- Title
- Improving antenatal risk assessment in a high risk population
- Creator
- Perry, Natasha
- Resource Type
- thesis
- Date
- 2012
- Description
- Professional Doctorate - Doctor of Clinical and Health Psychology
- Description
- Infants aged under one and those in-utero are the most frequently reported age bracket to child protection services in NSW, Australia. Antenatal substance abuse and other psychosocial risk factors have been associated with poor developmental, emotional and behavioural outcomes for children. Substance use is also a significant risk factor known to increase the likelihood of child protection involvement, less is known about the predictive nature of maternal reflective functioning (RF). Mothers with substance use disorders are more likely to have an insecure attachment and lower levels of RF. Parents with low RF may fail to recognise their infant’s feelings, or mental states, and often have a limited understanding of the impact of their behaviour leading welfare concerns. Moreover, low RF has also been associated with atypical maternal behaviour and low levels of emotional availability (EA). The current study aimed to improve antenatal risk assessment; it was hypothesised that substance dependent women would exhibit higher rates of psychosocial stress, mental health symptoms and past childhood trauma, as well as deficits in parenting capacity, when compared with controls. It was also anticipated that RF during the antenatal period would predict postnatal RF. Furthermore, a low level of parental RF was expected to mediate the impact of psychosocial risk factors associated with child protection involvement. Participants were 11 women on opiate substitution treatment (OST) deemed as ‘high-risk’ and the ‘control’ group comprised 15 women from a community sample without any substance abuse or child protection involvement. All women were recruited during the third trimester of pregnancy. At time one (T1) pregnant women participated in Pregnancy Interview-Revised (PI), Zanarini Rating Scale for Borderline Personality Disorder and completed Newborn Developmental Knowledge Questionnaire and Childhood Trauma Questionnaire. The routine Psychosocial Assessment Interview and Edinburgh Postnatal Depression Scale were retrospectively obtained. At follow up (T2), when the infants were approximately three months old, the Parent Development Interview - Revised Short Version (PDI) was undertaken and mother-infant dyads were videotaped to assess EA. Child protection services were contacted to determine if there had been any involvement from T1 to T2. Significant differences were detected for demographics, psychosocial factors, trauma and mental health symptoms between the ‘high-risk’ and ‘control’ group. Unexpectedly, no significant between groups differences were found for RF (as measured by the PI and PDI) or EA. The majority of women in the ‘high-risk’ group became involved with child protection services. Reflective functioning was not significantly associated with psychosocial risk factors, therefore, did not mediate the outcome of child protection involvement. When comparing women who became involved with child protection services with those who did not, several psychosocial (‘not living with the father of the baby’, relationship status, poor education, history of forensic charges, being in OST) and psychological factors (depression, borderline personality disorder symptoms, history of childhood trauma) were identified as risks associated with child protection involvement. The study aimed to implement a comprehensive screening battery targeting mental health issues and parental capacity to aid the identification of women who may benefit from more focused intervention and child protection approaches. The work presented throughout provides evidence to support a need for an expansion of the current routine of psychosocial assessment. Particularly, to include a measure of impulsivity given the increased likelihood of impulsive parents becoming involved with child protection services. Identifying pregnant women who may benefit from targeted clinical and parenting intervention to improve reflective functioning and parenting capacity may reduce future child protection involvement.
- Subject
- parenting; substance abuse; reflective functioning; risk; child protection
- Identifier
- http://hdl.handle.net/1959.13/1039443
- Identifier
- uon:13653
- Language
- eng
- Full Text
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| View Details Download | ATTACHMENT02 | Thesis | 1 MB | Adobe Acrobat PDF | View Details Download |