3.6.2 angela taft mosaic
TRANSCRIPT
![Page 1: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/1.jpg)
MOSAIC (MOtherS’ Advocates In the
Community) a randomised trial of mentor mother support
to reduce partner abuse and depression among pregnant and recent mothers
Angela Taft, Rhonda Small, Kelsey Hegarty, Judith Lumley,
Lyndsey Watson, Lisa Gold
![Page 2: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/2.jpg)
MOSAIC rationale
• Intimate partner abuse prevalent in general practice (GP) and maternal and child health (MCH) nurse populations (Hegarty and Bush 2002, Oriel 1998, MCHR unpublished PRISM data)
• GP and MCH nurse services important sites for victim support, but nurses and doctors under-confident, often untrained and poorly supported
![Page 3: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/3.jpg)
Victorian primary care services
General practice clinics
Maternal and child health nurse clinics
![Page 4: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/4.jpg)
MOSAIC aims and objectives
• To reduce partner abuse and/or depression among women aged 16+ pregnant or with children under 5 whom their GPs or MCH nurses identify as at risk of, or experiencing IPA
• To strengthen the health, wellbeing and attachment of at-risk or abused women to their children
![Page 5: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/5.jpg)
Evidence base for intervention• Little evidence for what works (Wathen and
McMillan 2003, Ramsay, Feder et al 2008)
• Some evidence social support improves mental health at any level of IPA (Coker et al, 2002)
• Some evidence for effectiveness of:– domestic violence advocacy (Sullivan
and Bybee, 1999)
– home visiting nurses with disadvantaged mothers (Olds et al, 1997)
– mentoring victimised pregnant women up until birth (McFarlane et al, 1997)
– MENTOR MOTHERS
![Page 6: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/6.jpg)
MOSAIC mentor mothers
• Open, compassionate, non-judgmental mentors
• Training in IPA advocacy, depression care, parenting support
• Provide befriending, a ‘listening ear’, empowerment, advocacy and support
• Contact once a week ~ 12 months• Mobiles for contact and safety• Regular group supervision and peer support
![Page 7: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/7.jpg)
Intervention processes
• Two co-ordinators provide training and ongoing support bi-monthly
• >60 women recruited (10+ Viet) and trained (~40+ retained)
• 4 and 8 month reviews and exit interviews by phone or face to face
• Mentors and co-ordinators keep consistent records for evaluation
![Page 8: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/8.jpg)
MOSAIC evaluation design•A cluster randomised trial
•Process evaluation
•Outcome evaluation– Valid and reliable measures of
• Partner abuse (CAS)• Depression (EPDS)• Health and wellbeing (SF36), • Parent-child dysfunction (PSI-SF)• Social support (MOS),
•Economic cost consequences evaluation
![Page 9: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/9.jpg)
MOSAIC design
24 GP clinics (28 GPs)
8 MCH nurse teams (n= 82 centres)
24 GP clinics (n=28 GPs)
ONE
DAY
IPV
TRAINING
Randomisation
INT: 12 GP clinics and 4 MCH teams
COMP:12 GP clinics and 4 MCH teams
B
A
S
E
L
I
N
E
F
O
L
L
O
W
U
P
Family violence referrals
Mentoring
Family violence referrals
![Page 10: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/10.jpg)
VAW ethical issues (WHO, 2001)
• Women’s safety – Enhanced health care for all participating
women– Women’s choice of meeting place– Well mother card includes family violence
services
• Researcher safety– Buddy system– Mobile phones
![Page 11: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/11.jpg)
Outcomes
![Page 12: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/12.jpg)
Clinician referral rates
• 24 GP clinics and 82 MCH centres
• 61% clinics (n=65/106) referred women
• 7% nurses and 11% GPs (6 or more) over two years
• 51% nurses and 46% GPs (none)
![Page 13: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/13.jpg)
Participation flowchart
167 women referred by 32 Intervention clinics
141eligible women
113 recruited (79%)From 29 clinics
90 completed (79%)From 26 clinics
61 recruited (84.5%)From 30 clinics
91 women referred by 33 Comparison clinics
74 eligible women
13 declined (15.5%)
13 uncontactable4 ineligible
10 lost to follow-up7 withdrew
6 no follow-up data
28 declined (26%)
16 uncontactable10 ineligible
43 completed (72%)From 30 clinics
8 lost to follow-up4 withdrew
6 no follow-up data
106 clinics (24 GP, 82 MCH clinics)
37 intervention clinics 45 comparison clinics
![Page 14: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/14.jpg)
Did women see mentors and what did they think?
• 86/90 supplementary surveys completed– 10 declined mentor (too busy, no need)
• 76% (58/76) mentored 12 months• 58% met weekly, 19% fortnightly • 62% at home, 26% elsewhere (cafés)• Most valued:
– Someone who always encouraged me (79%)– Talk about anything that bothered me (78%)
• Most gained– Felt better about myself (61%)– Less isolated (56%), better parent (56%)
• 82% would definitely recommend mentoring to another
![Page 15: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/15.jpg)
Characteristics of women retained in MOSAIC
FactorIntervention(n=90) %
Comparison(n=43) %
Mean age 32y 32y
MarriedSingle, separated or divorced
32%46%
26%48%
Only one child12 years schooling or lessHealth care card
46%47%
74%
53%51%
70%
Pension or benefitOverseas born
62%36%
53%32%
![Page 16: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/16.jpg)
Changes in socio-demographic characteristics
• Twice as many mentored women began more study in last 12 months
– 32% compared with 16% in non-mentored arm
• AdjOR 2.04 (CI 1.08 – 5.2).
![Page 17: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/17.jpg)
Partner abuse (Composite Abuse Scale)
• All women showed a decrease in levels of partner abuse levels at follow-up, compared with the baseline
• Evidence of a true difference in abuse - -8.67 (-16.2 to -1.15) CAS
• Less than half as many likely to be abused– Odds Ratio 0.47 (0.21 to 1.05 - weaker
evidence)
![Page 18: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/18.jpg)
Depression (≥13 EPDS)
• Average difference in EPDS score greater in mentored arm– 15.0 to 8.9 cf 12.9 to 9.9 – -1.9 (-4.12 to 0.32)
• Proportion of women depressed smaller in mentored arm– 72% to 22% cf 60% to 33%– 0.42 (0.17-1.06)
![Page 19: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/19.jpg)
Changes in women’s wellbeing (SF36)
Physical health average score +2.79 (range 0.40 to 5.99)
Mental health average score +2.26 (range -1.48 to 6.0)
![Page 20: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/20.jpg)
Conclusions
• Strong design• Qualified support for mentors• Bias and limited power due to low
number of referrals and 2:1 ratio• Statistical adjustment for bias
does not alter trend for benefit of mentor support
![Page 21: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/21.jpg)
• “I have more power now as a woman and I let [my husband] know that I will not let him abuse me or take my daughter away. He was always saying I am crazy and that he will get custody of our daughter and that used to upset me but now I just tell him that I will not let him do that and that I am not crazy.” ‘Annika’
• “a person who had never known me…she would keep the secret…In that role I felt safe to tell her what had been …in my heart’…she lifts my spirit…I was unravelling the knots in my mind” ‘Lien’
![Page 22: 3.6.2 Angela Taft Mosaic](https://reader031.vdocument.in/reader031/viewer/2022032620/55cb08dabb61eb0d758b486a/html5/thumbnails/22.jpg)
Acknowledgements• MOSAIC Coordinators
– Ann Harley, Kim Hoang, Viv Woska, Cath Kerr, Doris Sant
• Wonderful mentors• Research staff
– Jan Wiebe, Monique Keel, Vicki Wells, Lisa Patamisi, Karalyn McDonald, Kim Hoang
• Women’s Health West and Berry Street DV services
• Funding Agencies• NHMRC, VicHealth, Victorian Government,
beyondblue