This annual report - Taranaki District Health Board

Centers (CPC) included long term follow-up of 15 and 17 years. The weighted averageeffect size of programme participation was a 2.9 percentage-point reduction inmaltreatment (6.6% vs. 9.5%). Five programmes showed significant reductions insubstantiated rates of child maltreatment, and three provided strong evidence ofpreventive effects (the Parent Education Program, NFP and CPC). Common elements ofthe effective programmes included implementation by professional staff, relatively highdosage and intensity, and comprehensiveness of scope. The authors conclude that longerterm studies of a variety of intervention types are needed.Box 8. Key points emerging from the literature on interventions to address familyviolence in pregnancy There are few trials of interventions aimed at addressing intimate partner violence orfamily violence in pregnancy. Studies suggest that interventions aimed at reducing child maltreatment should also beable to address intimate partner violence. Advocacy interventions may help women in abusive relationships but the evidence basefor interventions in pregnancy is limited Integrating substance abuse treatments with family violence interventions may improveoutcomes.Mental Health Services for Pregnant WomenThe Ministry of Health has published guidance for DHBs and other health planners,funders and providers of perinatal and infant mental health and alcohol and other drug(AOD) services, on ways to address the mental health and AOD needs of mothers andinfants [279]. A range of international guidelines and reviews is also available. The keypublications in this area are briefly reviewed below. Please see page 382 for a discussionof infant mental health.Clinical guidelinesNICE has published evidence-based guidance on clinical management and serviceprovision for antenatal and postnatal mental health [280]. The recommendations coverprediction and detection; rapid access to psychological treatments (within 1 month of initialassessment, and no longer than 3 months afterwards) due to the changing risk-benefitratio of psychotropic medication in pregnancy; explaining risks; managing depression; andthe establishment of clinical networks providing specialist multidisciplinary perinatalservices. The use of psychotropic drugs during pregnancy and the postnatal period isreviewed and guidance is provided on the management of specific disorders in pregnancy.The Western Australian Department of Health has also published guidance on caring forwomen with mental illness in pregnancy [207]. The report provides a framework aimed atassisting mental health clinicians to manage the reproductive and pregnancy needs ofthese women, focussing on factors amenable to intervention such as early and ongoingcompliance with antenatal care attendance, smoking moderation or cessation, nutritionaladvice and links to appropriate support services at the earliest opportunity. It encouragesmental health clinicians to be ‘client advocates’ by initiating referrals to appropriateantenatal and/or family planning services.Managing mental illness in pregnancySeveral systematic reviews have also addressed the management of mental illness inpregnancy, although the very small number of trials identified makes the resultsinconclusive. Dennis et al. assessed the effects, on mothers and their families, ofpsychosocial and psychological interventions compared with usual antepartum care in thetreatment of antenatal depression [281]. Only one trial, involving 38 outpatient antenatalwomen, was included in the review. While interpersonal psychotherapy, compared to aparenting education programme, was associated with a reduction in the risk of depressivesymptomatology immediately post-treatment, the very small number of participants meansthat is not possible to draw conclusions or make specific recommendations. Dennis andAllen examined the effectiveness of non-pharmacological/psychosocial/psychologicalIn-Depth Topic: Adversity in Pregnancy - 303