An integrated group parenting model for mums with mental health issues and their babies: Findings from a participatory action research evaluation of the South Australian ACORN Program

摘要

There are established causal links both between parental mental health and the wellbeing of infants and children as they grow older (Stein et al, 2014; Goodman & Gotlib, 2002) and early parenting practice and subsequent child wellbeing (Green et al 2018). Interventions designed to improve the mother-infant relationship may have benefits both for the mental health of the mother and development of the child (Cohen et al, 2002). Improving social connectedness can also alleviate psychological ill health (Saeri, A.K. 2018). AnglicareSA's ACORN program is a 15 week group based program funded through the Hopwood Foundation which has been running for four years across metropolitan and regional South Australia. The program has engaged integrated multi-skilled care teams using Dance Play; Reflective Journaling; and strength based 'therapeutic' letters. The program employs teams of Psychologists, Family Practitioners, Dance Therapists and a sway of volunteers some of whom being former ACORN clients. There is also a more recent culturally modified group specifically for Aboriginal mums and children in the Northern suburbs (called 'Sacred Little Ones'), which has embraced a range of refinements advocated by participating mums and Aboriginal staff to enhance its cultural appropriateness. ACORN aims to improve participant wellbeing and their parenting relationship with their young children (aged 0-3 years). Inclusively complied objectives are to: enhance the quality of the parent-child interaction in order to strengthen the attachment relationship; improve parenting confidence, competence and enjoyment; enhance the parents’ coping skills, resilience and self-efficacy; expand and strengthen social/community supports and build social connectedness. To date ACORN has engaged over 250 mums with mental health issues and their children. Many of the mums who come to ACORN are socially isolated and have severe depression, clinically high parental stress, and clinically low parental confidence with around one third identifying with Borderline Personality Disorder. Substantial numbers have needed stays as inpatients at mental health hospitals and all have substantial difficulties parenting their young children with attachment issues a particular issue for many. The program has adopted a triangulated participatory action research approach to its evaluation including eight waves of pre/post measures, six-monthly follow-up surveys to explore sustainable outcomes, focus groups and regular in-depth interviews with all program staff and volunteers. The evaluation has engaged and been guided by the expertise of the ACORN staff and a Critical Reference Group. The ACORN model has been refined through a series of action research cycles. ACORN has generated excellent outcomes for participating mums and their babies. Significant improvements have been obtained in depression, parental confidence and parenting stress. Mums report learning about parenting, reflecting on their parenting and feeling closer to and having better relationships with their children. They socialise more and engage more in community activities as a result of ACORN. Many of these outcomes have been sustained (or improved) six months after completing the program. The benefits of providing an integrated, multifaceted parenting program will be examined and lessons in optimising the delivery of such programs will be presented.