk, develop safety plans, reduce abuse and ultimately improve health and wellbeing in women and children. IDVAs are placed in various sectors. It has been suggested that there may be benefits of placing IDVAs in a hospital setting DVA is associated with increased risk of obstetric complications, with potential negative impacts for the health and wellbeing of the developing child and future generations. Pregnancy is a time during which women are in repeated contact with health services so it is an opportune time to intervene. Research also suggests that women are likely to disclose DVA in the maternity setting, particularly in the presence of a trusted professional.
PenARC Lead for the Child Health & Maternity Programme, Dr Vashti Berry said: “This has been a truly collaborative process so far and we are all excited to see how the programme progresses and what we can learn from the implementation of these interventions at a wider scale. We’re also hoping to demonstrate how ARCs can achieve impact across divides by working with the Prevention and Inequalities programmes on two overlapping priority interventions. And most importantly, we are committing resources and support to ensure that patient and public involvement is at the heart of the programme and the research undertaken”.