Acacia exists to improve the lives of mothers and families affected by antenatal and postnatal depression (PND) and anxiety. Acacia was established in Birmingham in 2004 by two local mothers who had experienced postnatal depression and found that specialist support was lacking. Acacia was therefore founded on the principle that no woman should suffer postnatal depression alone: that they should all have a safe place to share their concerns and access support without feeling judged. This principle holds today. Acacia is a user led organisation. We were established – and are run – by people affected by PND.
Acacia exists to improve the lives of mothers and families affected by antenatal and postnatal depression (PND) and anxiety. Acacia was established in Birmingham in 2004 by two local mothers who had experienced postnatal depression and found that specialist support was lacking. Acacia was therefore founded on the principle that no woman should suffer postnatal depression alone: that they should all have a safe place to share their concerns and access support without feeling judged. This principle holds today. Acacia is a user led organisation.
We were established – and are run – by people affected by PND. The majority of our services are delivered by a team of over 50 volunteers. 60% of these volunteers and 70% of our staff team have themselves experienced postnatal depression or have lived experience of a mental health issue. Over the past 12 years, we have retained a focus on providing services that are user led: designed, delivered and evaluated by the families we support. These are based on a befriending model which we call ‘The Acacia Way’. Today, we run our services from four centres across Birmingham. Each centre provides a free crèche and offers the following:
• Individual befriending / peer support sessions – one to one support with a trained volunteer
• Group Support – 8 week courses teaching techniques to help mothers look at practical ways of improving their state of mind on a daily basis and delivered by trained facilitators.
• Helping Hands at Home – a project that delivers practical and emotional support to families in their home environment across the city.
• Telephone support
• Acacia Dads – peer support for father
• Couples workshops.
In addition we have recently introduced a fully mobile Young Parents Project for under 25’s and a BAME community engagement project.
During the year we worked with 529 mothers. The length of support offered is not time bound and varies from one off contact to on-going, regular support over a number of months. With women accessing a variety of services that is specific to their needs, we find that the average length of support is between 6 and 12 weeks. Acacia’s services are distinctive. a service that goes ‘above and beyond’ the provision available from statutory services.
We achieve tangible outcomes as demonstrated by our ongoing evaluations which indicate, that of the respondents:
• 91% feel more able to cope with their feelings
• 73% felt they had an improved relationship with the partner
• 84% felt more able to cope practically
• 82% felt less anxious and depressed
• 88% of men who received peer support reported feeling less anxious and better able to cope, 98% rate our services as excellent or good.
We also know that women attending our sessions make supportive and in many cases, long lasting friendships with each other and that they will meet together away from our centres. As the only organisation in Birmingham that offers this service to those affected by postnatal depression we are providing access to early interventions that otherwise would just simply not exist for these mums. Our aim is clear: to provide services that improve the mental health of mothers during pregnancy and after birth. One mother recently reported: “Since I have been supported by Acacia my depression and anxiety has generally been much better and thanks to them I now have a really strong bond with my little boy and find great joy in being a mum”
Wider Active Support
We are passionate about working in partnership/collaboration with other agencies and service providers. Below are two examples.
Example 1
Working in partnership with NHS Birmingham’s Healthy Minds (BHM) via the Birmingham and Solihull Mental Health Foundation Trust (BSMHFT)
Acacia has worked in partnership with the Birmingham and Solihull Mental Health Foundation Trust since 2010. Originally, Acacia were chosen as the sole provider for delivery of Birmingham’s Improving Access to Psychological Therapies (IAPT) Postnatal Depression Support. Although this direct commissioning process has ceased, as a member of Birmingham’s mental health consortium, we continue to have a working partnership with Birmingham’s Mental Health Trust (via BHM). This provides fast track (step up, step down) pathways between our services. Acacia refers clients for clinical assessment and support, and BHM therapists continue to see our clients at Acacia’s centres. BHM also refers clients into our befriending service and group workshops. Acacia also helps BHM to deliver a Mindfulness and Strengthening Relationship workshops for our clients once every term.
During the year Acacia has received a small amount of funding from the Trust in order to carry out this work.
Example 2
Acacia Young Parents Project in partnership with Forward Thinking Birmingham (FTB)
FTB is a partnership of organisations led by Birmingham Children’s Hospital that deliver mental health services for the 0-25 age group across Birmingham. In 2016 Acacia came together with FTB to deliver the Young Parents Project. This new 3 year project to deliver a city wide initiative for young parents provides direct support to young parents of school age – 24 affected by antenatal and postnatal depression and also provides awareness raising sessions to local mental health professionals. As with our BHM partnership this relationship provides a strong pathway into IAPT services and acute services should the client condition worsen.
Another great aspect of these partnerships is that our partners provide us with strong clinical supervision and for our staff and make significant contribution to our clinical governance.
Our partnerships with both BHM and FTB mean that women and families experiencing perinatal mental health problems are able to access a support service that provides help at a low level with access to a strong pathway into health services should her condition worsen. This enables FTB, BHM and Acacia to ensure that mums don’t ‘fall down the cracks’ but receive a seemless and robust service which meets NICE guidelines and IAPT positive practice for peri-natal period.
Co-Production
Since it’s conception Acacia has grown and evolved in direct response to client involvement and client and staff feedback. We are a user conceived and led organization. Client feedback is an integral part of our service delivery and clients are given every opportunity to give us direct feedback. This is built in to our mid-point and end point evaluations. We also provide ‘Recovery Meals’ twice a year where recovered mums are given the opportunity to get together to celebrate. A key component of these evenings is to provide us with further feedback. Our volunteers are also encouraged to provide us with feedback.
This is often informal as part of the debriefing groups at the centres but is also part of our twice-yearly Volunteer Training 2 Day Workshops. Our paid staff are given a monthly opportunity to feed into service planning as part of their regular line manager reviews. They also attend strategic planning workshops so that they can feed directly in to Acacia’s strategic, business and service planning. The operational management team includes all of our centre and locality managers to ensure that staff on the ‘coalface’ of service delivery are directly involved in service development and quality management.
Please see a couple of examples below of how this combined feedback has led to service development and improvement.
Example 1
Acacia were successful in an application to the Big Lottery’s Reaching Communities Fund which will continue to fund us until 2020. This was originally in response to ongoing feedback regarding the unequal distribution of PND services around Birmingham. Acacia, at the time were funded to provide support services in the North and East of the City, however there was no such service provision for families in South / Central Birmingham.
In response Acacia approached statutory funders to make a case for support for developing services in South / Central Birmingham however no further funding was available. Further feedback from clients, public and staff indicated that not only was service provision patchy but also that there was no support available for dads/partners at all in Birmingham. Another theme which arose at the time was that some mothers found it very difficult to access or attend our befriending or group work sessions. Their symptoms of depression meant that even the smallest practical tasks at home seemed unmanageable and overwhelming. To address these issues Acacia developed a project plan and successfully applied to the BIG Lottery for funding. This funding has enabled us to respond to client and staff feedback by extended our service provision across Birmingham, in particular the South / Central parts of the City.
We are delighted to now offer the following additional support services:
Pre and Postnatal befriending support in South Birmingham.
Acacia Dads.
This is a free support service for fathers and other family members who feel they may need some extra help and support after the birth of a child or help in finding ways to support their partner who may be experiencing postnatal depression.
Helping hands at home
This exciting project delivers practical and emotional support to families in their home environment across Birmingham. We recognise that some mothers find it very difficult to access or attend our befriending or group work sessions. Our Helping Hands at Home project offers practical support such as cleaning, ironing and de-cluttering services in mother’s homes. We also offer menu planning help, a mobile hairdresser and support packages of nappies, fruit and healthy meals.
Example 2
Acacia currently run an Acacia service from Adderley Children’s Centre in Saltly. The children’s centre sits in a predominantly Pakistani local community. Last year we received feedback from children’s centre staff that our service did not appear to be attracting local BME mums. We did some preliminary data analysis and discovered that whilst the proportion of BME mums accessing the centre was acceptable, none of those mums lived locally. We met together with childrens centre staff and sought feedback from local mums who access other services in the centre. The outcome led us to develop a project plan and partner with Adderley Children’s Centre to run a community engagement pilot program. The pilot is still running but has seen spectacular results in a short space of time. The pilot project delivers: weekly drop-in sessions (with a free crèche), 2 large scale community engagement events, and the development of culturally specific information and literature about perinatal mental health issues. We are running a focus group for the women who have accessed our services to learn more about the strengths and weaknesses of our approach. The focus groups are supported by local volunteer interpreters. We are hoping to use this project as a model to extend the service in the region.
Looking Back/Challenges Faced
It is always difficult to develop and introduce a new service, particularly when that service is being set up by ‘lay’ persons. It is a challenge to generate enough funding to carry you through long enough as you begin to grow in reputation and standing. It is inevitable with this kind of beginning that there is going to be a steep learning curve, particularly regarding quality and risk. As a charity Acacia has grown fairly rapidly, and like most other charities of this size we are short on resources. We overcome this by multi-tasking and by building mutually beneficial relationships to enable us to receive ‘in kind’ support. This makes the pounds and pennies go much further and enables us to be highly cost effective.
Another key component of our cost effectiveness is our reliance on volunteers to deliver much of the program. They are our greatest asset and we have learnt the value of investing in them as people. Retention is an ongoing challenge and our focus during the last 2 years has been to improve our volunteer recruitment and support systems eg. new online training package, streamlined internal processes and the appointment of a volunteer co-ordinator.
Our tenacity helps us to overcome the daily challenges and obstacles that come our way. All of our staff and volunteers are passionate about what we do. It drives us to go the extra mile and keep going, to press through challenges and obstacles because we believe in what we are doing.
Sustainability
Acacia is a mission driven charity. So often in many organizations our values and mission are paid lip service to but not much more. At Acacia they are central to all that we do as a staff team and as a service. Our mission is not dependent on a single person or persons but it is a core aspect of who we are. Most of our staff have experienced PND or other mental health illness and are highly motivated to support other mums and dads experiencing the same debilitating illness.
In early 2016 we underwent a full organizational re-structure to develop more of an operational team approach. This ensures a more even spread of responsibilities and provides a strong succession planning approach. The organization is no longer managed with a ‘top down’ structure but at its core is an operational management team consisting of 7 members who manage our services collaboratively. Within this team are two directors who share leadership responsibility. Our new structure incorporates a strengths based approach. It recognizes and nurtures specific skills and leadership potential within the team.
We have developed our own internal ‘Operational and People Performance Management System’ (OPPMS) which supports this method across our organization. This too is built on a strengths based approach and provides a framework for highlighting aspirations, skills and leadership abilities, ensuring that we continue to provide support and investment in the development of our team. Together these aspects of our approach ensure that our service success is not reliant on individuals but on a collaborative team.
Evaluation (Peer or Academic)
In July 2012, Acacia commissioned an independent economic analysis (Social Return on Investment) of Acacia’s befriending service. The report concentrates exclusively on Acacia’s ‘befriending’ service, providing a Social Return on Investment (SROI) analysis to show the value of Acacia’s work in economic terms. Acacia has grown since this evaluation was completed but our core befriending model is still central to all of our new service delivery. Conclusions can therefore still be drawn about whether the befriending service represents good value for money.
Please see extract below or follow link for full report
Extract
Three main outcomes were established for services users and included in the analysis: increased awareness of PND and PND support; improvements in mental health; and, increased ability to cope. Volunteers also experienced positive outcomes including improved satisfaction, increased understanding of PND and improved knowledge of techniques to support those affected by PND. There were also outcomes for health professionals and services. These included: increased awareness of / referrals to Acacia and reduced use of restorative health services.
Based on the evidence in existing literature, a number of long term impacts were also included in the analysis, including: reduced future mental health problems and better functioning families; improved outcomes for children; increased supply of labour to address PND; and, more appropriate service responses providing better value for money to the NHS.
Results of the Analysis
In addition to cash funding provided by the NHS and two local authority ward advisory boards, Acacia provides a significant level of inputs ‘in-kind’. These contributions included the provision of venues free of charge or at subsidised rates. The value of this support was estimated at over £71,000. Acacia’s befriending service is also delivered by volunteers, who undertake a range of different tasks. The value of volunteers delivering the service was estimated at over £33,000.
The figure to the right shows that in-kind support accounted for a significant proportion of the inputs to the service. For every £1 invested by NHS BEN in the service, Acacia is able to leverage around £1.30 of additional resources.
Taking a broad ‘societal’ perspective, for every £1 invested, the estimated SROI generated by Acacia’s befriending service is:
▪ £3 over the short term;
▪ £4 over the medium term; and,
▪ £6.50 over the long term.
The results presented above show that the befriending service provides very good value for money. The most accurate reflection of the return is provided by the longer term estimate (a return of £6.50 for every £1 invested), since it takes all benefits into account – including longer term impacts for children.
Finally, the model used to produce these estimates is stable (the results are not altered substantially by varying key assumptions) and conservative (the evidence connecting the service to the outcomes analysed is strong). Acacia and its commissioners can be confident that the befriending service is generating the value described in this report.
Outcomes
The monitoring and evaluation of our services is guided by Acacia’s monitoring and evaluation framework. Our services are established and run and evaluated using a variety of evidence. Over the years we have developed our capacity to self-evaluate to ensure our services are affective in achieving real outcomes and to inform service development
We evaluate the impact of our outcomes using a range of quantitative and qualitative evidence including:
1) Statistical analysis of data from psychometric wellbeing scales
At every support session, beneficiaries are asked to complete a General Anxiety and Depression (GAD7) Questionnaire and a Patient Health Questionnaire ( PHQ9). These questionnaires represent a robust and clinically credible tool to regularly monitor a beneficiaries recovery. They provide us with the opportunity to analyse ‘before’ and ‘after’ scores to assess overall improvement in their mental health as a result of using Acacia’s services.
2) Mid-point and exit evaluation forms
Project staff also use an evaluation form at the midpoint and exit point of beneficiaries’ relationship with Acacia. The form asks key questions about the user’s experience, the quality of the service they received, type of service, and a self-assessment of the key changes in their mental wellbeing that they had experienced as a result of using Acacia’s services.
3) An online survey for exited beneficiaries
We have utilized Survey Monkey to capture recovered mums feedback post service. A range of questions were asked about the overall quality of the services delivered and the impact of the service on their emotional wellbeing.
4) Individual case studies
Project staff complete case studies of beneficiaries that have used the project. This demonstrates the problem/actions/results achieved for individual beneficiaries, but it is also an excellent way to demonstrate the unexpected outcomes and added value that some beneficiaries gain from using our services.
5) Karitane Scale
We have recently introduced a new self-assessment scale for young parents to help us to accurately demonstrate improvement in parenting and attachment. The Karitane Scale measures parenting confidence and interaction. This is widely used in Australia and New Zealand. Our initial results are very encouraging showing a 100% improvement. However, we don’t have a big enough sample yet for this to be indicative of the whole client group.
Results
We know that our services work: the ‘before’ and ‘after’ GAD7 and PHQ9 scores demonstrate that
82% are less anxious or depressed as a result of accessing Acacia’s support.
Results completed exit evaluations show us that:
91% feel more able to cope with their feelings
71% of mothers felt less anxious or depressed (19% were signposted onto other more appropriate services and 10% saw no improvement)
73 % have better relationships with their partner
84% feel more able to cope practically
82% feel more able to support others affected by PND and
Our services are extremely well regarded:
98% rate the service as excellent and
98% would recommend to friends and family.
Work supporting fathers
During the year we have supported 44 fathers affected by pre and postnatal depression. 39 (89%) answered evaluation questions and stated that they felt less anxious or depressed and or had more information on how to tackle PND for themselves or their partner.
PHQ/GAD and feedback evaluation reveal that for male clients
91% felt more able to cope with their feelings
73% felt they had an improved relationship with the partner
84% felt more able to cope practically
86% felt less anxious and depressed
88% of men who received peer support reported feeling less anxious and better able to cope, and 98% rate our services as excellent or good.
We asked Mums accessing our services an open ended question about what they found the most useful part of our service and why. Below are some examples of responses grouped into key themes:
We offer a safe, non-judgmental environment:
“Befriending – being able to ‘unload’ in a safe, non-judgmental place “
The overall ‘feel’ of the service is friendly and less clinical than statutory support services:
“It felt very different from the doctors/health workers, where I felt I was being assessed all the time “ “Befriending was fantastic; counselling I had received from the doctor was very limited and textbook”
Our services help mothers to realise that they are not alone in how they feel:
“The group work was very good, realised other people felt the same”
“Group work. It was so nice to be around people who knew what I was going through “
“Individual befriending. It helped me with prenatal depression so much and the knowledge that I was not alone was such a big thing for me.”
Families greatly appreciate talking to someone who has been through a similar experience:
“Group work and support from volunteers whilst baby in the crèche. Speaking to people who understand and help” “Just to talk to someone each week that had been through the same and assured me I wasn’t alone or going mad was invaluable! “ “Befriending – to have someone there who seemed to understand and could make suggestions and give advice. “ “My befriending sessions were my lifeline during a dark time in my life helped me to find confidence and begin to feel my old self again. I cannot thank them or recommend them enough” “It was great to speak to people who really understood what I was going through “
Beneficiary case studies
Project workers complete individual case studies for project beneficiaries and we also ask recovered project beneficiaries to share their story “in their own words”. Examples of both are below:
Anonymised Case Study 1
Family
• Mom and baby live in the family home with her mother and young sister.
• Partner visits regularly.
• Baby is 2 months old.
Presenting Needs
• Telephone assessment completed with the grandmother part of the phone call also as mom was too anxious to take the call unsupported.
• Agoraphobic and has a history of depression – previously received therapy from BHM.
• Discontinued anti-depressant medication after 1 week.
• Fear of people speaking to her when she is in the community.
• Feelings of guilt to ask for help with baby from her mother.
• Anxieties having a negative effect on her relationship with the baby’s dad.
• Lack of appetite, missing meals.
Work Undertaken
Practical Support:
• CBT techniques shared at the assessment stage – small goals set.
• Confidence buildings talks.
• Faxed GP.
• Posted Cherished selfcare booklet.
• LLTTF booklets given. Registering to online with LLTTF course, provided an overview of accompanying booklets
Emotional Support:
• Provided weekly support to Mum listening/befriending enabling Mum to explore her emotions, her experience of parenthood.
• Support included mindfulness techniques, relaxation and grounding exercises
• Mums coping strategies improved and her ability to manage her anxiety improved, PHQ and GAD scores reducing.
• Supported mum in relation to social anxiety and to help overcome reluctance to go out and fear of social situations/ agoraphobia
Ongoing Work
• Ongoing weekly support to mom
• Working on building mums self-confidence and esteem.
• Continuing to look at nutrition and eating patterns
Achievements
• Mom has taken the wheelie bin out to the street without prompting.
• Mom went to the Safari park with her partner, baby and sister – took children to the toilet alone.
• Mood scores reduced 21/2/17 PHQ 21 GAD 19 – 7/4/17 PHQ 4 GAD 5.
• Allowing others to do things for baby.
• Walking around the block with her partner, baby and sister.
• Looking forward to days out with the family.
• Eating regular meals.
• Sleeping better, more energy.
Case Study 2
An Acacia case study: a mother’s journey to recovery in her own words:
“When I became pregnant with my fourth child, I was already in a difficult situation. I had a set of twins and another baby who was 2. One of my twins had hydroencephalitus and during my fourth pregnancy I started to suffer severe depression. My husband left me and I felt terrible. After I had my baby, a CPN nurse used to visit me at home.
I thought my children were suffering because of me. I had thoughts like “it’s my fault, everything is my fault. It’s my fault I’m pregnant. It’s my fault he’s left me”. I thought my kids would be better off without me. In my family, Asian people just don’t understand depression. My mum had 7 children but she didn’t understand. Just living day to day was so difficult. I forgot how to smile. My baby didn’t feel like he belonged to me. I was changing him/ clothing him but it didn’t feel like he was mine. I didn’t want to know my children.
My husband got arrested for drugs offences and was sentenced to 19 years in prison. It was a terrible time. I was living with my in-laws and they didn’t have a clue. I was scared of them. They thought everything was fine.
I heard about Acacia through a coffee morning at my local children’s centre and decided to go along to a session. On the very first day, when I walked through the door, I saw Emma from Acacia with a beautiful warm smile – I’ll never forget that. She said “we’re here to support you” and it felt so good. There were other ladies and volunteers there and I started to have one to one befriending. It really helped. Mandy from Acacia would also phone me just to check on me if I wasn’t there and that was wonderful.
Acacia also arranged for me to have some counselling and baby bonding sessions and they both really helped. They also offered a free hand and back massage service with a free crèche. Little remarks that the volunteers said made such a difference to me like “look at the way your son is looking at you…he’s smiling” It really helped my confidence. I slowly began to feel better. I gained so much confidence. They were there at a perfect time when I needed them the most. It was so reassuring to meet and know that other mums felt the same – that I wasn’t the only one. The simple things they did made a huge difference. Acacia helped give me some tips on how to cope with difficult situations. When I was better, I started to volunteer for Acacia and went through their training. I volunteered as a crèche worker and as a befriender. I attended every week. When they tell their stories, I feel like I’m helping others and making a difference.
I’ve since gone on to a childcare course and now have a job in a school working as a lunch time supervisor. Thank God Acacia were there for me. It’s a wonderful service. The simple things they do make a huge difference“
Please follow this link for examples of Acacia mums experience of PND and Acacia
At Acacia we are committed to partnership and collaboration. We are active participants in perinatal mental health in our region and participate in many advisory groups including:
West Midlands Perinatal and Infant Mental Health (PIMH) Forum
Birmingham Perinatal and Infant Mental Health Forum
Birmingham Universal Maternity Pathway PIMH Work Stream (BUMP)
Birmingham Universal Maternity Pathway PIMH Project Team (BUMP)
Birmingham Children’s Centres PIMH Champions Network’s
FAYS Locality Children’s Centre stakeholder group
Birmingham Healthy Minds PIMH Partnership Group
We regularly attend and present to these groups and many others including: GP’s, Health Visitors, Midwives, Children’s Centre’s, Social Workers etc.
Acacia has continued to work as a member of the Birmingham Third Sector Mental Health Consortium and Birmingham’s Third Sector Forum. We also continue to be an active member of the Maternal Mental Health Alliance: a national campaigning coalition of UK organisations committed to improving the mental health and wellbeing of women and their children in pregnancy and the first postnatal year.
Is there any other information you would like to add?
Acacia has grown from a tiny charity established by two local mothers in 2004, offering support in a single neighbourhood of Birmingham, to an organisation that employs 21 paid staff and nearly 60 volunteers, and now delivers services to the whole of Birmingham.
We are responsive. We have listened to the challenges and barriers our parents face. This has led our services to be ever evolving, community based, accessible, recognising the practical, cultural and psychological barriers to seeking help.
Keeping mums and dads at the centre of our service has led to services which have expanded in scope, coverage and effectiveness. Today, Acacia runs four centres across Birmingham.
Acacia uses a volunteer model of peer support to deliver its core befriending service. After recovery, many of our beneficiaries return to volunteer and support other mothers affected by similar issues. We believe our parents are best placed to tell us what works and also uniquely placed to help other mothers recover by developing relationships of mutual respect, empathy and trust engendered by common experiences.
By offering support from people with ‘lived experience’, we provide empathetic support. Our parents report being able to talk honestly to a volunteer who has built up a relationship of trust with them over time, when they have not felt able to ask for help from health or social care professionals. In this way, our volunteers can also challenge the stigma that exists around perinatal mental health issues – especially within certain minority ethnic communities and share their different experiences (as a ‘ripple effect’).
Our parents, volunteers and staff team have a unique insight into what is needed. Our outcomes verify that our model and our approach is highly effective in ‘Improving the lives of mothers and families affected by pre and postnatal depression’.
