Bluebell's mission is to provide holistic and inclusive community based perinatal mental health support for families experiencing anxiety and depression during pregnancy and up to 2 years after birth. Services are delivered now more widely across the South West of England and are all co-produced & delivered by many parents with lived experience. Founded in 2010, next year will be the 10th year of delivering support for by then over 6,000 families. Bluebell's aim is to ensure that all parents can access high quality, inclusive support wherever they live and whenever they need it and that services are developed to meet their needs.
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
Bluebell’s mission is to provide holistic and inclusive community based perinatal mental health support for families experiencing anxiety and depression during pregnancy and up to 2 years after birth. Services are delivered now more widely across the South West of England and are all co-produced & delivered by many parents with lived experience. Founded in 2010, next year will be the 10th year of delivering support for by then over 6,000 families. Bluebell’s aim is to ensure that all parents can access high quality, inclusive support wherever they live and whenever they need it and that services are developed to meet their needs. We now have a team of 24 which includes a mixture of peer support workers (Buddies) and professionals who lead our groups, however all have lived experience of perinatal mental health difficulties. We work closely with a wide range of local professionals, including GP’s, HV’s and midwives as well as with our local secondary mental health teams and specialist PMH community teams in Bristol, S Glos, Bath & NE Somerset and South Devon and we have excellent collaborative partnerships with them and with colleagues in early years settings, such as children’s centres. Our aim is to ensure that families can access a seamless pathway to meet their needs from the mild, to moderate to severe, end of the perinatal pathway and work with our local NHS partners and other agencies, closely to achieve this.
We are at a stage in our development where we are growing and have recently started to deliver services in Bath & NE Somerset with funding from the B&NES CCG, as well as independent funding to launch our service for fathers, Dads in Mind, more widely. We monitor our services continually, through capturing parents experiences, recovery and satisfaction with qualitative and quantitative data, including start and end EPDS & GAD&7 screening for all parents who access our 12-week therapeutic group programmes, as well as weekly wellbeing questionnaires, focus groups, interviews and creative methods, such as table cloth reflection drawings created by parents to express their recovery journeys, journals and creative writing. We deliver a wide range of services, which we feel are innovative and cover a wide range of needs, see more below…..
What makes your service stand out from others?
Our services provide a Tool-Kit of strategies and approaches for parents to enable them to feel more equipped to manage their mental health and wellbeing during pregnancy and up to two years after birth. We feel these make us stand out, as they provide a balance between peer and professional support. For example, 9 years ago Bluebell’s Occupational Therapist, Rachel, developed a unique 12-week therapeutic group programme for mothers experiencing perinatal mental health difficulties, which has grown to be a well respected and highly effective tool for recovery. The programme provides a mixture of information, strategies and activities to gently bring meaningful activity into mothers lives and is led by OT’s however is also co-facilitated by Bluebell Buddies, who are all peer support workers with lived experience and are trained and paid, by Bluebell to co-facilitate the groups, as well as provide 1-2-1 support, at home, for mothers. We have seen this model work extremely effectively as the Buddies are able to visits mothers at home before a group programme begins, to develop a trusting relationship with them, to then feed them into the group programme and to remain with them every week during the 12-week programmes and then to continue supporting them again 1-2-1 following completion of the group programme. We have seen how this model of support, combining the 1-2-1 peer support with the professional input of the OT’s leading groups, plus the structured but also highly creative nature of the group programme, provide a really robust, holistic and supported pathway for a mother’s recovery journey.
We feel this is fairly unique and over the past 8 years we have seen excellent recovery rates for mothers who have completed the pathway as outlined above, and we have also now seen this 12-week group programme become commissioned through 2 CCG’s and it will soon also become an integral part of the BNSSG IAPT service delivery for perinatal mental health more widely across S Glos and North Somerset. It is extremely well supported by GP’s, HV’s and other mental health professionals who refer 80% of the mothers who attend the programmes, which now run 21 times per annum in Bristol, S Glos and S Devon. It is also extremely well attend by mothers, with 10 women accepted onto each 12-week programme, and on average only 1 mother will not complete each programme, which is a very high retention rate, and which we believe, is due to the input from the Buddies each week, between group sessions by texting mums, calling them or arranging to see them at home to ensure they are held during their time in the programme. The other key element of the group programme, is that a creche for the infants up to age of 2 years, is provided free of charge alongside each weekly session, which enables mums who cannot afford to pay for childcare, the opportunity to access the programme in full. The creche teams are also highly trained and provide a sensory and therapeutic environment for each infant and can support mums with concerns they may also have around sleep, feeding, play or other anxieties related to their infants.
How do you ensure an effective, safe, compassionate and sustainable workforce?
99.9% of the Bluebell team are parents with lived experience of perinatal mental health difficulties including the health professionals who also work for us. We are highly invested in providing ongoing support, supervision and training for all the team and many of the team are parents who were previously supported themselves by Bluebell, who are now recovered and have been trained and supported to come on board as paid team members. We have always ensured that all our Bluebell Buddies, who provide 1-2-1 peer support at home for other mothers, have been paid and have received a varied and in-depth level of training which is ongoing, as our ethos is to ensure all peer support workers are fully supported themselves in their roles and they have opportunities to develop their careers again, after a period of time out due to becoming mothers and experiencing perinatal mental illness. Regular monthly supervision is provided for all the team, including both group discussion groups and 1-2-1, which is delivered by two of the Bluebell Trustee’s who are mental health professionals. The group discussion reflective groups, give the teams time to share learning with each other, support each other and develop new ways of working or reinforce the work they are already doing and the 1-2-1 reflective space, offers a personal space for them to develop their own practise, and focus on their own wellbeing. In addition, we have been able to provide some excellent training for our team including; the IHV perinatal champions training, working with emotional dis-regulation, reflective functioning for infants, risk and suicide awareness, mental health of fathers, diversity and equality and as as team, we often take days out for team building with everyone coming together at Bluebell Place, our Bristol hub, for a day of team building with lunch and head & shoulder massages for all the team.
Who is in your team?
Occupational Therapists x 3, Midwife x 1, counsellors x 2, Buddies (peer support workers) x 10, Dads peer support workers x 3, creche team x 3, CEO, Project Manager – plus 10 volunteers who help at Bluebell Place, our drop-in hub.
How do you work with the wider system?
Bluebell works in partnership with a wide range of professionals and other agencies, including GP’s, HV’s Midwives, local PMH professionals and mental health service providers and in partnership with many children’s centres, where we also run our group programmes. We are part of the PMH strategy group for BNSSG and also for the B&NES CCG and we work closely with NHS colleagues in primary care and maternity services, as we often refer parents in and out of each others services and we have frequent liaising with each other in order to provide parents with joined up care. Bluebell played an integral part in writing the bid to secure our Community perinatal mental health team for BNSSG and we often involve parents with lived experience, in providing feedback and input into NHS practises and to help NHS colleagues identify gaps in services and how services can be designed to meet parents’ needs. Bluebell is a partner in the new NHS Talking Therapies service that will be developing over the next 10 years in BNSSG and as part of this, will be delivering its’ group programme more widely. We also work very closely with multiple agencies who provide support for housing, drugs & alcohol, employment and benefits, legal, abuse and trauma and many more. Our CEO, Ruth Jackson, is also a co-director of Bristol’s Perinatal Mental Health HIT (Health Integration Team) with Dr Jonathan Evans from Bristol University, which is a multi-disciplinary team drawn from academia, the VCS, NHS and other agencies across the city. We have shared protocols with our PMH team and local mother and baby centre, for step down and step up and we also work closely with the local safeguarding teams and can call for advice and guidance whenever we need this.
Do you use co-production approaches?
Bluebell is built on a co-production model and from the start, we have been working with parents with lived experience to design, develop and deliver our services. Our CEO and the majority of the team are all parents with lived experience and we also work closely with other professionals, to ensure that services are co-produced by multi faceted teams, to ensure they are safe, quality assured and designed to meet the needs of families. We feel this works very well as our services are known for being user-led, for removing barriers to access, for being inclusive and they are also know for being high quality, responsive and safe. When we have needed to reach groups that are typically more marginalised, then we have seen the huge benefits of involving these groups in the design of these services.
A great example of this is our Dads in Mind service, as typically men are not able to access the same level of support or service, as women, in the perinatal period and can be harder to engage with or rather, services have not been deigned with Dads in Mind! In order to overcome this, we worked with many Dads with lived experience and delivered focus groups where they came to share their experiences and help us understand what they needed and where the gaps were. This service has always been run by Dads with lived experience and delivered by them, which has opened the door for many more men to now come forward for support, the groups have grown in size and the Dads Buddies are now supporting much larger numbers of Dads face to face. The marketing was designed by a Dad and we moved this away from the Bluebell brand to become a brand in it’s own right with different messaging and branding, which has been very successful in reaching men.
Do you share your work with others? If so, please tell us how.
We share our work and our learning on a regular basis at conferences, in workshops and in training for professionals and other agencies. We often speak, or ask parents with lived experience who we have supported, at training events locally within the NHS, e.g. for over 300 midwives in the NBT Trust and for many health visitors and other agency workers. In addition, we have been involved in lots of education and awareness raising projects, such as two excellent educational films – perinatal positivity – an animated film made by Formed Films in Bristol which involved many of the parents we support and members of our team, and which is now being used across the UK as a way of raising awareness for all expectant parents. Louis, our Dads workers, also made a film with BBC Tomorrow’s World, called Feeling Bad as a New Dad, which has been shared many times across the UK and in which he shares his story of paternal OCD alongside the type of work we do and how Dads can be supported. We also provide lots of local information resources for parents to enable them to access our services and information for HCP’s they can give to parents at appointments. We are part of several network learning groups, as outlined above the PMH HIT team and the SW Strategic Clinical Network for PMH, where we regularly attend learning workshops and where we can share our practise and learn from others.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
Bluebell uses a range of tools to measure impact and outcomes, including evidence based mental health screening tools, the EPDS (Edinburgh Postnatal Depression Scale) and the GAD7 at the start and end of each 12-week group programme, with each mother. In addition, we use our own weekly wellbeing check in forms to asses mood week by week and at the end of the whole 12-week programme, also our own programme satisfaction questionnaire. Alongside these, we use the GAD7 at start and end of all 1-2-1 peer support contacts with mothers and fathers and our own ‘Buddy’ feedback evaluations to asses satisfaction with the service as well as wellbeing levels. To capture the qualitative data, we use knowledge cafes at the end of each 12-week programme whereby mothers write, doodle or draw on table cloths their own selections to convey their journey from start to the end of the 12-week programme and we have hundreds of these, many very powerful. Many of these are framed and displayed at our perinatal wellbeing hub, Bluebell Place, as well as sent to funders and used in our evaluation reports for the CCG’s. We capture numbers using our services with registers, including numbers of infants with creche registers and we collect qualitative data relating to the infants in our care, through a diary for each infant over the 12-week programme, which includes pictures, feedback and observations of each infants time in the creches.
Overall, we will capture a data set for 90% of the parents and infants we support and we use the data to learn where our services may need to be improved, to share at workshops and in training the areas where they are woking well and which areas have been particularly important for parents, e.g. creche provision, colourful and clean spaces, refreshments, timing of sessions and the way the team interacted with them. We also use the screening tools to measure recovery journeys, with 80% of mothers who complete the 12-week programme, demonstrating a 90% positive recovery journey. All data is stored on a secure database, which keeps a record of parents ages, dob, postcodes, start and end of interventions and scores and also of any other actions taken and other HCP’s or agencies involved. This is anonymised with client number and initials only.
Has your service been evaluated (by peer or academic review)?
Our service has been peer evaluated by two PHD students, who produced three year service evaluations of all the services provided in these time sales. In addition, at the end of every 12-week programme (21 a year) Bluebell’s Project Manager produces a short evaluation report for each children’s centre where the groups take place, to add to their OFSTED data and early years feedback to their local council, which includes screening scores for each mum, recovery journeys, numbers of home visits received and table cloth drawings, quotes and feedback from parents. We also collect date for the CCG’s who fund some of our services on their own reporting templates, which includes, how many parents we refer on to other services and recovery rate for the parents we support.
How will you ensure that your service continues to deliver good mental health care?
Over the past two years, we have been working hard to ensure that Bluebell’s services are sustainable and that robust strategies and plans are in place for the future. This has involved several things: 1. A 3-year scale up strategy we have developed with Spring Impact, Scale up Incubator for the 3rd sector, where we pitched to investors and prepared decks to show the funding needed to further develop our group programme and Buddy support into new areas, as well as the core costs needs to sustain the organisation. This has been very helpful in helping us to plan our vision for the next three years and think about how to get there. 2. We have a robust ongoing programme of fundraising, which includes, a programme of bids continually being researched and written, a new programme of regular giving and events and several key main funders who we have developed long-term and ongoing relationships with. This has enabled us to secure funds for the next two financial years, with the year three already in progress and on target for growth. 3. We have been working much more closely with commissioners and we now have two areas of our work commissioned by BNSSG and B&NES CCG’s. However, we are very mindful that we don”t ever want to be more than 40% commissioned as it is very important to us to remain an independent, creative and agile charity that complements the work of the NHS but does not duplicate it. 4. To ensure our service continues if management changes, we have been investing in succession planning and with this in mind, have several members of the team who have been undertaking further training and who are being mentored and developed in their roles to enable them to take on more responsibility. This is a core part of the Bluebell plan for the next 3-5 years, as our ethos has always been to bring mothers and fathers with lived experience into the organisation in paid roles and to support them to grow, learn and develop, with a view to empowering them to take on larger roles, either at Bluebell or in other areas.
What aspects of your service would you share with people who want to learn from you?
As a charity which started very small, we have learnt a lot over the past ten years and often the hard way but also through feedback from the parents and families we support. This has been an amazing journey of learning for us, and we often share this with smaller, start-up VCS groups and individuals who often come to use for advice on how to start a PMH charity, how to raise the funds, how to keep parents safe and how to develop practises and teams. Some of the main challenges and solutions we often share are: 1. The importance of providing support, training and supervision for peer support workers, to keep them safe, protected and also to enable them to feel fully equipped for their roles in supporting others. 2. The importance of becoming embedded in your local health and social care community and landscape, in that forming strong relationships with local HCP’s and other agencies, will be the key to success in providing joined up holistic services for the families you support.
There has to be genuine mutual respect and collaboration between the VCS, the NHS and other agencies, that is aways in the best interests of parents and that this benefits everyone. 3. The need to provide your service is effective, professional, safe and well governed and that it meets the needs of families, is vital, particularly to be take seriously by commissioners, decision makers and also HCP’s. This is why monitoring of services, producing evaluation reports and sharing learning and outcomes is so important, as when positive impact and outcomes can be seen, then further funding can be released, commissioners will start to take notice and ask for your services and your beneficiaries themselves, will be reassured that you can offer them a safe and effective service. 4. Would also share that when running a small charity for many years, you may have to be a jack of all trades, from accounts, to running services, to managing team, recruitment, pay roll to raising the funds, to emptying the nappy bins at Bluebell Place – all in a days work. This can be challenging as you grow and need more time to focus on bigger picture, however is the best way to stay grounded and completely embedded in the community you are there to serve.
The following questions are an opportunity for you to provide further details on how you implement positive practice in your service delivery and how you ensure your service is advancing access and equalities. Answers to these questions will not influence how your PPiMH awards application is assessed, however any responses received may contribute to the potential inclusion of your service/team as a positive practice example within published guidance developed by NCCMH and NHS England.
How many people do you see?
We receive on average 250 visits from Parent to our wellbeing hub, Bluebell Place, each month, so over 2,000 per annum. In addition, we support on average another 200 mothers and 200 infants per annum in our 12-week therapeutic group programmes in children’s centres. We support on average 80 Dads per annum through our Dads in Mind groups. We also support on average 500 mothers per annum through our 1-2-1 Buddy support in the home. We have 2,000 people who have liked the Bluebell face book page. Nearly 4,000 followers on twitter and 750 followers on Instagram.
How do people access the service?
Parents can self-refer to our services in the community using referral forms which are downloadable from our website. HCP’s and agencies, can also refer parents into our services using the same referral form. When a referral form is received into our office at Bluebell Place, then a parent and the referrer will receive a call within one week to talk over next steps. This is done by Jess, who will make sure to spend enough time on the phone with each parent referred, or with the referrer, to capture their needs and to make sure the services we offer are right for them. We also sign post on to many other services, when we feel a parent may need more targeted support and we always ensure we make sure they can access the right support for their needs. The details are logged anonymously on our database, which is updated with next steps. etc. At our drop-in hub, Bluebell Place, parents can just drop-in without an appointment for an initial chat, which has made access very easy for parents who may find it hard to ask for help or access services. The Buddy support we offer, is also another way in which parents who may normally find it hard to access support, can be reached and which they find much easier than attending groups, until they are ready. We promote our services in a variety of ways, with postcards all over the areas we work in, which we make sure all the relevant HCP’s also have, and through our facebook page, website and other social media as well as by making the referral process easy to access from our forms that are downloadable on our website.
How long do people wait to start receiving care?
The average waiting time for an initial call to a parent after receiving a referral is one week, after which, depending on which service they need, the wait would be no longer than 3 weeks. With the Buddy service, a parent would be able to access this as soon as the Buddy who covers their area has capacity, which is on average in the region of 2 weeks maximum wait. The 12-week group programmes are closed and run termly, so when these are full with 10 mums maximum, then a mother would need to wait until the next term group starts, however in the meantime we offer mums who are waiting support from a Buddy and if they live in Bristol, they can come along to drop-ins at Bluebell Place straightaway and for as many sessions as they want to, every week from pregnancy up until their child is two years old.
How do you ensure you provide timely access?
We have clear referral guidelines and criteria on our website, which all HCP’s and parents can read, to ensure they are clear of who can access our service and where. We prioritise on a first come, first served basis but also on need, so for example, if a mother is completely isolated, and has no other support and is in urgent need, then we will prioritise her referral. Each mother, has an initial assessment, which is an informal 1-2-1 chat with a Buddy where they will compete the EPDS & GAD7, to assess their baseline scores and also to assess if our services are the best fit for their needs, or if we need to refer on or if there are risks we need to be aware of, after which a view will be taken on their needs. We always capture the HCP details for each parent and we gain permission to share if we need to, and often we may need a conversation with other who are also involved in a mother or fathers care. We have recently increased our staff levels to offer additional capacity for our Buddy service, which is our most over subscribed service to ensure we can keep our waiting times down. We are able to access immediate access to informal support for all parents in Bristol, as they can come along to Bluebell Place, whenever they need to.
What is your service doing to identify mental health inequalities that exist in your local area?
We are involved in many working groups which are looking at capturing the gaps that still exist for PMH services in our regions. We often contribute the views of parents to these, and also ways in which under represented groups, feel they have not been able to access the support they need. For example, at the moment we are part of a group looking at what services are needed for perinatal mental health for mothers who don’t have a baby with them either because they have lost a baby during pregnancy or at birth, or they have had their baby removed for protection reasons. They currently have inequitable access to mental health support after these traumatic events, and so we are working with parents and with experts in the field, to scope the need and to plan ways services can be developed for these very vulnerable parents.
What inequalities have you identified regarding access to, and receipt and experience of, mental health care?
See above for an example of parents who have lost a baby and we also see some very real gaps in perinatal mental health support for parents with learning difficulties, as there is no targeted support for them.
What is your service doing to address and advance equality?
We are actively working with research teams at Bristol Uni as patient feedback groups for trials exploring interventions for these groups of families and we are very active in involving parents from these marginalised groups in this research and also in helping us to ensure our services are meet their needs. We are a founding member of the Perinatal Mental Health Partnership , which is a coalition group set up to run and deliver the annual Maternal Mental Health Awareness Week, which this year was bigger than ever. We are always addressing stigma and normalising asking for help for perinatal mental health and have won awards for Bluebell Place, our Perinatal wellbeing hub which is right in the middle of the shopping district of Bristol and is the first of its kind in the UK, where parents can drop-in to have a chat, ask for help in a warm, safe and non-clinical space – where they also get great coffee and home made cake and can take part in knitting, crochet, pampering, writing, art – with a creche alongside so they can take a some time out.
How do you identify the needs of a person using the service ?
EPDS & GAD 7 are main screening tools Initial assessments to capture further info plus client detail forms to capture key health and safeguarding info for each parents. Wellbeing questionnaires Weekly session feedback forms Knowledge cafes to explore a parents needs creatively
How do you meet the needs of people using the service and how could you improve on this?
We continually consult with parents with lived experience and we have designed our services to meet their needs, based on their feedback. Even though we are not an NHS service, we do aim to meet NICE guidelines, however we can be more creative as a VVS provider and we do try to innovate and try new ways of working too.
What support do you offer families and carers? (where family/carers are not the service users)
When we are supporting a mother, we offer support for all their families, friends and supporters if they need it, which may just be a conversation with one of our team to help them understand how their loved one is feeling or how they can help and support them. We support the partners and Dads, not just the mother and we also support infants, even though they may not be the primary beneficiary.
Is there anything else you want to share about what makes you an example of positive practice?
Only that we love being part of the bigger picture of mental health support across the UK, of working with other charities and with our NHS colleagues and that we are passionate about continuing to find new ways to reach families and to continue to raise the funds we need to sustain and grow our services so that even more families can access the support they need!
Brief description of population (e.g. urban, age, socioeconomic status): Bluebell works with mums, dads and infants during pregnancy and from a wide demographic from very young parents aged 17 and up to in their 40’s, with dads as well as mums and with families from a diverse range of cultures and ethnicities. Also with many families from areas with high levels of deprivation and poverty, in both urban and rural areas.
Size of population and localities covered: Bluebell supports over 2,000 parents & infants per annum in Bristol, South Gloucestershire, Bath and North East Somerset and South Devon.
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): Partly commissioned by Bristol, North Somerset & South Glos CCG & Bath & NE Somerset CCG. Also part of talking therapies commissioned IAPT partnership for Bristol, N Somerset & S Glos.
Provided by (e.g. name of NHS trust) or your organisation: Also independently provided by Bluebell with funding from many funders, including Comic Relief, Big Lottery, Children in Need and many others.