Bryony E. Insua-Summerhays - Research Portfolio Submitted in Part Fulfilment of the requirements for the Degree of Doctorate in Clinical Psychology (DClinPsych)

Chapter 1.
Aims. To review systematically the psychometric properties of instruments used to assess mothers’ thoughts and feelings towards their unborn baby.
Background. A number of antenatal constructs have been used to assess mothers’ thoughts and feelings towards their unborn baby, including reflective functioning, mind-mindedness, representation and foetal attachment. Research shows these constructs predict parent-infant interaction and later infant adjustment. There is currently, however, no existing review comparing the quality and accessibility of instruments across these four constructs to identify women in need of additional support during pregnancy.
Design. A systematic literature review was undertaken to synthesise what is known about the psychometric properties of measures that report on expectant mothers’ thoughts and feelings about their unborn baby. Searches of six databases were conducted. English articles were selected based on inclusion and exclusion criteria. The QATSDD (Sirriyeh, Lawton, Gardner, & Armitage, 2012) checklist was used to assess study quality.
Results. Of 669 studies identified, 28 met the inclusion criteria. Thirteen different instruments were identified for psychometric evaluation. Reported reliability and validity varied significantly across instruments, as well as availability for research and/or clinical use.
Conclusion. Suggestions for research and clinical practice include further evaluation of the psychometric properties of screening tools, particularly for brief self-report measures of antenatal reflective functioning, use of additional assessment measures to scaffold reflexivity in expectant mothers, and the development of clinical policies and procedures to ensure clear pathways of care are available for women in need of further support.
Chapter 2.
Background. The COVID-19 pandemic necessitated that mental health services make the rapid transition to remotely-delivered telehealth assessment, support and intervention. Whilst formal guidance on how to approach this task with neurotypical populations has been developed, there is no existing framework on how to adapt telehealth to effectively meet the needs of young people with neurodevelopmental conditions.
Aims. The following study aimed to assimilate existing guidance on telehealth practice with clinicians’ experience and expertise within a CAMHS NDC Pathway. The objective is to develop a working guidance document that offers a framework for best practice in remote service delivery, as well as reviewing organisational features of the service which have supported this transition.
Design. A mixed methods design was undertaken using a PDSA cycle to 1) review existing literature and guidance frameworks on telehealth, 2) conduct in-depth semi structured interviews with clinicians and managerial staff within the NDC Pathway, 3) develop a guidance document for online service delivery to children and young people with NDCs, 4) receive feedback from the service stakeholders, developing a set of recommendations for continued service improvement.
Results. An NDC-specific framework was developed to capture specialist skills and techniques needed for delivery of remote assessment and intervention within the service. Exploration of issues related to clinical operations reflected themes around the importance of flexible clinical protocol, attendance of consultations, risk management and accessibility. A review of organisational factors in the adjustment to remote working highlighted the democratic and iterative process of change, based on collaboration and feedback.
Chapter 3.
Background. Mentalization, operationalized as the overlapping constructs of reflective functioning and theory of mind (ToM), has been separately shown to be impaired both in individuals with Autism Spectrum Conditions and those with Emotionally Unstable Personality Disorder (EUPD). Reports suggest that similarities in the functional presentations can result in misdiagnosis of women with Autism as EUPD. The present study builds on previous research investigating each clinical group separately to compare similarities and differences in mentalizing profiles.
Methods. This study used a between-groups cross-sectional design with data collected at a single time-point. Participants (N=21 Autism, N=21 EUPD, N=23 community controls) completed the RMET, RFQ-54 and CORE-10 to measure theory of mind, reflective functioning and mood respectively.
Results. In terms of the RFQ subscales of hypermentalizing and hypomentalizing both clinical groups showed significantly elevated levels compared to controls but did not significantly differ from each other. RMET scores showed the same pattern. Psychological distress was associated with impairments in reflective functioning in both clinical groups. The ToM measure was not significantly associated with distress for either group.
Conclusions. The current findings indicate comparable profiles of mentalizing deficits in both clinical groups. Findings underscore reported difficulties in distinguishing the two groups at a diagnostic level. Suggestions are made for further investigations to evidence the pathways underpinning mentalizing profiles in either group, including possible mechanisms of intolerance of uncertainty and epistemic trust.