ACP registered child and adolescent psychotherapists are involved in specialist work called parent-infant psychotherapy. This innovative form of early intervention is delivered throughout the UK and ACP member Robin Balbernie writes about the charity that champions this model and the work of PIP teams.
Parent-Infant Partnerships such as PIP UK is a charity originally established by Andrea Leadsom to promote and establish infant mental health teams across the UK within the voluntary sector. It is associated with the 1001 Critical days campaign, a cross party initiative to improve services in the early years. http://www.1001criticaldays.co.uk. We have been able to offer a three-year grant to set up an infant mental health team, as long as at least matched funding has been obtained locally. The application has to be in partnership with a voluntary body and then approved by the Board of Trustees. If this initial stage is successful then PIP UK can provide support, help and advice during the set up period and then for the following years. The teams in the PIP network are not homogenous in terms of the skills and background of the clinicians, but they are united in their dedication to offering specialist interventions to vulnerable families where the caregiving relationship is, or is likely to become, a source of stress to the baby.
The prime task of a PIP team is to provide specialised, strength-based, therapeutic services that focus on the relationship between baby and parents where this might be at risk in order to enhance the wellbeing and future development of the child. Parent Infant Partnerships are multidisciplinary teams with infant-parent psychotherapy as an essential, but not exclusive, clinical component; they are bound together by a working knowledge of early child development, neurobiology, attachment theory and an awareness of the importance of the "unconscious dynamics" of parenting.
A PIP team takes referrals based on risk and not presenting problem, making a PIP team truly a preventative service. Thus referrals can begin during pregnancy. A risk factor assessment completes part of the request for service form (for ACP members, a copy of this form can be obtained by emailing firstname.lastname@example.org). PIP therapists come from a background of psychodynamic psychotherapy, family therapy or counselling that includes modalities in child development and attachment as well as psychodynamic thinking and practice. At least one member of every team must be a parent-infant psychotherapist. In fact we prefer that every PIP team should have multi-disciplinary skill-base. This should include parent-infant psychotherapy and any of the following: Interaction Guidance, Watch, Wait, and Wonder, Mellow Bumps and Babies, Developmental Guidance and (still waiting) Circle of Security. We have picked a set of outcome measures that are applied once treatment has been established and have developed a system, called The Portal, for collecting and collating these – they are as follows:
- HADS for caregiver anxiety and depression.
- A risk factor analysis, which may get up-dated as more information is gathered.
- PIR-GAS for quality of the caregiving relationship, at start and end of contact. This may be replaced by the new evaluation of the caregiving relationship in the new DC: 0-3 just published by Zero to Three.
- ASQ: SE2 for the infant’s social and emotional development, at start and end of contact ideally, or if necessary a single measure towards the end of contact. This may begin at age one month.
- KIPS for the quality of interaction between caregiver and infant, again can be used in the early stages, during and at the end of contact. This also provides a sound basis for interaction guidance.
- A parent-completed evaluation during the course of contact as well as at the end.
PIP UK has neither the scale nor the finance for a RCT; instead, using the above measure we hope to use the collective data, which is entered anonymously on The Portal, to create an impact study. For further details please see http://www.pipuk.org.uk/home.