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HEALTH CHALLENGE WALES

VOLUNTARY SECTOR GRANT SCHEME


Final Project Self-Evaluation Report 2013 to 2015
The purpose of this template is to assist project partners in reporting their overall achievements to the Welsh Government. Completion and submission of this report in draft form by 17th July 2015 and final submission by 17th August 2015 is required in order to meet the monitoring requirements of the Grant Scheme.
The text boxes expand if required and contain guidance notes for completion. We have completed Section 1 for you, but you can revise and add to it as you feel necessary. You may attach appendices to provide any relevant supporting information, such as copies of questionnaires, examples of forms referred to within the report, or a summary of the project’s statistics and details of methodology.
1. THE ORGANISATION, PROJECT TITLE AND DESCRIPTION


1.1 Name of Organisation

(If a partnership project then please enter the lead organisation’s details here)


Mind Cymru


Contact name: Jenny Burns




Position: Perinatal Mental Health Project Manager





Project Title


Two in Mind – Perinatal Mental Health and Resilience – Early Support





Project Description

The Two in Mind project aims to raise awareness of perinatal mental health problems and increase recognition of the early signs in order to encourage people to seek support.





2. SELF - EVALUATION OVERVIEW
Please provide an overview of your approach to self-evaluating your project.


Self – Evaluation Approach
Aims and objectives of the evaluation

Objective 1: Through raising awareness of perinatal mental health problems among women and their families, we will increase the numbers of women who seek early support.

Objective 2: Through the provision of wellbeing training, we will increase the resilience of targeted women at risk of developing perinatal mental health problems.

Objective 3: Through raising awareness of perinatal mental health problems among GPs and primary care practitioners, including midwives, health visitors and other frontline services, we will increase the number of women who are offered early support.

Objective 4: Through providing training to GPs and other primary care practitioners, including midwives and health visitors, we will increase skills and confidence in responding to perinatal mental health problems and the distress this can cause.

Methods and tools
The evaluation has captured both quantitative and qualitative data to give a rounded picture of the overall success of the project. This includes:


  1. qualitative feedback from other organisations, stakeholders and families

  2. the number of positive links with other organisations, stakeholders and families

  3. the pre and post scores of those attending the Enjoy Your Baby course using the PHQ-9 and GAD-7 (depression and anxiety scales)

  4. qualitative feedback from the CBT course

  5. the number of registrations for the online CBT course

  6. the number of people accessing training

  7. pre and post questionnaires following training

  8. online rating scores for digital stories

  9. a telephone survey with GPs

  10. the number of visits to the Two in Mind website

  11. website viewer geographical location and the length of time spent on the website

  12. the number of posters and post cards distributed with information about perinatal mental health

  13. student hours and volunteer hours donated to project (with cost savings)

  14. attendance and presentations at key events.


Working with ECORYS
This project had three main evaluative interactions with ECORYS (external evaluators contracted by the Welsh Government):


  1. Phone calls and email discussions concerning the Two in Mind provision of cost data, i.e. a cost/benefit analysis with Melanie Jones and Pippa Swift from Swansea University in May 2014.



  1. A telephone interview with Jenny Williams (ECORYS) and the Two in Mind Project Manager on 6 November 2014.





  1. ECORYS visited Cardiff on 13 May 2015 to conduct qualitative face-to-face interviews with the Two in Mind Project Manager and two of the project volunteers/students. They also held a focus group with attendees of an Enjoy Your Baby CBT group, and qualitatively conducted telephone interviews with a sample of those delivering Enjoy Your Baby across Wales.

3. MAIN FINDINGS
Please outline the main findings of your self-evaluation, to include a description of activity, a report on your project’s performance and outcomes.


Description of activity (How much did we do?)
I wish I knew about this (the Two in Mind resources) when I had my little boy. Sharing in case it might be of help to someone who is pregnant or recently had a baby” – Mumsnet: niqnet January 2015.

Overall aim: The project aimed to raise awareness of perinatal mental health problems and increase recognition of early signs in order to encourage people to seek support.


Ongoing objective: Sign up and link with key individuals and organisations (eg. the Maternal Mental Health Alliance (MMHA)) and establish a project steering group. Share information and attend programme meetings in England.

Established the Steering Group, with the first meeting in December 2013 (followed by five additional meetings, three meetings in 2014 and two meetings in 2015). Key figures in attendance included Professor Ian Jones (Cardiff University), Grace Thomas (Cardiff University, Midwifery), Dr Jane Hanley (Marce Society President), Caroline Winstone (WHSSC), Sally Tedstone (Public Health), Dr Beckie Lang (Tommy’s and MMHA), plus representatives and mothers from different services and organisations across England and Wales. All the steering group members are prominent figures in the perinatal mental health field.

The project was an active member of the MMHA and was included in the circulars, discussions and attended meetings in London, as well as a member of the Association of Infant Mental Health (AIMH). The project also attended training and conferences with Robin Balbernie (CAMHS Consultant) and Oxpip.
The work of the project was presented at different events and audiences, including the International Marce Society conference in Swansea, the Pembroke Dock perinatal conference, the Mental Health Today conference in Cardiff, and the National Wellbeing at Work conference at the NEC. We also presented to health visitor leads, Flying Start, WHSSC (Welsh Health Specialised Services), North Wales Public Health service managers and Welsh Government health leads.
The project sought to influence other developments in perinatal mental health including a written perinatal mental health recommendation for the Children’s Commissioner of Wales (see Appendix A), membership of a strategic workstream for CAMHS new strategy (Together for Children and Young People), being part of the authorship group for the midwifery standards development of perinatal mental health in England, and part of the Health Education England (HEE) online perinatal mental health curriculum development.

Strong links made with other key organisations included Tommy’s (which is leading on the midwifery perinatal mental health standards (see point above), NSPCC (where discussion is being held to work together using the online Enjoy Your Baby course), Action for Children and Advance Brighter Futures, Homestart, Barnardos and local Mind’s (who are delivering the Enjoy Your Baby programme) and various interactions with Public Health Wales (Two in Mind resources included in the Bump, Baby and Beyond 2nd Edition book) plus interactions with Flying Start, All Wales Perinatal Mental Health Group, South Wales University and Five Areas Ltd.

The project also wrote a health feature in the Western Mail (July 2015) and an article for the online magazine VICE highlighting the issues of perinatal mental health which can be found at http://www.vice.com/en_uk/read/more-than-half-a-million-women-experience-perinatal-mental-illness-190
IMPACT IN BRIEF: Two in Mind has established itself as the ‘go to’ third sector voice for perinatal mental health in Wales.


Objective 1: Through raising awareness of perinatal mental health problems among women and their families, we will increase the numbers of women who seek early support.

The work plan was changed for this objective from producing leaflets to creating a website that could host digital stories, factsheets, the planned online CBT course and other resources for sustainability. Please see www.twoinmind.org. There have been over 3,500 visitors to the website since 1 May 2014.
We were asked to create 20 digital stories of lived experiences, and there are now over 25 digital stories listed on the Two in Mind website.
IMPACT IN BRIEF: Those who have watched the stories rated them highly and stated that they were more likely to seek help. This has also had a positive impact on those who contributed stories, as well as the students/volunteers. Before August 2013, Wales did not have a website dedicated to early interventions for perinatal mental health issues. Two in Mind has taken the initiative to provide this. Over 3,500 men/women have accessed these resources.

Objective 2: Through the provision of wellbeing training, we will increase the resilience of targeted women at risk of developing perinatal mental health problems.


This objective was met in partnership with Five Areas Ltd led by Dr Chris Williams who is a Psychiatrist and professor at Glasgow University where we developed resources to train women and health care practitioners in the issues surrounding perinatal mental health. These tools were; The Enjoy Your Baby Cognitive Behavioural Therapy (CBT) tool accessible face-to-face (in a group or one-to-one) and online as a five session course, or as a book (both online and as a hard copy). The book is also now available in Welsh and Urdu. 45 parents accessed the face-to-face Enjoy Your Baby CBT course and 80 parents are registered on the online Enjoy Your Baby CBT course. We also ran a training day on 18 September 2014 with 24 practitioners attending to be able to run the course themselves. CBT face to face and computerized is recommended by the NICE guidelines as a first line of low intensity intervention in 1.8.1 and 1.8.8/9 http://www.nice.org.uk/guidance/cg192/chapter/1-recommendations. (The NICE guidelines (national institute of clinical excellence) provide national guidance and advice to improve health and social care)
In addition, we printed 400 posters and 5,000 postcards with key messages from the ‘Experiences of Women’ report (www.tommys.org/file/Perinatal_Mental_Health_2013.pdf). 100 GP surgeries received this information and other key organisations across Wales.

IMPACT IN BRIEF: The online CBT course is the only one of its kind in the UK and helps fill the early intervention gap and is listed on the Royal College of GPs website (www.rcgp.org.uk/clinical-and-research/clinical-resources/perinatal-mental-health.aspx). It is also included in the Welsh Bump, Baby and Beyond book (page 171) which goes to every new parent in Wales and every practitioner (www.healthchallengewales.org/sitesplus/documents/1052/Pregnancy%20to%204%20Years%20Book%20FINAL%20English%20Revised%20E-Book%20Compressed.pdf).

The resources are easily accessible for signposting for primary care professionals and deliverable by non-health professionals, increasing capacity in primary care. 125 parents have accessed and/or completed the Enjoy Your Baby CBT course. In addition, 4,000 postcards have been distributed.


Objective 3: Through raising awareness of perinatal mental health problems among GPs and primary care practitioners, including midwives, health visitors and other frontline services, we will increase the number of women who are offered early support.

Our original project plan asked for one factsheet for health professionals on perinatal mental health but we produced four as downloadable pdfs – Wellbeing for new and expecting parents (written by North Wales Public Health), Perinatal mental health for new and expecting parents, Perinatal mental health for partners, family members and carers and Perinatal mental health for primary care professionals. Please see www.twoinmind.org/resources.
Primary Mental Health (PMH) Teams, Flying Starts, health visitors, CAMHS, midwives and third sector organisations throughout Wales have been signposted to the website resources through phone calls, team meeting visits, emails and personal contact.

All 7 Local health board primary mental health teams were contacted. Contacting individual PMH workers had limited success because of part time working and them not being in their offices very often, however contacting the administrative central PMH bases was more successful. Aneurin Bevan, Abertawe Bro Morganwg, Hywel Dda, Cardiff and the Vale and Betsi Cadwalder actively involved the project;

• The project was invited to present at various primary mental health teams. Invitations were accepted for Hywel Dda, Abertawe Bro Morganwg and Aneurin Bevan PMH.
• The project has been part of the specialist perinatal interest groups with PMH in Aneurin Bevan.
• Anuerin Bevan and Betsi Cadwalder have distributed the resources to all the children and adult PMH workers.
• Cardiff and the Vale CAMHS PMH have been engaged and have informed the PMH adult team of the resources and set up a presentation with the Paediatricians and children’s NHS staff in Cardiff and the Vale to hear about the resources.
• Betsi Cadwalader PMH was represented at the Public Health launch in St Asaph and were able to take the resources back to their team.
A PMH worker is also represented on the project’s steering group.
IMPACT IN BRIEF: All 462 GP surgeries received information to access the factsheets (250 GP surgeries were required). The factsheets were taken to all the meetings with partnership organisations and presentations listed under the first objective.


Objective 4: Through providing training to GPs and other primary care practitioners, including midwives and health visitors, we will increase skills and confidence in responding to perinatal mental health problems and the distress this can cause.

The work plan was adjusted from provision of an online learning tool to a face-to-face two day training course in partnership with Cardiff and Vale LHB/NHS. This was done so that there could be sustainability and expertise left beyond the life of the project. To date, four of these courses have run in their non-accredited form. The course is entitled ‘Maternal and Infant Mental Health’ (MIMH) and will be ready to deliver in its accredited form in January 2016. In addition, the Project Manager has been involved in the steering and authorship of the online Health Education England (HEE) online perinatal mental health education tool.

As required on the work-plan, this project ran four Youth Mental Health First Aid Courses (YMHFA) and three Applied Suicide Intervention Skills Training courses (ASIST). There were a mixture of different attendees including Health Visitors, Midwives, Nurses, Children’s workers, Youth Workers, Health care students, Occupational Therapists, 3rd sector family workers, volunteers and project leaders. These courses were deemed useful mental health information and skills for practitioners.
IMPACT IN BRIEF: The MIMH course is part of the core training for all staff in the 2015 Healthy Child Programme in Wales. The course will be accredited at Level 3 with Agored and be accessible for all different types of family workers, not just health professionals.
This course is for both adult and children’s mental health professionals and provides the latest evidence base for working with early attachment, optimising the mother/baby relationship and awareness of the vulnerabilities, mental health and other stresses on this dyad.
96 people have attended the MIMH courses, 78 people attended the ASIST courses and 47 attended the YMHFA courses.


Partnering with Cardiff University to encourage training health care professionals and volunteers.

One further evaluative achievement to note is the added value and benefit for project delivery brought by the work of students on placement with the Two in Mind project.

Between March 2014 and May 2015, four occupational therapy (OT) students and two qualified occupational therapists have given the equivalent of £17,284 worth of time based on the NHS gross salary banding system (band 4-6).This is the equivalent of 52 weeks of time. (40 weeks of student time and 12 weeks of volunteer time) All four of these students now volunteer for the project. One of the volunteers has now qualified as an occupational therapist and been employed by Social Services full time. Another student qualified as an occupational therapist and secured a post with Mencap.








Project performance (How well did we do it?)


Overall aim: The project aimed to raise awareness of perinatal mental health problems and increase recognition of early signs in order to encourage people to seek support.


Ongoing objective: Sign up and link with key individuals and organisations (eg. the Maternal Mental Health Alliance (MMHA)) and establish a project steering group. Share information and attend programme meetings in England.

I have been really impressed with the practical, no nonsense, ‘can do’ approach taken by the Two in Mind project. They have achieved such a lot in a short time. They have rapidly identified gaps in services and been innovative in finding smart ways of working to fill as many of them as possible. I am delighted to have been able to promote the Enjoy Your Baby online resource in the second edition of Bump, Baby and Beyond.

Sally Tedstone, Public Health Wales.


I saw first-hand through implementing the Enjoy your Baby course that women (and their babies and partners) were "crying out" for support and understanding and they benefitted greatly from participation in the course. I witnessed the mood and mental health of these ladies change for the better as the sessions progressed and believe the project to be of great value to the mental health of perinatal women in Wales.”

Tiffany Bales, Volunteer.

“Two in Mind has been a fantastic development for women with mental health problems in Wales. It has made a real difference for women with perinatal mental illness and it’s fantastic to see the project re-funded”

Professor Ian Jones, Cardiff University.

Please see “description of activity” section above for more details of the activities undertaken.


Objective 1: Through raising awareness of perinatal mental health problems among women and their families, we will increase the numbers of women who seek early support.

Over 3,500 people have visited the website since its launch in May 2014.
The effectiveness of the 25 digital stories were measured by a four question online survey (which was optional to complete). The 42 responses were as follows:
Watching this video has increased my awareness of emotional issues during pregnancy and birth. Where 0 is disagree and 5 is agree’

88% scored 4 or above


If you were struggling with your emotions, how likely are you to seek help? Where 0 is unlikely and 5 is likely’

78% scored 4 or above


How likely are you to recommend this story to a friend? Where 0 is unlikely and 5 is likely’

88% scored 4 or above


What would you rate this story out of 5. Where 0 is terrible and 5 is excellent’

88% scored 4 or above




Objective 2: Through the provision of wellbeing training, we will increase the resilience of targeted women at risk of developing perinatal mental health problems.

The Enjoy Your Baby cognitive behavioural course was evaluated quantitatively and qualitatively.

Quantitative: To date, and since its launch in September 2014, a total of 125 individuals have engaged with the course (45 face-to-face and 80 online). This intervention is in line with the antenatal and postnatal 2014 NICE guidelines (1.4.2.2 and 1.4.2.3) www.nice.org.uk/guidance/cg90/chapter/1-

Our evaluation of Enjoy Your Baby showed significant improvements in the wellbeing scales measured by the GAD-7 (standardised anxiety measure), PHQ-9 (standardised depression measure) and EQ-5D-5L (general health questionnaire). The GAD-7 and PHQ-9 are both listed as recommended in 1.5.5 and 1.5.7 in the NICE guidelines http://www.nice.org.uk/guidance/cg192/chapter/1-recommendations 77.3% of the participants showed improvement in their symptoms for the GAD-7 (anxiety scale) with an average of a 5.47 point reduction in scores. 73.9 % of the participants showed improvement in their symptoms for the PHQ-9 (depression scale) with a reduction of 6.59 points in their scores. 61.9% showed improvement in how they perceived their health (Health Today Question) with an average of 20.23 percent reduction in the scores.

100% of the participants have been white British and all female apart from one (a grandfather).


The project also attempted to engage with BME groups in the following ways:

The project met with ISSA (Islamic Social Support Association) a few times and attended a nursery to try to engage women and interest in starting an Enjoy Your Baby course. There was no uptake. ISSA informed the project that some of the barriers to engagement of women with mental health issues were the way Islam regards mental health and the stigma attached plus the women’s position within the family.

The project also attended an afternoon with Ashianna; Newport Mind’s BME group and presented the materials and resources available. Our presentation was translated into Hindi. Culturally many of the women had been asylum seekers with really difficult stories and different upbringings to a Western culture, however, we were able to leave some information and materials but received no subsequent response.

The project has also trained one project worker to run the EYB courses with OASIS in Cardiff (a charity to support refugees and asylum seekers). The project has creatively helped OASIS think through how the course could be delivered (e.g.; run the course over 5 mornings in one week and use verbal completion of the worksheets). Some of the barriers are poor literacy levels, asylum seekers often are moved on so it is hard to build a relationship over a long period of time and lack of social support and dealing with the trauma of their experiences.
Qualitative: Some quotes from the women who attended:
It is a wonderful course and it is my belief that it should be ‘rolled out’ throughout Wales to help all young mothers.’
The course was really helpful. It enabled me to have a better understanding of mental health issues.’
The seminars where we discussed CBT were particularly helpful.’
Learning new skills to help with emotional health and wellbeing is invaluable.’
Thank you so much for running the course. I got so much from it. I think I might be interested in running one in the future.’
The social element is beneficial especially if isolation is a factor.’

One of the aims that developed as part of this project was to increase worker capacity in primary care across Wales delivering early CBT interventions. With the reduced budgets in the statutory sector, increasing waiting lists and some excellent family projects running in the third sector, it seemed prudent that third sector workers could run some of the early interventions in partnership with the statutory sector. This has been occurring and the most successful use of the Enjoy Your Baby courses have been run by the third sector. One mum who attended the course also attended a second time so that she could learn how to run one in the future. Safeguarding issues have been taken into account with this by connecting the third sector to a mental health professional and/or local statutory teams for advice and guidance. The Enjoy Your Baby practitioner was also taught to screen the prospective participants using PHQ-9, so that if the participant’s mood was very low (higher than a score of 17) the practitioner suggested that they see their GP first.

A 25% sample telephone survey was taken of the 100 GP surgeries who received the information posters and postcards. Only one surgery had put the posters up, reporting that they receive lots of different resources every day and didn’t have the time or space to display them (see Appendix B). In light of this, the strategy was changed to delivering posters and postcards by hand after meeting practice staff and others in primary care settings (eg. Flying Start and health visitor bases).



Objective 3: Through raising awareness of perinatal mental health problems among GPs and primary care practitioners, including midwives, health visitors and other frontline services, we will increase the number of women who are offered early support.


All 462 GP surgeries received information on how to access the factsheets as a downloadable format (Our work-plan target was for 250 GP surgeries) using the help of Wales Mental Health in Primary Care to access surgeries across Wales.
The factsheets were also taken to all the meetings with partners and presentations listed under the first objective.
The Primary Mental Health Teams mentioned previously were contacted and were engaged with.



Objective 4: Through providing training to GPs and other primary care practitioners, including midwives and health visitors, we will increase skills and confidence in responding to perinatal mental health problems and the distress this can cause.

26 practitioners attended the Enjoy Your Baby training day in September 2014.

The unaccredited MIMH course which has been run four times this past year with 96 in attendance. The qualitative feedback included:



  • Excellent course with lots of information’

  • Very informative with valuable information’

  • Raised my awareness of how mental health issues can impact the

mum/baby relationship’

  • Increased my confidence bringing theory to practise’

78 people attended the Applied Suicide Intervention Skills Training (ASIST) courses and 47 attended the Youth Mental Health First Aid (YMHFA) courses. The anonymous qualitative feedback from the different attendees including Health Visitors, Midwives, Nurses, Children’s workers, Youth Workers, Health care students, Occupational Therapists, 3rd sector family workers, volunteers and project leaders were



The training is brilliant! Glad to have the opportunity before graduating as health care professional. Would be great if I had training before placements.’
Definitely worthwhile attending the course regardless of experience.’
The information delivered will and has helped me with my work.’
I feel a lot more informed and supported because of this training course and its motivation to help those suffering at any level of distress in terms of mental health’
Definitely useful for an overview for professionals.’
Useful strategies I can see myself using.’
Best course I have ever been on.’






Outcomes (Is anyone better off?)

  1. 125 parents have engaged with the Enjoy Your Baby cognitive behavioural course since September 2014. Of those who attended the face-to-face courses, there has been an average of a 62% improvement in their mood and anxiety scores over the five sessions.





  1. 26 individuals (made up of health professionals and other family workers) have been trained to deliver the Enjoy Your Baby course. 16 individuals are now actively delivering the course around Wales with different organisations (Pembroke Dock Perinatal Team, Monmouthshire Home-Start, Aspire (Barnardo’s, Mind and social services), Advance Brighter Futures, Neath Port Talbot Mind, Glenwood Church and Action for Children). The other 10 (from 3 different areas in Wales; Bridgend, Cardiff and Llanelli) had the following barriers (these were either reported verbally or were observed by the project manager); securing the £200 for the license, finding a venue, sharing of information and confidentiality worries, finding the time for the practitioner to deliver the course as a group away from their clinical caseload, budget for childcare, difficulty in being able to ’think outside the box’, perhaps mistrust in securing informal partnerships with 3rd sector organisations who could help provide venue and childcare, already had their own in-house programme being used, the ‘fear’ of addressing mental health issues especially with Health visitors/Midwives which is hopefully being addressed through the accredited training that is coming through this project.




  1. The project has created more resources to access for perinatal mental health in Wales, with over 3,500 visitors to the website since May 2014. There is now a free online CBT course, a bilingual website, factsheets, digital stories, resources and links for access by all professionals and other workers alike (these resources did not exist in Wales before this project).



  1. 125 individuals in Wales from different professions and organisations have attended either the YMHFA and/or the ASIST course, improving their skills in being able to assess the risk for suicide and obtaining a more thorough understanding of depression, anxiety, eating disorders, self-harm, psychosis and drugs/alcohol. This has helped to reduce stigma and increase the community effort to tackle mental health issues.





  1. The partnership with Mind Cymru and Cardiff and the Vale UHB has resulted in the design of a maternal and infant mental health course. This course brings together a few professions who do not always work closely with each other, such as adult mental health services, children’s mental health services, health visitors and midwifery. This course was piloted 4 times in Cardiff with 96 health visitors and others attending. Following its success and the gap in the market for a Level 3 qualification in this subject, it is now going to become an accredited course to be rolled out in January 2016.




  1. We have encouraged partnerships and joint working between statutory and non-statutory sector (eg. Advance Brighter Futures (a mental health charity in Wrexham) and the Primary Mental Health Team, Neath Port Talbot Mind and the local Community Mental Health Team, Monmouthshire Home-Start and their local Primary Mental Health Team, and Glenwood Church and local health visitors. This has increased work force capacity in primary care and reduced the burden on the health professionals alone.




  1. We increased the profile of perinatal mental health with Cardiff University’s Occupational Therapy Studies by offering full time placements for a total of 52 weeks (over the past two years with four students). This has contributed towards two of the students now being offered jobs in the statutory sector and third sector. Three of the students were single mothers and, with flexible working, the project enabled them to support their young children and complete their placement.



  1. Offering five volunteering positions to assist with the project, with three students (and an additional fourth student on placement, but who did not go on to volunteer) and two qualified occupational therapists. Each volunteer has also been able to work through different issues they have had personally with supervision from the Project Manager.





  1. We raised the profile of perinatal mental health and the importance of optimising the mother/baby relationship with many different organisations throughout the UK and became a perinatal representative of the third sector in Wales. We were also invited to write recommendations for the Children’s Commissioner, be part of the new CAMHS strategy work stream for early intervention, and spoke on the subject with Professor Ian Jones at the Mental Health Today Conference in May 2015.




4. LESSONS LEARNED
Please outline any areas where project performance, including self-evaluation, didn’t meet that set out in the action plan, to include reasons and remedial measures.


The delivery of Two in Mind saw some changes from the original project plan. These changes were agreed by Welsh Government during regular project monitoring meetings. The development of new training and online resources have strengthened the original project plan.


This project has been effective through:


  1. Development of working relationships with key people in the field of perinatal mental health.




  1. Wide dissemination of the project’s work and key message through invitations to be a part of presentations and different events.




  1. The experience of the Project Manager (being a mental health practitioner and having previous experience in mental health for children and adults).



  1. Using evidenced-based interventions that match the NICE guidelines.





  1. Identifying the gaps in Wales for early intervention and contributing into these.




  1. Working in partnership with others (Cardiff and the Vale NHS, Five Areas Ltd, Cardiff University, etc).




  1. Using existing material where appropriate for example; the Enjoy your Baby material.




  1. Choosing interventions that allow client choice.




  1. Choosing interventions that have the potential to be delivered by different workers therefore building capacity in primary care.




  1. Working with student volunteers.




  1. Ensuring that project staff are aware of the latest key research papers supporting the work in perinatal mental health.

The challenges the project faced were:




  1. Engaging mothers with low/moderate mental health issues. Mothers told us that they had fears of ‘failure’ as a mother, fear of their children being taken away, embarrassment, not believing there is a problem and the practicalities of engaging in a programme/course while looking after a baby (see www.tommys.org/file/Perinatal_Mental_Health_2013.pdf). Online resources have therefore offered a good alternate solution for those wanting to engage anonymously.




  1. Running a course for parents involves at least four workers to facilitate and run a crèche, which is effective but more challenging due to the potential costs, including wages and DBS checks. This was overcome by working with organisations that already had this set up (eg. Action for Children already run a post-natal group in Caerphilly with a crèche).




  1. Getting statutory and non-statutory services to partner with each other. Many statutory services are also understaffed, particularly in primary mental health and CAMHS, and under pressure due to low budgets and red tape, meaning that finding a venue and paying for a license is a major undertaking. One solution for primary care services would be to actively partner more effectively with third sector provision. This project has achieved this in some areas, for example Neath Port Talbot Mind now works closely with the Community Mental Health Team.




  1. Lack of time which has been overcome by efficient working practices and the use of volunteers. Students on placement with Mind Cymru was an unexpected benefit and the working model has proved to be mutually beneficial.




  1. The project required a mail out of 100 posters/postcards to GP surgeries. Following a 25% telephone sample, only one had displayed the posters. The learning from this was to hand deliver a smaller amount of posters and postcards to selected surgeries and primary care settings, which achieved 100% display of the materials. Two volunteers delivered and displayed 20 posters and 500 postcards to 20 different health sites including GP surgeries and 3rd sector charities including Women’s Aid. There has been 100% success in displaying the posters and putting the postcards out visibly.




  1. There were some difficulties engaging with the BME groups. See page 8 for further comments and description.




5. PROJECT CASE STUDY

Please provide a case study from your project (no more than 1 side of A4).


Jane is a mum to a five year old girl and twin girls aged seven months. She heard about the Enjoy Your Baby cognitive behavioural course being run at Glenwood Church, Cardiff, through one of the Two in Mind volunteers. She decided to attend and contacted Two in Mind to sign up.


Leaving the house was the biggest step with all three of her children with her, as she had been feeling low and defeated. ‘I felt so proud of myself to just get out and attend the first day of the course. It was a massive achievement’. She was more comfortable attending a course that was being organised by the third sector, as she felt she could be herself and wasn’t having to be on her ‘best behaviour’. She said that being in a Flying Start area in Caerphilly was great as lots of professionals visited every week, but there was a fear of failure and she felt like she had to put on a ‘good show’ to everyone who visited in case she was judged for being a bad mother or, at worst, have her children taken away from her. There was always a ‘pressure to do things right and look like I was coping’. Coming to the Enjoy Your Baby group felt like a choice Jane had made by herself.
Jane said that the Enjoy Your Baby course was immediately non-judgemental, there was no rushing and it was very nurturing. ‘The course content was relevant and really spoke to me. My mood has improved and my relationships have improved with my husband and mother. It has helped me deal with every day things, ask for help and sort problems out’. Jane stated that it was also ‘time to myself’ as there was a crèche provided.
Jane gave an example of how she has changed in her approach applying CBT to difficult situations:

I had just got home from taking my older daughter to nursery. The twins were both teething and both screaming. They both wanted feeding at the same time which is quite difficult when you are on your own. Before the course I would have had a meltdown, been angry and shouted. The thoughts would then have started of ‘I am a rubbish mum’ and ‘I can’t cope’. These thoughts would have had a knock on effect to my emotions of feeling down, anxious, angry and by the time my husband came home I would have been a wreck. Following the course, I handled this exact situation differently. I put both babies in their bouncy seats, walked into the other room for a few minutes, told myself that I was not a rubbish mum, calmed down and when I had come back both babies were asleep in their bouncers!’

Jane said that the course had impacted her life in other areas. She said that just recently she had to travel on the train. Normally she would feel claustrophobic and would struggle with this and possibly not choose to go, but she was able to recognise her thoughts, consider her reactions and the train travel was uneventful and she got to her destination.
Jane is now training to lead an Enjoy Your Baby group in her local area.
(The name of the participant in this case study has been changed to protect their identity).


6. CONCLUSIONS AND RECOMMENDATIONS.
Please present the main conclusions and recommendations arising from your self-evaluation.

In Wales, we take it for granted that all women will receive the support they need to look after their own physical health and that of their children during pregnancy and the first year after birth. However, being pregnant and then looking after a baby is not just a physical adjustment, but an emotional one too. This transition into parenting can affect the mother or father’s mental health, and more than one in ten can develop a mental health problem.


It is important that services focus on optimising the mother/father and baby relationship to give the baby the best emotional and social start in life. A vital part of this is better support for their mental health, whether diagnosed or not. Early intervention is a priority so that mental health is treated in the same way as a mother’s physical health during this crucial time.

Also, we would recommend that the perinatal mental health services are more available throughout the UK. Currently, women in large areas of Wales are not receiving the support they need (everyonesbusiness.org.uk/?page_id=349).

The priorities in Wales for perinatal mental health are:


  • early intervention

  • training

  • building capacity in primary care

  • building capacity in specialist perinatal mental health services

Our recommendations are:


Early intervention: to prioritise and invest in the provision of user friendly, facilitator friendly and evidence-based perinatal mental health interventions, and consequent training and dissemination so that these can be used by appropriate health professionals or other family worker staff across Wales. These interventions need to be delivered in flexible ways allowing the families choice, such as face-to-face with a facilitator (one-to-one or in a group), internet based or in book form. These interventions need to incorporate pregnancy, maternal or paternal mental health, and their relationship with the infant. It should not be just about the mood of the parents.
Training: a need to prioritise and consider training and education at all levels with key messages about perinatal mental health through publications, guidance, presentations and qualifications that can be accessed by health professionals and other family workers in all sectors of society. A key message is that perinatal mental health (or perinatal wellbeing) is about fostering a healthy relationship between the main carer and the infant. By removing difficulties so this can be optimal, this will allow the infant to have a healthy emotional and social foundation. This might include improving the mood of the parents. This key message also needs to include infants at risk of going into care and those who are already in care.

Building capacity in primary care: to prioritise and invest in building worker/volunteer capacity in the community to tackle perinatal mental health issues. Currently in Wales, midwives and health visitors are the lead professionals assisting families with mental health problems during the perinatal time. Some areas have the benefit of Flying Start (but not everywhere), CAMHS do not see children under the age of five, and primary mental health services will tend to refer to Flying Start or generic health visitors. There are huge gaps in services, and very few are joined up or share information. The only way to tackle this with limited budgets is to prioritise building capacity with statutory and non-statutory partnerships. For example, Flying Start work actively and closely with Home-Start, Barnardo’s, Mind and local faith communities.

Building capacity in specialist perinatal mental health services: re-establishing a mother and baby unit in Wales and ensuring that specialist perinatal interest groups, perinatal mental health pathways and specialist community perinatal mental health teams are available across all health boards in Wales. Currently there are no specialist mother and baby units in the whole of Wales and only two health boards have a perinatal community service.
Finally, in Mind as a whole, this project has:


  • Llinked into the bigger perinatal work across the whole of England and Wales.

  • Been able to inform Mind of the direction perinatal services should be going in England and Wales.

  • Been able to emphasize the importance of optimising the relationship of parent and infant not just looking at maternal mental health due to the clinical expertise within the project.

  • Helped recognise that just because a mother has post-natal depression does NOT mean she is going to be a poor parent.

  • Helped inform the information leaflets produced by Mind.

  • Been part of a strategy group of thinking how Mind can consider addressing 0-18 mental health issues in addition to adults.





7. SUSTAINABILITY
How will progress made by the project be continued now that funding is coming to an end?

This project has been refunded until July 2017, however the sustainability beyond this will be in the following ways:



  • The Enjoy Your Baby course and future courses are licensed product with Five Areas Ltd and can continue to be used and purchased through various charities and organisations across Wales.





  • Cascading the materials through partners allows a continuation of learning and knowledge of the materials within their client groups.




  • The Maternal and Infant Mental Health course will be accredited and, once trainers are in place, can continue with the oversight of Cardiff and the Vale UHB.




  • The recommendations and influence that the project has had with the new CAMHS strategy, Children’s Commissioner, etc, will continue through future policies and guidance.




  • The project’s national conference planned for 2017 will be a platform to disseminate the resources and evaluations.




  • The website can continue as a place for resources to be accessed, including digital stories and factsheets, and we are exploring whether this can be potentially assimilated into the national Mind website





8. GENERAL / OTHER COMMENTS
Please use this section to provide any final comments that you may wish to make, including any challenges that you have faced, any outcomes/impacts that you did not anticipate, how you found the self-evaluation process and the over-arching Grant Scheme evaluation etc.

Please also provide any comments / feedback you have on the support received from the Welsh Government during the life of the project (including the Joint Grant Holders’ Meeting). Include comments on where that support could be improved for future grantees. Perhaps as areas of need are identified for future funding e.g.; children’s mental health, the Government could directly involve someone at governmental level who has the expertise to help identify the actual need and can be a part of steering/support/evaluation guidance throughout the life of a project, for example; if the project is for children’s mental health include the children’s commissioner of Wales, an experienced CAMHS practitioner with knowledge of service delivery and perhaps a University link to help guide robust evaluation.


In conclusion, this project has been both timely and strategic. The sector now is beginning to recognise (through overwhelming research and evidence) the importance of optimising the mother/baby bond in the first years of life.


Two in Mind has been able to offer the creative expertise and flexibility that the third sector brings, providing early intervention resources, training and information, and has had the platform and recognition to speak about this vital agenda at a national level.

Signed by the Project Manager to confirm that the statements made in this Evaluation Report are true and the information provided is correct.




Signature:



Name in BLOCK LETTERS:


JENNY BURNS


Job Title:

Perinatal Mental Health Project Manager


Telephone no:

02920 395 123


Email:

j.burns@mind.org.uk


Date:

17 July 2015


Please return an electronic copy and a signed hard copy of the completed report, including any supporting documents to:


E-Mail: HPVSGS@Wales.GSI.Gov.UK

Signed hard copy to:
Mary Jones,

Working Age Health Branch,

Directorate for Public Health,

Department for Health and Social Services

Welsh Government,

Cathays Park,



Cardiff

CF10 3NQ


(initial draft by 17/07/2015 and final draft by 17/08/2015).
For general enquiries and advice please contact Mary Jones on:
E-Mail: Mary.Jones4@Wales.gsi.gov.uk
Tel: 029 20 826545
Or,
Gareth Davies on:
E-Mail: Gareth.Davies@wales.gsi.gov.uk
Tel: 029 20 826730





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