Implementing the Maternal Postnatal Attachment Scale (MPAS) in universal services: Qualitative interviews with health visitors

A secure parent-infant relationship lays the foundations for children’s development, however there are currently no measurement tools recommended for clinical practice. We evaluate the clinical utility of a structured assessment of the parent-infant relationship (the Maternal Postnatal Attachment Scale, MPAS) in a deprived, multi-ethnic urban community in England. This paper answers the question: what are health visitors’ views on the parent-infant relationship, and experiences of piloting the MPAS? It explores the barriers and facilitators to implementation, and complements the paper on psychometric properties and representativeness reported in Dunn et al (submitted). Semi-structured interviews were conducted with 11 health visitors and data were analysed using thematic analysis. Health visitors stressed the importance of the parent-infant relationship and reported benefits of the MPAS, including opening conversation, and identifying and reporting concerns. Challenges included timing, workload, the appropriateness and understanding of the questions and the length of the tool. Suggestions for improvements to the tool were identified. Our findings help to explain results in Dunn et al, and challenges identified would hinder routine assessment of the parent-infant relationship. Further work with health professionals and parents has been undertaken to co-produce an acceptable, feasible and reliable tool for clinical practice. Key findings and points for practitioners Health visitors saw identification and support of the parent-infant relationship as an important part of their role, however there are currently no recommended tools for this. Health visitors report some benefits to using the MPAS, but also several challenges to using this tool in practice, including the length of time required, the complexity of the language, potential to trigger distress and perceived intrusiveness of some questions. Further work in collaboration with health professionals and parents is needed to develop an acceptable, feasible and reliable tool to assess the parent-infant relationship. Statement of relevance to the field of infant and early childhood mental health A secure parent-infant relationship lays the foundations for children’s development, and identification of concerns and provision of support is a priority in the UK and internationally. However, no tools are currently recommended for assessing the relationship in clinical practice. Our findings on experiences, benefits and challenges of piloting a tool to assess the parent-infant relationship provide important directions for development of a short, clinically relevant and valid tool in clinical practice. Statement explaining how the research reflects an appreciation for diversity and an anti-racist approach This pilot was conducted with a diverse, multi-ethnic community (half of new mothers are from Asian/Asian British Pakistani backgrounds, a quarter White British, and a quarter from other ethnic backgrounds). The health visiting service engages with the whole population in a culturally sensitive way, including ensuring staff speak key community languages and using interpreters. None of the authors spoke community languages, but we purposively selected the health visitors to include experience of using the MPAS in community languages. Our findings reflect experiences implementing the tool with women from different ethnic backgrounds, and we report detailed findings on language. We hope our findings can inform appropriate and equitable implementation of tools in diverse communities.