Developing and Validating a New Scale to Assess Signs of Neglect of Infants and Caregivers

This study aimed to develop a scale assessing the early signs of infant neglect and to test its reliability and validity. Neglect is a frequent type of child maltreatment and a serious problem worldwide, but it has received limited research attention. Previous studies of neglect assessment have mainly been targeted toward assessing the risk of apparent neglectful caregivers and neglected children. Early needs assessment scale focused on neglect evaluated by public health professionals in infants is necessary for the urgency of preventing neglect from infancy. Participants were community/public health nurses across Japan with experience working with neglectful caregivers of infants. The initial Signs of Neglect in Infants Assessment Scale (SIGN) was developed and refined based on previous studies, community/public health nurse consultation, and expert review. In 2017, 474 community/public health nurses completed a questionnaire regarding one infant neglect case. Item analysis, exploratory factor analysis, confirmatory factor analysis, and comparisons with a preexisting scale and case reporting status were used to narrow the scale and assess its psychometric properties. Item and exploratory factor analyses reduced the scale to 14 items on three factors: lack of basic supervisory care, child underdevelopment, and lack of emotional behavior. A confirmatory factor analysis indicated a good model fit (adjusted goodness-of-fit index = 0.921). Cronbach’s alpha was >.80 for total SIGN and all three factors. SIGN score was positively correlated with the preexisting scale ( r = .335, p < .001) and with child protection services reporting status ( M = 12.8 for reported cases vs. 9.2 for unreported cases, p < .001). The SIGN is an innovative scale with good psychometric properties for assessing signs of infant neglect. It has the potential to contribute to preventing infant neglect by providing early support to infants and their caregivers.

Systematic risk assessment in a mother-baby unit (MBU)–Importance for maternal and infant safety

IntroductionSystematic assessment of risks is an essential component of care in psychiatric mother baby units. Self-harm, infant neglect and harm or the vulnerable physical health of both mother and infant may all pose risks.AimDevelopment of a risk assessment tool and risk assessment among mother-infant dyads at a MBU in Bangalore, India.MethodsBased on data from 200 admissions, doctors and nurses of the unit developed a 15-item tool for risk assessment. Risk was assessed by both nurses and doctors among 58 consecutive mothers admitted to the unit. Risk domains included risks to self, to infant, related to infant health and feeding and violence faced by mother. Frequencies of various risks were calculated. Nurses’ risk assessments were compared to the residents’ risk assessments.ResultsThe mean age of the mothers was 25 (±4) years, age of infant 4 (±4) months and duration of episode was 4 (±14) months. Diagnoses included acute polymorphic psychosis (30%), BPAD (27%) and depression (21%). 47% had high suicidal risk and 28% had made an attempt in the current episode. 22% had expressed ideas of infant harm and 24% had physically harmed the infant. 48% of mothers had been physically violent. Multiple risks were seen in 47%. Doctors were able to identify risks more often than nurses.ConclusionRisks for self-harm, infant harm and related to infant health were high. Systematic risk assessment by both nurses and doctors is important in an MBU to ensure adequate care for the mother infant dyad.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Postpartum Depression: An Update

Postpartum depression occurs in at least one in seven new mothers, usually within the first 6 months after delivery. By the time of onset of postpartum depression, the mother has usually long since been discharged from the maternity hospital. Early identification and treatment of these mothers reduces both maternal and infant suffering. Careful risk–benefit decision-making regarding various treatment options in the postpartum should be discussed with the mother. Risks of untreated depression include poor bonding with the infant, lack of self care, infant neglect and infanticide.

Clinical training of undergraduate communication pathology students in the neonatal assessment and neonate-caregiver interaction in South Africa

Developing an undergraduate clinical training module in Early Communication Intervention (ECI) that provides sufficient opportunity for students' learning experiences, and that allows contextually relevant and ethically accountable services to clients, as well as the dissemination of the latest scientific findings to both students and clients, poses a significant challenge. The article describes the development of a clinical training block and the development of an appropriate instrument for the assessment of neonatal communication skills that was used in this student practical. A qualitative research approach, employing a series of formative assessments, was used to refine the instrument. The results indicated changes in the content and use of the neonatal assessment instrument regarding the approach to infant and caregiver risk assessment; caregiver beliefs about neonatal capabilities; newborn state observation; caregiver training; language, cultural and age barriers; collaboration with nurses; kangaroo mother care; involvement of caregivers during the assessment; and adolescent mothers. The results confirmed the need for the ongoing refinement of an instrument to ensure quality training of students in the difficult field of neonatal assessments and neonate-caregiver interaction. The results also highlighted to the importance of initiating ECI services before birth in communities at risk for infant neglect and abuse, and the close relationship between ECI service delivery and student training.