[00:00:02] Speaker A: Welcome to the Emerging Minds Podcast.
[00:00:07] Speaker B: Hello, I'm Cathy Moore and you're listening to an Emerging Minds podcast. Before we start, we'd like to pay respect to the traditional custodians of the land on which we record this podcast, the Kaurna people. We also pay respect to all Aboriginal and Torres Strait Islander people, their elders, past, present and emerging from the different first nations across Australia.
Today I'm talking with Vicki Gilroy about infant mental health and the ways that workplaces can develop and grow a culture of understanding and support for infants and their systems of care. Vicki Gilroy is the Director of Innovation and Research at the UK Institute of Health Visiting. Vicki is a registered children's nurse, a health visitor and educator. She recently chaired the Expert Advisory Group for an evaluation of the Institute's Perinatal and Infant Mental Health Champions program, with a report of the evaluation published in 2025.
Vicki is visiting Australia to talk about perinatal and infant mental health and ways we can develop and support our workforce to increase wellbeing for babies and families. From their very beginnings, we know that infant wellbeing is connected to their early relationships which affect ongoing development and lifelong wellbeing. We can promote infant mental health and wellbeing by providing conditions and supports that all infants need for optimal development. Our Australian National Children's Health and Wellbeing Strategy recognises the importance of supporting children from infancy, particularly through empowering parents, carers and communities.
Australian estimates indicate that 8% of infants under 1 year of age have five or more risk factors for developing mental illness.
[00:01:50] Speaker C: Thank you for coming in.
[00:01:52] Speaker B: Can you tell us a bit about yourself and your role at the Institute of Health visitors?
[00:01:56] Speaker D: Yeah, of course. It's lovely to be with you today, Cathy. Really great to be in Australia for the first time.
So, I'm Vicki Gilroy. I'm the Director of Innovation and Research at the Institute of Health hosting. I'm a children's nurse and health visitor by background and have worked in clinical practice and then went into research and practice development before doing more service management roles and have worked latterly in the Institute of Helsing since 201314 when we were established in 2012 and so quite a long history of working in practice.
[00:02:28] Speaker B: What is the Institute of Health Visiting?
[00:02:31] Speaker D: So the Institute of Health Visiting is a national charity. The charity was established in 2012. There are a lot of organisations that support nursing more generally, but the founders, who were for academics, really felt there was a real gap in supporting research and excellence and education in health visiting practice and really giving the profession A voice. So they worked hard to set up the charity and get its formal status. And since then we've been delivering, delivering research and training and education and also influencing policy nationally across the uk.
As a member body, we have membership, so organisations, individuals and organisations that support healthists can join us.
And we do a range of different activities including delivering education and training, developing education and training, being part of research studies and also being part of developing clinical guidelines and protocols to new for practice in the future.
[00:03:25] Speaker C: And that's around perinatal and infant mental health much broader.
[00:03:29] Speaker D: So it's the whole health visiting practice. So in the uk, health visitors are all nurses or midwives who've done an additional one year master's or degree level study as specialist community public health nurses. So they are on our register as nurse and midwife and specialist community public health nurse. Specialist community public health nurses deliver a universal service to all families in the antenatal and period up to five years till the child goes to school, where they offer a number of visits, health checks, focusing on obviously perinatal infant mental health, but also the whole well being of the family and child. So focusing on nutrition, speech, language development, motor development, gross motor development, everything to do with that child and family's health in terms of giving the best start in life.
[00:04:20] Speaker C: So really seeing infants and children within
[00:04:23] Speaker D: the context of their families and the community they live in. So as a specialist community public health nurse doing a full holistic assessment of that family's needs in the context of where they're living.
So equally the health visitor could be involved in supporting housing, education, support for the whole family as a unit. Part of that holistic assessment involves supporting the mental health, mental and emotional wellbeing of both the parents and their baby's infants and children in the family as well.
[00:04:53] Speaker C: So can you tell me a bit about why infant mental health is important and why we need to think about infant mental health?
[00:05:01] Speaker D: I mean, obviously it's a foundation of your future life. Do you know, it's when babies right from infancy start to learn how they interact, to regulate their emotions, to build their relationships with others, which is then the foundation of how they're going to interact with the world as they grow older and grow through their education and learning. So it's so important in that, and we say the first 1001 critical days, to really be aware of what's going on for that infant from the moment they're born. You could, some would say before they're born in the antenatal period, they're already starting to build relationships with their caregivers in terms of their relationship in the womb. But really important that then we recognise that infant is a person in their own right with a voice and how they are then attuned and regulated through their development, through life. And if we don't get that right, if they don't have those early opportunities for building relationships, for being seen to being heard, to start to know how to interact with their world, we know that that can have long term poor outcomes for their health.
[00:06:06] Speaker C: So what role do the health visitors and all health practitioners have with supporting infants in those early days?
[00:06:14] Speaker D: Health visitors are in the uk, the only health practitioner that goes in without a need being identified to offer that universal support. So thinking about infant mental health, depending what's going on in that family, whether it's the parents have some mental health concerns themselves or some disabilities that they need some help to interact, then we can offer different interventions or refer on, which is really important as well for specialist support if it's needed through local pathways.
[00:06:42] Speaker C: So this might be the first and maybe even only opportunity for an infant to be noticed and to have their
[00:06:51] Speaker D: perspective once the baby's born. The only service that's routinely going to be going and seeing the baby, unless there's a need, you know, unless the parent presents them at the primary care doctor, this we are the only service that will routinely see that baby.
[00:07:05] Speaker C: So you've been really involved with the Champions program. Yeah, through and really keen to hear a description of that program.
[00:07:14] Speaker D: So initially, and I think it was 2012 or 13, it was identified that one in four women were suffering from perinatal mental health illness and one in 10 fathers. And actually some recent studies have shown that two to three babies a year lose their dads to suicide. So it's still a massive problem. So recognising the needs of parents in that perinatal period is really, really important. So the Department of Health at that time thought we need to do something and recognise that health visitors as the only universal service going into families in that perinatal period, were in a unique position to actually support parents, but they needed training.
So they commissioned the charity, the Institute of Helvesting, to develop a training program to really upskill the workforce around what are the signs of perinatal mental health illness and also how to recognise it and then what to do. So that was where it started in terms of we developed the program. So it was developed as a train, the trainer model. There's two days training really focusing on perinatal mental health initially alongside that we also developed an infant mental health programme which was also a two day programme champion programme.
And over the years it was felt that actually those two things needed to come together, that you couldn't look at the parents mental health in the perinatal period without looking at infant mental health, knowing the impact and of. Although the perinatal mental health champion programme included a real focus on why it's important for the infant, they needed to be combined. So I think it was in about 2015 that then the two programs combined into one champions programme. So when the champions come, we are quite clear that they've got a role to not just take the training themselves, that then they deliver the training to their workforce in the same way role modeled that we deliver it and the fidelity of the training, they're not intended to change the slide sets which are all based on lace and evidence and research. We had experts, not just ourselves, the health assistants. So we work Royal College of Psych, Royal College of Pediatricians, different professionals to support the putting together of the training materials. That was really important that it's evidence based, research, contemporary and up to date. So the model has shifted from it being centrally funded by government to being locally funded, which has its challenges because not all organisations have the same priority. So but we are still continuing to deliver regularly the training and some organizations invest in sending. Every couple of years I'll send some more.
[00:09:46] Speaker C: So how does that work? How does the cascading of the training.
[00:09:49] Speaker D: So when the champions come on the program, hopefully they're managers of selected people who have the capacity and resource and skill to deliver to their teams and their workforce. So then their responsibility is to then go set that up in their own organisation to arrange the training days and then deliver that training direct to their workforce. So the health visiting teams or the multi agency. Because actually now what we initially started, for which I should have said, when the training was first commissioned, it was very much focused on health visits and midwives. But we soon realised that actually there's a much wider workforce working with families in the perinatal period and actually that's a missed opportunity. So the training is now open to multi agency and multi professional groups.
[00:10:39] Speaker C: You mentioned being able to select and support champions who have resources, skill and capacity. Has that been a challenge?
[00:10:49] Speaker D: We learned quite quickly that the importance of making it really clear in the guidance before someone came on, that there was an expectation that you're going to use your role, your new knowledge, to share that with your colleagues, but also to be there as a person who could support Influencing local pathways, protocols, be involved as almost that lead person.
[00:11:14] Speaker C: So what tips do you have for leadership or executive level to be selecting and supporting those people who are to be champions?
[00:11:24] Speaker D: I think for the leadership is that they need to invest it in themselves. This isn't, it isn't cost free. If you're going to send someone on a program, you need to be behind them. You need to ensure that they have free space to be able to deliver it. You need to think about if they're going to deliver it in a space that they've got a building, they've got the materials that you're going to free the staff to go to the training. And that's been a challenge. They also need to think about the ongoing because people leave and move that it's not a one stop shop that you've trained them. And actually how do you embed that training update into your ongoing CPD program, your continuing professional development program for all your staff?
[00:12:04] Speaker C: So there's a few different mindsets, you know and I think the report comments on mindset. I really like that part. And one is about embedding and investing a resource to keep this going. What about the mindset that's about infant mental health? Can you comment on that? How the champions program might shift practitioners mindset about infant mental health.
[00:12:31] Speaker D: So it's really thinking about how do we ensure that people are thinking about the infant as a person in their own right with needs and actually recognising that as part of it and sort of keeping the baby in mind. So how do you really in the training keep that focus on the baby at all times? So what's going on for the infant and the baby even when you're supporting the parent, what's happening for the baby? How do you actually bring them into the picture at all times? And I think the training really, really does shine a light on the infant as this is the centre part of how do we move that forward?
[00:13:06] Speaker C: So a shift in highlighting that infancy is a really foundational, important and distinct
[00:13:14] Speaker B: part of a child's trajectory.
[00:13:16] Speaker D: Absolutely. And I know we, we have a section in the training which focuses on epigenetic genetics and really thinking about what happens in the womb will influence and that in terms of impact of anxiety and perinatal depression on the unborn infant is so important. So that's part of the program is really getting people to feel it and see it. Do you know, in terms of. And then that has greater impact of really as you say, how do we get that focus on the infant?
It's through the feeling, seeing and the research, obviously. Do you know that? We know that poor attunement and difficulties in building that relationship for infants does impact on their longer term ability to be socially involved and make the most of their achievements.
[00:14:02] Speaker C: Now you've made me think about reflective supervision and how reflective supervision must be an important component.
[00:14:09] Speaker D: Do you mind talking about reflective supervision a bit? We get the practitioners as part of the programme to reflect, but equally thinking about how they can themselves really think about what's impacting for them and then how they then can work effectively with a family. Or you've got your own things going on, you can't be there and listen effectively to the families. So that is a challenge. But something as an organization we absolutely promote reflective supervision, supportive supervision, both on an individual basis, the importance of taking time to reflect, but also accessing supervision for themselves as well so that they can do the best with the families they're working with.
[00:14:47] Speaker C: So for practitioners to be thinking about what they bring to an interaction, but then also to be able to reflect on and respond to the impact of the work for them as well.
[00:15:00] Speaker D: Absolutely. And I think throughout the training the training structure allows space for small group discussion, reflection, recognising how is this impacting on you as a practitioner? What you're hearing is so important, isn't it? Because to be there for a family and for the infant, you need to be free to think.
[00:15:20] Speaker C: Going back, you also talked about the multi agency, multidisciplinary delivery. Can you talk about the range of professionals?
[00:15:29] Speaker D: We've had, obviously the nursing profession, so midwifery nursing, mental health nurses who are working in perinatal mental health services. But all the practitioners working in specialist services, right up to the clinical psychologists have come on the program and we've had voluntary sector organisations that sometimes provide services as well, who will have a range of practitioners from early years, workers, nursery nurses, community workers coming on and we have had some doctors coming on, so pediatricians, GPs and a little more limited and we. I know in the valuation the groups that weren't really entering as much were the voluntary community sector organisations, which we feel there's a bit of a gap. We've had some over the years, but they're not the main audience for the programme or the main people who are commissioning the program. But we've had a wide range over the years, the sort of nearly 12 years the program's been delivered, a wide range of practitioners from different organisations and
[00:16:26] Speaker C: providing the up to date resources along the way.
[00:16:29] Speaker D: So in terms of sometimes Depending on the group that we're training, there'll be greater focus on some things than others. So if you've got got a group of clinical staff, you'd maybe spend more time on assessment and the assessment tools that we would use where targeted. Yeah. Although the slide set will be the same, you as a facilitator can spend more time on different bits depending on how the group and the knowledge and experience in the group as well.
[00:16:54] Speaker C: And now I'm really curious about the evaluation and what it showed. So how you actually unpacked the program and then demonstrated that this was having an impact.
[00:17:06] Speaker D: So obviously it was a mixed method evaluation with three work packages really focusing on one, the champions, in terms of what's happened to them, where they've gone, how impact, then the cascade. So some of the data, obviously we've got a number of years, so it was the quantitative data, so the pre and post surveys. So for all programs that we deliver, there's a pre training at looking at knowledge confidence around perinatal infant mental health. And then the post asked similar questions to see, has there been a shift in that knowledge and competence? And then the third bit of it was interviews with a selection of champions around their experiences, their knowledge shift, what they'd done with the thing, and a survey with them as well, and then some case studies of some of those champions. So really thinking about what does this mean for me?
[00:17:56] Speaker C: So you found shifts in knowledge, people's knowledge, specific aspects of knowledge.
[00:18:03] Speaker D: Yeah. So it's confidence to have conversations about it as well. It's not just confidence in themselves, so it's confidence to share their knowledge as well. Do you know, in terms of actually feeling more confident on the topic, but also more confident to talk to others about it, to work with families?
[00:18:17] Speaker C: And is that part of that cascade model that people, you know, then are more able to take this out into their workplace?
[00:18:24] Speaker D: And that's the whole purpose of the program. It's not just about you feeling confidence about actually that you can share that knowledge as well. And if you think of the Kirkpatrick sort of model levels of learning, obviously we've been assessing their initial reaction to this, is what. But equally we want to ask them, well, what are you going to do with it? Do you know, it's not just about, is it going to make a difference to your practice? So in the post training, it does sort of think, are you going, do you think this will be different for your practice going forward? What are you going to do? And do you feel more confident to have Conversations with families about this, which is the whole purpose of it, isn't it? Yeah. And I think one of the things we were concerned about was the fidelity of the information we shared with the champions maintained.
So we were reassured that whilst 80% did change add, it was predominantly adding in local information and context, which is really important.
[00:19:22] Speaker C: And I saw there was also an outcome around peer connections and, you know, whether you call them communities of practice or, you know, that that had an impact.
[00:19:33] Speaker D: So the Perinatal Implemental Health Forum, we coordinate that and all current champions are invited and they get great benefits. So we may have speakers, we may have a case study from one of the champions themselves. And in those forums online, they can do group work, they can talk about challenges in their role, but they also can have an update if there's some new research or researcher coming. And they've been really, really well evaluated. And I think that came out of the evaluation that really supported them staying connected, overcoming challenges, making sure that they felt up to date, giving them that community of practice, as you say, to come together. So that connectivity is really, really important as a champion role. And I think that came out really strongly from the evaluation that being connected to other champions who are in similar roles, facing similar challenges, is key to sustaining their role.
[00:20:26] Speaker C: Comes down to relationships again, doesn't it?
[00:20:29] Speaker D: Those relationships are everything, aren't they? The people you work with, and I think in some organizations where they've ended up with some champions have left, then the champions can feel quite isolated. So being part of a team is really, really important.
And that going back to your very first point around the infrastructure, the management, the leadership that actually we would always encourage an organisation not just to have one champion, that you. To have a group or a small number, depending on the workforce that they're responsible for, to have more than one.
[00:21:00] Speaker C: So that leadership, what strategies have been helpful for engaging and staying connected with leadership and executive level?
[00:21:08] Speaker D: I think it's thinking about the outcomes, isn't it? You know, this is what are the outcomes that. That this work supports in terms of connecting it to the Public Health Outcomes Framework, to the government KPIs, the key performance indicators that the organisation has got to deliver. So a lot of the commissioning guidance for the services does focus on identifying and supporting infant and perinatal mental health. So really getting into the mindset of the service leads and commissioners that actually this programme will help you achieve that because your workforce will be more skilled, to work more effectively with practitioners. In the uk. At the moment, we've got a really High focus on how do we support children, be ready to learn. And so the opportunity mission of the recent government, but actually connecting that back, that for an infant to be ready to learn, they need to be emotionally secure, to be able to interact with their environment. And that starts antenatally and at the early years. So actually having practitioners working in that early intervention prevention period is crucial and this program can help practitioners be prepared to do that. So for me it's always talking the language of the people who are buying the services.
And actually how is this going to help your outcomes? Are you going to hopefully identify but also support both perinatal and infant mental health by having practitioners skilled, which is one of the key performance indicators? Do you know, in terms of how are you doing that?
[00:22:30] Speaker C: Bringing it back to those frameworks that are around? Well, it's not the deliverables, it's the outcomes, but actually framing it.
[00:22:39] Speaker D: So how do you focus on outcomes? What's the outcome? If we do this now, hopefully those infants, babies, children are going to be ready to learn, which is one of the government targets, to be able to succeed in their education and therefore support the economy of the country going forward, you know, to be able to be self sufficient. And if we don't do this, then that ultimately will impact longer term outcomes for those children as they grow into adults. And actually there's a real focus because we're finding that, that many children aren't ready to learn. They're going in emotionally dysregulated, in nappies, unable to communicate or interact with their peers. And that's becoming a bigger problem, unable to communicate with their speech, language and communication.
So there's a big problem at the moment. So there's a real focus on how do we support. And what we're saying is actually you need to invest in training for the workforce to identify infants at risk and to put in early support for parents. And parents need support, and particularly some parents will need support to interact with their babies. It doesn't always come naturally. If they haven't had the role models themselves or they're suffering a disadvantage or they've got mental health issues themselves, it's really important we get in there early.
[00:23:54] Speaker C: So that's part of that mindset of being able to link early relational health with developmental outcomes and noting that currently poor developmental outcomes, and we have those in Australia too, we've actually got, we're going backwards in terms of developmental competency, that one of the key ways of supporting that is by focusing on those first thousand days and refocusing on babies in the context of their healthy relationships and having that mindset for everybody.
[00:24:31] Speaker D: It's holding the baby mind up all times, do you know? And actually keeping them. Who's the voice for that baby, do you know? And if we're not there, seeing the baby at every opportunity or the infant, in terms of how do we really think that this is really so important for their future outcomes? How do we actually help practitioners understand?
[00:24:49] Speaker C: The Champions model to me really helps support practitioners with their role in holding families and infants in mind and having the tools and the skills to do that. So acknowledging that relationship that practitioners have with families that then enables families to hold infants in mind.
[00:25:11] Speaker D: Ultimately our goal is to support the families to be able to hold that infant in mind, to give their infant the best start in life and how
[00:25:19] Speaker C: we can build the capacity of the workforce. Yes, to hold families in mind and build their capacity. So it's.
It very much is that ecological model, isn't it?
[00:25:30] Speaker D: It is. It doesn't sit on its own. It's not. One doesn't support the other. They all have to be there. And I think your point on the reflective supervision that actually a well workforce can support a well population and we know that from a lot of the research that actually where workers are well supported, emotionally regulated, held they can hold others. Where workforce is stretched, demoralized and feeling like they can't do a good job, they're not able to be free to hold the families they're working with.
[00:25:59] Speaker C: And recognizing that this needs support for the workforce at all levels, you know, so from leadership, but also having engaged and well supported practitioners out there and that it needs sustaining. Yeah, we don't do this work and then we're finished.
[00:26:16] Speaker D: Actually if more of us have that knowledge, we're going to create that groundswell and shift in culture that this is an important stage and babies and infants need a voice in our society.
[00:26:26] Speaker C: Thank you, Vicki.
[00:26:29] Speaker A: Visit our website
[email protected] au to access a range of resources to assist your practice.
Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The Centre is funded by the Australian Government Department of Health, Disability and Ageing under the National Support for Child and Youth Mental Health Program.
