Evaluation of a Home Visiting and Befriending Scheme for Young Mothers: Newpin

Volunteer peer support and befriending for carers of people living with dementia: An exploration of volunteers' experiences

With ageing populations and greater reliance on the voluntary sector, the number of volunteer-led peer support and befriending services for carers of people with dementia in England is set to increase. However, little is known about the experiences of the volunteers who deliver these interventions, many of whom are former carers. Using in-depth semi-structured interviews with 10 volunteer peer supporters and befrienders, this exploratory study investigated volunteers' experiences of delivering the support, the types of relationships they form with carers and their perceptions of its impact upon them and on carers. Data were analysed using framework analysis. Findings showed that volunteers benefitted from their role due to the 'two-way' flow of support. Experiential similarity and having common interests with carers were considered important to the development of mutually beneficial relationships. Volunteers perceived that carers gained emotional and social support, which in turn improved the carers' coping ability. Being able to see positive changes to carers' lives was important for volunteers to gain enjoyment and satisfaction from their role. However, volunteers also identified challenges with their role, such as dealing with carers' emotions. Future research should investigate ways of reducing potential burden on volunteers and explore the impact of volunteering specifically on former carers of people with dementia.

Structured social relationships: a review of volunteer home visiting programs for parents of young children

Objective The aims of the present paper were to: (1) review the research literature that contributes to an understanding of the role of volunteer home visiting programs in supporting the health and well being of families with young children; and (2) propose a conceptual model outlining service pathways for families in need of additional support. Methods An integrative literature review method was used, with a mix of electronic and manual search methods for the period January 1980–January 2014. Forty-five studies were identified that met the inclusion criteria for review and were coded according to themes developed a priori. Results There is little formal research that has examined the effectiveness of volunteer home visiting programs for supporting family health and well being. The available research suggests that volunteer home visiting programs provide socioemotional support through structured social relationships; however, there is limited empirical evidence to explicate the factors that contribute to these outcomes. Conclusion In recognition of the importance of peer support for new parents, the not-for-profit sector has been involved in providing volunteer home visiting services to families for decades. However, the body of research to support this work is characterised by methodological limitations, and rigorous evidence is limited. What is clear anecdotally and qualitatively from the existing research is that parents who are in need of additional support value engagement with a community volunteer. These structured social relationships appear to fulfil a service need within the community, helping build bridges to support social networks, and thus complementing professional services and relationships. Overall, structured social relationships in the form of volunteer home visiting programs appear to provide an important pathway to support family health and well being. Findings from the existing research are mixed and often characterised by methodological limitations, pointing to a need for further rigorous research. What is known about the topic? Volunteer family support programs have been an important part of the service landscape for vulnerable families, both nationally and internationally, for many years. Anecdotal reports suggest that this is a valued form of support that increases a sense of community connectedness and breaks down barriers for families in accessing other community support services. What does this paper add? This paper proposes a model identifying broad service pathways impacting on family health and well being that takes into account the importance of structured social relationships and social connectedness. What are the implications for practitioners? The proposed model may encourage discussion by practitioners and organisations interested in models of support for families who are socially isolated and/or in need of assistance to access and engage with services within the community.

The impact of peer support in the context of perinatal mental illness: a meta-ethnography

OBJECTIVE

this paper is a report of a systematic review and meta-ethnography to explore the impact of peer support in the context of perinatal mental illness (PMI).

METHOD

systematic review methods identified five qualitative studies about women's experiences of PMI, and the impact peer support has on their journey towards emotional well-being. Findings from the identified studies were synthesised into themes, using meta-ethnography.

SYNTHESIS AND FINDINGS

the meta-ethnography produced four themes; 'Isolation: the role of peer support', 'Seeking validation through peer support', 'The importance of social norms of motherhood', and 'Finding affirmation/a way forward; the impact of peer support'. These themes represent women's experiences of PMI, their encounters with peer support groups within that context, and the impact of such encounters on their mental health status.

KEY CONCLUSION

recognising the risk of isolation and having pathways of referral to peer support networks is important, as are practitioners roles in nurturing peer support networks in perinatal care. More research is required to establish the most successful formats/structures of peer support. Practitioners should also recognise their individual and collective professional duty to challenge stereotypical depictions of motherhood wherever they arise, as this 'gold standard' benchmark of good mothering engenders guilt about not being good enough, often leaving women feeling inadequate.

IMPLICATIONS FOR PRACTICE

isolation is a key factor in PMI. Practitioners should be instrumental in their acceptance and development of peer support for PMI, ensuring these networks are valued, nurtured and encouraged. This study illustrates the powerful effect of professional and social forces on how new mothers feel about themselves.

Mother to Mother (M2M) peer support for women in Prevention of Mother to Child Transmission (PMTCT) programmes: a qualitative study

Introduction

Mother-to-Mother (M2M) or “Mentor Mother” programmes utilise HIV positive mothers to provide support and advice to HIV positive pregnant women and mothers of HIV exposed babies. Médecins Sans Frontières (MSF) supported a Mentor Mother programme in Bulawayo, Zimbabwe from 2009 to 2012; with programme beneficiaries observed to have far higher retention at 6–8 weeks (99% vs 50%, p<0.0005) and to have higher adherence to Prevention of Mother to Child Transmission (PMTCT) guidelines, compared to those not opting in. In this study we explore how the M2M progamme may have contributed to these findings.

Methods

In this qualitative study we used thematic analysis of in-depth interviews (n = 79). This study was conducted in 2 urban districts of Bulawayo, Zimbabwe’s second largest city.

Results

Interviews were completed by 14 mentor mothers, 10 mentor mother family members, 30 beneficiaries (women enrolled both in PMTCT and M2M), 10 beneficiary family members, 5 women enrolled in PMTCT but who had declined to take part in the M2M programme and 10 health care staff members. All beneficiaries and health care staff reported that the programme had improved retention and provided rich information on how this was achieved. Additionally respondents described how the programme had helped bring about beneficial behaviour change.

Conclusions

M2M programmes offer great potential to empower communities affected by HIV to catalyse positive behaviour change. Our results illustrate how M2M involvement may increase retention in PMTCT programmes. Non-disclosure to one’s partner, as well as some cultural practices prevalent in Zimbabwe appear to be major barriers to participation in M2M programmes.

Peer-mentoring for first-time mothers from areas of socio-economic disadvantage: a qualitative study within a randomised controlled trial

Background

Non-professional involvement in delivering health and social care support in areas of socio-economic deprivation is considered important in attempting to reduce health inequalities. However, trials of peer mentoring programmes have yielded inconsistent evidence of benefit: difficulties in implementation have contributed to uncertainty regarding their efficacy. We aimed to explore difficulties encountered in conducting a randomised controlled trial of a peer-mentoring programme for first-time mothers in socially disadvantaged areas, in order to provide information relevant to future research and practice. This paper describes the experiences of lay-workers, women and health professionals involved in the trial.

Methods

Thematic analysis of semi-structured interviews with women (n = 11) who were offered peer mentor support, lay-workers (n = 11) who provided mentoring and midwives (n = 2) who supervised the programme, which provided support, from first hospital antenatal visit to one year postnatal. Planned frequency of contact was two-weekly (telephone or home visit) but was tailored to individuals' needs.

Results

Despite lay-workers living in the same locality, they experienced difficulty initiating contact with women and this affected their morale adversely. Despite researchers' attempts to ensure that the role of the mentor was understood clearly it appeared that this was not achieved for all participants. Mentors attempted to develop peer-mentor relationships by offering friendship and sharing personal experiences, which was appreciated by women. Mentors reported difficulties developing relationships with those who lacked interest in the programme. External influences, including family and friends, could prevent or facilitate mentoring. Time constraints in reconciling flexible mentoring arrangements with demands of other commitments posed major personal difficulties for lay-workers.

Conclusion

Difficulties in initiating contact, developing peer-mentor relationships and time constraints pose challenges to delivering lay-worker peer support. In developing such programmes, awareness of potential difficulties and of how professional support may help resolve these should improve uptake and optimise evaluation of their effectiveness.

Trial Registration Number: ISRCTN55055030

Evaluation of a family support service: short-term outcome

The aim of this study was to evaluate the short-term impact of two types of family support services (FSS) for children with behavioural problems (N = 51 and 49 respectively). These were compared with children (N = 40) matched for presenting problems and referred to specialist CAMHS in a locality without FSS. Pre and postintervention measures were the Health of the Nation Outcome Scales (HoNOSCA), the Strengths and Difficulties Questionnaire (SDQ), and a service utilization checklist. Although all three groups were associated with decrease of child behavioural scores, the two family support services provided an earlier response and resulted in significantly higher reduction of HoNOSCA and SDQ scores. The two FSS types implemented different 'levels' of interventions, as FSS-B resulted in a more favourable short-term outcome and appeared to operate more closely to specialist services, while FSS-A appeared to adopt a more preventive role. Family support services have an important role within a comprehensive child mental health service, but the specificity of their interventions for different target client groups requires further investigation.

Parenting programmes for behavioural problems: where do tertiary units fit in a comprehensive service?

Children with behavioural problems are often referred to child mental health services without rationalization of criteria or referral routes. The aims of the present study were to establish the psychosocial characteristics of children with behavioural problems referred to a tertiary Day Resource, and to compare these with children referred for similar problems to a specialist outpatient child mental health service and a family support community service. Demographic data, the Strengths and Difficulties Questionnaire and the Health of the Nations Outcome scales for Children and Adolescents were used. Families attending the Day Resource were found to have more involvement with other agencies, and children showed higher levels of clinical severity and complexity. Most of this difference was accounted for by attentional difficulties, as well as communication and physical health problems. These findings confirmed the hypothesis that families seen at tertiary service level presented with more complex psychosocial needs and frequent child comorbidity, thereby justifying the multimodal treatment package developed at that service level. It is concluded that there is a need for this level of parenting interventions, but only for complex cases that have not responded to community interventions.

An Evaluation of a Volunteer-Support Program for Families At Risk

A descriptive comparative design was used to evaluate the Cottage Community Care Pilot Project, a family support/child protection initiative linking trained volunteers with "vulnerable" first-time parents. Fifty-eight eligible and consenting families enrolled in the program and formed the intervention group. A further 35 eligible families consented to participate in the evaluation and received assessments only and formed the comparison group. No differences were evident between the intervention and comparison groups on parenting readiness. For the intervention group (n = 25), improvements occurred in seven aspects of family functioning (items on the Scale of Family Functioning) when contrasted to the comparison group (n = 24). Two areas of family functioning were found to be statistically significant: access to social support (p = 0.02) and age appropriate expectations of infants (p < 0.001). Participants reported satisfaction with the program, and the study emphasized the need to include all families, not just those at risk. This evaluation supports the continued development of volunteer-support programs and the active role that public health nurses play in the growth and development of children in our communities.

PRISM (Program of Resources, Information and Support for Mothers) Protocol for a community-randomised trial [ISRCTN03464021]

BACKGROUND

In the year after birth one in six women has a depressive illness, and 30% are still depressed, or depressed again, when their child is 2 years old, 94% experience at least one major health problem (e.g. back pain, perineal pain, mastitis, urinary or faecal incontinence), 26% experience sexual problems and almost 20% have relationship problems with partners. Women with depression report less practical and emotional support from partners, less social support overall, more negative life events, and poorer physical health. Their perceptions of factors contributing to depression are lack of support, isolation, exhaustion and physical health problems. Fewer than one in three affected women seek help in primary care despite frequent contacts.

METHODS/DESIGN

PRISM aims to reduce depression and physical health problems of recent mothers through primary care strategies to increase practitioners' response to these issues, and through community-based strategies to develop broader family and community supports for recent mothers. Eligible local governments will be recruited and randomised to intervention or comparison arms, after stratification (urban/rural, size, birth numbers, extent of community activity), avoiding contiguous boundaries. Maternal depression and physical health will be measured six months after birth, in a one year cohort of mothers, in intervention and comparison communities. The sample size to detect a 20% relative reduction in depression, adjusting for cluster sampling, and estimating a population response fraction of 67% is 5740 x 2. Analysis of the physical and mental health outcomes, by intention to treat, will adjust for the correlated structure of the data.

School-based indicated prevention: a randomised trial of group therapy

BACKGROUND

One hundred and twenty-two children identified by teachers as at risk for behavioural or emotional problems were randomly allocated to drama-group therapy or to a curriculum-studies control, based in school.

METHODS

One hundred and seventeen completed the intervention phase of the trial, which comprised 12 hour-long sessions. Post-intervention self-reports showed significant effects associated with both interventions.

RESULTS

However, there was a clear advantage of group therapy over both a waiting list control and curriculum studies, according to teacher reports. This was true also of categorical analyses focusing on those with the most severe symptoms.

CONCLUSIONS

These analyses confirmed sustained teacher-reported improvement over a year-long follow-up period.

The concept of resilience

OBJECTIVE

The concept of resilience highlights the complexity of psychopathology, helps to clarify possibilities for prevention and keeps hope alive in clinical practice. This paper reviews definitions of resilience, the nature of risk factors and of moderating processes.

METHOD

The place of single case studies is described, the components of resilience are outlined and consideration is given to how resilience can be fostered in the face of adversities and stresses: socio-economic deprivation, family discord and divorce, and maternal depression.

CONCLUSION

A plea is made for increased efforts to make knowledge more widely available: public and politicians need to know how decisions about housing, employment, welfare, education and criminal justice impinge on the development of children, and what changes in the macro-environment will preserve and enhance childhood resilience.

Befriending young mothers

The context of voluntary befriending schemes to help mothers of young children is outlined. There is evidence that two main UK voluntary befriending schemes to help mothers of young children engage families where there is significant psychosocial morbidity. It is concluded that well conducted befriending schemes can make a significant contribution to the mental health of mothers and children. Whether they do so will depend on their experience and training and the elements they incorporate.