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
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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
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Inpatient units in infant mental
health
 In adult psychiatric units
 In paediatric units
 In child psychiatric units
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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
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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
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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:
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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
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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?
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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