Possible reasons – Ockenden Review. Three-year IICSE. High levels of deprivation in Telford and rural pockets of Shropshire. High number of teenage pregnancies. High number of CP. Many years of lack of mental health care within the area (eg 4 year wait for psychology). Successful promotion of service and increased awareness of mental health needs within maternity services.

Audit – Feb – April 2024 – Identified that 100% of perinatal assessments offered met 1 referral criteria with 90.83% meeting 2 of the service criteria.

Triage system – Successful system in place embedded within SOP. In the same audit 7.22% following telephone triage were not offered full assessment and were signposted to other suitable services.

King’s research suggests that moderate-severe/complex need may be higher than the rates that the LP was modelled on.

What are we doing well?

• Daily shift co to triage/discuss referrals/offer advice.

• Providing a quality service in which professionals can refer directly into the service, with communication on progress of referrals.

• Positive relationship with partner agencies with regular communication and joint working -perinatal frame of mind.

• Linking in with LA re development of service to address perinatal mental health needs to prevent or step down from PMHT. Family hubs and best start for life offer.

• Reaching women from groups underrepresented – young mothers, and those with multiple adversity. (presented at national webinar)

• Offer pre-conception appointments.

• KPI’s – Met

• Good knowledge of community resources to signpost.

• Mental health birth planning.

• Physical health assessments.

• Provide a wide range of intervention options in addition to psychological interventions – OT, PSW, NN group & individual.

• Clear pathways with secondary mh in place.

• Lived experience within team. Links NMVP

• 17 PALS compliments since January- October 2024

What could we be doing better?

Accept referral 13 – 24 months.

What pressures does a higher access rate have on our staff/service?

Wait times impact on all areas of service.

Increased need in supervision.

Increasing challenges in offering F2F assessment where clinically indicated or requested with no base. Environmental risks with children attending unsuitable facilities.

Inability to release staff for long-term training.

9-5 service difficulty accommodating 12+ returning to work.

Assessment & Formulation

Group/workshop & individual work

Specialist interventions – COS, VIG, NBO, IT, EMDR

All psychologists trained in above, & where relevant receive intervention specific supervision.

Not offering longer pieces of work as per AMH model as per guidance.

What are we doing well?

• Psychology input into all MDT planning.

• Education to team.

• Consultation slots to discuss complex cases.

• Utilising underspend for fixed term AP

• Recruited preceptorship due to recruitment challenges - posts successfully developing.

• Implementing evidence based national guidance.

• Trainee placement area.

• Prioritising antenatal anxiety work average wait time being 3.6 weeks

• Additional training planned in 2025 for NN in VIG & NBO

What do we need to improve?

Waitlists for treatment - Average wait time for psychology assessment (Oct 2023- Oct 2024): 6.3 weeks (44 days). Average wait time for psychology intervention (Oct 2023- Oct 2024): 10.81 (75 days)

Recruitment challenges – 8C post across system never recruited to.  0.67 psychologist post not recruited to.

Other workforce challenges – LT sickness, maternity leave planned January 25.

Parent/infant therapist not a funded post.

Couples’ interventions – no specific training.

Accept referrals up to and including 12 months.

Audit - January 2024 to October 2024 (inclusive) 10 months

23.3% of all discharges were 12+ months postnatal

9.3% of all  discharges were 18+ months postnatal

21 months was the longest duration with team – 2 patients. Both were engaging in identified specialist perinatal interventions.

Patient 1 – EMDR for birth trauma

Patient 2 - Intrusive Thoughts Group. Sensory OT interventions. Nursey Nurse.

12 months + discharges – 40% were 18+ months

NHSE data Jan – Dec23 – 26% over 12 months.

What are we doing well?

• Continuing to provide specialist interventions to those on caseload over 12 months.

• Where applicable stepped down approach with clear discharge planning.

• Relapse planning.

• Team open to change & development.

• Development of pathway with BeeU 0-2

• NN attended Let’s Play Training

What do we need to improve?

Accepting referrals 13+ months.

Additional training to develop knowledge of infant development over 12 months.

Adaption of groups & environments for infants that crawl &walk.

Education of professionals in referrals 13+ months – clear rationale for identified specific evidence based only available within PMHT.

Systems to record additional LTP work to report on.

Family focused work as a whole.

Resources for partners section on webpage.

Leaflet of resources available for fathers and partners.

Assessment letter details signposting to NHSTT and highlights priority in perinatal period.

What are we doing well?

• Signpost and utilising relevant agencies – NHS TT, social prescribing, GP, support groups,LHS

• Team have good understanding of partners mental health needs  - training by Mark Williams and Dads Matters

• NN & psychology  include partners if patient consents.

What do we need to improve?

Offer partners assessments consider evidence-based tool

Pre-conception

Specialist assessment/treatments for differing conditions

Physical health

Psychological

Nursey Nurse

Emergency assessment for PBU

Wrap around care with CMHS

Occupational therapy

Peer support

NHS TT – prioritise partners in perinatal period.

Social prescribing – service for partners, and up to 2 years.

BeeU

Seachange

FNP – up to 2 years postpartum.

CMHS

Health visiting

Triple P parenting – for partners (Family Hubs)

Establish priorities.

Establish additional funding availability.

Current recruitment – Maternity leave cover advertised fixed term Therapist & OTA. Discussions to extend AP fixed term from April 25 onwards.

Skill mix – B6 vacancies to contribute to full time psychologist due to challenges in recruiting to pt.

Trial of effectiveness of therapist within service.

Continue to provide specialist interventions 12+ months. Identify when referrals should be accepted until (18 months)

Plan additional training needs plan.

Factsheet for partners in communication/relationship building with baby.

Consider additional supervision structures needed.

Consider group adaptions in planning for different aged infants.

Consider purchasing dad’s pads with underspend?

Consider as a team the needs of 12+ referrals -mother & infant offer.

Medium -

Meet with Brockington Team to further explore ward offer and suitability to embed and adapt into community model.

Consider evidence-based tool for partners.

Consider how data is captured to report on 12+ work & partners assessments – offered/declined/outcomes.

Consider additional specialist new roles within team.

Educate partner agencies on 12+ referrals – specialist perinatal work.

Long term –

Clear processes/pathways to guide team

Consider COS for partners.

Capture information on experience and outcomes 12-24 month timeframe to evidence impact & inform future service development.