Peer-Supporters

5.3.1.

Introduction

The Mums4Mums study comprised an evaluation of the impact of TBPS in reducing the depressive symptomatology of new mothers who were experiencing mild / moderate PND. A peer volunteer was defined as a mother from the community who had (1) previously experienced postnatal depression, (2) offered her time to provide telephone-based support to a new mother experiencing PND, and (3) completed eight hours of training.

5.3.2.

Recruitment

The health visitors in the Coventry and Warwickshire Primary Care Trust identified potential participants to be trained as peer-supporters. The peer-supporters were recruited by personal invitation using a specification that set out essential and desirable attributes established from stakeholder consultation (Caramlau – not

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published). The specification included that they had a) recently experienced PND (i.e. within the last five years), b) fully recovered from depression, c) had an empathic and non-judgmental disposition, and d) could commit the time to participate in the training and provide the telephone-support. The clinical

psychologist on the research team (Dr Kirstie McKenzie-McHarg) made multiple assessments of mental health and social wellbeing, and their GPs were required to confirm the suitability of individuals identified for the proposed peer-support role.

5.3.3.

Training

In considering the role of peer supporters within the intervention, it was recognised that they may find it challenging to deal with the very complex domain of maternal mental health, especially as they themselves had recently recovered from PND. It was therefore crucial that they were provided with the training, support, information, tools and strategies necessary to deliver the intervention.

The peer-supporters were asked to attend four training sessions over a period of two weeks. The trainings sessions lasted approximately two hours each and were

delivered by Kirstie McKenzie McHarg (Clinical Psychologist) and Liz Castle (the volunteer support coordinator). Each of the sessions covered a specific topic to develop their understanding of the role of the peer-supporter and their confidence to deliver the intervention. These included 1) confidence and self-esteem, 2) empathy and skills, 3) feelings, behaviours, and thoughts, and 4) risk. The training was based on Dennis’s (2003) training manual, but was adapted to include other material about active listening skills, promoting successful behaviour change (Anderson et al., 2000, Rollnick et al., 1999), and encouraging goal-setting and decision-making (Egan, 1998). For example, goal setting involved actually helping the participants to

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set a time aside for themselves: “when your husband comes home from work, ask him to have the baby and go for a ten-minute bath”; or “have a coffee on the way home from work on Wednesday afternoon”. The training was provided in the local

children’s centre, and crèche facilities were made available. The peer-supporters were asked to complete an evaluation form with reference to the training they received, how appropriate they perceived this training to be, and how well they felt the sessions prepared them for their role as a peer-supporter. No analysis was carried out with these evaluation forms.

5.3.4.

Manuals

The peer-supporters were provided with training manuals after the training sessions. These were developed to provide the peer-supporters with the information they required to effectively deliver telephone-based support to a new mother. This programme is one of the first mother-to-mother telephone-support programmes to address postnatal depression, and part of the peer-supporter’s role in this programme was therefore to help the research team to evaluate the effectiveness of this

intervention for future research.

5.3.4.1. Operational Manual

The operational manual contained information about the structure of the study, who was involved, their roles and contact details.

5.3.4.2. Skills Manual

The skills manual provided peer-supporters with details about professional and community services available to refer the mother to, if required.

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The peer-supporters were also provided with contact numbers for the research team and were encouraged to ask questions if there was anything that they did not

understand, or if they had any concerns / questions when they were supporting a new mother. The research team emphasised that the peer-supporters were not alone and would be fully supported in their role.

5.3.5.

Delivering the Intervention

It was at this stage in the process that the ethics committee was informed that a new lead researcher had been appointed to conduct the research study. The new

researcher concentrated on building positive relationships with health visitors, staff at the children centres and peer-supporters who had been recruited to deliver the intervention. Amendments were made to the existing processes based on the

knowledge and experience of the new researcher to enable the study to be conducted effectively.

The peer-supporters were required to make initial contact with the participant whom they were supporting within a specified time-scale (within twenty-four hours after they had been provided with the participant's contact details). If they were not able to reach the participant they were contacting, they were advised to leave three

messages, after which they were asked to contact the research team to seek advice.

If they had successfully made contact with the participant whom they were

supporting, they were required to introduce themselves, discuss confidentiality, and make the participant aware that this would be breached if there was any indication of self-harm or causing harm to their child. Afterwards, they were required to negotiate an appropriate time to make the supportive calls on a weekly basis.

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The peer-supporters were informed that their clinical supervisor would contact them within seventy-two hours of being matched with a participant. The peer-supporters were also informed that they could contact their clinical supervisor at any time if they urgently needed to address any issues that had occurred when providing the intervention. They were also asked to refer to the skills and operational manuals that they were provided with as guidance. The manuals consisted of general information that had been presented to the peer-supporters during their training. Any specific issues that arose during the actual calls were discussed in clinical supervision. Finally, all the peer-supporters were advised that they could contact the research team at any time throughout the intervention should the need arise.

The peer-supporters were asked to provide the calls to the participants they were supporting over a period of four-months - a total of eight telephone calls. However, each dyad was unique, so the timing and frequency of the call were negotiated to meet the needs of the person they were supporting. The peer-supporters were also required to complete an activity log of each call. This was to ensure that the weekly calls were being made and to explore what type of issues were discussed.

5.3.6.

Financial support

The peer-supporters were not offered a financial incentive to take part in the study. However, various financial payments were provided for taking part in the study, including:

• The peer-supporters who attended the training were compensated for their

time by being offered £100

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• The research team offered to reimburse peer-supporters for the telephone-

support calls they made to the study participant who they were supporting at the end of the four-month intervention.

5.3.7.

Supervision

The peer-supporters were provided with clinical supervision from Dr Kirstie McKenzie-McHarg and in her absence (due to three months annual leave)

supervision was continued with the Volunteer Coordinator, Liz Castle. This enabled them to offload any information that they found distressing, to manage issues with the study participant whom they were supporting, and to seek advice if they felt unsure about issues that emerged during the four-month intervention.

The first supervision timing was pre-arranged and the peer-supporter had been informed that they would receive their first supervision call seventy-two hours after they had been matched with the study participant. The seventy-two hours allowed for the time required for the peer-supporter to make the initial contact with the study participant, and also to reflect on their call and the issues that had arisen. The

following supervision calls were negotiated and the peer-supporters were encouraged to call the research team as and when the need arose.

5.3.8.

Informal Support

In addition to clinical supervision, the peer-supporters were invited to attend coffee mornings in their area. Four coffee mornings were held in total, two throughout each year, as well as an annual peer-supporter picnic event in the local park. These

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issues that were of concern, receive updates from the research team, and to feel like a valued member of the study.

An online blog was also created on the Warwick University Website. This was aimed at improving communication between the research team and the peer- supporters. No confidential information was disclosed on the blog, which proved useful for arranging meeting times as well as raising concerns about being

volunteers. Access to the blog was only available to peer-supporters and the research team, and was password protected.