Delivering on peri-natal support together: The 3 rd sector working with health

1. Delivering on peri-natal support together: The 3rd sector working with health Rhian Beynon Head of policy and campaigns

2. About Family Action • Established 1869 • Works with around 45,000 disadvantaged parents and children a year • More than 100 England-based early intervention services • Distribute grants UK wide for immediate financial hardship and training and education • Campaigning against poverty

3. Our services • Children’s centres • Professional family support in the home? “Troubled” families • Education-linked services, young carers’ projects; • Health-based well-being projects • Peri-natal projects

4. Our peri-natal support project • A service for mothers who are either affected by or at risk of postnatal depression and other mental health problems • Established July 2010 onwards in four areas of the country: • Hackney • West Mansfield • Oxford • Swaffham • Referral via GP, HV, midwives or self referral

5. Referral criteria Mild to moderate mental health difficulty 3-9months pregnant And/or Child under one year

6. Our PSP model • Recruitment and training of volunteer peer befrienders to provide one-to-one support for mothers For families: • Provision of assessment visit by a qualified project co-ordinator experienced in peri-natal work • Regular visits from a volunteer • Provision of parenting groups to increase understanding and knowledge of the child’s needs and to develop informal support networks • Linking to other services i.e. children’s centres

7. Service evaluation Data collected pre and post intervention by practitioners • Rosenberg’s Self Esteem Scale (with VB’s) • Mental health and wellbeing: Hospital Anxiety Depression Scale (HADS) • Mother-child relationship: Mother Object Relationship scale (MORS) • Social isolation: Maternal Social Support Index (MSSI)

8. We also spoke to • Service Providers – health service managers • Service users – mums and mums-to-be • Referrers to the service – incl midwives and health visitors

9. Volunteer outcomes • Age range: 20 – 60’s with over half in their 40’s • All but one had children • Half had suffered from PND • The majority described themselves as White British • One was single with no children • Most were either married or in stable relationships • Significant improvement in self-esteem following the training (p<0.005)

10. Outcomes for mums and babies • Between 27 – 34% service users completed both pre- and post- questionnaires Statistically significant improvements in: • Depression and anxiety (p<0.00) (HADS) • Social support (p<.007) (MSSI) • Warmth (p<0.00) towards the babybut not invasiveness (P=.109) (MORS)

11. A case study • Shaun and Tracy are in their late twenties • Both have learning difficulties • Tracy is also physically disabled and a wheelchair user • Shaun is Tracy’s full time carer • Both parents report unhappy childhoods and difficult relationships with their families • Tracy has difficulties making and sustaining friendships

12. Thanks to a midwife referral we • Visited them weekly for one year Other services were put in place via the PSP coordinator • Infant massage • Peri-natal counselling for Tracey • Mother and baby group • Respite care for the parents when Tom was six-months-old - this was highly valued by both parents as time for themselves but also as an opportunity for Tom to mix with other infants, something they were unable to provide for him themselves

13. What we found out in interviews • The PSP was welcomed by a range of existing services, including health visitors, midwives and social workers. Described as a ‘desperately needed service’ • The PSP has established links with appropriate professionals • Working to capacity with waiting lists operating at times

14. A midwife ‘My initial reaction was this will be brilliant if it’s going to actually give us somewhere to refer the ladies that aren’t seen by the psychiatric team and the community psychiatric nurses.  We obviously as midwives we’re very very busy and the amount of visits we do are getting less and less.  So for women to get support if they’ve got mental illness or you know borderline mental health problems, especially women that we’ve had that have had premature babies or there’s lots of other little things underlying that you know they could do with some support, but up until now we’ve had nowhere that we could actually send them.’

15. A social worker: “But I thought mm that sounds really good because we deal with um lots of mums who are socially isolated or culturally isolated, who have difficulties getting out, who suffer with a bit of depression, but not serious enough to bring in the services of sort of mental health or anything”

16. Conclusions Service Evaluation • Difficulties in collecting data from all families (e.g. 30% complete data) • But many users saw positive outcomes from the intervention Stakeholder Evaluation • Recognition of significant need for a service of this nature • All stakeholders rate the service very highly

17. Role in future service provision • NHS and health professionals alone can’t respond to range and depth of peri-natal mental health need • Volunteer befriending can offer a cost-effective and safe route to integrated NHS and social care across the range of need • Ideally linked into children’s centres and/ or co-located with midwives and hvs in some way • Can be effective in reaching very vulnerable women who may not be eligible for, or respond to, statutory intervention

18. Contacts • Find the Warwick Medical School evaluation of our PSP at www.family-action.org.uk • To find out about providing our PSP in your area contact jayne.stokes@family-action.org.uk • If you want to be put in touch with the new Maternal Mental Health Alliance contact rhian.beynon@family-action.org.uk