Results from the Focus Group Factors that Challenge Effectiveness Analysis of the written transcript resulted in five sub-themes that challenge the effectiveness of

the IMH NGs. These are: ‘Difficulty Disseminating Knowledge’, Resource Constraints’, ‘Challenges to Self-Sufficiency’, ‘Pitching Material at Optimal Level’ and Difficulty Measuring Outcomes

Difficulty disseminating information

Participants reported challenges in disseminating the information they acquired to other colleagues who were not informed about infant mental health and to people in the community, including parents. One Focus Group participant stated, “The real challenge for us is to get it out so that parents have a knowledge about the importance of relationships”.

In some cases, only one person from the workplace attended the IMH NG. On a practical level, one person said that it was “hard to bring everything back when you are the one person that attends”. Another felt that sharing the knowledge would come across as she “knows it all”. Other difficulties included a sense of confusion about what information was copyrighted and what was not. One participant stated, “..the copyright of some of the materials is a challenge...you know there is some confusion about that in terms of what you are allowed to bring back to your colleagues and share”.

Resource constraints

This included the lack of people to provide psychological input, lack of input from Public Health and the lack of time. Participants acknowledged the important role that Psychology has in the provision of ongoing training and consultation to the IMH NGs but referenced the limited amount of time Psychology has to provide training.

Participants also referred to the decision made by management to withdraw public health nurses from the IMH NGs because their services were needed on the “frontline”. As one person observed, “the biggest challenge is the absence of public health nurses in the NGs”

because of the nature of the work that they do and the fact that they meet parents and infants in the very early stages of their relationship. Public health nurses are in an ideal situation to recognise difficulties early on and ensure early intervention. One participant explained, “That’s a huge loss because they are there two days after the birth”.

Focus Group members pointed out that their frontline services are “completely over- stretched as it is” and that attendance in an IMH NG posed significant challenges in terms of time constraints. Creating the “space [for the groups] to happen in work time’” was difficult. Participants also pointed to the roll of higher management in supporting their attendance as critical in ensuring the continuation of the group.

Challenges to self-sufficiency

Focus group participants had reservations about running and sustaining a group on their own, “We are really over-reliant on the [Clinical Psychologists] to run [the groups] and do the teaching part of it”. They also expressed concerns around lack of confidence, “…within our own network I don’t know how confident people would feel delivering an input”. This lack of confidence appears to be associated with a perceived lack of expertise to take on new roles. Participants referred to a sense that they were not well equipped to take on the teaching role that the groups require, stating that they were not ‘specialists’ in the field themselves.

Pitching material at an optimal level

This fourth challenge centred on ensuring that teaching material is relevant, pitched at a level appropriate to members and producing benefit for them. Newer members could feel like they were “trying to read a different language” that “…is difficult to grasp”. In the words of one participant, “If it’s [the material] pitched too high for where you’re at, you’re not going to feel motivated to keep going”. However, there was also a consciousness of the risk of pitching the material at a level too low for the more experienced group members and causing experienced members to cease attending because they “are not benefiting from it”. This is a challenge which needs to be addressed by striking an appropriate balance in the level of material.

Difficulty measuring outcomes

Participants reported finding the measurement of their case outcomes somewhat difficult as the changes they observed with clients were “very, very subtle” and that “it is very hard to pin down what is different”.

Factors that Challenge Effectiveness - Results from the IMH Network Group Questionnaire

IMH NG respondents did recognise the challenge of disseminating knowledge beyond the NGs to colleagues, parents and the community in general. However, most disagreed that it was a

challenge to bring knowledge and skills back to the team (67.6%, n=21/31 rated as neutral/disagree) and did not identify negative perceptions (i.e. being seen as a ‘know it all’) as a barrier to sharing knowledge with colleagues (71%, n=22/31 strongly disagreed/disagreed). The questionnaire did identify a misunderstanding among group members that they could not share handouts outside the group because of copyright (71%, n=22/31). The responses identified, the absence of Public Health Nurses in the IMH NGs and constraints in terms of time to attend (67.8%, n=22/30). The majority did not find it difficult to advocate to line managers for time to attend the group and most were provided with time to attend by line managers (77.4%, n=24/31).

Respondents were in agreement regarding the challenge of developing a self-sufficient and self-perpetuating group (87.1%, n=27/31, strongly agreed/agreed). However, the results did not support the subtheme of over-reliance on Psychology for group facilitation: 67.8% (n=21/30) strongly disagreed, disagreed or were neutral on this item. When asked, just over a third (32.3%, n=10/31) of the group members reported that they would feel comfortable taking on a leadership or facilitator role in their IMH NG. The survey questions attempted to clarify the factors that may inhibit a member taking on a facilitator role including lack of confidence, lack of expertise and feeling under pressure. The results were mixed regarding a lack of confidence and feeling pressured at the idea of facilitating an IMH NG. Over half of respondents (54.8%, n=17/30) agreed that they lacked the confidence to take on the role but over a third disagreed that they lacked confidence for the role (35.5%, n=11/30). The respondents were also almost equally split about the idea of feeling pressured to facilitate the group. While just over 70% (n=22/31) agreed that they lacked the expertise to take on a facilitator role, less than half (45.2%, n=14/29) believed that being an IMH specialist as a requirement for taking on the facilitator role. Examining the data for these items more closely, the only respondents who were strongly positive in being comfortable at taking on a facilitator role and who also felt they had the expertise for this role were Community Workers (n=3/3) followed by Clinical Psychologists (n=2/3).

On the subtheme of pitching material at an optimal level within the IMH NGs, the respondents were almost unanimous in agreeing that the relevance of the material presented at groups is essential to maximise learning (93.5%, n=29/30). Respondents also agreed that it can be difficult for members to understand if material is at too high a level and that achieving the correct level is difficult in the context of rolling groups (87.1%, n=27/31). Most agreed that joining a group without previous IMH knowledge would be difficult (74.2%, n=23/31) and that completing a master class before joining a group is necessary (87.1%, n=23/31). Fewer respondents agreed that new members would feel out of their depth entering a group at its current stage (61.3%, n=19/30) or that they are likely to find material difficult to grasp (64.5%, n=20/31). In addition, 64.5% (n=20/30) agree that steps need to be taken to ensure that all groups are working at a similar level. The majority agreed that pitching material at too high (74.2%, n=23/31) or low a level (67%, n=21/31) may affect attendance.