Guest blog by Louse Harrington, Development and Impact Manager at the NSPCC
Up to one in five mums and one in 10 dads experience perinatal mental health problems (Bauer, 2016 and NHS England, 2018). However, access to the right support at the right time isn’t guaranteed and the pandemic has exacerbated things. During the last year, for many expectant parents, government restrictions have meant being away from supportive family and friends, dealing with new pressures, and uncertainty around birth arrangements. For some, this combination of challenges has intensified feelings of stress, anxiety and apprehension.
Through NSPCC’s Fight for a Fair Start campaign we’ve been calling on governments across the UK to ensure training and resources to spot perinatal mental health problems are available so parents can receive the support they need, at the earliest opportunity, for themselves and their babies. And where parents need specialist care and support, the NSPCC want governments to ensure it’s available to them, wherever they live.
To support improvements to early help on offer to parents, we’re sharing what we’ve learnt from adapting our preventative mental health service, Pregnancy in Mind, to virtual delivery, enabling us to still be here for families when they need us most.
Adapting our preventative mental health service
Last year, we adapted our Pregnancy in Mind group-work service to be delivered using a combination of one-to-one telephone calls, group video calls and peer-to-peer messaging apps. The service is designed to support expectant parents experiencing or at risk of mild to moderate anxiety or depression. It helps parents to overcome the challenges they’re facing and builds their capacity to provide sensitive, responsive care to their babies.
We evaluated the virtual service between 23 March and 30 September 2020. During this time, 192 new referrals were received for virtual Pregnancy in Mind and the programme was delivered to 186 parents. Through a process evaluation of the virtual service, which drew on routinely collected service and outcome data as well as information gathered during interviews and focus group discussions with practitioners who deliver the service, we’ve learnt valuable lessons about the process of adapting the service to virtual delivery, what helped and hindered delivery to parents in this way, and importantly, we have also been able to collate key evidence on programme outcomes.
The recent report ‘Maternal Mental Health during a Pandemic’, published by the Centre for Mental Health and commissioned by the Maternal Mental Health Alliance called for a greater understanding of the impact of providing perinatal mental health support virtually. Adaptation to virtual delivery of the Pregnancy in Mind service and its evaluation provides evidence of the feasibility of virtual delivery and the outcomes achieved.
Need among parents
Analysis of depression and anxiety scores collected during the initial holistic telephone assessment of need that took place after referral and before virtual Pregnancy in Mind was delivered, suggests that two in three parents were experiencing mild-moderate depression (62%) and anxiety (67%). During this assessment, proportionately more concerns were noted by practitioners relating to parental mental health difficulties and parental stress, and fewer related to parenting, than in the previous year, prior to the pandemic. All six teams that were delivering the service identified the pandemic as contributing to parental anxiety.
Outcomes for parents
Parents who accessed Pregnancy in Mind virtually experienced an improvement in reported depression and anxiety over the six sessions of the programme. This improvement was statistically significant with the greatest rate of improvement experienced by parents who reported higher depression and anxiety at assessment.
Adaptations for virtual delivery
In the weeks following the first national lockdown, practitioners were aware of how the pandemic was impacting parents’ access to midwifery support services and the associated anxiety it created. As a result, programme inclusion criteria were extended to address this gap in provision for women at a later stage of pregnancy. The programme is usually delivered during the second trimester of pregnancy (from 12 to 28 weeks). During the pandemic, this has been extended to include women (and their partners) up to 34 weeks gestation.
Teams found that virtual and digital delivery was more intense for practitioners and parents. As a result, session length and content were reduced from two-hour sessions to around 45 minutes. Practitioners found one-to-one sessions helped to build a relationship and parental confidence before moving into group sessions with other parents. It also provided an opportunity to tailor the programme to parents’ specific needs not always addressed within the group work element. The option of one-to-one delivery is also considered for those who do not wish to join a group, or who are unable to due to anxiety levels.
Opportunities and challenges associated with virtual and digital delivery
By adapting our service to virtual delivery, not only did we keep the service running, but in some areas, we were able to reach beyond existing geographical boundaries to open the service up to a wider group of parents. It helped by removing barriers like travel time and cost, and having access to appropriate venues. In some cases, we extended beyond the immediate local area by partnering with other NSPCC service centres where Pregnancy in Mind isn’t normally delivered, to provide support to parents there.
“Women would come but then they would find it too much to get onto buses to the venue. People being able to tune in without having to travel is a huge advantage”
– Team Manager, Pregnancy in Mind
Virtual delivery was found to help remove some barriers to engagement for parents who were particularly anxious. For instance, being able to develop relationships at a pace that suited anxious parents was identified as a benefit. However, some practitioners continued to have concerns about building relationships with and between parents, and increasing diversity and inclusion among parents virtually, and development work is ongoing within teams to address these issues.
What helped and hindered?
Teams that benefitted from a supportive local context with existing pathways, demand and awareness of the Pregnancy in Mind programme found it easiest to establish virtual delivery. In contrast, those experiencing change and instability within the local delivery team struggled more with virtual delivery. Practitioners identified challenges around their own confidence and skills with technology and the physical absence of pregnancy bumps during sessions. Technology, in terms of skills, comfort and access was also seen as a barrier for some parents.
What’s next for Pregnancy in Mind?
Prior to the pandemic, a process evaluation of Pregnancy in Mind when delivered face-to-face was undertaken. We published the findings in November 2020 and shared them in a blog for Maternal Mental Health Alliance. The evaluation found that the service is feasible to implement and that it appeared to have a positive impact on most parents who attended, helping them to manage their anxiety and depression. It also identified areas for improvement for the service. Using this learning, we’ve developed and embedded a rapid cycle improvement approach aimed at increasing the number of Black and Asian parents-to-be and partners who attend the programme, diversify referring agencies and reducing attrition rates after referral and assessment. Over the coming months, we’ll continue to implement these changes and monitor our progress.
To find out more about what we learned from delivering Pregnancy in Mind virtually, read the report on NSPCC Learning. You can also join our free online event on 17 June, 10.30-12pm to find out more about what’s next for the service. Learn more about the event and register here.
Pregnancy in Mind is delivered in Leeds/Bradford, Jersey, Swindon, Tidworth and York. To refer to the service, find the contact details of our service centres on the NSPCC website.