Lynn E. Priddis

Motor Neurone Disease family carers' experiences of caring, palliative care and bereavement: An exploratory qualitative study

Background: Motor Neurone Disease (MND) is a neurodegenerative disease with a sudden onset, a rapid progression, a profile of complex disabilities and fatal consequences. Caring for a person with MND is an unremitting commitment, yet little research has examined the experiences and needs of carers for palliative care and bereavement care. Aim: This study explored the experiences of MND family carers, both during their time as carers and following bereavement. Particular attention was paid to the carers’ prolonged grief status and to the implications for service delivery, including palliative care. Design: A qualitative approach consisted of interviews with 16 bereaved family carers. The Prolonged Grief tool (PG-13) measured the carers’ prolonged grief. Setting/participants: sixteen family carers participated in the study, between one and four years after the death of their spouse from MND in Western Australia. Results: The thematic analysis of the interview transcripts revealed five themes – the work of family carers, the change in relationship from spouse to family carer, family caring as a series of losses, coping mechanisms of family carers and supportive and palliative care experiences of family carers. The six participants who met the criteria for prolonged grief disorder accessed palliative care at a later stage in the disease trajectory. Conclusions: The study provided a basis for more research into the role palliative care services has in supporting MND carers before and after the death of their spouse and in particular the provision of more tailored respite and bereavement support.

Tuned in parenting and infant sleep patterns

This paper focuses on infant sleep behaviour that is of concern to mothers of young infants, and disruptive to families. It reports on the incidence of sleep problems in dyads that self‐referred to a specialist clinic, and the relationship between the mothers sensitive responsiveness and infant sleep patterns in a sample of 65 Australian infants. It briefly considers an intervention programme tailored to the specific needs of the dyad where the problem is severe. The sample consisted of a clinical self‐referred group and a comparative group from the community. Self‐report scales assessed infant sleep pattern while the Child–Adult Relationship Experimental Index assessed maternal sensitivity. All referred infants met the cut‐off point for ‘sleep problems’, while only two of the community group met this criterion. Results demonstrated a clear association between maternal sensitivity and infant sleep disorder and are discussed along with limitations of the study.

Innovations in interprofessional education and collaboration in a West Australian community health organisation

This article is a short report that describes an initiative in interprofessional education (IPE) and collaboration in health practices in a community health organisation. Staff and students from nursing and allied health professions collaborate to implement a video feedback parenting programme. The results include an increased awareness of the benefits of both IPE and infant mental health principles, in particular the establishment of a common language across professions. Further systematic evaluations are required.

Parent-Child Relationships and Quality of Children's Episodic Recall.

This paper explores the ability of five‐ to six‐year‐old children to remember past experiences. A set of stimuli cards modelled on adaptations of the Separation Anxiety Test was generated. Interview transcripts are scored for the child’s ability to recall past experience in episodic form. The quality of episodic recall is compared with attachment pattern and with quality of the dyadic mother–child interaction. Participants are 61 Western Australian children and their parents. There is a significant level of concordance between attuned dyads and the capacity of the child to relate complete episodes about past experiences. This capacity also relates to security of attachment at four–five years. The results are discussed in the context of the growing body of knowledge that suggests that the relationships parents have with their children shape their psychological world, in this case the child’s recall of episodes.

The vicissitudes of mother–infant relationships between birth and six years

This study examined contributions of maternal sensitivity and maternal representation of childhood experiences to differences in attachment strategies in a cohort of infants from birth to six years. Antenatal maternal attachment representation was assessed with the Adult Attachment Interview. Maternal sensitivity was assessed with the Child–Adult Relationship Experimental Index at 15 months. The child’s attachment strategy was classified with the Strange Situation for preschool children at 24–30 months and with a new representational measure at six years. Results indicate that mothers with a secure representation of the attachment system are more sensitive to their infants, and their children tend to develop secure attachment patterns. Changes in patterns of insecurity over time are discussed along with limitations of the study.

Parental Experience of Information and Education Processes Following Diagnosis of Their Infant With Cystic Fibrosis Via Newborn Screening

UNLABELLED Following diagnosis with cystic fibrosis (CF), initial education powerfully influences parental adjustment and engagement with care teams. This study explored the education needs of ten parents following their infants diagnosis with CF via newborn screening. DESIGN AND METHODS Phenomenological study using van Manens approach, with ten participant parents of children 1-8 years with CF. RESULTS Parents recounted varying degrees of coping with information they acknowledged as overwhelming and difficult. For some it was too much too soon, while others sought such clarity to put CF into context. CONCLUSIONS Participants delivered insight into their engagement with their education about CF. Their recommendations for appropriate context, content, format and timing of delivery enable development of education that is accurate and relevant.

BUILDING A WORKFORCE COMPETENCY-BASED TRAINING PROGRAM IN INFANT/EARLY CHILDHOOD MENTAL HEALTH

This article describes findings from a project conducted in Western Australia (Mental Health Commission WA, 2015) that investigated the education and training needs of the Infant/Early Childhood Mental Health (I/ECMH) workforce. We examined international training programs and models of delivery in infant mental health, including a review of the current training available in Australia. Data collected from over 60 interviews were analyzed, and a staged delivery model for I/ECMH training and supervision that aligned with the Michigan Association for Infant Mental Health (2014) Competency Guidelines was recommended. These findings led to the purchase of the Michigan Association for Infant Mental Health (2014) for use in Western Australia. In a very short time, use of the Michigan Competency Framework by the Australian Association for Infant Mental Health West Australian Branch Incorporated has begun to change the training and education opportunities for upskilling the infant and early childhood workforce in Western Australia. It has resulted in a map to guide and develop training in the I/ECMH field for individual practitioners and professionals as well as for workplaces that will ultimately benefit Western Australian infants, young children, and their families during the perinatal period and in the early years.

Insecure attachment patterns at five years. What do they tell us

Developmental outcomes for children whose primary caregivers are misattuned but not considered abusive are unclear. This paper argues that if by the pre-school years, insecure patterns of attachment are evident then a continuing dysfunctional attachment relationship is indicated and the likelihood of later difficulties is increased. The current study compared attachment patterns in a cohort of pre-school children from the regular community with concurrent behavioural ratings obtained from caregivers and teachers. The sample was followed up seven years later. At pre-school age, there was no association between teachers or caregiver ratings and pattern of security in the children. By pre-adolescence, children with compulsively insecure patterns showed higher levels of depression on a self-report measure. Ratings by caregivers of the pre-adolescent children did not differentiate the two groups. The paper argues that since caregiver misattunment to the child contributed to the initial problems, emotional difficulties in the pre-adolescent might go unseen.

Building Resilience for Separating Parents Through Mentalizing and Constructive Lawyering Techniques

Recent research suggests that by using mentalizing and constructive lawyering strategies, lawyers working with families in separation can help parents build resilience for themselves and their children (including babies), and can help parents think and reflect about, rather than react to, the situation that is developing around them. Mentalizing, understanding ones own and the others intentional mental states, is a key to resilience, or the ability to adapt successfully to adversity, challenges and stress, such as family separation. Constructive lawyering is a balance of adversarial and interest-based lawyering techniques that promote the clients perceptions of fairness and satisfaction with the dispute resolution process, and creates space for the parents to mentalize and to hear the voices of their children and babies. By understanding the importance of mentalizing and constructive lawyering, and by putting theory into practice, family lawyers can help their clients to resolve their disputes amicably, and to negotiate safe and sustainable relationships after separation.

narrative as a window to the inner mental world of young children: attachment representations, affect and memory:

This article describes a procedure which has proven useful in facilitating narratives about experience of everyday family situations in order to provide insights into the inner world of children around five—seven years. The Windows to Attachment in Young Children (WAYC) consists of the procedure itself and scoring frameworks through which the narrative is analysed. Reports from three studies demonstrate its success in generating rich narrative accounts from Australian children. A system for coding attachment representations shows promise. A system for coding quality of recall of episodic experience has enabled research into the relationship between children’s memory and parent—child communication.