Birth and Beyond Community Supporters Programme

Themes this local practice example relates to:

  • Early Years

Basic details:

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:

  • provide a strengths-based, empowering service for mothers that reduces isolation, stress and low mood during pregnancy and the first two years after birth.
  • recruit and train community volunteers to work as peer supporters, providing them with necessary skills and knowledge to deliver the service and improving their personal confidence, building social capital and enhancing opportunities for  further training and employment.

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:

  • Establishing and sustaining partnerships and collaborations with local health and social care professionals, children’s centre managers and strategic officers and professionals working within voluntary and community support organisations. These included midwives, health visitors, mental health and social services and organisations such as the NSPCC, Homestart and Bradford Action for Refugees
  • Involving stakeholders in development of the service to identify ways of working together, cross referring and signposting to each other’s’ services
  • Recruiting volunteers with a direct understanding of the experiences and concerns of local families, awareness of cultural beliefs and values and understanding of the day to day challenges for mothers;
  • Providing Open College Network (OCN) accredited training delivered by NCT practitioner trainers who brought expertise in pregnancy, birth, infant feeding, parent support and perinatal education and training
  • Training and supervising volunteers as perinatal peer supporters known as Birth and Beyond Community Supporters (BBCSs) to support local mothers and engage with local services
  • Providing support to mothers in local community settings

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:

  • describe how the service was  developed and established locally; and 
  •  assess the impact of the programme on the volunteers and mothers supported.

This included:

  • Before and after questionnaires with trained volunteers and women supported
  • Use of validated outcome measures
  • Interviews and focus groups with volunteers and women supported
  • Interviews with local programme managers, national management and external partners/stakeholders.
  • Use of local project monitoring systems

Performance measures for the programme included: 

  • Evidence of the partnership working and local collaborations
  • Number of volunteers recruited and trained
  • Number of volunteering hours
  • Number of mothers supported
  • Positive feedback on the programme from volunteers, mothers and external partners
  • Positive outcomes for volunteers:
    • development of knowledge and skills,
    •  confidence
    • personal development specifically opportunities for further progression
  • Positive outcomes for mothers included:
    • Improved access to services
    • Reduced feelings of loneliness and isolation
    • Reduced feelings of low mood and improved confidence

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.

Findings

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:

  • 59% identified themselves as from a Black and Minority Ethnic (BME) group;
  • 38% were under the age of 29; and
  • 48% of volunteers recruited in West Yorkshire were asylum seekers or refugees.
3. Delivery of approximately 3500 hours of volunteer support to mothers with each volunteer providing a minimum of 2 hours of support a week over three months.
4. Provision of a range of support to mothers including:
  • signposting mothers to relevant services including health and social care services;
  • accompanying mothers to appointments and sometimes providing transport;
  • providing emotional support one-to-one;
  • facilitating mother-to-mother social contact in groups;
  • providing practical support with young children and household tasks; and
  • attending established postnatal support groups in children’s centres.
  • establishing new drop-in groups for pregnant women and mothers with babies and young children and in Catterick area use of structured activities to  facilitate discussion, identity problems and focus on solutions 

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:

  • limited knowledge of and access to available services and worries about ability to communicate or express concerns and needs to professionals;
  • feelings of loneliness and isolation including parents who were new to the areas in which they lived, some with little English,
  • low levels of  confidence
  • mothers who were under the care of other agencies for example mental health or social services
  • poor mental wellbeing including feelings of sadness, low mood, stress and depression  exacerbated by specific events such loss of a baby, experiences of domestic abuse , loneliness and difficulties with immigration
  • pregnancy  -including lone pregnancy, worries about pregnancy  and giving birth
  • coping as a mother with a new baby or a mother with several young children
  • little access to baby equipment and other resources

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] :

  • Significant improvements in understanding of the peer support role and knowledge and skills needed to provide effective support to mothers.
    • Between 88% and 97% reported an improvements in their understanding of key elements of the peer supporter role after training including:
      • The importance of building supportive relationships
      • Providing emotional support
      • Listening and encouraging
      • Signposting to services
      • Knowledge of the boundaries of support
      • Maintaining confidentiality
    • 96% of volunteers felt the training had made a difference to their understanding of the role
    • 92% felt ready to offer support after training 
  • Improved self-confidence and self-worth as a result of taking on a social valued and recognised role and feelings of making a difference.
    • 74% of volunteers reported feeling more confident as a result of taking part in the programme (training and providing support to mothers)
  • Increased awareness and shift in attitudes about different communities as a result of training with and supporting women from diverse cultural backgrounds.
  • Personal development including opportunities to go on to further education and/or take up employment:
    • 64 volunteers became employed or went onto study further
    • 61 volunteers took up further volunteering, ran stakeholder events and took part in training health professionals on the needs of vulnerable groups.
  • Formation of a new community support service for parents (Parents4Parents) by volunteer BBCSs trained in the North Yorkshire area.

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:

  • Improved access to services and support which included:
    • an increase in knowledge of services reported by 85% of mothers compared with 63% at baseline;
    • Improved confidence to access services reported by 89% of mothers copared with 61% at baseline;
    • increased in use of children’s centre and mental health services reported by 46% and 20% respectively.
    • Improved feelings of wellbeing with fewer women reporting feelings of isolation (34%) and low mood (23%) compared with baseline of 73% and 50% respectively.                                                                                                         
  • 83% of women reported that contact with the service had made a positive difference to their mood.
  • 91% of women reported feeling more positive about their life and situation as a result of contact with the service.
  • Personal development with seven mothers taking up BBCS training after receiving a period of peer support.

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:

  • the value of employing managers with community development expertise;
  • be flexible and responsive to local needs whilst retaining the fixed aspects of programme delivery.
  • developing innovative ways to respond to volunteers’ education and support needs including the offer of study skills as part of training for volunteers with limited formal education;
  • provide suitable training for example safeguarding, clear boundaries and proactive supervision of volunteers in areas where volunteers work with vulnerable families with complex needs; 
  • use of established volunteers as mentors for newly trained peer supporters;
  • the provision of additional training in person-centred counselling skills an/or the Solihull Approach to working with parents with complex needs, based on theories of containment, reciprocity and behaviour management;
  • promote open communication between local programme management and local professionals and the need to communicate the philosophy of the programme when working with partner agencies;
  • proactively engage with external stakeholders whilst retaining relative independence
  • locate where possible community outreach services in community venues including those provided by local voluntary agencies who work with vulnerable and disadvantaged groups.
  • establish clear boundaries of responsibility when working as an adjunct service;
  • consider the size of a manager’s caseload as this will have implications for quality;
  • Carry out further monitoring and evaluation to explore implementation of this complex programme in other settings.

C4EO Golden Threads

  • Know your communities

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

  • Unite to succeed

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.

  • Together with children, parents & families

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.

  • Prove it- making change happen

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.

  • You can do it

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.

  • From good to great - leadership vision and embedding is key

The local project teams have worked tirelessly with project beneficiaries and external stakeholders to shape the vision of the service.

Reference List

(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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