The perinatal journey : the process and impact of psychosocial assessment

Abstract

The importance of early identification of women with psychosocial risk factors, such as child sexual abuse, substance use and domestic violence during pregnancy and after birth has gained significant recognition both nationally and internationally. Policy and guidelines, such as the Supporting Families Early (SFE) package in New South Wales (NSW), Australia, have been developed and recommend that psychosocial assessment be conducted by midwives and child and family health nurses (CFHNs). The purpose of this ethnographic, qualitative study is to examine and understand the meaning midwives, CFHNs and women make of the process of psychosocial assessment and depression screening undertaken during pregnancy and following birth. Specifically, this study describes and examines how midwives and CFHNs approach and deliver the psychosocial assessment questions; and their experiences and perceptions of the assessment process. This study sought to understand women's experience of being asked the assessment questions. Thirty four women, 18 midwives and 13 CFHNs participated in this study. Participants were recruited from two different settings in NSW, Australia. Data were collected through observations of the interactions between the women, midwives and CFHNs during assessment and screening. An observation tool (4D&4R) and field notes were used to record observations of the assessment and screening process. Following the observations, face to face interviews were conducted with the women, midwives and CFHNs. Approximately 60 Midwives and 70 CFHNs also agreed to participate in discussion groups, reflecting on their experiences and perceptions of the assessment and screening process. The findings presented in this thesis, including three published papers, demonstrate that midwives and CFHNs in this study experience tensions in conducting assessments, which may influence how questions are delivered. A flexible approach to assessment was preferred whilst incorporating structured tools into the process, however, some of the CFHNs in this study rejected the use of structured tools. A relationship based approach was common, developing rapport with the women to establish comfort prior to asking psychosocial assessment questions. Midwives and CFHNs utilised other skills such as observation, and drawn upon to inform their clinical judgement as to a woman's propensity to be at risk of social and emotional distress. The tensions midwives and CFHNs experienced conducting assessment may be partially explained by the varying interpretations of the NSW SFE policy recommendations. Overall, the women perceived the assessment questions were important, however, some women experienced discomfort, surprise and felt unprepared to be asked these questions. Women who disclosed previous negative life events, such as child sexual abuse were distressed by this experience and appeared to comply with the assessment process. In this study partners who attended the clinic with the participating women were excluded from part of or the entire visit. Women reported in interviews, that their partners had a sense of what was being discussed in their absence and provided support to women who were distressed following disclosure. Effective delivery of assessment and screening requires ongoing education, training and supervision in the use of structured tools and how to best incorporate these into a relationship-based approach. Women could be better prepared prior to the assessment and may experience less distress if their midwife or CFHN responds with sensitivity and care. This study is part of a larger study funded by an Australian Research Council (ARC) linkage grant, in partnership with Karitane and was completed by me on a full time scholarship over three years. This thesis is presented as a series of four publications.

Date of Award	2013
Original language	English