PERINATAL MENTAL HEALTH SIMULATION: A novel and effective way of training a multi-professional audience to improve interprofessional working. Dr Catherine Wilson catherine.wilson@slam.nhs.uk ST5 General Adult and Old Age Psychiatry Honorary Senior Fellow in Medical Education South London and Maudsley NHS Foundation Trust
BACKGROUND
AIMS We developed an interprofessional perinatal mental health simulation training course to try to meet some of these unmet needs i.e. Improving collaborative working within and between professions to improve the quality of clinical care. Improving confidence, knowledge and skills around the identification, assessment and management of perinatal mental health difficulties. Changing attitudes amongst professionals towards the field of perinatal mental health.
WHAT IS SIMULATION An educational intervention that is evidence based to improve human factors and non-technical skills in healthcare. Provides a framework that is as close to real life as possible but which is safe for participants and patients (confidential and non-judgemental). Structured debriefing allows all the course participants to learn from the scenario and share knowledge and experience with the group.
METHODS We developed a 1 day simulation training course. o 6 scenarios based upon common and important clinical scenarios. We have run the course 27 times with 237 participants. o A wide variety of health and social care professionals. o In our training centre and at other centres across London and the South East
We developed a 30 item self-report questionnaire that was completed anonymously before and after the course. Quantitative data was analysed from the first eight courses (n=82). Written and verbal feedback was obtained for all 27 courses (n=237). Data was analysed using thematic analysis.
THE COURSE
RESULTS There were statistically significant increases in: Positive attitude scores pre- (M=24.12, SD=3.44) to post-course (M=26.40, SD=3.05), t(76)=-5.84, p=.001 Eta squared indicated large effect size =.31 Confidence scores pre- (M=76.60, SD=15.05) to post-course (M=92.78, SD=9.83), t(77)=-11.76, p=.001 Eta squared indicated large effect size =.64 Knowledge scores pre- (M=8.65, SD=1.69) to post-course (M=9.74, SD=1.27), t(79)=-5.75, p=.001 Eta squared indicated large effect size =.30 N.B. Effect sizes..01 = small.06 = medium.14 = large
Confidence Items RESULTS Pre-course Mean (SD) Post-course Mean (SD) p value Effect size.01*.54 Recognise the signs of mental illness in a woman in the perinatal period. 6.71 (1.87) 8.43 (1.05) Ask my patients/clients questions about their mental health. 8.34 (1.69) 9.06.01*.21 (1.00) Determine whether someone has a perinatal mental illness. 6.20 (2.08) 7.96.01*.49 (1.42) Undertake comprehensive risk assessments for women with 5.56 (2.64) 7.83.01*.51 perinatal mental health problems. (1.78) Know which cases to refer regarding safeguarding concerns. 7.04 (2.05) 8.35.01*.42 (1.34) Know how to manage perinatal mental health problems 5.74 (2.26) 7.76.01*.46 (1.58) Balance the risks and benefits of the mother and the infant. 5.94 (1.93) 7.90.01*.56 (1.28) Understand the pathways in managing a woman with perinatal 5.84 (2.18) 8.05.01*.62 mental health problems. (1.34) Ask for necessary assistance from colleagues 8.51 (1.47) 9.17 (.97).01*.26 Ask for necessary information from colleagues 8.44 (1.47) 9.16 (.94) N.B..01* Effect sizes..35.01 = small.06 = medium.14 = large
RESULTS Attitudes Items I feel that mental and physical healthcare teams and social care can work well together in the care of pregnant/post partum women with mental health problems. I feel that asking about the wellbeing of other children in the household is not part of my job. I feel comfortable with my own roles and responsibilities as a member of the Multidisciplinary Team I find communicating with members of the multidisciplinary team from a different professional background difficult. I feel confused by how the systems work together to manage a woman with perinatal mental health problems. I feel comfortable with the roles and responsibilities of other members of the Multidisciplinary Team Pre-course Mean (SD) Post-course Mean (SD) p value Effect size 4.48 (.75) 4.70 (.56).01*.08 4.71 (.87) 4.74 (.87).86 4.22 (.88) 4.47 (.68).01*.09 3.91 (1.07) 4.14 (1.11).07 3.22 (1.13) 4.00.01*.27 (1.15) 3.57 (.91) 4.35 (.79).01*.44 N.B. Effect sizes..01 = small.06 = medium.14 = large
Interprofessional collaboration Increased awareness of health visitor/midwife role Encouraging group feedback allowed participants to explore ideas/share thoughts and experiences which was very insightful.
Increase MDT links make links today I will find out about Mental Health referral pathways Try to allocate more time to establishing clearer links with MIMHS Multidisciplinary working
ask open ended questions think of body language/posturing discuss perinatal care more openly Mindful of non-verbal communication Communication
Take more time (protected) to reflect on practice Reflection with other staff members/debriefing Reflection
Knowledge & Confidence it will help my skills and confidence to identify clients with mental health disorders in the perinatal period feel more confident in asking questions on risk a more systematic approach to assessment more confident in signposting use the mental state examination when assessing/examining our patients safeguarding midwife
Interprofessional collaboration Multidisciplinary working Knowledge & Confidence Reflection Communication
CONCLUSIONS We have developed an unique training course to effectively improve multidisciplinary working in the field of perinatal mental healthcare. Knowledge Confidence Attitudes We are now assessing how the impact of the course translates back into clinical practice at 3-6/12 after taking the course. We are training other teams to deliver the course so it can spread nationally and hopefully internationally.
REFERENCES CENRE FOR MATERNAL AND CHILD ENQUIRIES. (2011). Saving Mothers Lives: reviewing maternal deaths to make motherhood safer: 2006 08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG: an International Journal of Obstetrics and Gynaecology, 118(Suppl. 1). NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. (2014). Antenatal and postnatal mental health: clinical management and service guidance. NICE: London. WORLD HEALTH ORGANIZATION. (2010). Framework for Action on Interprofessional Education & Collaborative Practice. WHO Press: Geneva.
THANKS Dr Gertrude Seneviratne, Consultant Perinatal Psychiatrist, SLaM Maudsley Simulation
Any Questions?