Transcript BABY-TEAM”
Inpatient units in IMH
Regional WAIMH Conference
Acre, Israel 8-10.9.2009
Kaija Puura, MD, PhD
Adjunct Professor
Tampere University and University Hospital,
Department of Child Psychiatry
Correspondence: [email protected]
Introduction
Parents are sensitised to meet the needs
of their offspring
Genetic background for parenting behaviour
in various species (including beetles…)
Cultural aspects of parenting: what is
considered as good parenting – changes
with time
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Introduction
Things can go awry because of
Environmental threats
Parental illness, somatic or mental
Parental distress
Child characteristics making parenting
demanding
Problems with regulating physiological and
emotional states
Chronic or recurrent illness, or disability
K. Puura 10.9.2009
Inpatient units in infant mental
health
In adult psychiatric units
In paediatric units
In child psychiatric units
K. Puura 10.9.2009
Parent-infant dyads in adult
inpatient units
Since 1950s
Infant hospitalised with the parent
(mother) in connection with parental
mental illness
Postpartum depression
Postpartum psychosis
Other type of psychotic disorder
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Parent-infant dyads in adult
inpatient units
Goal:
Support the mother infant bonding
Avoid disruption of parent-infant relationship
Best results with postpartum psychosis
Less successful with parents with affective
disorders or schizophrenia
need for intervention focused on
parenting behaviour
parental sensitivity
enjoyable interaction
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Residential parent-infant care in
paediatric units
Focused on treating problematic behaviour in
the infant in
Feeding
Settling down
Sleeping
Behavioural context: teaching the infant to
abandon ”bad habits”
Need for multifaceted interventions for parents
with psychological distress or mental health
issues
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Residential parent-infant
care in other services
Services provided by social and welfare
authorities
Focus on teaching parenting – staff not familiar with
infant development and mental health issues
Residential care for substance abusing
mothers
Extremely demanding: need for expertise in
substance abuse, adult psychiatry, child psychiatry
Great need for health care services
Longer stay – better outcome
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Parent-infant treatment in child
psychiatric unit: TAUH Family ward
Founded in 1993 for
Treating parent-child relationship and
parenting problems
for families with infants, toddlers or
preschoolers
Today part the Infant and Family
Psychiatric Unit in the Department of
Child Psychiatry in Tampere University
Hospital (process organisation…)
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Family Ward
Our department in 2004
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Family Ward
the whole family participates
three families at the same time
inpatient period lasts three weeks
child psychiatric evaluation and
treatment:
child
family
interaction
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Reasons for referral
Developmental, behavioural or emotional problems in
infants or young children
Serious difficulties in family interaction
marital difficulties, divorces or separations with conflicts over
contact or residence of the child
parental psychiatric disorders
problems in the interaction between the child and the parents
and/or siblings
Problems in parenting
inadequate parental care
attachment difficulties
family violence
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Multidisciplinary team
child psychiatrist
head nurse
family therapists (psychologist, nurse)
six nurses
doctor in training
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What do we do?
Build an alliance by being caring but honest
Integrative child psychiatry in a multilevel
approach
Everyday interactions - work on the parent-infant
interaction
Attachment
Cognitive-behavioural techniques
Neuropsychiatric treatment techniques
Family discussions - systemic family level
Discussions with parents - work with
representations of the parents
Networking – safety nets for the family
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Model of treatment
preliminary interview:
family
referring agency (when useful and possible)
professionals who have worked with the family in social and
health care
three-week inpatient period:
primary nursing: home visits, functional sessions in the ward
child psychiatric assessment (e.g MSSB, psychological tests)
assessment of interaction (EAS, LTP)
family assessment
meetings:
family meetings
team meetings
Puura
10.9.2009
meetings with healthK.and
social
welfare agencies
Pre-admission phase
Referral
•phone calls to the family and referrer
•invitation to the preliminary interview
Preliminary interview
•Building alliance, focus of treament, objectives, decisions
Introductory visit
Home visit
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Inpatient period
Family inpatient period
Team
meetings
Working on
the ward
1st
week
Focuses of
treatment
Methods of
intervention
Primary nursing
Treatment
•child
•family
•interaction
Feedback
Reflection
Evaluation
2nd
week
Focuses of
treatment
Methods of
intervention
Primary nursing
Treatment
•child
•family
•interaction
Feedback
Reflection
Evaluation
Evaluation
Planning of
further
treatment
Visiting
professionals
Primary nursing
Treatment
•child
•family
•interaction
Feedback
Reflection
Evaluation
3rd
week
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Family
meetings
Treatment days include:
one meal and a snack, one of the nurses
joins the family in the table
Free play situations with the family
Family discussions
Discussion with parents alone while
children play in another room
Open feedback to the family each day
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After the family inpatient
period
1-2 information transfer meetings:
agreement of further support/treatment
written reports:
family
referrer
professionals providing further
support/treatment, social workers in most of
the cases
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Further treatment and
recommendations
Individually tailored intervention plannew
inpatient period
outpatient visits and home visits
family therapy
individual psychotherapy
parent-child psychotherapy
support by social services
Sometimes recommendation for foster care
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Strengths of the model
intensive 3-week period - huge amount of
information and possibilities to observe,
understand and work with families and share
the experience and understanding with health
care and social welfare professionals
basis for meaningful and appropriate
intervention plans: what is needed and what is
possible
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Statistics: the first half of
2008
Altogether 27
children
girls 10
boys 17
GIRLS
37 %
BOYS
63 %
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Age distribution:
5
4
3
2
1
0
1
2
3
4
5
6
7
8
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9
11
14
Family types
Foster
parents
7%
Step-parent
family
4%
Biological
parents
45 %
Single parent
44 %
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Where did they come
from?
Family guidance center 19%
Social services 33%
Child health clinic,school health clinic 15%
Child psychiatric clinic 30%: family ward period
combined with the care in the Baby-team or the
home-hospital team when needed
Other 3%
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ICD-10 Diagnoses
Diagnosis
%
Affect disorders (F32, F93)
19
Traumatic and adjustment disorders (F41-43)
11
Developmental and organic disorders (F80-84)
19
Oppositional and conduct disorders (F90-92)
ADHD
Disorders of social interaction (F94)
15
15
15
Functional disorders (F98)
11
No F diagnosis
26
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Further treatment
family guidance center 19%
new inpatient period 19%
outpatient visits and home visits, child
psychiatric clinic 82%
Support by social services 78%
public health care 7%
other 52%
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What do the families
think?
They like the food…
That the treatment is tiring, but useful
For some families the treatment is too intensive
Many families wish to come back for a shorter
interval period
In families where children have to be taken into
foster care, parents are often initially angry, but
are able to consent and work together better
with the foster parents
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Future plans
Research study on what helps children
with problems in emotion regulation
Follow-up study of families treated in the
infant outpatient and inpatient unit
Further development of the treatment
model in the infant outpatient and
inpatient unit
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Thank you for your
attention!
K. Puura 10.9.2009