Infant Mental Health Implementation and Advisory Group minutes: 31 March 2021

Minutes from the meeting of the group on 31 March 2021.


Attendees and apologies

Author

  • Alex Brown             

Present

  • Anne McFadyen, Chair, IMH-IAG, NHS National Services Scotland
  • Marita Brack, Head of Parenting and Infant Mental Health Programme, NHS Education for Scotland
  • Alex Brown, Programme Support Officer, NHS National Services Scotland
  • Andrew Dawson, Professional Lead for Child Psychotherapy, NHS Greater Glasgow & Clyde
  • Rachel Fraser, Scotland Development Lead, Parent-Infant Foundation
  • Susan Galloway, Information Development Officer, NSPCC Scotland
  • Judith Gemmell, Change and Improvement Manager, IMH Team  NHS Fife
  • Douglas Guest, Head of Development, Home Start Scotland
  • Ann Marie Kennedy, Childcare Team Leader, Change is a Must Team, NHS Tayside (Perth & Kinross)
  • Nashwa Matta, Associate Specialist in Paediatrics, Royal College of Paediatrics and Child Health, NHS Greater Glasgow & Clyde
  • Chris Miezitis, Co-Director, Father’s Network Scotland
  • Helen Minnis Professor of Child and Adolescent Psychiatry, University of Glasgow
  • Wendy Mitchell, Professional Advisor, Chief Nursing Directorate, Scottish Government
  • Katherine Morton, Consultant Psychiatrist, PMH Service, NHS Lanarkshire
  • Juan Perez-Olaizola, Consultant Child and Adolescent Psychiatrist, Royal College of Psychiatry, NHS Forth Valley
  • Joanne Smith, PIMH Policy Manager, and Chair at Maternal Mental Health Scotland, NSPCC Scotland
  • Harriet Waugh, Team Lead, Perinatal and Early Years Mental Health, Scottish Government

In attendance

  • Rod Finan, Chief Social Work Advisor’s Office, and GIRFEC Hub, Scottish Government
  • Barbara Kennie, Policy Officer, Perinatal and Early Years Mental Health Team, Scottish Government
  • Irene Permaul,  Senior Policy Officer, Perinatal and Early Years Mental Health Team Scottish Government

Apologies

  • Iona Colvin, Interim Director and Chief Social Work Advisor, Children and Families Directorate Scottish Government
  • Karen Lamb, Head of Specialist Children's Services, NHS Greater Glasgow & Clyde
  • Shona McCann,  Lead Midwife NHS Grampian, NHS National Services Scotland
  • Alison Robertson, Consultant Clinical Psychologist, Maternity and Neonatal Services, NHS Greater Glasgow & Clyde

Items and actions

Minutes

Welcome, apologies and housekeeping

Anne McFadyen (Chair) welcomed everyone to the seventh Infant Mental Health Implementation and Advisory Group (IMH-IAG) meeting, and apologies were noted as above. Introductions were made to members of the group joining for the first time.

The group agreed that the minutes were an accurate representation of the January 2021 meeting.

Chair’s update

Anne advised that the Perinatal & Infant Mental Health Programme Board (PNIMH-PB) 2021 to 22 Delivery Plan was in development, and input was welcome. The plan will have integrated perinatal and infant mental health actions, moving towards a family-focused, systemic approach. Looking at what has been achieved in 2020 to 2021, it is clear that some actions have been addressed more fully than others. The pandemic has presented challenges for families and services, and has impacted service development.

Please see Annex A for action update table.

Harriet Waugh (Team Lead, Perinatal and Early Years Mental Health, Scottish Government) gave a PNIMH-PB update:

  • recently released a note of interest for a Perinatal Development Advisor to work between the PNIMH-PB, the Perinatal Mental Health Managed Clinical Network (MCN), and the Scottish Government (SG) Policy Team, to support implementation of statutory services in development. The closing date is 16 April, and Harri asked the group to share the post information with interested parties
  • the Evaluability Assessment (Public Health Scotland) and the Equality Impact Assessment (SG) were published in March
  • Inspiring Scotland consultation for the Small Grants Fund (‘Supporting Local Innovation’) closed 31 March. Aligned to the outcomes of the main fund, this is a smaller pot of funding that will support local services that are making effective and innovative contributions towards perinatal and infant mental health, and were not included in the main funding. The Small Grant Fund will open in May
  • The Peer Support Action Plan was published in February, and the SG Policy Team are currently working on taking the actions forward
  • in March, the Minister for Mental Health wrote to the Scottish Health Boards to advise that £8 million of PNIMH-PB funding had been earmarked as recurring funding. The aim behind this was to reflect the intention that funding would be provided to Boards as part of the baseline allocation following the conclusion of the PNIMH-PB, for specialist community perinatal mental health and infant mental health (IMH) provision. It is hoped that this will reduce some of the barriers to recruitment and service development that Boards have been facing
  • Health Boards have been asked to respond by 31 March regarding their progress over the past year, and their plans for 2021 to 2022 regarding IMH, community perinatal mental health, and Maternity and Neonatal Psychological Interventions (MNPI) services. The SG Policy Team are currently collating the information and looking to finalise the forthcoming years allocations

NHS Education for Scotland (NES) update

Marita Brack (Head of Parenting and Infant Mental Health Programme) provided an update on the work of NES:

  • in March, an additional 40 practitioners started the Warwick University IMH online course, and there is a waiting list for the course in September
  • the Institute of Health Visiting (iHV) Perinatal and Infant Mental Health Champions Training took place in February with a cohort of 20 practitioners from the North of Scotland. The training was well received, and the Health Board areas are working with iHV on implementation plans and the rollout of local training
  • NES are developing a new IMH training module for staff working with infants with physical health complications, including neonatal complications
  • Solihull Approach foundation level and “Train the Trainer” training courses took place again in February, with others planned for May. Work is progressing with school nurses and health visitors to ensure an effective cascade is established for those professional groups. NES will be sharing a Solihull Approach Implementation Guide with Boards and networks to help them carry out training sustainably within their area. The Solihull Approach online course has had over 10 thousand registrations
  • support continues for practitioners who are receiving supervision in Video Interactive Guidance. The March training did not go ahead due to insufficient numbers, but NES hopes to reschedule before summer

Action seven

(Consider what support might enhance the delivery of services to neonates with complex needs in the context of prematurity, congenital abnormalities or other health challenges who are returning to their home area after a period of inpatient specialist interventions).

Nashwa Matta (Associate Specialist in Paediatrics, NHS Greater Glasgow & Clyde) gave an update:

-         MNPI services in NHS Greater Glasgow & Clyde are focused on completing recruitment for four Clinical Psychology posts and one Psychological Therapist post.

  • three Specialist Midwife posts start on 29 April
  • a Consultant Clinical Psychologist (covering MNPI and the perinatal team) has started in NHS Ayrshire & Arran, and recruitment is underway for another Clinical Psychologist
  • a Clinical Psychologist, a Child Adolescent Practitioner and a Specialist Midwife have been recruited in NHS Lothian. Another Consultant Clinical Psychologist will cover the perinatal community team, MNPI and the Mother-Baby Unit

It was agreed that the IMH-IAG needed to consider a systematic method of accessing the relevant data in order to address action seven.

Action: All

Father’s Network Scotland

Chris Miezitis (Co-Director) gave an overview of the March panel discussion where Father’s Network Scotland (FNS) and key stakeholders reflected on feedback from fathers regarding their experiences of lockdown. It is clear that the Covid-19 pandemic has accentuated issues that already existed, and that fathers’ mental health has been negatively affected. Chris advised that fathers have been spending more time with their children, and they want that to continue.

FNS are collaborating with Clare Thompson, Participation Officer for the PNIMH-PB, to ensure that fathers’ voices are contributing to the Experts by Experience group. They hope the input will bolster collected feedback and inform the IMH-IAG and other major networks.

Over the past three years, FNS have trained over 1,200 perinatal staff in the NHS and the Third Sector in understanding paternal mental health. Chris stated that capacity building was needed to change things on the ground, and training will only be consistent across Scotland when there is a formalised approach to how fathers and partners are included. Anne agreed that all pieces of work on fathers, partners, mothers and babies needed to be joined up, with a cohesive family-centred approach.

Evaluation group

Susan Galloway (Information Development Officer, NSPCC) presented an overview of the data collated as part of the IMH Needs Assessment in NHS Lanarkshire, which is being carried out by the NSPCC. The assessment seeks to build a picture of the scale of need in infancy in Lanarkshire, using administrative data to determine rates of infant vulnerability.

A recent study of Growing Up in Scotland data found that poverty in childhood is highly correlated with socio-economic disadvantage in the first year of life. In 2018, there was an average of 1,800 babies in Lanarkshire born to mothers in the most deprived income quintile. 11% of children in the lowest income quintile at birth had experienced four+ adverse experiences by the age of eight. Using this information, it can be estimated that 200 infants are born into this circumstance in Lanarkshire each year.

Susan highlighted that the data was a snapshot from 2018-19 and does not show cumulative need or the interrelationships between the information points. The data does show a significant number of infants who have early experiences that can compromise their wellbeing and development from the start of life. This data is valuable as it helps make the case to permanently embed specialist IMH services, and will be useful in the development of pathways into care.

Susan emphasised the group’s responsibility to make effective use of the sensitive information that had been collected from women and families, to design, guide and evaluate new services. A full report of the needs assessment findings will be available soon, and Susan’s slides can be shared on request.

Helen Minnis (Professor of Child and Adolescent Psychiatry, University of Glasgow) gave an update on the qualitative interviews with professionals, which aim to build an understanding of the barriers to IMH service development. Helen and other members of the Evaluation subgroup have been supervising two higher trainees in child psychiatry and one medical student who have been carrying out the interviews with Lanarkshire stakeholders, asking two main questions:

  • why is it so challenging to build specialist IMH services, despite the fact that we know that the baby’s brain is developing so rapidly?
  • how do the personal experiences of stakeholders influence their views about IMH service development?

So far, the interviewees have been mostly optimistic and believe that barriers to service development can be overcome. The interviews are being transcribed and a standard coding framework has been established.

Next Meeting: Wednesday 26th May 2021, 10-11.30 a.m.

Annex A

Action Update Table

Action one: expand Participation Officer time to ensure experts by experience are engaged around IMH. Local Implementation groups progressing with appropriate leadership appointments

Addressing delivery aim: Leadership and co-production         

Action two: launch of IMH Campaign Wellbeing for Wee Ones    

Addressing delivery aim: Raise awareness and promote understanding of the importance of infant mental health and develop a shared language and approach that is accessible to parents and families, as well as professionals.

Comment: Hosted at Parentclub.scot and development of site ongoing

Action three: Models of IMH are developing and being tested in different health boards

Addressing delivery aim: PMHNS has developed care pathway models for those in perinatal services and further work required on whether pathway guidance for broader IMH services is needed    Develop a framework and model for the delivery of IMH services

Comment: MCN draft paper on services for families with substance use and joint working with the Alcohol and Drug National Support Team should inform reach to this population

Action four: first wave services are developing as planned but the pandemic has resulted in delays to recruitment. These services are feeding back information and through IMH Forum and Parent Infant Foundation Learning Community should be in a position to share good practice        

Addressing delivery aim: Learn from Quality Improvement work in two Health Board areas (first wave projects)

Comment: Fife and Lanarkshire

Action five: three health boards have identified or recruited IMH service leads and development work under way

Addressing delivery aim: Identify health boards where sufficient infrastructure in place to invest in further service development in 2020 to 2021 (second Wave Projects)

Comment: Highland, Lothian, GGC

Action six: other board areas need to be supported to develop funding bids in order to develop services. The appointment of a Service Development Adviser at SG will help to support this

Addressing delivery aim: identify health boards looking for support to prepare for service development by addressing infrastructure development and encouraging a shared visions across agencies (third wave projects)

Action seven: the development of MNPI services has supported the development of services required to support babies and their families in the context of prematurity and other physical health challenges. Pathway work has progressed but further work is still required in relation to input to NNUs and other hospital settings and ‘repatriation’

Addressing delivery aim: Consider what support might enhance the delivery of services to neonates with complex needs in the context of prematurity, congenital abnormalities or other health challenges who are returning to their home area after a period of inpatient specialist interventions

Action eight: NES have continued to develop relevant trainings including iHV PIMH Champions training to health visitor and midwives in NoS

Addressing delivery aim: PB now has workforce working group

Action nine: SG has funding third sector IMH training via Inspiring Scotland and HDS      

Addressing delivery aim: Training and Workforce Development and Retention

Action ten: the Evaluation sub group have compiled a list of evaluation projects. The needs assessment project in NHS Lanarkshire is nearing completion, as is the qualitative research into attitudes to IMH. Piloting of the use of IMH indicator set with HVs. PMHNS CAS data set includes IMH measures. Service development, eg in GGC, incorporating discussion of impact

Addressing delivery aim: Impact, Evaluation and the development of Outcome Measures

Action eleven: Liaison with FNP national lead and with CSP re learning from others’ experience, inc LA services eg NHS Highland  

Addressing delivery aim: Innovation         

Comment: Use of remote access improving in context of pandemic

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