Team insights on the first six weeks of working in lockdown
04 May 2020
Over these first weeks of lockdown, we have been talking to some of the specialised parent-infant relationship teams around the UK and hearing about their experiences, challenges and learning during the COVID19 crisis. Thank you to all the practitioners who have shared their insights. We’re sharing some of the themes here as we think they might be helpful to other teams and practitioners working to support the parent-infant relationship.
Immediate issues: headspace, technology and staff welfare
Headspace was the greatest commodity in the first three weeks of lockdown. The immediate reaction phase was characterised by a scramble to manage the cancellation of face to face activity, the adoption of alternative tech options and staff welfare. We saw the NHS parent-infant teams at a disadvantage because of the NHS’s lack of agility in getting the necessary technology and permissions into the hands of the staff who needed them. Charities faced immediate worries about financial certainty and decisions about mothballing or furlough.
Starting work by phone or video
Once teams had established the options for virtual contacts, some adapted their consent forms to include work by phone or via video platforms. Families have responded differently to virtual work and there have been some surprises. A small minority of families have chosen to reject all contact by online media, even where they have had the means to engage. Some families didn’t have the devices, wi-fi or phone credit to engage. There is rarely wi-fi in refuges. Families experiencing poverty, chaotic homes or more significant difficulties have been at a cumulative disadvantage.
Those families who have been engaged in parent-infant work for some time and have a good therapeutic alliance have been able to make use of virtual contact but most workers describe a change in the work; from therapeutic endeavour to listening, containment, help with practical needs such as finance or getting food, or stress management. Previously fragile therapeutic alliances frequently haven’t survived the transfer online. Planned discharges have sometimes had to be cancelled. Practitioners explicitly using manualised interventions seem to be finding video work less disruptive.
Some families have thrived in the virtual space, where there are fewer barriers than face to face attendance. We are hearing that young parents, in particular, find the increased use of Whatsapp and other text or video-based services familiar and welcome. In some teams, “contacts” have increased due to failed attendance rates decreasing, one-hour sessions being split into two half-hour phone calls, and there generally being increased phone and text contact with families.
Regarding families in the referral, engagement or assessment phase of parent-infant work, practitioners are reporting generally more difficulties in building rapport, establishing boundaries and being able to successfully focus on the parent-infant relationship. Some work has been lost as families avoid new contacts in case it’s the debt-collector or other worry. In some cases, the child’s voice has been all but lost from the work. Assessing and monitoring of safeguarding risk has inevitably become harder, so practitioners are using more session time trying to establish how the baby is and what support the family needs at this time. We have had lots of questions about whether anyone has successfully worked out how to use video platforms to conduct an observational assessment of the parent-infant interaction. Some services have relied on self-report questionnaires either completed by video/phone or emailed to and fro.
Practitioner reflections of the virtual therapeutic space vary. There are some positives; families may find it easier to attend and it cuts down on staff travel time especially in rural areas. More often, practitioners are preferring video to phone contact; there is palpable relief at being able to clap eyes on the baby and read the families non-verbal cues. There are ongoing frustrations at the lack of timely and effective tech support in NHS Trusts, where there is variable use of Attend Anywhere, Zoom, MS Teams and Google Hangout in contrast to families’ preferences for Whatsapp and Facetime. Mobile phones and laptops have needed rapid updating to avoid staff being forced to rely on their personal smart phones.
There is a consistent message about the limitations of video and phone as the sole mechanism of contact. There are the obvious limitations about rapport, assessment and safeguarding risks. One practitioner told us “how can you support parents to attune better with their baby when you can’t attune better to them; if it’s not a freezing screen, or wi-fi dropping out it’s delayed sound and distorted images”. It’s also tiring – for practitioners and families – possibly due to the conscious mind having to work overtime to make up for the disruptions to unconscious communication. Families don’t always have a private space free from other household members, and it’s hard for practitioners to maintain boundaries if you’re Zooming from your own spare bedroom or your own young family is audible in the background. Some teams have tried video calls with an additional interpreter and found it nearly impossible but certainly unfruitful. With all these challenges, the space for the baby becomes less. No one wants this to become the new normal.
Some parent-infant teams are running groups – usually by Zoom, MS Teams or Whatsapp call. These seem to be going surprisingly well. Some teams are offering phone or video “drop-in” slots where families do not need a referral. All teams we’ve spoken to have either maintained or increased the availability of consultations to local professionals and several have started additional staff support work. Some teams are going to try and deliver training by video platform – if you’ve done this do let us know how you got on.
Changes in workload; referrals down, workload up
Referrals have generally dropped, in some areas quite considerably, most likely due to lack of contact between families and referrers. Certainly, some referrals since lockdown are appropriate but a percentage seems to have an element of hopeful expectation – that the parent-infant team can offer something the referrer can’t despite the obvious unsuitability of parent-infant therapy for online delivery. Whilst referrals may have decreased, the amount of work involved in transitioning a service to online delivery, and the increase in multi-agency liaison has led to substantial increases in overall workload. Some NHS parent-infant teams face additional pressures through a recruitment freeze, redeployment, and all teams are at risk of staff absence through shielding, illness or bereavement.
Some parent-infant teams have been reassured by managers, funders and commissioners that they are not being held to the same expectations during COVID – this is not true everywhere. Those teams on fixed-term funding arrangements are worried about what the post-COVID landscape will mean for their long-term survival. The irony is not lost on us; the infant mental health needs of babies have always been important but during and post-COVID it will take on heightened urgency in a greater number of families.
Anticipating the recovery and resumption phase
We are commonly hearing that teams aren’t quite sure how best to plan for the resumption of face to face activity, but everyone is clear – demand is expected to surge. We are noticing some teams increasing their use of Facebook and other social media in anticipation that this will help them now but will also become ‘Business As Usual’. Increased birth trauma in women and their partners who have given birth during COVID, increased strain in couple relationships and increased domestic abuse, increased financial concern, and more bereavement could all put increased pressure on the parent-infant relationship. Thinking space remains at a premium.
Supporting one another
Many teams continue to provide high levels of colleague support – through Whatsapp groups, online team meetings and supervision, and social Zoom calls. At the Parent-Infant Foundation, we started the lockdown with a daily virtual staff room for anyone who wanted to connect during the middle of the day, and as we settled into our new circumstances this changed to once a week. Our weekly peer support calls for parent-infant team leaders have been well used and we are likely to carry these on as monthly drop-ins as they have proven a great place to share ideas and practice as well as to connect.
As always, we’d love to hear from you and we’re here if you have any questions.