Nurture the Borders Annual Review 2020-2021 by Rosie Kennedy

Annual Review 2020 - 2021

www.nurturetheborders.com

CONTENTS

TABLE OF CONTENTS

We are Nurture the Borders

The Impact of Our Work

Welcome

What our Service Users Said

Our Response to Challenges

Thank You

Our Work this Year

We are Nurture the Borders

Everything we work to do is rooted in the experiences of women who know what it's like to experience the challenges of becoming a mum. That includes the women who access our services, our incredible supporters, champions, volunteers, staff and board members. Your experience and dedication brings our work to life and shapes our whole purpose. We provide much needed support, information, education and advocacy to women who are experiencing challenges within pregnancy and as they become a mum so that they can become the kind of mum and woman they wish to be and access the support and things they need to do this.

Five One One in Five women are diagnosed with a mental illness during pregnacy or within the first year of their baby's life - many more go undiagnosed

reasons we're here

Three Two That's over 220 a year here in the Scottish Borders

Isolation and lack of support increases risk and compounds the problem

Four Suicide is the leading cause of death during this time in a woman's life - 86% of these deaths are preventable

Five Mum's are excellent at supporting other mums to recover. Infact research shows peer support has many benefits including: shared identity/acceptance, increased selfconfidence, developing and sharing skills, improved mental health, emotional resilience and wellbeing, information and signposting, challenging stigma and discrimination.

Welcome Nurture the Borders The past year has certainly seen Nurture the Borders face many challenges. We have worked extremely hard to adapt and find new ways of working that allowed us to operate safely within the changing restrictions and meet the significantly increasing demand for our support services. We could not be prouder of our team of staff and volunteers. Their dedication, creativity, flexibility and compassion have been fundamental to ensuring that we could be there to support the many women and families we have this year. This report provides a review and insight into the challenges we and the women and families we have supported have faced this year; the work we have done and the impact of our work.

Context of this year March 2020 saw the United Kingdom become part of the COVID 19 global pandemic. We are all living through the most significant crisis facing civil society since the second world war. Indeed, the restrictions placed upon us in response to this global pandemic exceed those placed on the ordinary citizen during that war. The pandemic has raised anxiety levels whilst the restrictions have removed access to the type of support we might previously have accessed; not just services, but also contact with family and friends. Many people have struggled with their mental health as a direct and indirect result of the crisis with women and families in the perinatal period becoming some of the most impacted and vulnerable.

Pre the pandemic, the perinatal period was known to be a time of significant risk to women’s mental health, with up to two in ten women suffering some form of mental health problem, ranging from mild to moderate forms of anxiety or depression to a minority who will suffer from more severe mental health problems. For some women, the risk is even higher: half of women with a history of psychosis are at risk of relapse during this period. During the perinatal period, women can be affected by a range of problems such as antenatal and postnatal depression, obsessive compulsive disorder, post-traumatic stress disorder (PTSD) and postpartum psychosis. Stigma can be a significant barrier to seeking help and women may worry that they appear incompetent or that their children may be taken away from their care if they appear not to be coping. Of most immediate concern is the risk of suicide during this period, which is a leading cause of maternal death in the UK. From early on in the Covid-19 pandemic, The Centre for Mental Health and Maternal Mental Health Alliance were concerned about the likely increased mental health challenges that women in pregnancy and early motherhood were facing as a result of the pandemic and governmentimposed restrictions introduced to tackle it. Their research has found evidence of a significant increase in poor mental health for women in the perinatal period.

Our Response to the Challenges

Lockdown On March the 23rd 2020 the whole of Scotland went into Lockdown, everyone was instructed to stay at home and only leave for essential purposes. Statutory Maternity Services were significantly disrupted, with routine appointments reduced or cancelled. Antenatal and mother and baby classes and groups were cancelled and we were all asked to isolate ourselves from all social contact. All childcare settings closed except for the children of essential workers and pregnant women were put into the "Increased Risk" category for COVID. At the time we had 52 service users engaged and being supported by our staff and volunteers. We were deeply concerned about the potential impact this lockdown may have on their mental and emotional wellbeing and knew we needed to respond rapidly to ensure that we could continue to provide support and mitigate the impact.

Policy & Training We developed policy for; and delivered training to our perinatal support officers and volunteers to support them to transition safely and confidently to support women and families virtually.

Resources

We developed resources both online and physically to enhance the work we could do with women including producing our own wellbeing journal that we send out to all service users who then work through this with their mum befriender and perinatal support officer.

Technology

We invested in upgrading our technology to ensure we could deliver as high quality support virtually as possible. 6

Adapting the way we work We rapidly adapt our provision as the pandemic evolved so we could keep everyone safe while also meeting the needs of the women reaching out and accessing our support. All women on our caseload were offered a weekly support contact via phone while we transitioned.

During lockdown we provided;

One to One Support

Our perinatal support officers and volunteer mum befrienders provided weekly one to one support via video and telephone call.

Trauma Recovery Therapy We offered our trauma recovery session via secure video call.

Positivi-Tea

Our perinatal support officers facilitated a weekly perinatal peer support. group via video call.. Due to demand they also offered one to one support sessions following the call

Antenatal Chat Group Due to increasing demand and the presenting isolation pregnant women expressed to us we started a weekly antenatal chat group via video call where women can access support from our Doulas and peer support from each other.

Antenatal Classes

We moved our weekly antenatal education, movement and relaxation classes online. As the NHS antenatal classes are no longer available due to the pandemic, we made our classes free and accessible to all pregnant women in the Scottish Borders.

Post

We utilised the good old fashioned post to send service users resources to support recovery, promote connection, self worth and wellbeing

Six service users found the transitions lockdown brought too difficult to continue accessing support from us and disengaged. Over the following weeks and months we saw a significant increase in our referral rate.

Opening up & Evolving Coming together Again

Towards the end of the summer restrictions started to ease. We knew how important it was to our services users, volunteers and staff to have the opportunity to meet face to face. again Initially we undertook risk assessments and wrote guidance to allow our volunteers and staff to meet with the mum they were supporting for a walk and talk session outside. These sessions were really well received and our service users expressed how much they appreciated them. Our Perinatal Support Officers were also able to recommence home visits under controlled measures. We then undertook rigorous risk assessments and with advice and guidance from the Scottish Government, specialist health and safety advisors and the local authority we set about making adaptations to our premises to create a COVID Secure Environment which would allow us to open up at the start of October 2020.

Two Meter

Masks While

Wipe Down

Distancing

Moving

Surfaces

Hand Hygine

One Way System

Individual

Around the Building

Resources 8

Our Work This Year We Supported

Over

163 New Referrals

210 Women who were experiencing mental health difficulties during their pregnancy and/or within the first two years of their baby's life.

we received 163 new referrals for support which is an increase of 150% compared to the year before.

Most women presented

Reasons for referral

with two or more mental or emotional difficulties

Headline Changes this year

Anxiety went up by 20%

Isolation,

Lack of support & Trauma

Women referred in with symptoms of anxiety increased by 20% compared to the previous year

The percentage of women presenting with issues around isolation, lack of support and trauma also significantly increased compare to the previous year.

Wellbeing Scores

23% More women

Down By 4

presented in

points

pregnancy

The average score for mental and emotional wellbeing on entering the service was down 4 points on the previous year.

More women were referred in during their pregnancy and needed support for longer than the previous year

this year we delivered.........

Isolation, 1630 one to one support sessions

912 one to one

84Trauma Lack of support support sessions

Recovery Therapy

with our Perinatal

With our volunteer

support officers

mum befrienders

sessions & Trauma

48 antenatal classes

18 Antenatal chat

60 Positivi-tea

which were attended by

group sessions hosted

Facilitated perinatal

286 women and 17 men

by our Perinatal

peer support group

educator and doulas

sessions

our specialist mental

15 baby massage

We set up an online

health doula's provided

sessions

mental health support

support at two births

group for new dads

I was very, very low when I came into the service, and was suicidal. Julie visited me every week, and gave me confidence through her kindness that I was an adequate parent. She taught me how to do baby massage, and was a kind and sympathetic ear when I felt like I was too terrible for anyone to trouble with. Natalie (Mum Befriender) met me when I was starting to pick up, but was an enormous help whenever I had a dip. She was patient and sympathetic, but also pragmatic, giving me helpful advice. Our walks were a highlight of my week, and talking through my feelings with someone was so helpful. Thank you. 11 .

What we do......... One to One Support Perinatal Support Officers Our perinatal support officers provide emotional and practical outreach support to women experiencing emotional or mental health challenges during the perinatal period (pregnancy up to baby being 2 years old). Support is tailored to the individual woman's needs based on her circumstance and presentation. We take an empowering approach to our support and aim to enable a women to move forward towards recovery by providing support, information, signposting, goal setting, modeling and mentoring. This way of working encourages our service users to identify their own strengths, needs and abilities, build confidence, knowledge and understanding which in turn enables them to work towards being in the place they want to be.

I got on really well with my perinatal support officer she was really friendly and I felt like she took a genuine interest in me. She was great at listening when I shared different challenges I was facing, and would offer really helpful strategies for coping. She's helped me to realize caring for myself is really important, not only for myself but also for my family, she's put me in the picture :) and I'm so thankful for that.

Here are some of the things we do:

provide time to talk and a non judgmental independent listening ear provide psychoeducation share coping strategies and skills encourage relationship building (with baby, family and community) enable mum to access services and social activities advocate and support at meetings and appointments education to build confidence ideas and information to support mums to find their own solutions

What we do......... One to One Support Volunteer mum befrienders We have a team of 19 trained volunteer mum befrienders. All our volunteers are mum's themselves and have experiences the challenges of the perinatal period. They provided one to one peer support to our service users and are supervised by our perinatal support officers. here are some of the ways they help; Offer mothers regular emotional support to reduce social isolation and to help mum be more emotionally available for her baby and other family Assist mothers to identify their own strengths and goals, and support them to work towards these Observe how the mother responds to her baby and offer gentle guidance on how she can better relate to her baby to build her confidence and skills Help the mother take her baby and other children outside of the home so they can access services they need – i.e. health services, shops, parks Give the mother support with issues which concern them, for example by signposting to organisations that can help with benefits

Having someone there who didn't judge, who gave me time, who really listened and understood where I was coming from made the world of difference for me. She didn,t tell me how to do things, instead she encouraged me to find my own way and supported me every step of the way

Our volunteer training All our volunteers are required to successfully complete our in-depth training programme which includes the following modules; Perinatal health & well-being of mother & infant Understanding perinatal mental health, infant mental health, attachment theory and infant development The role of a Mum Berfiender Boundaries in relation to ourselves and others. Safeguarding of vulnerable adults and children Equality & Diversity in relation to working with mothers Practical skills for supporting mothers and babies Communication & Interpersonal Skills Understanding our community and other community supports. Following this initial training our volunteers are required to keep their knowledge and skills up to date and must attend a minimum of 4 group supervision and training sessions a year. They also have regular one to one supervision sessions with our perinatal support officers.

What we do......... trauma recovery therapy Perinatal Trauma Recovery sessions provide a safe space for service users to tell their story and to begin the journey of recovery. Life with a new baby can of course be a life changing event but hopefully a positive one. Lingering trauma from a difficult birth experience can turn this most precious time into a daily struggle, trying to process what happened instead of focusing on the here and now and indeed the future. Our trauma recovery sessions are a safe and highly effective, psychological therapeutic intervention. These sessions, reduce the impact quickly, empowering the the service user to move forward with their life.

I can’t put into words how beneficial birth trauma therapy was for me, the weight lifted off was pretty instant, I highly recommend it.

Positivi-tea

Perinatal peer support group Positivi-tea is a weekly virtual (physical when lock down restrictions ease) peer support group hosted by our perinatal support officers and volunteer mum befrienders . The group offers discussion topics and opportunities to meet up with other Mums, as well as a chance to share the good – and not so good - bits about being a Mum. We also offer one-to-one chats, by appointment, after PositiviTea for those who feel they would benefit from that. Positivi-tea offers mums the opportunity ti bring questions, worries, fears and concerns and have a chat with one of our our team and others going through similar experiences

What we do......... Antenatal education classes & workshops Our antenatal classes and workshops are designed to physically and mentally prepare women and their birth partners for their birth. Nurture birthing is a women only class which runs in blocks of six weeks. This class combines yoga and pilates based movement to support the pregnant body, prepare the body for birth and aid fetal positioning; Active birth and evidence based antenatal education, to build knowledge, understanding and confidence; Breathing techniques and comfort measures for labour; and birth hypnosis and relaxation techniques. Our essential Birth Prep Workshop provides empowering education and practical skills to support mum and her birth partner to work together as a team during the birth. As the NHS Classes were cancelled due to the pandemic we made our classes and workshops free and accessible for all pregnant women in the Scottish Borders.

I just wanted to let you know how much i am enjoying the antenatal classes. they give me a bit of time each week to just focus on my pregnancy. the breathing and relaxation has really helped my anxiety (i use the breathing techniques most days), and i have learned so much about birth.

antenatal chat group We set up our virtual antenatal chat group in response to the women in our antenatal classes and our service users expressing how isolated and lonely they felt in pregnancy. This weekly group is facilitated by our Perinatal Educator and Doulas. It provides women with a chance to ask questions, share experiences and build a peer support group. Our facilitators share hints, tips and education on all things pregnancy, birth and beyond. The group has been very well attended with 8-12 women attending a week.

the tips sharon (Doula) shared yesterday on the group were really helpful and its so good to be able to talk to other pregnant women and know i am not the only one who has been experiencing this. 15

Volunteer support..... Our volunteers are the backbone to our organisation, and we know good support starts at home. We aim to provide our volunteers with a rich supportive volunteering experience which helps build confidence and self esteem. All our volunteers must complete our eight week training programme before they start supporting another mum. Our training is designed to equip them with the knowledge, skills and confidence they need to be able to support another. It also provides an opportunity for our volunteers to get to know each other, build friendships and provide peer support to each other as they become part of our community. The support doesn't end there, all volunteers are given their own mentor who is there to ensure their well-being while they are volunteering with us. Once matched with a mum they are given regular supervision and guidance from our Perinatal Support officers and we also hold regular group supervision sessions, in which they can share experiences, gain peer support and undergo further training. This year our group supervision sessions have training has included boundaries & confidentiality working remotely, practical case studies and tips on how to support someone through challenging times. Our volunteers have been fantastic at embracing the changes this year bought and moving to working remotely and in COVID safe ways. Understandably a few of our volunteers felt that they were unable to continue volunteering due to the way the restrictions were impacting their lives (e.g. home schooling, working from home ect). With the increased demand on our service we new we needed to recruit more volunteers, in order to do this we had to first transition our training so we could deliver it remotely. We moved to a blended model of learning using a combination of an online learning platform and weekly face to face delivery via zoom. This worked really well and 9 new volunteers completed our training in October 2020.

9 New Volunteers Successfully completed our Mum Befriender training

i find volunteering with nurture so rewarding. i learned loads on the initial training. the mum i am matched with is really lovely and its wonderful to see how her confidence is growing each week.

the impact of our work

94.7% of women's mental & Emotional wellbeing improved when working with us

108 women exited from our support 108 women's wellbeing had improved to the point that they no longer required our support so they exited the service.

Measuring the impact of our work is an essential part of the way we work. Understanding the impact of our work allows us to understand what works well and also helps us to identify areas we can work on to improve the support we deliver. This is really important to us as we strive to deliver the best support we can to the women and families we support. We have use a variety of quantitive and qualitative measures consistently for a number of years which has allowed us to see our impact over time. This year we have had to change the way we deliver our support due to the pandemic but we have kept the same outcome measures. This has allowed us to understand more about how the pandemic has effected women and families and how the changes in our delivery have impacted our service users. This is what we found... 17

Warwick Edinburgh mental wellbeing scale We use the Warwick Edinburgh Mental Well-being Scale. as a measure while working with a mum. The scale is a 14 item scale with 5 response categories, summed to provide a single score ranging from 14-70. The items are all worded positively and cover both feeling and functioning aspects of mental well-being, there by making the concept very accessible. Scores of 50 and above indicate good mental well-being. Scores between 40 and 44 indicate psychological distress. Scores of 14 to 40 indicate a major depressive episode. The average initial scores for women entering the service this year were four points lower than last year. However we consistently see improvements in the scores during our work with them and have continued to see an average 15 point improvement (the same as the last two years) on the exit scores even though we have had to adjust the way we work during the pandemic.

Nurture Maternal wellbeing Web We use our own wellbeing web which we specifically designed to help our service users to assess their own wellbeing in all the different areas of their lives. This tool not only helps us measure progress, it also enables conversation, helps identify key areas to work on and goal set. We use the web throughout the time our service users work with us. When using the webs we ask our service users to score each area of their life out of 10 with 0 being worst and 10 being absolute best. Example of Two Webs from one of our service users this year, you can really see the progress she made

Entry Web (Start of Working With us)

EXIT Web (At the End of Working With us)

What the data from the Nurture Maternal wellbeing Webs showed.....

52% Average improvement in Emotional and Mental Wellbeing

33% Average improvement in Bonding and Parenting

41% Average improvement in Family Relationships

28% Average improvement in Body Wellbeing

17% Average improvement in Social & Recreational Life

29% Average improvement in Lifestyle

Subject Units of Distress scale

Within trauma recovery therapy we use the Subject Units of Distress Scale. This is where the client places a score on a distress scale of zero to 10 when recalling the event. 0 indicates neutral feelings - no distress and 10 being horrified - the most distressed you could be. .

8 points

Our birth trauma recovery service users saw an average reduction of 8 points in their feelings of distress at the end of their sessions with us.

The day I gave birth was the worst day of my life. I couldn't get over it no matter what I did, it felt like it was happening to me all over again every day. I felt like I broke the day I had my daughter.The words that were said to me would reply over and over and over in my mind, I tried to fight it but it was all I could think about and it effected every bit of my life. I couldn't let my partner near me but at the same time I was worried sick something terrible would happen to him when he walked out the door. I worried about every tiny thing, I felt like the world was ending. When I finally agreed to my health visitor making a referral for me I was vomiting everyday with the worry. The sessions have changed my life, they have helped me deal with and process what has happened and finally start to enjoy being a mum. I still worry sometimes but now its normal mum worries and I have learned techniques to help me manage my feelings. I can't express how grateful I am to have been able to get the help from Nurture, i just wish i had the courage to get help sooner so i didn't suffer for so long.

Exit Survey Results When a service user exits from our support we ask them to complete our survey so that we can better understand their experience of accessing our support. Here are what this years results from those who completed showed.....

9.6 out of 10 Our service users rated their experience withe us 9.6 out of 10

100% 100% of service users

84.2 % of service users

felt their emotional

felt their Mental Health

wellbeing improved

improved through

through accessing

accessing support from

support from Nurture

Nurture the Borders

the Borders

100% 100% of service users would recommend our support to other mothers

84.2%