Title: Enhancing maternal and infant wellbeing: a feasibility study of the Baby Triple P Positive Parenting Programme for mothers with severe mental illness
Funder: Department of Health and Social Care

Abstract: Background The role of the mother as the primary caregiver in the optimal physical and psychological development of her baby is well established. Recent government and other reports call for parents to be supported in their endeavours to raise successful, socially and academically competent children who will reach their full potential13-19. The use of established parenting interventions has been advocated in families without parental mental illness and with older children (aged 2 and above). For infants, the mother s ability to sensitively respond to her baby s needs has received most research attention20-23. Whilst researchers advocate the use of parenting interventions in the treatment of mothers caring for babies24, there are as yet very few studies that have examined the benefits of parenting intervention for mothers with severe mental illness (SMI). Although Mother and Baby Units treat mothers with SMI, they do not yet offer formally evaluated, evidence-based parenting interventions. The extensively researched and effective Triple P Positive Parenting Programme6-11,25-28 has now been expanded to families with babies. Baby Triple P targets three important areas crucial in enhancing maternal and infant wellbeing: 1) positive parenting skills promoting secure attachment, reducing maternal and infant distress; 2) improving partner and social support to increase maternal and overall family wellbeing and 3) increasing maternal coping resources to combat mental illness. Aims The overall aim of this study is to evaluate a recently developed parenting intervention in mothers whose SMI has necessitated admission to a Mother and Baby Unit (MBU) for treatment. This feasibility study aims to evaluate Baby Triple P in a parallel-group, single-blind (outcome assessor) randomised controlled trial (RCT) comparing Baby Triple plus Treatment as Usual (TAU) versus TAU alone. This study will also examine the key cost indicators associated with the intervention and its acceptability to mothers and MBU staff through qualitative and quantitative evaluation processes informed by service user involvement. Plan of investigation We plan to recruit 60 mothers with SMI who have been admitted, jointly with their babies, to a Mother and Baby Unit in Manchester or Birmingham. We will randomly allocate mothers to receive either eight sessions of Baby Triple P plus TAU (n=30) or TAU alone (n=30). We will pilot a range of self-report and observer-rated outcome measures at baseline, post-intervention and 6-month-follow up assessments, which will be administered by research assistants blind to allocation. The piloted primary outcome measure will be maternal competence and confidence in caring for her infant. as wellbeing indicator. Secondary measures will assess maternal mood, mental health symptoms and the mother-infant-bond. In addition, data on the acceptability and feasibility of the intervention alongside the costs of delivering this intervention will be collected. We will conduct qualitative interviews with participants and staff to identify the intervention s strengths and weaknesses and any perceived benefits. In preparation for a definitive RCT, we have involved a health economist and the Clinical Trials Unit (CTU). Potential benefits We anticipate that the results of this study will improve understanding of a) the parenting support needs and preferences and b) barriers and solutions to engaging this clinical population. This study is an opportunity to evaluate an intervention combining parenting skills with psychological coping strategies. If found to be clinically and cost effective, it can readily be implemented within existing perinatal outpatient and inpatient NHS services and may be efficacious in less severe maternal mental illness, thereby ensuring a wider population reach. The intervention s focus on ensuring a positive family pathway for child development could potentially reduce the economic as well as personal costs of perinatal mental illness for mothers, children and their families.

Lay abstract: About one in a hundred mothers develop severe mental illness after giving birth. Psychosis or severe depression can have a significant negative impact on the mother and her baby. These mothers are usually admitted to a Mother and Baby Unit (MBU). MBUs are psychiatric wards which aim to improve the mother s mental health and her relationship with her baby. At present, MBUs offer a range of different types of support but no structured therapy. MBU staff and mothers believe the recently developed parenting programme called Baby Triple P could be helpful. The aims of this therapy are to strengthen the relationship between mother and baby and their wellbeing. Mothers can learn skills to cope and skills to look after their baby. These are provided in a book they can also share with their partners/family. So far, though, its possible benefits in this NHS setting are not known. In this feasibility study, we will test whether it is possible to recruit, engage and retain 60 mothers admitted to a MBU. Half will be offered eight sessions of Baby Triple P in addition to their usual care. The other half will receive their usual MBU care only. Mothers in both groups will be asked to fill in questionnaires before and after their treatment and at a 6-month-follow up. Mothers and MBU staff will also be interviewed to give their views on this therapy. We want to know whether they liked the therapy and if they felt any benefits or not. We will also identify how much it will cost to deliver this therapy in this NHS setting. We will ask service users to contribute to all aspects of this study to be sure it is relevant to them. We will also ask them to contribute to the evaluation and any publications.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH;MENTAL HEALTH