ACORN: maternal mental health support research

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Research summary

Maternal mental illness (MMI), and notably depression, is a global growing public health concern affecting up to one in five mothers. MMI can impair the quality of parenting with lasting negative consequences for the parent-child relationship even after remission.

The quality of the mother-infant relationship predicts a range of child cognitive, socio-emotional and behavioural outcomes in later life including poorer parenting in adulthood perpetuating problems through generations. Evidence largely derived from small scale population specific studies indicate potential benefits of developing engaging holistic community-based interventions for mothers experiencing MMI that provide both psychotherapeutic group support and maternal-child interaction guidance to improve both the mother’s mental health wellbeing and the quality of parenting relationships.

This research project evaluates an innovative successful group-based holistic SA parenting program (‘Acorn’) that has successfully done this through a blend of evidence -based strategies: dance play, reflective journaling and therapeutic lettering. The program has successfully engaged over 400 mothers and children (0-36 months) referred by existing mental health services to the program.

Research impact

Given the global expansion in numbers of those experiencing greater parental stress, isolation and mental illness, the increasing numbers of previously undiagnosed cases of maternal depression emerging through the implementation and expansion of routine screening procedures, the profound inter-generational consequences of poor quality parenting, and the difficulties of mental health system engagement with these vulnerable families, the Acorn program model offers the potential to provide an effective broad public health response to an expanding global problem for a diversity of families.

Research team

  • Dr. Paul Aylward, Torrens University Australia and Action Research Partnerships
  • Anne Sved Williams, Department of Psychiatry, Adelaide Medical School University of Adelaide 
  • MeB4three (Acorn Program), The Hopscotch Foundation PTY

Research question

Can the expanding global issue of maternal mental illness be successfully addressed for a diversity of vulnerable families through community-based holistic group parenting program that benefits mothers and their young children?

Research aims

This evaluation sought to identify the extent to which the Acorn program has successfully achieved its stated goal and objectives.

The stated goal of the Acorn program is: ‘To holistically nurture and enhance parental wellbeing and the quality of the parent-child relationship for mothers experiencing identified mental health illnesses and their young children aged 0-36 months’.

The four longer-term collectively agreed objectives of the program are:

  • to enhance the quality of the parent-child interaction;
  • to improve parenting confidence, competence and enjoyment for vulnerable mothers;
  • to enhance mothers’ wellbeing, coping skills, resilience and self-efficacy;
  • to expand and strengthen social/community supports and build social connectedness.

Research approach

Acorn was evaluated over a six-year period using action research enabling collective ongoing program model refinement and a broad range of positive and enduring outcomes to be identified for a diversity of vulnerable sub-groups including single mothers, CALD families, households with low incomes, and mothers with lower education levels, in addition to those experiencing more profound MMIs, notably Borderline Personality Disorder (with around one third of the mothers indicating this).

Mixed methods were applied including pre-post measures through a battery of standardised.

Case studies

Acorn has successfully engaged the large majority of even the most vulnerable of its targeted population, many of whom living with profound comorbid mental illness. The program is achieving its objectives for a broad variety of mothers and their children with these being sustained over time. Many mothers revealed how the program helped them to communicate, play and discover love for their children for the first time through this highly valued program. Improvements in child behaviour and intimacy with their mothers was broadly cited and supported by the objective tools used in the evaluation, and this continued months after completing the program.

This evaluation demonstrates that by integrating specific evidence-based strategies within a holistic group-based community program that addresses both maternal mental health wellbeing and the mother-infant relationship, substantial benefits to both can be acquired for a diverse population of mothers and a range of specific ‘at risk’ groups of vulnerable mothers experiencing mental health issues, their children and families. To our knowledge this is the first study that examines the effectiveness of a single program for the range of subgroups of mothers with maternal mental health issues we have identified.

Reference: Aylward P and Sved Williams A. Holistic community-based group parenting programs for mothers with maternal mental health issues help address a growing public health need for a diversity of vulnerable mothers, children and families: Findings from an action research study. Frontiers in Global Women's Health. (2023) 3. Original Research. doi: 10.3389/fgwh.2022.1039527.