:
- That the management plans developed during the KMMS for those at lower risk are appropriate.
In order to meaningfully assess the above and to test for applicability in other remote regions to inform recommendations for wider use, it is important to re-evaluate the KMMS in a larger population during real world implementation. In partnership with health services and Aboriginal communities in northern Western Australia (WA) and Far North Queensland (FNQ), this study aims to:
- adapt the Kimberley Mum’s Mood Scale (KMMS) and develop locally appropriate versions for participating partners as required;
- evaluate the real-world performance of KMMS in the Kimberley and other remote regions in northern Australia; and
- evaluate the process of implementation.
Progress so far:
A protocol paper for the study has been developed in conjunction with partner health services and the investigators of the study.
Our paper ‘Risk and Resilience’ analysed 91 KMMS assessments from the validation study to identify different risk and protective factors associated with perinatal depression and anxiety. Almost all of the women had protective factors and that contributed to them not experiencing anxiety or depression despite many women experiencing significant risk factors. The most prominent protective factor was positive relationships with family members. This study highlights the importance of health professional exploring a woman’s whole context; that is, the way she experiences stress and risk and how her protective factors support her. This will help the woman and her health professional best understand and support her mental health and wellbeing. Assessing Aboriginal women’s perinatal mental health by only looking at risk is not enough.
Our paper ‘Having a quiet word’, reflects on the yarning-based consultation process we undertook with Aboriginal women in the Pilbara region of Western Australia to explore the acceptability of the KMMS as a feature of their perinatal health care. Fifteen women aged 18-42 were interviewed for the study. The group consisted of pregnant women (n = 4), women who had a child under the age of three (n = 6), and women who were both pregnant and had a child under the age of three (n = 5). Participants valued the KMMS for its narrative-based approach to screening that explored the individual’s risk and protective factors. While support for the KMMS was apparent, particular qualities of the administering health care professional were viewed as critical to the tool being well received and culturally safe. Building on these findings, we will work with our partner health services in the Pilbara to validate the KMMS with Pilbara Aboriginal women.
Our paper ‘Why validation is not enough’ looks at what happens after a new screening tool (the KMMS) has been validated. It explores the views of health care professionals and intended end users (in this case Aboriginal women who held administrative, professional or executive roles) to explore the trajectory for clinical implementation and use. This paper highlights some of the complexities involved in implementing a culturally secure perinatal mental health screening tool. Time constraints and a perception that the KMMS is only appropriate for women with literacy issues were identified by health professionals as significant barriers to KMMS uptake. In contrast the Aboriginal women interviewed considered the KMMS to be important for literate Aboriginal women and placed high value on having the time and space to ‘yarn’ with health professionals about issues that are important to them. Aboriginal women identified the KMMS as holistic, which aligned with their views and expectations of culturally safe care. The KMMS (along with the Here and Now assessment) are the only two Aboriginal specific mental health tools that inductively and iteratively build risk profiles that are focused on a patient’s strengths and resiliency, not just deficits.
Throughout the study we identified a range of practical improvements that would assist with the KMMS implementation including: a KMMS graphi