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Northamptonshire Parent Infant Partnership (NorPIP)

Supports the nurturing of secure attachments and loving, care-giving relationships between parents and their under-twos

Action
Future in Mind, the 2015 report setting out a vision for transformed child and adolescent mental health services, emphasises the link between parent and children's mental health, calling for every birthing unit to have a specialist perinatal mental health clinician by 2017 and for an expansion of programmes to strengthen parent-infant attachment. It cites 2014 research findings from the London School of Economics and Political Science showing perinatal mental health problems costing the UK £8.1bn a year, with three-quarters relating to negative impacts on the child.

NorPIP helps parents form a loving, care-giving relationship with their baby from the earliest opportunity, through parent-infant psychotherapy. It was launched in 2011 by South Northamptonshire MP Andrea Leadsom, inspired by the work of Oxford Parent Infant Project. In 2012, Leadsom founded national charity PIP UK, to help the creation of similar projects. NorPIP is now one of six PIPs across the UK.

NorPIP works with parents struggling to bond with their child due to mental health issues such as postnatal depression, or because the bonding process has been interrupted by situations such as homelessness, domestic violence, drug issues, birth trauma or bereavement. Executive director Anna Day says memories of childhood trauma can sometimes resurface in flashbacks for the first time when victims become parents, sparking emotions such as shock or anger, or complete withdrawal and breakdown.

NorPIP clients include mothers with psychosis, who may report hearing voices telling them to kill or harm their baby. "It's a very difficult taboo subject, so it's no surprise that women don't come forward to seek help," says Day.

NorPIP works with parents-to-be or parents and under-twos, ideally when babies are under six months. They can be referred by children's centre staff, midwives, social workers and GPs, or parents can self-refer. After a referral is accepted, the charity's clinical director will allocate a therapist, who delivers between eight and 20 50-minute weekly sessions for individual parents and their child, mainly in their homes or children's centres.

In the first session, the therapist helps the parent examine his or her relationship with the baby and the family's mental health, as well as assess the baby's development through a questionnaire.

Therapists use a range of therapeutic tools, such as "ghost in the nursery", to help parents explore childhood relationships with their own parents and draw strength from the positive influences in their life. Another technique, called "Watch, Wait and Wonder", involves asking parents to step into their baby's world, reflecting on his or her experiences and reactions. Through video interactive guidance based on footage of the parent's interactions with the baby, the therapist positively reinforces the most successful exchanges, helping parents tune into their baby and respond to his or her cues.

"Sometimes, we have to help parents understand how their experiences are affecting their ability to care," says Day. "When people have had a very difficult time, their acceptance of what they term as ‘normal, might be different to what's normal for the rest of us. So we try to help parents shift what is ‘normal, to ‘not acceptable,."

Clinicians are supervised and cases reviewed by NorPIP's clinical director, who helps assess whether a safe, caregiving relationship has been achieved.

NorPIP also provides training for other professionals in identifying attachment difficulties and helping carers build secure attachments with their children. It has started developing the Early Help Mental Health Consortium, in partnership with Northamptonshire Council, health agencies and voluntary organisations. Day hopes this partnership can develop ways of providing routine early support to the "massive population" of women with mental health histories at risk of being thrown back into these difficulties after giving birth.

She envisages a service where midwives routinely check a woman's mental health history on booking in a pregnancy. If she has previous issues, she is offered one of a range of support pathways as part of her antenatal care. NorPIP is also developing information to destigmatise postnatal conditions.

Impact
An independent evaluation of NorPIP's work last year, by clinical psychologist Dr Ruth Butterworth, indicates improvements to mental health and attachment. It shows 43 parents, average score on the Hospital Anxiety and Depression Scale as 18.73 at the start of the intervention, indicating ‘mild, conditions, reducing to a score of 13.65 for 26 parents at the review stage of the intervention, taking them out of the clinical range. The average score reduced further to 10.83 for 6 parents by the end.

The Parent Infant Relationship Global Assessment Scale, measuring the quality of parent-infant relationship, increased from an average of 46.35 for 40 parents to 59.80 for 35 parents, an increase in two classifications. Those with the lowest scores increased by four classifications.

Of 74 parents, 88 per cent said their relationship with their child had improved following NorPIP intervention, 83 per cent reported increased wellbeing and 90 per cent improved situations.

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