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Royal Commission into Victoria’s Mental Health System

Case study:

Infancy Access Project

Eastern Health’s Infancy Access Project aims to support improved early intervention with families who would benefit from targeted support. It was developed in recognition of the under‑representation of children under four years of age within child and youth mental health services. Initially started in 2017 as a partnership between Eastern Health’s Child and Youth Mental Health Service and Maroondah Maternal Child Health Services, it has now expanded to two more local government areas: Whitehorse and Yarra Ranges.

Ms Lynne Allison, Associate Program Director at Eastern Health Child and Youth Mental Health Service, said the child and youth mental health service was aware that it was perceived as prioritising adolescents due to this cohort’s often acute mental health challenges and not necessarily giving appropriate weight to the complex developmental risk factors that younger children and infants present with.

Consequently, we sought to make our service more flexible and accessible for the younger age group, bearing in mind the importance of early intervention.

The Infancy Access Project co‑locates senior mental health clinicians with local enhanced maternal child health services to provide mental health assessments in the family home alongside the enhanced maternal child health nurse. Ms Allison noted one of the benefits of working with maternal child health services is that they have broad reach and are trusted in the community.

Every family that has a newborn baby is connected to Maternal Child Health. It is a very safe space to engage, it is non stigmatising, it is local, and they have an engagement with a family for several years, possibly longer because of subsequent children.

Ms Amity McSwan, Team Leader of the Specialist Child Team 0–12 at Eastern Health’s Child and Youth Mental Health Service, and one of the clinicians working in the project, said that the ability to meet with families in their own home alongside the enhanced maternal child health nurse provides a more casual setting in which the family is more relaxed and the family dynamics and needs can be more easily understood. It builds on the established relationship between the family and the enhanced maternal child health nurse.

The nurse might be assessing the baby while we’re all having a chat. It’s a pathway to siblings as well as to the baby. We see the whole context of the family and the difficulties they are experiencing.

Ms Allison explained that the project can also reduce parents’ fear of accessing child and youth mental health services because it is not in a clinical office setting where parents can sometimes feel there is something seriously wrong with their child.

By locating the service in the safe space of maternal and child health, some of the fear and stigma is removed and many of these concerns can be quickly allayed directly.

Ms McSwan said the project has helped build the capacity of both maternal child health and child and youth mental health service staff.

Initially, we ran professional development for the nurses, not just the Enhanced Maternal Child Health nurses, but all of the Maternal Child Health nurses. Most of the learning for me has been on the ground working alongside the Enhanced Maternal Child Health/Maternal Child Health nurse, and I know they would say the same, in terms of what we are looking for and how we engage with families.

Because we have had more referrals of infants coming through this Project, it has improved clinicians’ capacity to understand and effectively work with younger children and their families.

Ms Louise Dockery, an enhanced maternal child health nurse who works with the project through Maroondah Maternal Child Health Services, said the program has led to significant sharing of knowledge and resources.

The [enhanced maternal child health nurse] is an outreach service to those families experiencing vulnerability, and endeavours to forge a positive and trusting relationship with families. The establishment of a positive relationship with families has resulted in the acceptance of a referral to and an in‑home assessment with the [child and youth mental health services] clinician. Families meeting with a [child and youth mental health services] clinician in their home has proved highly beneficial and resulted in high engagement with the service.

The relationship between the [enhanced maternal child health nurse] and [child and youth mental health services] clinician is respectful and supportive and is key to the success of the program.

Ms Allison said that over the first 12 months of the project, it increased referrals in the 0–4 age range by 30 per cent. An external evaluation is underway to understand the program’s broader benefits. Ms Allison said Eastern Health hopes to expand the project to the remaining local government areas in its catchment in the future.

Note: The Enhanced Maternal Child Health program is an assertive outreach program that is part of Victoria’s Maternal and Child Health Service. It is offered to at-risk families as an extension of the universal Maternal and Child Health program.

Source: RCVMHS, Interview with Lynne Allison and Amity McSwan, October 2020; Eastern Health, Submission to the RCVMHS: SUB.0002.0028.0585, 2019; Amity McSwan, Correspondence to the RCVMHS, 2020