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PROJECT OF MENTAL HEALTH PROMOTION DURING PREGNANCY AND EARLY CHILDHOOD 7 th Masters on Public Health Lisbon-Galway, 8 th July 2004.

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Presentation on theme: "PROJECT OF MENTAL HEALTH PROMOTION DURING PREGNANCY AND EARLY CHILDHOOD 7 th Masters on Public Health Lisbon-Galway, 8 th July 2004."— Presentation transcript:

1 PROJECT OF MENTAL HEALTH PROMOTION DURING PREGNANCY AND EARLY CHILDHOOD 7 th Masters on Public Health Lisbon-Galway, 8 th July 2004

2 THEORETICAL STATEMENT Mental Health is … “… a state of well-being in which the individual realizes his or her own skills, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (WHO, 2004)

3 Mental Health Determinants Mental Health Genetics Early Experiences Life Events Coping Social Suport Housing Employment Socio-Economics Health Care

4 Mental Health Influences Mental Health PhysicalPsychological Social

5 Burden of Disease Mental problems… One in four people around the world (WHO, 2001) 20% of the adult and adolescents population in EU (Lavikainen, Lahtinen, Lehtinen, 2000) 2020: 2 nd cause of global burden of disease (WHO, 2001)

6 Mental Health and Health Promotion «(…) some mental disorders can be prevented; most mental and behavioural disorders can be successfully treated; and (…) much of this prevention, cure and treatment is affordable.» (WHO, 2001) «Every country, no matter what its resource constraints, can do something to improve the mental health of its people. What it requires is the courage and the commitment to take the necessary steps.» (WHO, 2001)

7 Mental Health and Health Promotion ”In today’s society no one can avoid confronting stressful situations and setbacks, and the way in which people react to such stress is a decisive factor for their mental health. A more positive approach to mental health should therefore be developed, with special programmes (…) that teach people «life skills», i.e. interpersonal skills and mature decision-making and stress-coping techniques.” (Health for all for the twenty-first century: the heath policy for Europe – WHO, 1997)

8 Salutogenesis “The salutogenic orientation primarily explores the conditions of health and the factors that protect health and contributes to invulnerability.” (Bengel; Strittmatter; Willmann, 1999) Sense of Coherence Comprehensibility Manageability Meaningfulness

9 Social FactorsPsychological Factors Pregnancy Attatchment Parental Skills Why did we choose to intervene in these life stages? FAMILY FOCUSED INTERVENTION social support network, childhood cetres, school and health services (Lahtinen, Lehtinen & Riikonen) Child benefits

10 Why did we choose to intervene in these life stages? State of the art … Pregnancy as a stage of adaptation (Born, Zinga, Steiner, 2004) Pregnancy experience and early attachment (Born, Zinga, Steiner, 2004) Intervention during pregnancy and child benefits (WHO, 2004) Early childhood as a basis of a healthy development (WHO, 2004) Interventions focused at early stages are more efective on preventing children mental health problems (Lahtinen, Lehtinen & Riikonen) Relevance of psychosocial factors during pregnancy to promote the early attachment and parental skills (Lahtinen, Lehtinen & Riikonen) Family focused intervention – social support network, childhood centres, school and health services (Lahtinen, Lehtinen & Riikonen)

11 Description PLACE Almada and Seixal Municipalities PROMOTERS 3 Health cetres 1 Central Hospital 2 Drug Addiction Prevention and Treatment Units Child and Youth Protection Comission National School of Public Health TARGET POPULATION Pregnant women that initiate Maternal Health Appointments between November 2005 and January Children born between July and September 2006 witch mothers were intervened. PROJECT LENGTH 5 years (possible extent for one more year)

12 Planning Steps Intervention planning Evaluation planning Work with local stakeholders Diagnoses Work with local stakeholders Prior intervention groups Action areas selection Settings Intervention on field with local partners Evaluation Common needs in mental heath promotion Partners Action Research

13 Mental Health Promotion Approach Mental Health and Selected Areas Prenatal CareSocial SupportParental Skills Child Development Population GroupsHealth Promotion Actions Children Parents Care providers Skills development Organizational development Community strengthening Health services reorientation Sectors and Settings for Action Health (Primary and Hospital Care) Community Education (Child cetres)

14 Mental Health Promotion Approach Intermediate Outcomes Improvement of parents well-being and psychosocial adjustment Improvement of parental skills More accessible and more involved organizations Improvement of social support Improvement of children’s social and pshycological skills Improvement of professional skills Main Long-Term Benefit Improvement of children’s well-being (social, psychological, physical, spiritual)

15 Prenatal Care Problem … A Maternal Health Appointment without detection and intervention ability in face of mental problems risk factors, signals and symptoms. Purpose … To improve pregnant women’s social and psychological adjustment.

16 Prenatal Care General Goals … 1.To increase to 90% the number of pregnant women who are systematically evaluated on mental health, at the Maternal Health Appointment. 2.To increase to 60% the number of pregnant women identified with mental risk factors, at the Maternal Health Appointment. 3.To increase the number of pregnant women whom are diagnosed with mental health problems at the Maternal Health Appointment. 4.To increase the number of pregnant women who receive an intervention to face their mental health needs (skills promotion).

17 Prenatal Care Strategies … Reorganization of the Maternal Health Appointment through the involvement of health and social professionals in order to introduce on it the mental health concerns – Reorient health services Strengthening knowledge's and skills of the maternal health care professionals, concerning the evaluation and intervention on mental risk factors for mental health – Develop personal skills Improvement of the articulation between the Maternal Health Appointment and the health and community resources relevant for mental health - Strengthen community action

18 Social Support Problem … The need to improve existing social support network for promoting mental health during pregnancy and infancy in the areas served by the health cetres involved. Purpose … To improve the existing social support network for promoting mental health during pregnancy and infancy in the areas served by the health cetres involved.

19 Social Support General Goals … 1.To carry out a detailed and up-to-date inventory of the social support resources available to pregnant women and the parents/family of infants. 2.To improve the articulation between the Health Centres involved and the local resources providing social support to pregnant women and the parents/family of infants. 3. To improve early detection of risk cases and appropriate answers 4. To develop the psychosocial skills in mental health promotion in several health professionals and socials partners. 5. To promote a culture of larger patient’s participation in the activities of the Health Centres involved.

20 Social Support Strategies… Development of a wide and functional social support network, to pregnant women and parents/family of children, with several community partners (already existing or new ones) choosing the leadership according to each situation- Strengthen community action Development of health professional and partner’s psychosocial skills through training actions - Develop personal skills Client, family and community involvement in Health Centres activities, through improvement of accessibility and promotion of self-help groups – Empowerment

21 Parental Skills Problem… Few supporting programmes to “pregnant couples”. Purpose… Improve parental skills of “pregnant couples” that will have a baby for the first time and also of those parents who had been identified at risk, during Maternal Health Appointments.

22 Parental Skills General Goals … 1.To create a supportive structure to first time parents and to parents identified in Maternal Health Appointment as being at risk of developing mental health disturbances 2.To reinforce parental skills of “pregnant couples”.

23 Parental Skills Strategies… Development of a “Parent School” by creating a team with skilled professionals from the Maternal Health Appointment and volunteer parents – Develop personal skills Development of professionals and parents skills involved in the “Parent School”, identifying skills needed to the project’s development and involving experts from the different areas – Develop personal skills

24 Childhood Development Problem… Lack of relationship between family, childhood centres and child health centre team, to promote health nutrition as a determinant of good physical, psychological, social and spititual development in childhood. Purpose… Optimize the capacity of childhood centres to promote health nutrition and supply deficits, and also promote relationship among family, childhood centres and child health centre team.

25 Childhood Development General Goals… 1.To establish, or optimise, a network between childhood centres and child health team, in order to support the child and his family during childhood 2.To promote health nutrition in children, at childhood centres with the support of Social Security 3.To promote autonomy and psychosocial development of children 4.To optimize appropriate answer to family with economical needs in partnership with social network 5.To improve parents and educators participation near Social Security to apply legislation considering the correct number of educator/child needs

26 Childhood Development Strategies… To create conditions for breastfeeding and health nutrition in order to assure good childhood development - Supportive Environment Workshops to educators, parents, professional health team and social support to promote health nutrition, considering economic needs and social problems of population target – Equity To stimulate autonomy and socialization of children during meals - Autonomy Parents and educators approach near Social Security to apply legislation considering the correct number of educator/child needs - Strengthen community action

27 An Example... General Goal: To increase the proportion of mental health problems diagnosis in pregnant women, in three years Specific Goal: To guarantee that 90% of pregnant woman from the Health Centres Maternal Health Appointment are monitorized according to specific technical guidelines for evaluation and intervention in mental health, in three years. Operational Goal: To develop and implement specific technical guidelines for monitoring and intervening in pregnant mental health of pregnant woman from the Health Centres maternal appointment, in 8 months. Activity: Promoting meatings between professionals from Maternal Health Appoitment, mental health and social care, from the geographic area of this project, in order to discuss monitoring and intervention areas that should be integrated in the technical guidelines of the Maternal Health Appointment.

28 Evaluation of the Project’s Effectiveness

29 Process Evaluation Purpose Evaluate the reach on the target group Evaluate the participants satisfaction Evaluate the adequacy of used resources Evaluate the activities implementation Procedure Identify indicators Determine ways to evaluate indicators An example… Activities developed / Previewed activities (registers) Number of professionals that refer the existence of specific technical orientations/ number of inquired professionals of the maternal health appointment

30 Impact Evaluation Purpose Evaluate the immediate effect of the program Evaluate if the general and specific goals were achieved Procedure Identify indicators Determine ways to evaluate indicators An example… Number of evaluated pregnant/ total number of pregnant *100 (checking the filling up of the pregnant clinical record)

31 Results Evaluation Questions Did the intervention raised parents SOC? Did the intervention raised children physical, psychological and social development? Are the results of parents SOC correlated with the children physical, psychological and social development? Design Pre and post intervention evaluation of mothers and fathers SOC comparing to control mothers and fathers SOC Results evaluation on the physical, psychological and social development of intervened children comparing to non intervened children

32 Results Evaluation Subjects Pregnants that initiate maternal health appointments in health centres between November 2005 and January Children of Health centres comprising areas born between July and September 2006 witch mothers were intervened. Instruments Orientation to life questionnaire (SOC) Children Health Bulletin/ Clinical Schedule – different percentiles for child growth development Clinical Schedule - psychomotor development Evaluation instrument of attachment

33 Results Evaluation Calendar Years Trimester SOC Questionnaire Developmental Evaluation – Child 8 months and 3 years Attatchment Evaluation - Child 8 months and 3 years Analysis Presentation +

34 Project Calendar Years Trimester Diagnoses++ Intervention design ++ Intervention development ● Setting previous conditions +++ ● Subjects selection + ● Control group selection + ● Action research & other interventions Evaluation ● Process evaluation ● Impact evaluation +++ ● Results evaluation ● Results communication +

35 “Actions speak louder than words”


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