The Birmingham Inpatient Mother and Baby Unit is a 10 bedded ward admitting women from 32 weeks gestation up to 12 months postnatal. Like all of the 19 MBUs in England, we are a national service and so accept referrals from anywhere in the country. Admissions can take place at any time during the week. On admission, a full psychiatric history is obtained by the medics and the nurses. This helps to inform the assessment process.
Every Monday morning, we hold a Multi-disciplinary Team meeting, where all professionals are represented (nurses, medics, clinical psychologists, nursery nurses, health visitors and occupational therapists). The care of all patients is reviewed and aims for the week ahead are identified. All new inpatients are discussed in more detail and we are able to review the assessments that have been completed so far, helping us to identify any gaps in our knowledge and plan for how we will complete the assessment. We also complete a HoNOS score at this time using the collective information from the various professionals - agreeing a score for each domain.
There are certain aspects which have specific significance for women in the perinatal period:
- Question 5 asks about physical illness or disability. It is important to consider the impact of the pregnancy, the birth and any consequences arising from them.
- Question 9 asks about problems with relationships. It is important to consider the relationship with the baby and any other children as well as adult family members.
- Questions 10 asks about problems with activities of daily living. It is important to consider the skills that new mothers must learn when becoming parents, as well as personal selfcare activities.
- Question 11 asks about problems with living conditions. This needs to include a consideration of the needs of the baby and how it allows the mother to reach her full potential as a parent.
- Question 12 asks about problems with occupation and activities. This needs to consider the needs of the mother as a parent. Does she have access to socially supportive activities such as Children’s Centres or stay and play groups? Does she have sufficient support from support workers, nursery nurses so that both mother and baby can attend these facilities.
This scoring takes place as soon after admission as possible and when we have all of the detailed information necessary to give a representative score. It is then repeated at any stage of significant change - specifically shortly after childbirth, but also at any major changes in mental state.
In Birmingham, we have a planned Care Programme Approach (CPA) review every 4 weeks when we invite all key professionals to attend a larger meeting to plan for discharge and moving onto the next steps. Therefore every 4 weeks we ask whether we should be repeating the HoNOS score depending upon the mum’s presentation over the previous 4 weeks. Sometimes it is useful to repeat the scoring so that we can identify the areas where we are making progress but also, more importantly, those areas where we are not making progress. Sometimes areas can be missed - where there is dramatic improvement in mental state - we may overlook some of the social needs for this new family.
We always repeat the HoNOS score when we are planning to discharge the mother. As a team it is useful for us to compare the before and after HoNOS scores. This gives us an objective measure of change. If it is thought this will be helpful to the mum, this can be shared with the family and the CPA team at the discharge planning meeting. Even though it may seem clear that great progress has been made, having an objective score is positively reinforcing for care providers and receivers alike. As a service we hold an annual review and we present the finding of the HoNOS scores once they have been collated. This helps to recognise objectively the impact the team has had on those using the service. These findings are reported, together with the POEM and with real time patient feedback about how the service is doing, the areas we need to continue to maintain and those where we could improve further.
The Child Outcomes Research Consortium (CORC) in partnership with experts in the field of perinatal mental health from the Anna Freud National Centre for Children and Families (AFNCCF) have been commissioned to provide guidance on best practice and how to overcome common barriers to implementation by producing an Outcome Measurement Implementation Manual and by disseminating the manual, case studies and learning via 12 regional training workshops in collaboration with Perinatal SCNs.