Building Bonds Ltd. – Knowsley. (ARCHIVED)

Building Bonds is a unique, empowering, strength-based, ‘easy to engage’ Parent Infant Mental Health Service which offers Psycho-therapeutic Interventions to families across the borough of Knowsley. Parents/Carers are supported to build a more secure attachment with their babies using a strength-based model of Psycho-therapeutic Interventions.


  • From start: No
  • During process: Yes
  • In evaluation: No


  • Peer: Yes
  • Academic: No
  • PP Collaborative: Yes

Find out more



What We Did

‘Probably the most important period in everyone’s life is the one that they cannot remember’ (Balbernie, 2008)

As the quote reads above… there no other important time in anyone’s life than the first two years. We know from research and past literature, the early years of a child’s life from conception to two years are the most fundamental in laying the foundations for future parenting, bonding and attachment, brain development and future mental health and emotional wellbeing. Research has shown that those children who do not have a secure attachment to their parents in these early days are at a greater risk of developing mental health problems, social, educational and behavioural difficulties later in life. During pregnancy and the first year after birth, we know that women can be affected by a range of mental health problems including anxiety, depression and postnatal psychotic disorders. These are known as perinatal mental illnesses.

Building Bonds is a unique, empowering, strength-based, ‘easy to engage’ Parent Infant Mental Health Service which offers Psycho-therapeutic Interventions to families across the borough of Knowsley. Parents/Carers are supported to build a more secure attachment with their babies using a strength-based model of Psycho-therapeutic Interventions.

Building Bonds is for Parents & Infants who are struggling in their early attachment relationship, and parents who struggle with their mental health/emotional well-being and/or are considered ‘at risk’ & of developing an insecure attachment with their baby.
The Building Bonds Service fits within our Knowsley’s Public Health ‘Start Right’ Outcomes. In particular, offering preventative support in the areas of: ‘child poverty, emotional well-being in pregnancy-2 years and supporting vulnerable families. Building Bonds also fits within 5 of the Knowsley CCG’s broader and more long-term outcomes indicators for mental health, 2015/16. Most importantly, the Building Bonds Service ‘fits like a glove’ in supporting our vulnerable parents and Infants in the community, those offered referred as ‘difficult to engage’ and who are most need of specialist, therapeutic, community based support.

The aims of the Building Bonds PIMHS are to: support parents to build the secure bond and attachment they want to have with their babies; to increase parental sensitivity and reflective functioning whilst enhancing a parents’ ability to ‘hold their baby in mind’ and become more in tune with their baby; to improve the mental health of parents, reducing depression and increasing self- confidence as a parent/person. We work with parents to reduce isolation by increasing support networks and bring about lasting changes in the quality of life for families. Building Bonds is very much a multi-disciplinary team working with other professionals and services to support families to achieve the best possible outcome. We work to promote the importance of early attachment and investing in very early relationships to improve life outcomes for children.

See BUILDING BONDS SHORT DVD Password: buildingbonds


Wider Active Support

Building Bonds works as part of a multi-disciplinary team and here lies one of our key strengths. We work in collaboration with the specialist Public Health Midwives during the ante natal period as this ensures the intervention is offered at the earliest opportunity. The joint collaborative work is crucial in the achieving the high engagement rate which the service is immensely proud, (which is currently 96%). The Midwives play a central role in the health and emotional wellbeing of pregnant women and their babies. Evidence clearly shows that investment in the early years will have the best health improvement returns of all.
In Knowsley,  we are very lucky to have 2 Public Mental Health Midwives who work extremely hard in supporting vulnerable parents in the antenatal and postnatal period. The Public Health Midwives work jointly and collaboratively with the Building Bonds service and other services to support women with perinatal mental illness. The impact and outcomes of the Specialist Public Health Midwifery role working in collaboration with mental health/clinical psychology professionals is clearly evident throughout our work.

We are primarily based within Knowsley Children’s Centres (‘in the heart of the community’) where we offer in partnership, a Tier 2 Intervention, called ‘Holding your Baby In mind’ antenatal/postnatal groups which promotes attachment, Parent-Infant Interaction and Reflective Functioning to families.

In addition the Building Bonds Service works collaboratively with Knowsley’s NHS North West Boroughs Foundation Health Visiting Service. As a result of good multi-agency and partnership working, Building Bonds is now part of the NHS North West Boroughs, Health Visitors Perinatal Early Attachment Pathway.

We work closely with other partner agencies/professionals to deliver a holistic approach to supporting parental mental health and parent-infant attachment. These services include: Housing, Adult Mental Health, Centre 63/community support, Knowsley Children’s Centre’s, Nurseries, Social Care, Family First/Early Intervention Social Care, and the Perinatal Mental Health Teams.

“I have seen firsthand how a positive therapeutic relationship that explores a parent’s own experience of being parented or childhood trauma in a safe way can help to break down barriers and so they learn how to be the best parent they can be. I have witnessed how VIG can demonstrate to a parent with zero confidence of parenting, how warm and loving her parenting style is and how well her child responds to her. This is ground breaking for many parents as they have never been told that before. The fact that Building Bonds is so successful for our families is not surprising, we know that starting early with families and building positive foundations paves the way for emotionally healthy and successful children and young people – in my opinion this should be a service that all children 0-18 have access to.” Karen Nock, IRO for Knowsley MBC




Building Bonds has a steering group who provide strategic vision, direction and leadership to the service. The steering group is tasked with ensuring that the service delivers outputs and outcomes as agreed to time and to budget, and in particular they contribute to the formulation of a borough-wide strategic plan. The group also provides a critical steer and expert knowledge on emerging themes and issues and advises on prioritisation as necessary. Membership of the group includes representation from Public Health, Local Authority, Midwifery, Health Visiting and Community services representatives.

Building Bonds also facilitates feedback sessions from our service users every quarter, these group are called BEBE (Building Bonds, Experts by Experience). The key aims for these feedback sessions are for past Building Bonds Service Users/Parents to get together and share their experiences, views, thoughts and feelings about the Building Bonds Service & reflect on their own experience. The group is encouraged by staff to have a ‘voice’ and role in evaluating, shaping and developing the Building Bonds service. Parents who have used the Building Bonds service are seen as our experts and what is discussed is used to inform the future needs of the service and offer a voice to mangers, commissioners and future parents.

The BEBE Group has provided invaluable feedback on the Building Bonds Service and the care they received. Their thoughts have been actively translated by the Building Bonds staff team, with the group recently providing feedback on the Building Bonds Service Design and promotional leaflets/ DVD etc.


Looking Back/Challenges Faced

The demand for the Building Bond Service is growing rapidly in Knowsley (already in Huyton and Kirkby there are growing waiting lists). Commissioners, Managers, Clinicians and families do not want Building Bonds to become an inaccessible specialist Parent Infant Mental Health Service. The demand/need for the service at times has outweighed the clinical therapeutic capacity available. Thus the challenge is ensuring capacity meets local demand for support.

We are working hard to overcome challenges by: 1) constantly shouting about the importance of supporting Parent-infant mental health in the perinatal period 2) building capacity in the workforce by delivering specialist PIMH Training to equip, develop the skills of other multi-agency professionals who can join forces and support ‘the cause’ 3) evaluating the outcomes we deliver and auditing the demand for the service and need for more clinical capacity.

Lastly, For all professionals working in Maternity Services to reflect on the ‘under reporting and under identification of parental mental health’ in the Perinatal period and how policies, practices and procedures could be changed slightly to ensure that our vulnerable parents and infants in Knowsley are picked up and supported; and prevented from falling deeper into the cracks in services.

However one of the main challenges we have faced as a team, is enabling families to believe in their own potential, breaking them trans-generational cycles and realising that they can achieve goals. This explains why the service is ‘strength-based’ and aims to build of parents strengths and how important they are to their baby.



See below section on outcomes. The service is now commissioned by the CCG as our success in starting as a small pilot programme and obtaining NHS/CCG money is ensuring that the service is outcome driven and monitored and evaluates the difference it makes to families lives. We collect pre and post outcome data to measure impact and outcome in relation to parent-infant bonding and attachment, and parental mental health. We are also ‘big’ on feedback from service users and stakeholders, partner agencies.

The past 2 years we have carried out a cost benefit analysis on the service outcome and showcased the outcomes and cost savings made to government/services by offering this innovative, preventative specialist, much needed provision.

In addition, along with our NHS Provider Service (North West Boroughs NHS Trust) we have recently carried out a need/demand/capacity analysis to ensure that commissioners are aware of the need, demand of the area and ensure that commissioners and service managers accept responsibility that we have a duty of care to offer this needed support. This has ensured that the service now has funding for the next 3 years and is under a permanent NHS stream of funds.


Evaluation (Peer or Academic)

The service is currently being evaluated in conjunction with Edge Hill and Leeds University. The outcome of this research should be completed late 2018.



The outcome data reported clearly shows the positive impact, benefits and ‘life changing difference’ the Building Bonds service has already made to many parents and infants in Knowsley. 100% of Parents have reported an increase in their mental health wellbeing and have shown improvements in maternal attachment & positive feelings toward their baby. Additionally 100% of parents referred to Building Bonds demonstrated an increase in parent/child interaction, bonding & attachment.

The outcome data shows significant changes/improvements in women’s mental health (depression and anxiety) and all round well-being; with 40% of women no longer taking anti-depressant medication; 83% reduction in women involved with domestic abuse; 81% reduction is women using drugs/ alcohol and 90% of women reporting that their mental health has improved, as a consequence of being referred to this service.

“Getting up, getting dressed and taking the baby to school was difficult before I came to Building Bonds. Now I feel so much better, I don’t feel depressed anymore and I have more energy. I have never had someone tell me that I was doing good – I was always put down by everyone else. Building Bonds made me feel, good about myself.” Quote from a service user, 2016

“Building Bonds is a fantastic service. Building Bonds is a much much needed service for parents like myself. Building Bonds has quite possibly saved my life as I couldn’t see any light before joining the service. I dread to think where myself and other Mums would be without the help given by Building Bonds. I feel Building Bonds has played an essential part in getting my mental health back on track.” Quote from a service user, 2015.

The tracking of outcome data post discharge has been encouraging, to hear how 67% of parents post discharge moved onto accessing universal services. Also, how a number of parents have moved onto volunteering, training, further education and returning to work. The other 33% were referred by our team to other mental health services or to local authority and community services for further targeted support.
286 Parents across Knowsley attended the 8 week ante/post-natal Tier 2 Building Bonds PEEP ‘Holding your Baby in Mind’ Group Programme. The 286 is reflective of the parents who accessed the 8 week group programme across Knowsley (from September 2014 – May 2017). 90% of parents have reported an improvement in their health and wellbeing, with an increased awareness of their own mental health. 100% of parents reported that they would recommend this course to their families and friends

The ‘demand’ for the ‘Building Bonds via Building Skills’ Service Provision has also been high. The 8 Day Building Bonds Perinatal Mental Health Training Programme has been requested and attended by many Children’s Centre Staff, Health Visitors, Midwives, Nursery Nurses, Social Workers and Mental Health Professionals. We have delivered the 8 Day Building Bonds PIMH Training Programme to 79 professionals and the 2 Day Building Bonds PIMH Training Programme to 74 Health Visitors across Knowsley. 92% of delegates reported improved knowledge of the key areas covered. (Attachment, brain development, parent-infant mental health, VIG, ghosts in the nursery). 100% of delegates reported in their post training evaluations that they felt more confident in working with families with parent-infant mental health issues.

“I have learned a lot of useful information around brain development, attachment and the early relationships between mother and baby, and how a baby’s brain develops in the first two years. This information has given me more confidence to deliver PEEP sessions. I have really enjoyed the training and have found it very interesting. I have been reading to find out more about some of the topics covered. I now feel more confident supporting parents who are struggerling to bond with their baby.” Quote from a professional who accessed the training in 2016.



Building Bonds recently hosted a celebration event to reflect on the past, present and future importance of supporting Parent Infant Mental Health in Knowsley. The event was a resounding success with over 85 delegates attending from a range of services. Delegates in attendance included our service users, commissioners, assistant directors, heads of service, midwives, representation for the Midwifery Trusts and other professionals who work within the field of Perinatal Mental Health. During the event we shared the inspirational studies of some of the families we have supported and data on how well the service is developing.

Building Bonds is committed to inform researchers other services and policy makers about the service in order to influence service provisions and is therefore working on a joint research bid with Edge Hill and Leeds University.

The Service Lead for Building Bonds and Public Health Midwives sit on the Strategic Perinatal Network Committee and Group for Cheshire, Wirral and Merseyside and ensure that information, good practice and developments are regularly shared with other areas.


Is there any other information you would like to add?

In 2012, 1,971 babies were born in Knowsley. Thus, from the statistics presented around perinatal mental health we can estimate that in just 1 year (2012) around 400 women potentially presented with perinatal mental illness in Knowsley. In Knowsley we know that high levels of poverty and other poor social factors mean that Knowsley families are at risk of poor mental health in pregnancy.

Other interesting statistics relating to families during the ‘1001 Critical Days’ in Knowsley:
• In 2013 around 5% of all referrals to Knowsley Domestic Violence Support Service were pregnant women.
• In 2013/14 – 87% of the referrals for the Public Health Midwives in Knowsley were described as having mild to moderate mental ill health.
• Just over 60% of the referrals for Family First in Knowsley identified Mental Health as the primary reason for the referral.
• In 2014/15 – 50% of the referrals received by Building Bonds had not been reported at maternity booking as suffering with previous/present mental health issues.

50% of cases of mental ill health during the perinatal period go undetected (Baucer et al 2014). This is very worrying as we know that the onset and escalation of perinatal mental health problems can often be prevented through early identification and the offer of specialist perinatal mental health interventions/treatments, management and support.

In a Bounty Survey 41% of new mothers said that their health visitor or midwife had never asked them about depression in their most recent pregnancy.

We know for sure if BUILDING BONDS Parent-Infant Mental Health service was not commissioned in Knowsley, there would be a huge gap in perinatal services and in the Parent-Infant Mental Health and Attachment pathway for families. We know that if vulnerable parents and infant are left unsupported/untreated and continue to fall down huge gaps in service provision in the crucial perinatal period (‘The 1001 Critical Days’) – negative/damaging trans-generational cycles of attachment and poor mental health will continue, very sadly infants can be removed from their parents, parents mental health crumbles, and this costs the families, tax payers, our society massively in the short and long term.




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