Ellie Kerry - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)
Keywords: attrition
droupout
trainee clinical psychologist
neonatal care unit
experts by experience
participation
postnatal depression
cognitive behavioural therapy
involvement
parenting self-efficacy
teaching
social support
CBT
NICU

Systematic Review of the Literature
Introduction: Postnatal depression is experienced by 10-15% of new mothers and can have long-term consequences for their wellbeing and the development of their baby. Cognitive Behavioural Therapy (CBT) has been shown to reduce symptoms of postnatal depression by targeting unhelpful cognitive appraisals and behaviours. Dropout rates vary widely between cognitive behavioural interventions for postnatal depression, and higher dropout rates are associated with poorer therapy outcomes. Understanding the reasons for dropout could help improve the delivery of CBT interventions for postnatal depression. Methods: The dropout rates in quantitative studies of CBT interventions for postnatal depression, and the factors accompanying dropout, were systematically reviewed. Three databases were searched, resulting in twenty-two papers meeting inclusion for the review. One of these papers included two CBT intervention arms so a total of twenty-three interventions were reviewed. Results: There was a wide range of dropout rates across the included studies. Dropout rates were lower for in-person interventions compared to remotely provided interventions. The interventions with the lowest dropout rate were those delivered as home-visits. The papers employed different clinical thresholds for identifying PND and five studies found no difference in baseline PND severity when comparing dropouts to completers. Conclusion: Given the heterogeneity of the studies reviewed, recommendations were made regarding the reporting and analysis of dropout, and the inclusion of a wider demographic of participants in future interventions.

Service Improvement Project
Introduction: There is growing acknowledgement of the value of creating partnerships between those delivering and those accessing health services. Less is known about Expert by Experience (EbE) involvement in the context of clinical psychology doctoral training programmes. This study explored the models of involvement of EbEs in teaching on a DClinPsych course in England; the impact of EbE involvement, both for EbEs and trainee clinical psychologists and whether improvements were required to better meet their needs. Methods: The level of current involvement was explored by review of course records. A qualitative design was employed in which EbEs and trainees completed one of two survey questionnaires designed around commonly used frameworks of participation and reflective learning were completed by EbEs and trainees. Thematic Analysis was used to evaluate the written feedback from the surveys. Results: Records of current EbE involvement were found to be lacking in detail and sometimes missing. Ten EbEs and nineteen trainees completed the survey questionnaires. Key themes extrapolated from the surveys highlighted the importance of EbE involvement in supporting the wellbeing of EbEs and the learning experiences of trainees. Conclusions: Recommendations are given regarding the processes for future EbE involvement in teaching.

Theoretically Driven Research Project
Introduction: Parenting self-efficacy (PSE) encompasses the set of beliefs a parent holds about their capability to care for their child. Admission to a Neonatal Care Unit (NCU) can disrupt the development of PSE, because parents are less able to provide active care for their newborn. Reduced PSE can interfere with the bonding process and is associated with negative physical and mental health outcomes. Greater perceived levels of social support have been found to play a role in promoting parenting confidence, but this relationship has not yet been studied within a UK neonatal population. The aim of this study was to investigate whether greater perceived levels of social support predicted greater PSE in parents of infants admitted to an NCU following birth. Methods: A longitudinal, within-group design was employed in which participants completed self-report questionaires about their perceptions of social support and PSE at three time-points; 69 completed time 1 measures, 52 completed time 2 measures and 56 completed time 3 measures. Hierarchical Multiple Regression, a repeated-measures ANOVA and partial correlations were used to investigate the change in PSE over time and the relationship between perceived social support and PSE. Results: A strong positive correlation was found between perceived social support and PSE. PSE was also found to increase significantly over time. Perceived social support at admission to the unit was found to predict PSE one month after discharge. Perceived social support was not found to predict social support at discharge. Conclusion: The implications with regard to staff support and training are explored, as well as the strengths and limitations of the research.