Levels of intervention

In this video, I want to summarise for you some of the key methods of working during the perinatal period in terms of the target of some of the interventions on which we’ll be focusing later. The three main groupings in terms of how interventions are delivered are universal, targeted, and indicated. The key feature of a universal approach is that it is available to everyone. Key practitioners involved in the delivery of universal methods to promote infant mental health include midwives and public health nurses, or health visitors within the health service, and early years practitioners within the early years sector.

It should be noted that a universal approach, however, doesn’t necessarily involve a practitioner at all and can simply involve the use of a public health approach, such as the delivery of leaflets or newsletters, or even wider societal changes, such as modifications to the law to prohibit certain types of parenting practice, such as, for example, smacking. Targeted interventions are provided to parents who are at risk of poor parenting because they are in some way vulnerable and need additional support. Targeted interventions are typically delivered to specific groups of parents.

So for example, they might be directed at parents living in an area of socioeconomic disadvantage or parents who have particular characteristics that put them at risk, such as being a teenager, or parents who are also immigrants.

Indicated interventions are provided to parents who are experiencing problems. So for example, women who are identified in the postnatal period as being postnatally depressed would be offered an intervention. Other high risk groups of parents include couples where there is domestic abuse or substance dependency. Interventions are also classified, however, in terms of whether they are dyadic or non-dyadic. Non-dyadic interventions target the parent only, whereas dyadic interventions target the parent and baby together. If, for example, we take the case of a woman who is postnatally depressed, a non-dyadic method of working will be to offer her counselling or interpersonal psychotherapy, with the aim of modifying her depression.

However, a number of studies have shown that while such methods are highly effective in terms of improving the mother’s depression, they are less effective in terms of improving her interactions with the baby. And if you remember from early material in the course, the research shows that it’s the impact of the depression on the interaction that is important, rather than the depression per se. This suggests the need to work with both the mother and baby together. Examples of dyadic methods that target both mother and baby when the mother is experiencing postnatal depression include video feedback and parent-infant psychotherapy, both of which we’ll examine in more detail shortly.

In the next two parts of the course, we’re going to be examining some of the key methods of working in pregnancy and the postnatal period. The postnatal interventions that we examine will focus primarily on dyadic methods of working.