Better, together: improving parent and infant mental health in the perinatal period through collaboration and innovation: Sheffield City Council

Prior to Start for Life/Family Hubs investment, dedicated infant mental health and parent-infant relationship support within Sheffield was very limited. This, coupled with the lack of an established connected community of care for families within the perinatal period, led to support often being delivered reactively, or late, and the risk of service users either being lost in gaps in provision, or struggling to access the right support for their needs in a timely manner. Such challenges can result in avoidable emotional distress for caregivers and their infants, heightened vulnerability and increased developmental risks for babies, and, ultimately, the need for more costly and intensive clinical and social intervention further down the line.

Nationally, parent-infant relationship and infant mental health provision often sits within wider mental health services and operate primarily within the specialist tier of need. To avoid siloed working, and to improve connectivity and service uptake/access, the Sheffield PAIRS service is delivered through a unique joint working model, with Specialist Community Child and Adolescent Mental Health (CAMHS) clinicians working in true partnership with 0-19 Health Visiting colleagues. The service offers a responsive ‘no waiting list’ model of provision, as to ensure timely and accessible support, and accepts referrals through a single point of access from any services and self-referral. 

The service developed new PAIRS 0-19 Infant Mental Health Practitioner (IMHP’s) Roles, with these clinicians being embedded across Sheffield’s citywide Health Visiting Locality teams. To further improve the awareness of and support for parent-infant relationship services within Sheffield, there has also been a targeted rollout of communications, training and consultation provision. 

In addition to bolstering parent-infant support, Sheffield City Council has also supported the development of a proactive offer of support for women and birthing people (WBP) who are identified by their midwives as having mild-moderate mental health difficulties, as this is a known risk factor for the parent infant relationship. The Sheffield Maternal Mental Health Midwifery Team now jointly deliver an Emotional Wellbeing Clinic with Early Years Family Intervention Service in the Local Authority. 

Implementation steps

• Building a shared case for the importance of improving perinatal mental health (PMH), infant mental health (IMH) and parent-infant relationship provision within Sheffield.
• Establishing joint leadership and a coordinated workstream to support and enable delivery.
• Ensuring effective information sharing to support joint working and oversight and ensure continuity of care.
• Upskilling the Sheffield workforce and building a shared language.
  
   

The unique joint delivery model of the PAIRS service has enabled earlier identification of parent infant relationship difficulties and more effective prevention, offering support from conception to age three across universal, targeted and specialist levels of need. This has reduced the average age of babies at the point of referral since the initiation of the service by 2.92 years, with this now just 4.4 months. 57 per cent of current PAIRS service users fall within the bottom three Indices of Multiple Deprivation, and 30.4 per cent of service users identify as an ethnicity other than White British, with the relative overrepresentation of these cohorts a positive equity marker illustrating parity of service access. Over 500 women have received support through Sheffield Emotional Wellbeing Clinics, with 27.5 per cent of them receiving referrals for Family Intervention Support. 

Moving from a fragmented support offer to a new integrated approach in a short timeframe and shared goals, flexible thinking, clear communication and building trusted relationships have all being fundamental in driving the model forward successfully.

Creating complex system wide change requires significant time commitment, which can be heavily impacted by limited capacity within often strained systems. It is essential that those embarking on change projects of this scale develop an understanding of the wider factors which limit service and individual buy-in and commitment at all levels, and work to support effective engagement through clear communication, collaboration and mutual support. 

Involving service users is essential to ensure the development and delivery of services which meet local needs. Through listening to and learning from service users and community organisations, services are more able to meet the diverse needs of the Sheffield population, and service offers and resources better engage and serve local families. 

Julia Thompson – Health Improvement Principal – Sheffield Public Health and Integrated Commissioning Directorate, Sheffield City Council 

Email: [email protected]

 

Jennifer Turner – Service Delivery Manager, Sheffield Parent-Infant Relationship Service (PAIRS), Sheffield Children’s NHS Foundation Trust

Email: [email protected]