Assessing Capacity to Change in High‐Risk Pregnant Women: A Pilot Study

Abstract

Pre-birth risk assessment is a process by which circumstances affecting an unborn child can be identified and support for mother and infant embedded. This mixed methods study describes a community-based pre-birth assessment and care pathway that utilised the Parents Under Pressure (PuP) programme to assess parenting capacity and provide support pre-and post-birth for 'at risk' women. Sixty-eight pregnant women referred to children's social care services were allocated to the pre-birth assessment and care pathway (n = 35) or to routine care (n = 33). Standardised measures of psychological distress, social support and alcohol measured change for the women in the assessment and care pathway. Twenty women who provided pre-and post-data reported significant improvements on all measures except alcohol use. Safeguarding outcomes at 12 months were obtained for both groups using administrative data. Forty-two per cent of the infants whose mothers received the pre-birth assessment and care pathway showed an improvement in child protection status compared to 14 per cent of the routine care infants. Safeguarding status deteriorated or stayed the same in 52 per cent of the routine cases compared to 26 per cent of those receiving the pathway. Qualitative data revealed that the pathway was acceptable and helpful to service users and service providers. Copyright © 2017 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGES:• The current project found that a community-based pre-birth assessment and care pathway with high-risk pregnant women was feasible and acceptable for practitioners and service users.• The pathway began mid-pregnancy and support was provided following the birth of the infant for up to 12 months.• Over 40 per cent of infants whose mothers were allocated to the pre-birth risk assessment pathway showed improvements in child safeguarding status at 12 months.

Predicting maximal oxygen uptake from a 3-minute progressive knee-ups and step test

“…Specifically, three heart rate measurements are used to calculate the step-up index. However, previous studies have reported considerable differences in the validity of using the step test index to evaluatė VO 2 max, with the corresponding correlation coefficient (R) being 0.35-0.94 (Buckley et al, 2004;Chang & Lin, 1995;Mazic et al, 2001;Su, Lin & Hsieh, 2006;Chang & Lin, 1995;Yoopat, Vanwonterghem & Louhevaara, 2002). Furthermore, step tests require the use of step-up boxes, and the overall test time must be at least 6 min to allow for heart rate recovery.…”

Addressing the Disconnects in Child Protection Practice

“…While there were acknowledged limitations to their study design, Harnett et al . () did find a distinctly different pattern of child protection outcomes for those infants whose mothers were part of the PuP programme compared to those receiving routine care. The quantitative data identified that many women on the PuP programme experienced significant improvements in wellbeing and perceived social support, and the qualitative data suggested perceived benefits of the programme among both the practitioners and the mothers involved.…”

“…Our final research paper in this issue from Paul Harnett et al . () takes us a stage further in evaluating an intervention designed to address an important disconnect in relation to mothers and infants considered high risk during pregnancy. Recognising that ‘despite their vulnerabilities, ‘at risk’ infants are often not given adequate protection within a time frame that is consistent with their developmental needs’ (Harnett et al ., , p. 73), Harnett and colleagues used a quasi‐experimental research design to evaluate the impact of the Parents under Pressure (PuP) programme for high‐risk families with potential or current involvement in child protection services.…”

An Attachment-Based Parental Capacity Assessment to Orient Decision-Making in Child Protection Cases: A Randomized Control Trial

“…More recently, two studies, one with maltreating parents (Van der Asdonk et al, 2020) and another with at very high-risk pregnant mothers (Harnett et al, 2018), tested a PCA protocol with an embedded video-feedback parent-child intervention to assess the potential for enhanced sensitivity, but mixed results were shown. The RCT study of Van der Asdonk et al (2020) showed that children of the target and control groups experienced similar recurrence rates of maltreatment 10 months after the intervention Also, evaluators of the target group did not feel more confident about their child placement recommendations.…”