The Birth and Beyond Community Supporter service (BBCS) is a community development programme that provides volunteer peer support training and perinatal peer support to parents who are vulnerable during the first 1000 days of parenthood. These include refugees and asylum seekers, BME communities, younger parents and those living in difficult social circumstances.
The programme was developed and piloted in East Lancashire (Burnley), North Yorkshire (Catterick and surrounding localities) and West Yorkshire (Bradford, Huddersfield, Halifax and Wakefield).
Development and implementation relates to recommendation 1.4 of the NICE guideline NG44 on community engagement which sets out local approaches to making community engagement an integral part of health and wellbeing.
Aims and objectives
NICE recommends that directors of public health and other strategic leads planning health and wellbeing initiatives and working in collaboration with local communities offer training and mentoring support to community members, and consider providing formal recognition of their contribution and other opportunities for development.
The focus of the Birth and Beyond Community Supporters (BBCS) programme is to deliver community-based peer support from volunteer befrienders who have 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. Volunteers receive peer support training and on-going supervision and support by a local project manager and NCT trainer working together. This enables them to provide the social and emotional support that vulnerable groups of mothers need during pregnancy and the period after birth with opportunities to signpost mothers to relevant statutory services where needed. The programme aims to achieve positive outcomes for both the volunteers who provide support and for the mothers who use the service. Specifically the programme 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 local women from disadvantaged communities to work as volunteer peer supporters, providing them with the skills and knowledge necessary to deliver the service whilst improving their personal confidence and self-esteem and enhancing their opportunities for further training and employment.
Reasons for implementing your project
The BBCS programme was developed and piloted by NCT UK’s largest parenting charity. NCT has for many years delivered breastfeeding peer support training, community-based antenatal and postnatal support services with some initiatives specifically targeting refugees and asylum seekers, younger parents, and parents from South Asian communities. Community based support has been delivered via children’s centres, the NHS and through partnerships with community and voluntary organisations.
Practice based experience and consultation with partners in the pilot areas reinforced the view that there was a need for a broader programme of peer support covering the whole perinatal period. This included more targeted outreach to enable some of the most disadvantaged families with complex needs to get involved with parent-to-parent support and networks to help reduce isolation and low mood and to better link them with health and family support services.
Access to timely and adequate maternity care is critical to improving health outcomes for new mothers and their families but there remains persistent inequality in the UK’s maternity population. Socio-economic deprivation, non-white ethnicity and asylum seeking status, single status, younger age and non UK place of birth have been associated with late initiation of care, isolation, poor physical and mental health and adverse clinical outcomes during the transition to parenthood. Government drivers together with growing evidence suggests that peer support can be used as a means of outreach and engagement, processes that are necessary to enable families to make use of maternity and family services, and to reduce health inequalities.
The provision of peer support with opportunities to build and maintain on-going trusting relationships was seen to potentially benefit midwives in terms of time and cost savings. It was believed that if women are provided with social and emotional support and encouraged to attend regularly for antenatal, care and signposted to relevant services, then any complications during pregnancy or after birth could be prevented or managed early.
How did you implement the project
The programme (development and piloting) cost £425,000, funded by DH with an additional £22,000 from the Armed Forces Community Covenant Grant to cover travel and subsistence in rural North Yorkshire. It was implemented by:
Establishing and sustaining partnerships: Local project managers maximised partner involvement with midwifery and health visiting services, emotional health teams, and voluntary services such as Bradford Action for refugees, Home Start and the NSPCC by ensuring cross referring and signposting and inviting representatives to join the project’s local advisory group.
Volunteer recruitment: Local managers used outreach work and awareness raising events to help select and recruit volunteers. Flexible recruitment prioritised inclusivity. Early experience and volunteer feedback highlighted a need to offer training more widely to help address local needs e.g. some South Asian parents were concerned about confiding in a member of the same community.
Volunteer training and support: A 30-hour portfolio course, accredited by Open College Network, was designed to equip volunteers with the skills for directive support, brief advice and signposting. Early consultation with volunteers and parents revealed a mistrust/fear of formal statutory services for some groups (younger mothers, refugees and asylum seekers), so the training and parent support was delivered outside these settings. Additional support was given to women who had difficulty with written English support. Volunteers were given on-going support and supervision by the local project manager and trainer. Peer-to-peer mentoring was put in place, with additional training opportunities, to enable established volunteers to support those in training.
Referrals: There was an agreed process for referrals from midwives, health visitors and voluntary support agencies. Volunteers were active in signposting women to the service.
Matching mothers with volunteers for one-to-one support: Following referral, local managers conducted an initial visit to assess need. Mothers were then matched with a volunteer, taking into account similar or relevant experiences, cultural background, language and location. Some mothers were supported by 2 volunteers. Often a subsequent meeting was arranged with a mother, volunteer and project manager.
Support groups: Volunteers ran support groups to encourage social inclusion, boost confidence build social support networks, explore feelings about pregnancy and parenthood.
NCT’s Research and Quality Department, with external quality assurance from Charities Evaluation Service, conducted a mixed-methods evaluation across 3 pilot areas.
The programme trained 121 volunteers who supported 253 mothers either through one-to-one support, group support or both. More than half of volunteers and mothers were from BME groups and refugees in West Yorkshire were of African origin. Around 93 mothers were referred by health, social and voluntary agencies. The evaluation revealed positive health and social benefits for both the volunteer supporters and the mothers who they supported.
- 74% of volunteers felt that they had improved self-confidence and self-worth as a result of being supported to take on a socially valued and recognised role.
“The training has given me confidence when I had none, made me feel like a professional when everyone treated me as a criminal and given me something to live for.”
- Volunteers demonstrated an increase in awareness and shift in attitudes about different communities and groups as a result of training with and supporting mothers from diverse backgrounds.
“It’s been enlightening for me. It’s dispelled quite a lot of myths about the Asian community. The girls that I trained with have been absolutely fantastic. They were wary of me to start with because I was the only white British woman…I think in the end they suddenly realised that actually, the problems they have, we have as well so it became sort of like our problem rather than us and them”.
- Involvement in the BBCS programme inspired one group of volunteers to set up a new community service to support parents, building on the success of the NCT project.
- 85% of mothers reported improved knowledge of services.
- 89% felt more confident to access services
- An increase in the use of some services, including in Children’s Centres and mental health services
- Improved feelings of wellbeing with fewer women reporting feelings of isolation and low mood compared with baseline.
- 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.
“I needed someone to talk to, someone on my side…I can call her up when needed. It’s hard for me to open up but I wanted to do that”.
Key learning points
Success factors and points to consider
- recruit local managers with community development and outreach expertise who can build trust with individuals from hard to reach groups
- establish and sustain partnerships and collaborations with relevant local stakeholders both statutory and voluntary at the programme proposal stage and early on in project.
- Involve all stakeholders in development of the service enabling you to respond to local needs and circumstances and fostering a culture of open communication and joint working.
- ensure regular and on-going supervision and support of volunteers from disadvantaged groups who many be living in complex circumstances themselves.
- provide additional and relevant training through local opportunities to enhance volunteer confidence and skills.
- use established volunteers as mentors to support newly trained peer supporters, and including some administrative tasks as volunteer roles, to spread the load and share responsibility for running the programme with those working in the programme.
- locate where possible your programme in community venues including those provided by local voluntary agencies who work with vulnerable and disadvantaged groups to foster trust
- consider number of volunteers recruited and the number of mothers supported according to complexity of social and emotional needs and the extent of the support required.
- Cost and budget for large programmes carefully, particularly when providing a community outreach service, to facilitate quality of training and supervision, and community development approaches such as outreach activities, work with vulnerable families, community marketing provision of crèches, transport, meals
- take account of volunteers educational support needs when providing training being flexible in the length of training and including a variety of assessment methods to differentiate between skills levels.
Development and pilot of the new service was funded by the DH – Health and Social Care Volunteering Fund and the Armed Forces Community Covenant Grant 2011-2014.