/ All District Health Boards

support services for

mothers and their INFANTS / pĒpi

SERVICE SPECIFICATION
STATUS:
Approved to be used for mandatory nationwide description of services to be provided / MANDATORY þ
Review History / Date
First Published on NSFL / May 2012
Review of Support Services for Mothers and their Pēpi (July 2002) service specification.
Amendments: Updated formatting, terminology, links to other service specifications, updated service components, exclusions. New additional purchase units MAOR104A and MAOR104B. / 29 May 2012
Amendments: updated reporting requirements regarding smoking, and Sector Services email address. / 30 October 2013
Consideration for next Service Specification Review / Within five years

Note: Contact the Service Specification Programme Manager, Ministry of Health, to discuss the process and guidance available in developing new or updating and revising existing service specifications.

Nationwide Service Framework Library website http://www.nsfl.health.govt.nz/


SUPPORT SERVICES FOR MOTHERS AND THEIR INFANTS / PĒPI

SERVICE SPECIFICATION

MAOR0104, MAOR104A, MAOR104B

This service specification for Support Services for Mothers and their Infants / Pēpi (the Service) must be read in conjunction with the tier one Maternity Services and the tier one Services for Children and Young People Services service specification, as appropriate.

This service specification is also linked to the documents listed below:

·  Specialist Neonatal Inpatient and Home Care tier two service specification

·  Perinatal Mental Health and Infant, Child and Adolescent Mental Health, Alcohol and / or other Drugs service specifications

·  Maternity Services tier one service specifications, and

·  Section 88 Primary Maternity Service Notice 2007.

Refer to the table below for service coverage overlap periods:

Service / Coverage period
Lead Maternity Carers / Pregnancy to 4-6 weeks following birth
Antenatal and Parenting Programmes or others / Pregnancy and limited follow up post birth
Well Child /Tamariki Ora (Core services and additional support according to assessed need) / 4-6 weeks following birth to 4 years of age
Family Start / Early Start Service. [1] / 6 months before the birth of the child up to the age of six years.

1. Service Definition

The Service is intended to contribute to the ‘at risk’ women’s emotional health and wellbeing to support positive outcomes for them and their babies. This Service is an intensive service with a particular focus on Māori women and other ‘at risk’ high needs women and their family and whānau, including pregnant teens and other pregnant women with multiple disadvantages.

The aim of the Service is to provide education, support and advice to mothers during pregnancy, following the birth, and up until the child is at least 24 months old. Older children may be included within this Service to an appropriate age that is agreed between the funder and the Service provider, and is specified within the local Service provider contract requirements.

The Service is to operate in partnership with other maternity and early childhood service providers. The role of the Service provider is to support the Service User’s engagement with these other service providers: General Practitioners (GPs), Lead Maternity Carers (LMCs), Midwives, Obstetricians, maternity and neo-natal services operating within hospitals, and Well Child / Tamariki Ora (WCTO) service providers.

2. Exclusions

Excludes services that are funded under the Section 88 Primary Maternity Service Notice 2007, Family Start / Early Start, and other service specifications such as the tier two Well Child / Tamariki Ora Services, DHB funded Maternity Services and Pregnancy and Parenting Education Service.

3. Service Objectives

3.1. General

The Service is designed to generate a warm, therapeutic, non-judgemental and culturally safe supportive environment for ‘at risk’ pregnant women and new mothers, their partners / family and whānau and their infant / pēpi, to develop positive and responsible parenting skills, build self-esteem and confidence.

The Service is expected to contribute to the reduction in health inequalities in particular, by focussing services to impact on asthma, diabetes, injury prevention, smoking cessation, hearing, mental health, oral health and immunisation, and violence prevention through:

·  early identification of health issues, referral

·  ongoing support for maternal mental health and poor infant attachment

·  the provision of:

-  parental support

-  health promotion

-  care and education during pregnancy and following birth, and

-  effective linkages to other providers.

3.2. Māori Health

An overarching aim of the health and disability sector is the improvement of health outcomes and reduction of health inequalities for Māori.

In addition to the generic objectives of the service specification it is expected that the services will:

·  address the health needs of Māori

·  be clinically sound, of quality and culturally appropriate[2]

·  be accessible, timely and effective

·  ensure equitable outcomes for Māori

·  collect ethnicity data for Māori in accordance with the Ethnicity Data Protocols for the Health and Disability Sector 2004.

4. Service Users

The Service is primarily focused on Māori women with high needs and ‘at-risk’ mothers and their infants, and other at risk pregnant women with multiple disadvantages (Service Users).

These at risk Service Users may:

a.  be teenage mothers, or

b.  have an alcohol or other substance abuse / addiction, or

c.  have troubled family history and / or be in unstable relationships, or

d.  suffer post natal depression, or

e.  have past history of abuse or trauma, or

f.  have multiple foster care placements, or

g.  have mental health issues, or

h.  have inadequate parenting knowledge and / or life skills.

5. Access

5.1 General

Access to the Service is via self-referral or referral from:

·  other Non-Government Organisations / Māori health services providers

·  GP, LMC or other maternity care provider, WCTO service providers

·  neo-natal units

·  whānau, marae

·  school, polytechnic or university

·  other social agencies, eg, Ministry of Social Development, Child Youth and Family.

The Service will be provided to mothers / families and whānau in the agreed area by Māori health workers / other health staff who are strategically located to provide home visitation as well as on-site services to mothers residing in the agreed area.

5.2 Time

Advice and access to the Services will be provided, as a minimum, between the hours 8.30 am and 5.00 pm, five days per week (Monday to Friday).

Service delivery will include outreach through home visitation, but may also be complemented by delivery of services from other locations such as from the Māori / other Health Centres. Flexibility in the timing of service delivery is desirable and may include weeknights (as advertised) depending on the Service capacity or as otherwise agreed.

6. Service Components

6.1 Key components of the Service include:

·  education and advice to enable the mother, family and whānau to develop positive attachment with their infant / pēpi promote the infant’s emotional and physical development.

·  education and advice regarding self-awareness of the mother / family and whānau support networks and stress relief and her relationships with others

·  assist the mother to identify and utilise her existing family and whanau support networks and identify how these supports can help relieve stress by providing tangible and emotional support.

·  advocacy and co-ordination with local primary care providers and community and social services

·  reduction of social isolation and assisting family / whānau to meet their basic needs

·  reinforcing provider messages regarding basic home care and preparation for the infant / pēpi for example: nutrition, hygiene, nutrition, baby care, bathing, recognising illness, well child care, preparation for and encouragement of breastfeeding, breast care and breast examination, safe smoke free environments, baby sleeping positions, immunisation, etc. which will be the primary responsibility of the LMC / midwife, WCTO service provider or GP.

6.2 Service Components
Service component / Description /
Infant mental health / attachment / Provide information about attachment (eg, DVD on attachment), model positive parenting for the developmental ages and stages and provide appropriate information and sources of parenting support. Help women and family to access resources to reduce social and economic stresses. Provide information about early brain development in modes that woman and family understand.
Needs Assessment / Needs assessment will be undertaken in partnership with the family and whānau and will have a focus on family and whānau strengths and resiliency factors as well as needs and risk factors.
The Service providers will build on needs assessment carried out by health professionals involved in the mother’s care such as GPs, practice nurses, LMC, midwives and WCTO nurses.
Information passed on by the LMC will form the basis for the Service Provider’s ongoing assessment and support of a child, the family and whānau needs within the WCTO programme. The assessment and plan will become part of the child’s ongoing health record. The training on the new process / tool will have an emphasis on attachment, maternal depression, family violence, and other environmental factors.
This Service is a continuous process of assessment which involves:
a.  observing the presence or not of certain behaviours at designated periods in time
b.  asking workers to report on specific activities such as infant mental health/attachment
c.  a conversation in case management supervision in which all Service Users reviewed during the previous month are either assigned a rating or have their previous rating reviewed according to the attachment rating scale ie. 10 = excellent, no assistance needed, 5 = needs considerable support / input, 1 = serious concerns, needs referral.
Health promotion / Provide culturally sensitive and accessible information and advice, health promotion material which empowers at risk / high risk women to make informed decisions, eg, smoking cessation for pregnant women, safe sleeping practices to reduce risk of sudden unexpected death in infancy (SUDI)
Assist women to access information about maternity services choices and access to preferred LMC.
Access to relevant education and information for people of other cultures, including a Māori prospective promoting and understanding Māori view of health in terms of:
·  taha wairua (spiritual) – the capacity for faith and wider communion
·  taha hinengaro (mental) – the capacity to communicate, think and feel
·  taha tinana (physical) – the capacity for physical growth and development
·  taha whānau (extended family) – the capacity to belong, share and to care.
Parental support / Health advice and support, particularly in areas of nutrition, immunisation, general child care, provision of safe environment and referral to the appropriate type of parenting support.
Parenting meetings / hui, networks and other initiatives including Family Centres.
Access and availability of antenatal education and support networks.
Assist with accessing WCTO care, including liaising with local providers
Use of promotional materials to reinforce health education programmes.
Pregnancy care and education / Encouragement and promotion of early antenatal care ie, referral to the Services in first trimester.
Information and advice concerning early pregnancy support and management eg, preparation of the home environment and managing financial risk
Education about self-care, exercise, alcohol, tobacco and other substance use during pregnancy.
In collaboration with the LMC:
·  education and assistance with preparation for breastfeeding, and breast care in collaboration with the LMC and access to a lactation consultant when necessary.
·  discussion on woman’s experience and birth fears, options for child birth and post-natal support
·  discussion on options for handling of a women’s placenta (whenua) and pito (umbilical cord).
Care and education following birth / Advice and assistance in collaboration with the LMC regarding:
·  development of personal skills
·  support for enabling skills as parents
·  establishment and importance of breastfeeding
·  contraception and sexual health advice or referral
·  referral of the infant / pēpi to the WCTO service provider as required and support in transition to WCTO service provider
·  education about importance of health promotion and risk prevention eg, hearing checks, baby positioning, smoke-free, asthma immunisation, nutrition and risk management such as safe environments, accident prevention
·  support and education with and for maternal mental health (post natal depression, or other)
·  prevention of SUDI, including promoting minimising risk factors (such as smoke free environments) and promoting safe sleeping surfaces and practices, and providing SUDI support for the mother including stress and grief counselling (as appropriate)
·  availability of telephone support / advice and support groups / networks
·  referral for home help and assistance outlets for parents or family and whānau under financial or emotional pressure
·  support and advice with relationships; referral as appropriate.
Links with other service providers / Integration with other primary care providers, and systems of information sharing and or referral with general medical paediatric services.
Links with WC / TO service providers, local midwives, LMCs, GPs, obstetricians and other health service providers.
6.3 Settings

Most services will be delivered in the home of the Service Users and / or other suitable community based clinics may be used. Consultation with the Service Users will determine appropriate settings for them.

Education and Health promotion meetings / hui will be conducted in venues as considered appropriate to attract potential Service Users.

6.4 Key Inputs

The key inputs are health staff who have recognised skills or experience in the maternity or childcare areas (and / or early childhood training) and Māori health workers who have strong links with the Māori community.

Training of staff will be carried out with other service providers such as midwives, LMC, Plunket and WCTO nurses, social workers, be multidisciplinary, and include collaborative working and other environmental factors.

Staff training is an integral part of the Service provision and must be provided to staff as described specifically in:

·  parenting, child development and cognitive behaviour, and Attachment[3] education and advice to enable the woman, family and whanau to develop positive attachment with the infant / pēpi

·  attachment theory and practice including identification of poor attachment

·  family interventions to address family dynamics

·  disability awareness and assessment of a range of environmental and social risks, including family violence, child abuse prevention and maternal depression