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Kimberly Mum's Mood Scale - Kimberly Aboriginal Medical Services and Rural Clinical School of WA (UWA)
1. Kimberley Mum’s Mood Scale
(KMMS) Validation Project
Improving mental health screening
for Aboriginal and
Torres Strait Islander women
Emma Carlin- Kimberley Aboriginal Medical Service Senior Research
Officer/ Research Fellow UWA
Di Jans- KMMS Project Officer; Care & Protection of Children Advisor;
Stillbirth, Cape York Parents Story Project; Maternal Child Health Social
Work - Apunipima Cape York Health Council
2. PERINATAL MENTAL HEALTH
• Important for all women
• Rates are unknown
• Clinical screening is a routine and effective
way to provide support and early
intervention
3. PERINATAL MENTAL HEALTH SCREENING
• In Australia, national clinical guidelines
recommend routine use of the the
Edinburgh Postnatal Depression Scale
(EPDS)
• Research shows Aboriginal women are 4
times less likely to be screened
4. HISTORY – DEVELOPMENT IN THE KIMBERLEY
• 100 Kimberley Aboriginal women and their health care
professionals
• KMMS Part 1- adapted version of the EPDS
• KMMS Part 2- template for a psycho social yarn a participant
led, narrative based exploration of a woman’s risk and
protective factors, resilience and strengths
5.
6.
7. HISTORY – VALIDATION IN THE KIMBERLEY
• KMMS was validated with 91 Aboriginal women
• Aboriginal women completed the KMMS with a
health professional and were then assessed by
a GP
• The KMMS can accurately identify depression/
anxiety
• Acceptable to women and health professionals
8. WHAT WE LEARNT IN THE KIMBERLEY
• Rapport is crucial
• The KMMS was seen as a time for ‘listening
and yarning’
• Women valued the focus on their strengths
and resiliency
9. What now?
The KMMS is the first validated
Aboriginal specific perinatal depression
and anxiety tool
How do we implement the KMMS into
routine clinical practice across the
Kimberley?
Could the KMMS be clinically valid and
acceptable to other regions?
10. What’s happening?
• KAMS, member services and WACHS keen
to implement and evaluate the KMMS in
routine clinical care
• Pilbara and Far North Queensland
partnership to validate KMMS
• Phase 1- Consultation
• Phase 2- Validation
11. SETTING THE SCENCE FOR VALIDATION PILBARA &
FNQ
• Depth interviews with 15 Aboriginal women
in the Pilbara and 11 Aboriginal women in
Cape York
• Depth interviews 19 health professionals
involved with women during the perinatal
period in the Pilbara and 23 in Cape York
12. CONSULATATION FINDINGS- MENTAL HEALTH
DURING THE PERINATAL PERIOD
• Women spoke about their or a close family
member’s experience with perinatal depression or
anxiety
• Other women identified extreme and multiple
stressors during the perinatal period (violence,
homelessness, issues surrounding drugs/alcohol
use, DCP intervention, traumatic birth outcomes)
• These women talked about things being ‘hard’ or
‘stressful’’
13. CONSULTATION FINDINGS: MENTAL HEALTH
LANGUAGE
“I never heard anyone say they are
depressed, I hear them say they are
‘stressing out’, ‘going mad’. We find it hard to
talk about pain, I don’t know why, I think as
Aboriginal people we like to laugh and talk for
the good times but now everyone has a story
of pain and we don’t know how to talk.”
14. CONSULTATION FINDINGS: CELEBRATING RESILIENCY
“Talking about the protective stuff, right,
the stuff that keep us going, keeps us
strong, that’s something. We are living this
life the best way we can and for us to hear
that, to talk about it. For clinic, my midwife
to hear that. Now that is a powerful thing.”
15. WHAT HEALTH PROFESSIONAL SAID
“Understanding risk factors is very important for us.
Our patients glaze over words, multiple choice. Partly
literacy, but partly the concepts are unfamiliar. The
focus on strengths is important. This is the reality for
women. In case you haven’t noticed its not resource
rich out there, seeing it through their eyes, how they
are managing. That is the best insight we can get. It
is a continuous process, I think the KMMS approach
reflects that”
16. CONSULTATION SUMMARY
• Women and health professionals found the KMMS
an acceptable screening tool and were keen to trial
the KMMS in clinical settings
• Several quality improvement initiatives were raised
during the consultation which led to the refreshed
graphics and a new manual
• Ethical approvals sought
• Regional project officers employed
17. NEXT STEPS
• Training and supporting staff and clinics to use the
KMMS
• Assessing ‘user acceptability’: women and their
health care professionals?
• Sustainability and adaptability (regional name
changes perhaps?)
• After recruitment stops- Statistical analysis starts
(specificity, sensitivity, cut points)
19. Significance
• Mental health crucial in achieving and
maintaining other primary health benefits
• Health services that have training and tools to
approach perinatal mental health in a way that
is culturally safe has untold benefits for
mothers and their families
• We hope the KMMS will be valid and
acceptable for other regions and become the
screening tool of choice for ACCHOS across
the country.
20. ACKNOWLEDGMENTS AND THANKS
• To our partner services for working with us to
improve screening rates and the impact of
screening for Aboriginal women.
• To the women who consented to be part of the
consultation. Thankyou, your stories motivate us
to make this project the best it can be.
Honor the land on which I stand, the Larrakia Nation, and Pay respects to traditional owners and to elders past, present and future
Di
Di.
1/10 depression in pregnancy, 1/7 depression in year after birth
In Australia, there is little evidence of the prevalence of perinatal anxiety and depression among Aboriginal and Torres Strait Islander women. Given the higher levels of trauma and distress in the Aboriginal population as a whole it is thought that rates of depression and anxiety during the perinatal period are also higher than the national average.
Untreated perinatal mental health disorders can have a severe impact on the mother, child and extended family. Specific impacts of perinatal anxiety and depression may include poorer birth outcomes poorer bonding and attachment between mother and baby ongoing emotional and cognitive difficulties for children and enduring (and possibly escalating) mental health disorders for the woman.
Di.
The EPDS, validated in 1987, [16] represented a significant step in advancing a routine and ‘effective’ clinical screening tool for perinatal depression and anxiety.
Not validated for Aboriginal and Torres Strait Islander women
Emma
Emma
Emma
The KMMS Kimberley validation study demonstrated that the yarning process (KMMS Part 2) fostered a rapport between the woman and her health care professional that enabled the woman to share details of her life.
The open ended questions helped to explore the woman’s unique context and to inductively build her profile of risk while reflecting on her protective factors and her ‘resiliency’ [29].
This is in contrast to perinatal screening tools such as the EPDS and the ANQR that use closed questions with numerical scores to determine risk likelihood.
In addition neither the ANQR nor the EPDS emphasise or promote a strengths based [30] exchange between the woman and her health care professional during the screening process. The KMMS approach to screening was highly valued and the Kimberley validation study [8] found that Aboriginal women and their health care professionals identified the KMMS as acceptable and culturally appropriate.
Di.
Di
Emma
Emma
The idea of not knowing what to say or having the ‘right’ words was a common theme. All of the women interviewed spoke about the concepts and language of depression and anxiety as unfamiliar for Aboriginal people.
Emma All participants identified how strong and capable most Aboriginal women are in managing their lives and their families despite the complexities they face. The majority of participants emphasised that a focus on their ‘strength’, ‘resiliency’ or protective factors was important. Participants perceived this to have two benefits, first helping women to reflect on how well she managed, and second to assist the health care professional in understanding the woman as a whole person.
‘
Emma Overall the health professionals that participated engaged in the consultation reported that the KMMS was a good approach to screening and supporting Aboriginal women during the perinatal period.
Emma
Emma
Di
Cairns and Cape training poster for all Health Professionals – some info about stats as from PANDA, info about the Validation and steps on how to KMMS with Validation
