The Intervention - Mellow Bumps
Mellow Bumps is delivered antenatally to groups of pregnant women in 6 weekly 2-hour sessions. It is aimed at pregnant women with additional social care needs. Mellow Bumps aims to increase a mother-to-be’s knowledge and understanding about mother focused activities for managing stress, anxiety and self-care, baby focused activities which help the mother to bond with her unborn baby and to recognise the baby’s social-emotional development, relaxation to decrease stress and anxiety during and after pregnancy and ‘have-a-go’ activities to allow mothers to put these into practice at home.
The Service - 3D Drumchapel
3D Drumchapel is a charitable organisation that offers support to families with the aim of improving family relationships, improving parenting skills, increasing family members’ wellbeing and improving child development. They serve families with children from pre-birth to 12 years old living in 3 areas in the West of Glasgow. 3D Drumchapel has been running for 22 years and for the last 7 years they have been offering families perinatal support including through running Mellow Bumps groups.
Elaine Milmine and Sarah Williams started working for the service as Perinatal Family Support Workers, Elaine is now Operations Manager. They both described the experience of their service implementing and delivering Mellow Bumps.
NEED – Making the Decision about Mellow Bumps
Local need: 3D Drumchapel recognised the need within the community for support for many women during pregnancy. They provide support in an area of high deprivation, and from local knowledge of families they were aware that lots of pregnant women in the area feel isolated and could benefit from a safe, reliable place to access support and discuss any anxieties surrounding their pregnancy. They wanted to get health messages across to mothers focusing on both physical and mental health of the mother and child.
Sarah noted that: “There is such value I think, in putting the information that we know is out there and is evidenced, packaging in a way that is accessible to people and equipping them to do something about it”.
She felt, from a Health Improvement view, Mellow Bumps “is getting the right level of information across but not in a way that bamboozles people”.
Programme Selection: 3D Drumchapel chose to implement Mellow Bumps as an early intervention because, at the time of implementing, it was the only antenatal programme that was specific to Scotland, having been developed locally. Given the population they serve they chose not to target the intervention but provide it as a universal offer. They think this works well and feel that it reduces any perceived stigma attached to targeted interventions. They find that most parents who attend do meet the intended targeted group of the programme. This is the only formal antenatal intervention their service offers.
Intended outcome: They said that the intended outcome of implementing Mellow Bumps was to reduce social isolation during pregnancy, to get health messages across and to help mothers-to-be make small changes and promote the importance of looking after themselves.
Local Reach: In March 2020 they had delivered 29 groups and continue to offer a rolling programme of groups. They explained that there is a cross section of women who attend the groups, for example, mothers who are having their first child, those who have had a number of children, young mums, older mothers and mothers with additional support needs. They find that mums with all different experiences join the groups.
“most people will know someone who has done it
and people love it when they come”
FIT – How Does Mellow Bumps fit with 3D Drumchapel and the Community?
Sarah and Elaine explained how they link closely with the antenatal clinics which run locally. As part of their implementation they looked at the antenatal assets in the community and the biggest was the antenatal clinics. It was a place where all the pregnant women in the community were meeting. From the start of their implementation they worked closely together with the midwifes and set up an information table in the waiting rooms of the antenatal clinics where they engage with pregnant women, promote the groups and recruit women to the group. They found this worked well and as time goes on, they often find, when talking to one mum in the waiting room, another will hear and say they have previously attended a group. Sarah noted that this is often all it takes for a mother to agree to attend.
Elaine and Sarah explained that Mellow Bumps at 3D Drumchapel is the main service in their community that is offering a perinatal programme. They find that Mellow Bumps fits in well with their wider service as they are supporting families pre-birth up to early secondary school age. Sarah said:
“I think it [Mellow Bumps] works really well as
part of an established service”.
They thought that the environment created by the groups was one that fit well with their service. They said the groups are a place in which open discussions could happen and where the mothers could have conversations and ask questions about pregnancy and being a mother that they had possibly not had the chance to ask anyone before. They thought this environment and the group topics covered could help break down barriers or change perceptions for parents. They thought the topics of breast feeding and the discussions around baby’s brain development were particularly effective.
About running Mellow Bumps groups, they said
“We love running it, we have tweaked it over time
but it is still very true to the manuals and the families
really engage with it well”.
They noted that the feedback they collect from families who have attended the groups is generally really good.
One parent feedback form noted:
“Everything has been great. 3D Drumchapel Mellow Bumps has helped my confidence a lot”
And another said about the group:
“Get a break just for me, learn new things. Very helpful, friendly. Great service – would highly recommend it”
Fit with existing programmes: Delivery of Mellow Bumps allows 3D Drumchapel to support mothers before the birth of their child and then signpost them into other supports they have available in the service, for example they can access support in the Baby and Me post-natal groups which run alongside the local baby weighing clinics. They also have a 6–week post-natal group that parents can access called Baby Steps.
From Mellow Bumps they are also able to signpost parents into other supports in the local community such as book bug. They have good links with the Family Nurse Partnership (FNP), who have referred mothers into the groups.
Sarah and Elaine also noted that they are both trained in the Solihull Approach and feel that the concepts of Containment and Reciprocity within this approach fit well with Mellow Bumps.
SUPPORTS – What Supports did Mellow Parenting Provide?
From initial implementation, 3D Drumchapel received support from Mellow Parenting. They noted that from their first contact they found them very supportive, responsive and approachable. Mellow Parenting provided the training and have been accommodating in ensuring that 3D Drumchapel continue to have enough trained staff in their service and were therefore able to maintain their capacity to deliver a rolling programme of Mellow Bumps groups.
Sarah and Elaine thought that Mellow Bumps fit well into their service and all the processes they already had in place at 3D Drumchapel. They explained that they had been recruited as Perinatal Family Support Workers whose role would include delivering the Mellow Bumps groups. Due to this and the systems already in place in the service, they did not require supports with staff selection, administration, recruitment or promotion from mellow Parenting. They thought that these types of supports would be available from Mellow Parenting if this was requested.
3D Drumchapel accessed support from Mellow Parenting around; training, data collection and accreditation.
Training: Sarah and Elaine said there were no prerequisites for the training. They thought the 1-day specific training for Mellow Bumps was very good. They said the materials were very good and easy to follow.
Data collection: In the service they use the measures developed by Mellow Parenting to measure outcomes from the groups. Data are collected through a pre and post group questionnaire which consists of 18 questions about the mother’s health and wellbeing. They gather demographics and follow up after the birth and collect information such as gestation period and birth weight. They have an agreement with Mellow Parenting to collect this information which Mellow collates and provides them with an evaluation of each group.
Accreditation: Mellow Parenting offered an accreditation pathway which involved accessing supervision from Mellow Parenting, this was done over the phone and did not require their practice to be viewed. They also had to submit group evaluations.
Supports from Mellow Parenting, with the exception of training, are optional but Sarah and Elaine thought that Mellow Parenting would support services with anything that they requested support with.
Financing: 3D Drumchapel were able to fund their initial training and costs of running the group through dedicated funding for their perinatal service. This funding came mostly from Health Improvement and foundations such as the Robertson Trust. This part of the service is now core business and so is funded mostly through the main service budget.
USABILITY - What was 3D Drumchapel’s experience of implementing Mellow Bumps?
Elaine and Sarah thought the manual and materials were well developed. They noted that through the training day, and then initial delivery of a group, they developed a good understanding of the group content. They said
“The facilitation documents are great”
“They’re not too descriptive, they’re quite basic, so it does
give a bit of leeway for introducing things that are related to
that topic, it gives you a bit more flexibility.”
Modifiable components: Elaine and Sarah reported how they liked the flexibility the group offers. They said that there are agendas for the group sessions but that there is a good balance of being prescriptive and flexible. They noted that the manual and agendas means you don’t feel adrift when facilitating the groups. However, there is the flexibility to explore topics of have discussions that that just come up and that are not in the programme. They said that they can follow the parents lead in discussions but then get back onto the agenda or cover any missed topics at a later date. They also noted that there is flexibility around the activities they use in the groups. They said as long as the topic and message of the activity is as intended in the manual, they can be flexible in what activity they use to get the message across.
Fidelity: As part of the evaluation of the programme and as a way to monitoring their fidelity, the practitioners complete a debrief form as part of the paperwork they send onto Mellow Parenting, where they record what topics were covered, any sections of the session they missed and any additional materials covered.
CAPACITY – What 3D Drumchapel require to deliver Mellow Bumps
3D Drumchapel aims to deliver 4 Mellow Bumps groups a year, one each school term. They noted that with their 2 dedicated Perinatal Family Support Workers, who deliver the groups, this is manageable, both with regards to having time to recruiting families for the groups and staff capacity. They noted that if they delivered any less groups there would be the potential for mothers to miss out as they need to engage during pregnancy.
They currently have 3 staff trained to deliver Mellow Bumps and this is helpful as their 3rd person can step in and deliver the group if one of the perinatal workers are not available to deliver a group run (e.g. on maternity leave or long term sick).
Staff prerequisites/experience: Elaine and Sarah said that although there are no prerequisites to doing the training, it can be helpful if practitioners training to deliver are fairly experienced group facilitators, especially if they have not worked with women perinatally. They explained that the emotions that come up for women in this period can be difficult to manage if you are not experienced. They thought that counselling skills would be beneficial for practitioners to have before running groups.
Prior to the training, Elaine had experience of supporting families in the local community and Sarah was a midwife so had lots of experience of working with women in the perinatal period. Both felt that the different experiences they brought to facilitating Mellow Bumps groups together was a good mix.
One parent attending the group gave feedback, including about the facilitators:
“Helps support me and gives me time to relax. Facilitators are lovely, very kind and welcoming. Makes you feel very relaxed, very knowledgeable.”
Time commitment: They reported that the time commitment in their service for delivering the group involves 6 weeks lead into the group for recruitment, a couple of hours a week. They then have a week of calls to mothers to arrange one to one meeting with them prior to the groups. Then a week of one to one meeting to engage women into the group and to get to know them. These meeting usually take place the week before the group commences. The group is then 6 weekly sessions of 2 hours. They require about 30 minutes before and after the groups to prepare. They also require time to follow up with parents after the groups to collect evaluations. The paperwork involved prior to the group and after is completed by the facilitators themselves, they do not find that they require support from an administrator.
Elaine recommended that if services are considering implementing Mellow Bumps, to take any opportunities to learn from other organisations delivering and to link in with Mellow Parenting and the support, training and networking opportunities they offer.
With regards to running groups she recommended always planning ahead and preparing for groups. She said not to worry about any of the conversation or topics that might come up or of getting off track. She said all conversations can be helpful and to just let them happen.