Organisation submitting example
National Childbirth Trust
Local authority/local area:
Programme piloted in:Burnley- East Lancashire
Catterick and surrounding areas – North Yorkshire
Bradford, Halifax, Huddersfield, Wakefield – West Yorkshire
Dudley and Birmingham – West Midlands
1. The context and rationale
Birth and Beyond Community Supporter programme is an innovative community development peer support service designed to provide support to pregnant women and their partners and families with a child aged 0-2 years. The programme focuses on engaging and supporting women and families who are vulnerable or from communities that experience exclusion during the first 1000 days of parenthood.
The importance of support for women and their families during the first 1000 days of parenthood (from early pregnancy to around the child’s second birthday) is increasingly recognised in research literature. Timely and adequate maternity care and support is considered to be effective in improving health outcomes during this period. However, evidence suggests that there are persistent inequalities in access to and receipt care and support and outcomes for particular groups of parents. Groups of parents include those who are refugees and asylum seekers,1 from Black and minority ethnic communities (BME), younger parents and women who have experienced domestic abuse.2, 3 These parents often tend to access care and support late and therefore do not receive timely interventions, monitoring and screening which may benefit their health and that of their infants.4 Late initiation of care has been associated with lower socio economic class,5 level of education, 6 residence in a socioeconomically disadvantaged are , non-white ethnicity, single status,3 younger age7 and non-UK place of birth.8
The BBCS programme combines local community support with NCT’s expertise in pregnancy, birth, infant feeding and parent support, perinatal education and training.
The programme builds on research evidence on the value of peer support9,10,11and the benefits of volunteering in improving people’s experiences of care, contributing to improvements in public health and reducing inequalities for particularly vulnerable and socially disadvantaged groups.12-16 Within the current policy context, in which there is less public funding and yet a widely accepted need to tackle social and health inequalities, models to develop volunteer peer support are a priority. The service reflects the prevailing thinking about enhancing opportunities for development of community networks and social capital, and generation of family and community resilience.17
The focus of the service is to provide the social and emotional support for these vulnerable groups of mothers need during pregnancy and the period after birth, to maintain or improve their health and wellbeing and help them to give their children a positive start in life. There is strong evidence from the Family Nurse Partnership (NFP in the USA) that intensive person-centred, strengths-based interventions with young parents and vulnerable families has positive outcomes for the children and for mothers and fathers.18
The new service aims to achieve positive outcomes for both the mothers who use the service and the volunteers who provide it. Specifically, the service aims to:
References are located at the end of the document
2. The Practice or Process
NCT’s birth and beyond community support programme was developed to deliver community-based peer support from volunteer befrienders who were carefully selected before receiving training and on-going supervision and support by a local project manager and NCT trainer, working together.
Some aspects of the programme are ‘fixed’. This includes the underpinning core philosophy of a strengths-based approach to supporting women with a commitment to using non-directive listening skills, and building relationships of trust and respect to improve emotional well-being. As well as listening and empowering through positive supportive relationships, volunteers signpost to reliable sources of information and other relevant services.
Some aspects of the programme are ‘flexed’. Local managers, employed in each of the four pilot areas, who were experienced community development leaders added value to the development of the model, and were able to ‘flex’ aspects of the operation of the training and the support service according to local opportunities and their judgement of needs.
In all pilot areas the programme was developed and implemented by:
Development and piloting of the programme in four areas of England (Burnley, Catterick, West Yorkshire and West Midlands) has resulted in two operational models of training and service delivery which were flexed according to local needs.
BBCS as an adjunct service working through children’s centres - the service provided in Dudley and Birmingham was integrated into existing children’s centre services. Children’s centre managers wanted to work closely with NCT and all the recruitment, volunteer training and parent support activity took place within this setting. After training, operational supervision of volunteers was provided by children’s centre staff. Almost all the support provided to parents by volunteer peer supporters was provided through established children’s centre drop-in and postnatal groups.
BBCS as a community outreach community support service -in the three other areas the service was flexed in response to local circumstances and needs resulting in the provision of community outreach services. Volunteers were recruited through extensive outreach work in local communities and through awareness raising events. The establishment of partnerships with a range of statutory health and voluntary agencies for example midwifery and health visiting services, emotional health teams, and voluntary services such as refugee and family support organisations resulted in women being referred to the service for additional one-to-one support.
Women and families were visited by local project managers and matched with trained BBCSs who provided support over a number of weeks. Home visits were provided when required, after careful assessment, and new group support activities and services were run in community venues for example local halls or rooms provided by voluntary support organisations.
Activities and services included groups led by trained BBCSs with opportunities for mothers to participate in facilited discussion designed to build confidence to talk, discuss issues and concerns and develop strategies to deal with problems. For women and families who are socially marginalised and often face multiple problems, including long-term health conditions, acute poverty and social and emotional problems, a community outreach approach was vital. This involved identifying affected families and their particular circumstances and needs, including any particular cultural or language issues.
The programme was funded by the Department of Health’s – volunteering funding stream from the ‘Health and Social Care Volunteering Fund’ for three years. The programme funding ended in September 2014
3. Evidence and evaluation - making a difference to children, young people and families
Researchers in NCT’s Research and Quality Department, with external quality assurance from Charities Evaluation Service, conducted a mixed-methods evaluation across the four service delivery areas to:
Performance measures for the programme included:
During the evaluation it was not possible to collect much impact data on mothers receiving support where the programme was implemented as an adjunct service, so further evaluation is required making adjustments based on lessons learned during this initial pilot.
The evaluation findings suggest that the programme, as implemented during the pilot, provides a feasible way of engaging and training volunteers to provide a service that is valued by mothers, contributes to reducing isolation and low mood and improves their sense of well-being, at relatively little cost. Volunteers have benefited from the service personally, gaining a range of transferable skills and knowledge and enhanced self-efficacy that will enrich their lives beyond the lifetime of the project.
Key successes/achievements of the 3 year programme included:
1. A range of partnerships and involvement in the programme with local statutory health and social care services including midwives and health visitors, emotional health teams and social services and voluntary organisations supporting particular vulnerable groups for example those supporting refugees and asylum seekers, young parents, and families living in difficult social circumstances.
2. 199 trained volunteers from groups that are often difficult to engage:
5. Support provided to 444 mothers either one-to-one, in a group or using both of these approaches.
6. Mothers came onto the project with a range of social, emotional and health needs. They presented with one or more of the following issues:
7. Positive evaluation of the training and support experience was provided by 99% (143) volunteers on post training questionnaires, 72 %(47) at six months post training 38 volunteers during interviews . Benefits included[V3] :
8. In the three areas providing community outreach services, baseline data was collected from 54 mothers receiving one-to-one support and 3 month post support data was collected from 35 mothers. All 35 mothers who provided feedback at three months and 19 mothers who took part in interviews provided a positive evaluation of the support they received through contact with the service.
Assessments of women before and at 3 months after support together with interviews provide evidence that the programme may be helping mothers. Benefits included:
9. Positive evaluation of the programme by external partners who saw the programme as unique, mutually beneficial and ensuring effective support for women and families addressing more of their needs. They saw the need for the programme to continue beyond the funding period
4. Sustaining and Replicating your Practice
Sustaining your practice
BBCS as a community outreach service is sustainable by embedding the service provision within other existing voluntary support services that specifically work with engaging with women who are vulnerable and are at risk of social exclusion. The programme has demonstrated this as an effective means of engagement with these groups. Sustainable models of delivery are being developed in conjunction with other, local, voluntary sector organisations who are working closely with those most in need of this service.
Costs of commissioning the delivery of the OCN accredited peer support training
Depending on specific local circumstances e.g. availability of venue for training, location and recruitment of volunteers being undertaken by the partner organisation, the 30 hour training, Open College Network accredited course with 6 sessions of reflective support for the volunteers once trained, can be commissioned for approximately £5000.
Overall assessment of benefit
The volunteers, mostly mothers themselves, gained from their engagement in the programme as well as contributing substantially and generating value and are therefore regarded as beneficiaries along with mothers receiving support.
Learning from the experience
A number of learning points have been identified and practice recommendations made to inform future roll-out of the programme. These include:
C4EO Golden Threads
It is essential to carry out outreach work with the communities you intend to support to assess need and flex your service to meet those needs in terms of training and delivering support to vulnerable families
NCT has worked extensively with local authorities, children’s centre strategic managers, professionals from local health and social care agencies and voluntary agencies to develop a programme of support that with engage families that are hard to reach and who don’t engage. Programme support is seen as mutually beneficial enabling opportunities for intensive support to be provided addressing more needs.
Involving service users in the design and delivery of the programme in the three community outreach areas has ensured that the programme has engaged with those who most need support. The expertise and knowledge held by parents and families should be respected, and their capacity to share responsibility should be recognised and nurtured.
By conducting and collating pre and post data we are able to demonstrate promising evidence of the impact of our programme both mothers and volunteers. Outreach work and partnership working with programme beneficiaries and external stakeholders proves the need and demand for the service.
Promoting resilience and confidence of both volunteers and mothers supporters is key to positive outcomes. The programme has raised the aspirations of some of the most vulnerable and socially excluded women in society through its strength based and empowering approach.
The local project teams have worked tirelessly with project beneficiaries and external stakeholders to shape the vision of the service.
(1) Centre for Maternal and Child Enquiries (CMACE). Perinatal mortality 2009: United Kingdom. London: CMACE; 2011.
(2) Hollowell J, Oakley L, Vigurs C, Barnett-Page E, Kavanagh J, Oliver S. Increasing the early initiation of antenatal care by Black and Minority Ethnic women in the United Kingdom: a systematic review and mixed methods synthesis of women's views and the literature on intervention effectiveness. Final report. Oxford: National Perinatal Epidemiology Unit; 2012.
(3) Redshaw M, Heikkila K. Delivered with care: a national survey of women's experience of maternity care 2010. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2010.
(4) National Collaborating Centre for Women's and Children's Health. Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors. London: RCOG; 2010.
(5) Rowe RE, Garcia J. Social class, ethnicity and attendance for antenatal care in the United Kingdom: a systematic review. J Public Health Med 2003 Jun;25(2):113-119.
(6) Raleigh VS, Hussey D, Seccombe I, Hallt K. Ethnic and social inequalities in women's experience of maternity care in England: results of a national survey. J R Soc Med 2010;103(5):188-198.
(7) Kupek E, Petrou S, Vause S, Maresh M. Clinical, provider and sociodemographic predictors of late initiation of antenatal care in England and Wales. BJOG 2002 Mar;109(3):265-273.
(8) Rowe RE, Magee H, Quigley MA, Heron P, Askham J, Brocklehurst P. Social and ethnic differences in attendance for antenatal care in England. Public Health 2008 Dec;122(12):1363-1372.
(9) Murphy CA, Cupples ME, Percy A, Halliday HL, Stewart MC. Peer-mentoring for first-time mothers from areas of socio-economic disadvantage: a qualitative study within a randomised controlled trial. BMC Health Serv Res 2008;8:doi: 10.1186/1472-6963-8-46.
(10) Mead S, Hilton D, Curtis L. Peer support: a theoretical perspective. Psychiatr Rehabil J 2001;25(2):134-141.
(11) Dykes F. Government funded breastfeeding peer support projects: implications for practice. Matern Child Nutr 2005;1(1):21-31.
(12) Casiday R, Kinsman E, Fisher C, Bambra C. Volunteering and health: what impact does it really have? Report to Volunteering England. London: Volunteering England; 2008.
(13) Department of Health. Opportunities for volunteering: the legacy report: 30 years of funding volunteering in health and social care. Department of Health; 2011.
(14) Sevigny A, Dumont S, Cohen SR, Frappier A. Helping them live until they die: volunteer practices in palliative home care. Nonprofit and Voluntary Sector Quarterly 2010;39:734-752.
(15) Farrell C, Bryant W. Voluntary work for adults with mental health problems: a route to inclusion? A review of the literature. Br J Occup Ther 2009;72(4):163-173.
(16) Ryan-Collins J, Stephens L, Coote A. The new wealth of time: how timebanking helps people build better public services. London: New Economics Foundation; 2008.
(17) Seaman P, McNeice V, Yates G, McLean J. Resilience for public health: supporting transformation in people and communities. Glasgow Centre for Population Health; 2014.
(18) Department of Health. Family Nurse Partnership Programme. 2011Available from: URL: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_118530
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