Service Evaluation of Bluebell Nurses’ Mums’ Comfort Zone & Bluebell Buddy Services “ knowing I wasn’t the only person who sometimes couldn’t cope “ Providing Support for Young Mums and Families in South Bristol Affected by Depression in Relation to Pregnancy and Birth. Written By Anna Mathieson, Ruth Jackson, Sally Cottrell and Rachel Jenkins Bluebell Nurses registered charity No. 1136818 Ltd Company no. 7101628. registered address VealeWasbrough Vizards, Orchard Court, Orchard Lane, Bristol, BS15WS. Address for correspondence Tall Pines, 26a Henbury Road, Bristol, BS9 3HJ. www.bluebellnurses.org
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Service Evaluation of Bluebell Nurses’ Mums’ Comfort Zone & Bluebell Buddy Services
“ knowing I wasn’t the only person who sometimes couldn’t cope “
Providing Support for Young Mums and Families in South Bristol Affected by Depression in Relation to Pregnancy and Birth.
Written By Anna Mathieson, Ruth Jackson, Sally Cottrell and Rachel JenkinsBluebell Nurses registered charity No. 1136818 Ltd Company no. 7101628. registered address VealeWasbrough Vizards,
Participants were asked to evaluate the programme overall at the end of the 12
week programme. Table 3 below shows the average ratings on a scale of 1 to 5
(with 5 being the most positive rating) that the mothers gave in response to the
evaluation questions.
Table 3: Average Ratings for the Overall Evaluation Questions
Question Mean Rating
How do you feel the overall programme helped you manage your 4
problems?
Overall how satisfied were you with the support group programme? 4
Overall how satisfied were you with the group being held at the 5
Teenage Parents Project?
Overall how satisfied were you with the time of day the group 5
was held?
Overall were you satisfied that the group leaders communicated 5
topics clearly and in an interesting way?
How useful did you find the buddy service? 4
How do you feel about the amount of information provided and 4
the number of topics covered?
Do you feel you had the opportunity to ask questions? 5
Rate your current overall wellbeing 4
Figure 2 below contains pie charts showing the distribution of responses to each option ofthe questions in the table above.
18
How do you feel the overall programme has helped you manage your problems?
Not at all
Slightly
Adequate
Well
Very Much
Overall how satisfied were you with thesupport group programme?
Not at all satisfied
Slightly satisfied
Quite satisfied
Satisfied
Very satisfied
Overall how satisfied were you with thesupport group being held at the Teenage Parents Project?
Not at all satisfied
Slightly satisfied
Quite satisfied
Satisfied
Very satisfied
Overall how satisfied were you with thetime of day the group was held?
Not at all satisfied
Slightly satisfied
Quite satisfied
Satisfied
Very satisfied
Overall were you satisfied that the group leaders communicated topics clearly and in an interesting way?
Not at all satisfied
Slightly satisfied
Quite satisfied
Satisfied
Very satisfied
How useful did you find the Buddy service?
Not at all useful
Slightly useful
Quite useful
Useful
Very useful
How do you feel about the amount of information provided and the number of topics covered in the programme?
Too little information
Slightly too little information
Enough information
Good amount of information
Too much information
Do you feel you had the opportunity to ask questions?
Not enough opportunity
Some opportunity
Enough opportunity
Good opportunity
Plenty of opportunity
19
Figure 2: Pie charts showing response distributions to the evaluation questions from the end of the group programme.
These results show that participants
were satisfied with all aspects of
the group. When asked whether
they felt they would like any further
support after the group had finished,
eight mothers answered "yes", seven
answered "no", and one answered
"not sure".
Activity Implementation at home
In one of the latter groups, mothers were asked to indicate whether they had
implemented the skills and activities practised on the course whilst they were
at home. Table 4 below shows the responses of 7 mothers, showing how many
participated during the group, and how many then practised at home.
There were two mothers who did not complete the full course, one of whom left
the group due to gaining employment, and therefore they did not participate
in the latter activities at all. Others did not participate due to being absent for
Please rate your current overall wellbeing
Very poor
Poor
Average
Good
Very good
Table 4: Implementation of activities at home
Activity Number who Number who participated (out of 7) applied at home (out of 7)
Ice breaker, journal 6 5 writing
Breathing exercise 6 4
Yoga 4 4
Zumba 4 0
Let’s stick together, 5 5 communication with partner
Art session 3 0
Medication session 5 3
Debt management 4 2
Music session 3 0
Pamper session 3 3
Dramatherapy 2 2
20
some sessions, or because they chose to opt out of the activity. As can be seen
from the table, some activities that need higher self-motivation or specific tools
were not implemented at home, such as Zumba, art and music. However, the vast
majority of the activities were practised at home by at least some of the mothers,
suggesting that the group achieved its aim of teaching the mothers new skills
that can be used outside of the group.
Longer term follow up
Mothers were invited to a follow up session where they were asked to complete
a further questionnaire about their experience on the programme. Those who
attended this session were mothers who had participated in a programme at
any point during the past year. During this session they completed further GAD 7
and EPDS questionnaires. The range and mean of scores from the follow up were
as follows:
GAD 7: Mean- 8 Range 0 to 17
EPDS: Mean- 10 Range 3 to 21
When asked what aspects from the programme they had continued to use at
home, most answered that they had continued practising some form of exercise,
whilst others said taking time for themselves and using the relaxation techniques.
All mothers responded positively when asked how they were currently doing in
themselves.
Mothers were asked, "Do you feel more able to manage your mental health as
a result of attending Mums’ Comfort Zone"? In response, 5 of the 7 mothers
answered "yes"; one answered "no" and one answered "not on my own but with doctor’s
help". Therefore the majority of the mothers felt that the programme had helped
them manage their mental health issues.
21
Discussion
“ They were very welcoming
and are great to talk to “
This evaluation set out to establish whether the services offered by Bluebell
were making a positive impact to the wellbeing of young mothers with perinatal
mental health issues. The results show that the service is making a valuable
contribution to the wellbeing of the young mothers, primarily because the average
depression and anxiety scores reduced as a result of attending the group. The
qualitative data results also illustrate that the mothers felt that attending the
group was a positive experience for them, and that meeting others in a similar
situation was particularly beneficial. Due to these results, the aims of the charity
as a whole were also achieved, as the mothers’ anxiety and depression levels were
reduced overall, and new strategies were learnt that the young mothers could then
implement at home when the group had ended.
Satisfaction with the group
In their weekly session evaluation forms, the mothers gave satisfaction ratings
for each week. Although the ratings varied, the vast majority of the mothers stated
that they were satisfied or very satisfied with the sessions. Across the whole
programme, the average rating that the mothers gave was 4 out of 5, indicating
that they were satisfied with the content of the sessions. Mothers also stated that
they felt that the group provided valuable support and that the topics covered
were communicated clearly. Therefore the service is working according to the NICE
guidelines through providing information and advice on mental health aspects of
perinatal health in a way that is accessible and valuable to the mothers involved.
Improvements in health and wellbeing
On average, the mothers’ anxiety and depression scores decreased by a similar
margin as a result of attending the group programme in comparison with their
scores at the start of the programme. Depression scores reduced by a larger margin
over the course of the group compared to anxiety scores. Therefore the main aim
of the charity has been achieved, as anxiety and depression levels were reduced
as a result of attending the group sessions. From the illustration of examples of
mothers’ journeys throughout the group, it can be seen that although the mothers
experienced high and lows throughout the group, in general attending the sessions
resulted in a positive wellbeing experience overall. This is a very encouraging
result for the charity after its first pilot year, as the standardised measurement
of the mothers’ mental health proved that the group did result in a significant
improvement in wellbeing.
Most useful part of the group
The overwhelming response to the question of which part of the group was most
useful was that it was meeting others in a similar situation and sharing their
experiences. The mothers also valued receiving information and advice from
reliable and trusted sources. This relates to the NICE guidelines in that providing
23
information and advice can improve mothers’ wellbeing and better equip them
with strategies for managing their mental health.
Group attendees were asked to make suggestions for ways to improve the
programme. Many stated that they did not have any suggestions of how to
improve the group. The suggestions that were given were that there should be
more group activities and that the sessions should last longer.
Knowledge café table cloths
The table cloths session at the knowledge café provided the mothers with an
alternative method of expressing themselves and feeding back about their
experiences. As can be seen from the results, the mothers indicated on the table
cloths that there was a significant improvement in their positive emotions and
wellbeing after attending the programme. The majority of the words used to
express their emotions at the start of the group had negative connotations, and
there is an obvious difference between these and the words that were used to
express their emotions at the end of the programme, which were mostly positive.
This is further evidence that the group programme had significant positive effects
on the wellbeing of the young mothers.
Overall evaluation of the group programme
In the final evaluation questionnaire, mothers were asked to reflect upon their
experiences of the programme across the whole 12 weeks. On average, the
mothers stated that they were either satisfied or very satisfied with every aspect
of the programme.
The results overall demonstrate that the structure and content of the programme
are satisfactory to the group attendees. Mothers benefitted from meeting others
in a similar situation to themselves and receiving information and advice from a
trusted and credible source.
Activity implementation at home
Mothers were able to implement the activities from the course at home, apart from
those that required specific tools i.e. art and music. This is very encouraging as it
indicates that the skills being taught and practised are being used by the mothers
outside of the course, and therefore the programme is succeeding in teaching new
long term skills. However, not everyone practised the new skills. This could be due to
lower motivation which may be a consequence of low mood. In the future it may be
beneficial to discuss with the mothers ways in which the programme leaders can
help them to implement the activities outside of the group.
Longer term follow up
At the follow up session, the mean scores on the GAD 7 and EPDS questionnaires
were lower than the mean scores on the questionnaires completed by the mothers
24
when they initially finished their programme. Whilst direct conclusions cannot be
drawn from this, it is possible that there is a beneficial long term effect of attending
the programme in relation to anxiety and depression scores lowering over time.
The vast majority of the mothers stated that attending the group had helped them
to manage their mental health. This is a very encouraging result as it shows that
the overall aim of the programme is being achieved, as the group is providing
the mothers with skills and opportunities to improve their ability to cope with
perinatal mental health issues.
Limitations
One limitation of these results is that the number of participants involved in the
evaluation was not sufficient to generalise the findings to the wider population.
However the results do provide a valuable insight into the experiences of young
mothers in the South Bristol area.
The literacy levels of the mothers provided a particular challenge in evaluating
the service, as completing questionnaires each week requires a certain level of
reading and writing ability, as well as motivation and concentration. This method
may also impact upon the ability of the mothers to express their thoughts about
the service, as a questionnaire has limited space for respondents to answer and
some may find that written emotional expression is not an adequate method.
It is possible that due to the low literacy levels amongst the young mothers,
the evaluation methods were not able to comprehensively collect the mothers’
feedback and experiences. In the future it may be necessary to include further
creative methods of evaluating the service. However, asking the mothers to
decorate the table cloths during the ‘knowledge café’ session in whatever way they
wished (e.g. drawing, writing key words) provided an alternative, more imaginative
way of evaluating the programme that may have helped to overcome any literacy
problems. Mothers were also given the chance to have one on one interviews with
the Buddy, or record their experiences in a film through interviews and using
cards to hold up key words to describe their feelings in a non-verbal manner
(please see the link on you tube http://www.youtube.com/watch?v=TiJHen_XCF
M&list=PL4AD32AFD77534329&index=15&feature=plpp_video). Therefore, there
were a number of ways for the young mothers to provide feedback about the
service.
Final Conclusions
This evaluation found that the services that Bluebell has been providing over the
past year have had a positive impact upon the mothers that have been involved.
Average anxiety and depression scores decreased after attending the group, and
the attendees were satisfied with how the group was run as well as the content
and structure. Therefore, these services will continue to run in order to support
25
young mothers who are experiencing perinatal mental health problems. The
learning from this evaluation will be utilised to expand the service and inform
further projects supporting partners of those experiencing perinatal anxiety
and depression, as well as mothers from other locations within Bristol. Current
funding has been restricted to supporting young mothers, however with further
funding the services can be offered to parents of all ages and socio economic
statuses. More one to one support could also be offered, as additional workers
could be recruited and trained to provide a bigger Buddy service.
26
Recommendations for practice
Written by Rachel Jenkins, Occupational Therapist, Anna Thompson, Project Manager & Ruth Jackson, Charity Director.
From our experience of establishing and running the Mums’ Comfort Zone
therapeutic group programme and the Bluebell Buddy service for one year, we
recommend the following for practitioners and organisations considering setting
up a similar service:
l Practitioners should try and cultivate an empathy with teenage mums who
contact them for help with suspected postnatal depression. One of the
key points made by the mums was that they felt listened to for the first
time when attending the group. They also felt respected, which gave their
confidence a huge boost.
l Practitioners should take time to explain medical jargon. Some mothers
on medication did not feel they understood their medication clearly,
including side effects, dosages and withdrawal symptoms.
l Introducing a parenting element into the programme would probably help
the mums develop coping strategies for their PND.
l It is effective to involve project beneficiaries in developing and designing a
programme from the outset, including marketing materials and language,
so they feel their ideas and needs are being listened to and have a sense of
ownership.
l That offering a peer-to-peer support, such as the Buddy role, would be
recommended as a key way to engage with hard to reach young mums who
demonstrate high levels of suspicion around professionals including GP’s
& Social Workers.
l We would emphasise the importance of having realistic expectations
about service users’ abilities to always engage with the offered provision.
l It is beneficial to try to think ‘outside of the box’ when thinking of ways to
overcome obstacles to accessing the provision of new services.
l When accepting new clients on to courses it is vital to ascertain some
personal history and very useful to have details of engagement with
previous services.
l During initial assessment it can be really useful to ascertain the levels of
users’ literacy in order to target any course materials effectively and put
support in place where it is needed.
l Offering a 1:1 visit with potential clients prior to uptake of any offered
provision has proved invaluable.
27
28
Acknowledgements
Avon Primary Care Research Collaborative
Avon Hello Tomorrow Fund
Comic Relief
Glamour magazine
Health Together - money raised through the Health Lottery
OMB Direct limited
Dr James Costello, PHD, the University of the West of England
The Co-operative Membership Community Fund
The Hartcliffe & Withywood Teenage Parents’ Project
The Pfizer UK Foundation (an initiative of Pfizer Limited)
References
Annual Conception Statistics, 2010. Office for National
Statistics, 2012. From education.gov.uk, accessed on
26-07-2012 at 16.21.
Kielhofner, G. (2008) Model of Human Occupation Theory and
Application. 4th edition. Baltimore:Lippincott, Williams &
Wilkins.
NICE Guidelines for Antenatal and Postnatal Mental
Health: Clinical management and service guidance (2007)
Petrou, S.; Cooper, P.; Murray, L. & Davidson, L. L. (2002).
Economic costs of Post-natal Depression in a high-risk
British Cohort. British Journal of Psychiatry, 181, 505-512.
Petrou, S.; Cooper, P.; Murray, L. & Davidson, L. L. (2006).
Cost-effectiveness of a preventative counselling and
support package for post natal depression. International
Journal of Technology Assessment in Health Care, 22, 443-453.
Rogers, C. R. (1979). The Foundations of the Person-Centred
Approach. Centre for Studies of the Person. La Jolla,
California.
‘Teenage Pregnancy Strategy: Beyond 2010’, Department
of Health; Department for Children, Schools and Families,
Crown Copyright.
World Café Presents Café to go (2008).
http://www.theworldcafe.com
29
Appendices
Appendix A- Information about the Charity
Bluebell was founded by Ruth Jackson and registered as a charity in 2010. Due to
her own personal experiences and her background in the voluntary and charitable
sectors, Ruth founded the charity with the aim of providing more support to all
those affected by perinatal mental health problems. Specifically the aims are to
reduce anxiety and depression in the perinatal period, increase education and
awareness about perinatal mental health problems, and to provide support where
there are currently gaps in service provision. Bluebell is proud to be user led, and
to have its foundations built upon the identified needs and gaps in services for
service users.
In order to establish whether there was a need for increased support, some
community events were run in cafes as informal public consultations as to
what the community felt was needed reaching over 100 local parents and health
professionals.
This led to the registration as a charity, and a bid for funding which was
successfully received from the Avon Hello Tomorrow Fund, which Bluebell won in a
national competition run by Glamour Magazine receiving more public votes than
any other project.
The next step was to ascertain which service user groups would most benefit
from increased support. To achieve this, focus groups were conducted in Bristol
from March to June 2011 with various service user groups. Focus groups attendees
represented Black and Ethnic Minority mothers, single mothers, partners of those
who had severe post-natal depression, young mothers and mothers from a middle
class background. From these sessions, it emerged that young mothers may
benefit most from the support services that Bluebell planned to offer. This more
specific focus led to funding from The Pfizer UK Foundation (an initiative of Pfizer
Limited) for the first year of the programme, and from Comic Relief for a further
three years of the programme with young mothers.
From the focus groups, the main themes that emerged were a desire for peer to
peer support, more information on signs and symptoms of post-natal depression
and anxiety, and a need for normalisation of post-natal depression, and
reassurance that things will get better. All of these themes are fundamental to
Bluebell’s work, and the focus group themes laid the groundwork for the services
that are now provided.
30
A board of trustees was also established in this time, including a Consultant
Psychiatrist from a local Mother and Baby unit and a Social Worker. The
board works in conjunction with a wider management committee which has
representation from health visitors and midwives, as well as mothers and fathers.
Therefore the charity is represented by those with relevant qualifications and
experience, as well as service users themselves.
Service users can be referred in to the charity through a health professional,
or they are also able to self-refer. Advertising materials for Bluebell include a
telephone referral number, which when contacted leads to a one to one visit
being arranged.
The referral criteria for the charity dictates that those with very complex needs
should be signposted to others agencies, for example to their General Practitioner
(GP), health visitor or other health professional. However Bluebell is flexible in their
referral criteria and do accept those with multiple and complex needs, working
in partnership with other agencies to ensure best practise and that high levels of
care are provided.
Alongside the group programme, a ‘buddy service’ was provided. The buddy
service was run by a member of Bluebell staff who was herself a young mother
who experienced perinatal mental health problems, and has since overcome these
problems. One to one sessions, telephone and text support were all offered by the
buddy. This part of the service was open to all group attendees, but it was left up
to them to decide whether they accessed the service or not. The buddy attended
each week of the programme, but was also available to support those who did not
attend the programme. The young mothers were also given journals to reflect upon
their experiences each week.
Future Directions
Bluebell has recently received funding to provide support to fathers and partners
of those who have perinatal mental health issues. The NICE guidelines for
Antenatal and Post-natal Mental Health state that "Healthcare professionals should
assess and, where appropriate address, the needs of the partner, family members and
carers of a woman with a mental disorder during pregnancy and the post-natal period"
(page 11, section 1.1.2.1). Therefore it is acknowledged that partners also require
support, and Bluebell plan to again address a gap in services and provide
additional support to fathers and partners outside of the medical model.
Funding is currently being sought to roll out new groups. These groups will be
open to mothers of all ages, and will be run in areas that are more ethnically
diverse than the area in which the current group was conducted. Therefore
there may be new challenges whose first language/or for whom English is not
31
the first language is not English and cultural differences that haven’t yet been
encountered. The model under evaluation in this report will be replicated for the
new groups, including the processes of designing the marketing materials. This
will ensure that the new group is tailored to the specific needs of the new service
users from the very beginning. Any changes will be service user led and more
events may need to be offered to gather views from other mothers as to how they
would want the groups to be run.
The aims of the new services are to meet the needs highlighted by the community
in relation to perinatal mental health issues, for example by supporting those
around the mothers as well as the mothers themselves. The current services
aimed to support 50 mothers each year, and the new branches of the service will
aim for a similar number to support directly, as well as those that the service can
indirectly support such as partners and children. Therefore through the group for
young mothers as well as the two new groups to be set up, it is hoped that Bluebell
will be supporting approximately 150 individuals directly in the near future, in
addition to the support that will be provided to partners. The service will also aim
to reach mothers of all backgrounds and cultures. The service users included in
this evaluation were mostly of Caucasian origin, and therefore it is hoped that
providing services in other areas of Bristol will make the group more accessible to
other minority ethnic groups.
In the long term, Bluebell hopes to measure the impact that the services it is
providing is having on the wider system around a mother with perinatal mental
health issues. For example, it may be possible to measure the impact that the
increased support has had on the children’s development and wellbeing. This
could be done through interviews or questionnaires with teachers, other family
members, and health professionals to gather opinions on whether the children
of mothers who have experienced perinatal mental health problems have been
affected adversely. A comparison could be made between children of those who
had received support from Bluebell and those who have not.
32
Appendix B- Statements of Income and Expenditure
Income:
l £10,000 - start up funding from the Avon UK Foundation to enable Bluebell
to run focus groups across Bristol with parents with lived experience of
depression related to pregnancy and birth to gather their views on gaps in
services.
l £30,000 - One year funding from The Pfizer UK Foundation (an initiative of
Pfizer Limited) to run pilot project with young mums in South Bristol - Mums’
Comfort Zone and the Bluebell Buddy services launched in September 2011.
l £65,000 - Three year funding from Comic Relief from June 2012 to continue the
project with young parents in South Bristol until 2015.
l £2,000 - recent donation from the Co-op community fund to start work with
young Dads who are supporting their partners though perinatal depression.
l £10,000 - a recent grant received towards our Dads’ Zone project with
young fathers from money raised by HealthTogether. 51 Community Interest
Companies raising money to address health inequalities across England,
Scotland and Wales through The Health Lottery.
Expenditure:
l £10 per week will fund one young mum to attend the 2 hour Mums’ Comfort
Zone group programme and enable her child to access the creche for 2 hours.
l £10 will fund one young mum to receive support from the Bluebell Buddy for up
to two hours per week either at home or in the community
l £200 per week will enable 10 young mums affected by depression to access
group and buddy support compared to £300 quoted by the Government as the
average cost for just one mum to receive support.
l £500 every quarter will pay for sessional workers to come and deliver sessions
on art, drama, music, Zumba, Yoga and pampering to allow the mums some
time out and to complement the therapeutic programme.
l £1,000 per annum will enable Bluebell to produce all the marketing, flyers and
postcards needed to promote our services in the local community.
33
34
Appendix C - Referral form
1
BLUEBELL BUDDY/MUMS’COMFORT ZONE REFERRAL FORM
(to be returned to: Danielle Sealy c/o The Teenage Parents’ Project, Tenants’ Centre, Gatehouse Way, Withywood, Bristol, BS13 9AN or tel. 07517 374699 in case of query)
Bluebell Client number:
Please note that all referrals must be made with the consent of the individual. The individual should
have been affected with depression relating to pregnancy and/or birth
Have you discussed this referral with the individual prior to completing this form? YES/NO
We aim to respond to all referrers within 2 weeks after receiving the referral to report progress. If you have any issues or concerns about the referral process or the support for the individual please contact Danielle Sealy on [email protected] or [email protected]
Name of client........................................................................ Date..............................................
Can you describe briefly why you are referring, providing any other information that you think will be useful to be aware of when assessing the client’s needs?
Your Date of Birth: ____________________ ___________________________
Baby’s Date of Birth: ___________________ Phone: _________________________
As you are pregnant or have recently had a baby, we would like to know how you are feeling. Please check the answer that comes closest to how you have felt IN THE PAST 7 DAYS, not just how you feel today.
Here is an example, already completed.
I have felt happy: Yes, all the time Yes, most of the time This would mean: “I have felt happy most of the time” during the past week. No, not very often Please complete the other questions in the same way. No, not at all
In the past 7 days:
1. I have been able to laugh and see the funny side of things *6. Things have been getting on top of me As much as I always could Yes, most of the time I haven’t been able Not quite so much now to cope at all Definitely not so much now Yes, sometimes I haven’t been coping as well Not at all as usual
2. I have looked forward with enjoyment to things No, I have been coping as well as ever As much as I ever did Rather less than I used to *7 I have been so unhappy that I have had difficulty sleeping Definitely less than I used to Yes, most of the time Hardly at all Yes, sometimes
Not very often *3. I have blamed myself unnecessarily when things No, not at all
went wrong Yes, most of the time *8 I have felt sad or miserable Yes, some of the time Yes, most of the time Not very often Yes, quite often No, never Not very often
No, not at all 4. I have been anxious or worried for no good reason
No, not at all *9 I have been so unhappy that I have been crying Hardly ever Yes, most of the time Yes, sometimes Yes, quite often Yes, very often Only occasionally
No, never *5 I have felt scared or panicky for no very good reason
Yes, quite a lot *10 The thought of harming myself has occurred to me Yes, sometimes Yes, quite often No, not much Sometimes No, not at all Hardly ever
Never
Administered/Reviewed by ________________________________ Date ______________________________
1 Source: Cox, J.L., Holden, J.M., and Sagovsky, R. 1987. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150:782-786 .
2 Source: K. L. Wisner, B. L. Parry, C. M. Piontek, Postpartum Depression N Engl J Med vol. 347, No 3, July 18, 2002, 194-199
Users may reproduce the scale without further permission providing they respect copyright by quoting the names of the authors, the title and the source of the paper in all reproduced copies.
No, most of the time I have coped quite well
Edinburgh Postnatal Depression Scale 1 (EPDS) Postpartum depression is the most common complication of childbearing. 2 The 10-question Edinburgh Postnatal Depression Scale (EPDS) is a valuable and efficient way of identifying patients at risk for “perinatal” depression. The EPDS is easy to administer and has proven to be an effective screening tool.
Mothers who score above 13 are likely to be suffering from a depressive illness of varying severity. The EPDS score should not override clinical judgment. A careful clinical assessment should be carried out to confirm the diagnosis. The scale indicates how the mother has felt during the previous week. In doubtful cases it may be useful to repeat the tool after 2 weeks. The scale will not detect mothers with anxiety neuroses, phobias or personality disorders.
Women with postpartum depression need not feel alone. They may find useful information on the web sites of the National Women’s Health Information Center <www.4women.gov> and from groups such as Postpartum Support International <www.chss.iup.edu/postpartum> and Depression after Delivery <www.depressionafterdelivery.com>.
SCORING QUESTIONS 1, 2, & 4 (without an *) Are scored 0, 1, 2 or 3 with top box scored as 0 and the bottom box scored as 3.
QUESTIONS 3, 510 (marked with an *) Are reverse scored, with the top box scored as a 3 and the bottom box scored as 0.
Maximum score: 30 Possible Depression: 10 or greater Always look at item 10 (suicidal thoughts)
Users may reproduce the scale without further permission, providing they respect copyright by quoting the names of the authors, the title, and the source of the paper in all reproduced copies.
Instructions for using the Edinburgh Postnatal Depression Scale:
1. The mother is asked to check the response that comes closest to how she has been feeling in the previous 7 days.
2. All the items must be completed.
3. Care should be taken to avoid the possibility of the mother discussing her answers with others. (Answers come from the mother or pregnant woman.)
4. The mother should complete the scale herself, unless she has limited English or has difficulty with reading.
1 Source: Cox, J.L., Holden, J.M., and Sagovsky, R. 1987. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150:782-786.
2 Source: K. L. Wisner, B. L. Parry, C. M. Piontek, Postpartum Depression N Engl J Med vol. 347, No 3, July 18, 2002, 194-199
Appendix D - continued
37
GENERALIZED ANXIETY DISORDER 7 (GAD-7)
NAME: DATE: PHONE: ADDRESS:
GAD-7
Over the last 2 weeks, how often have you been bothered by any of the following problems? (circle the best answer)
Not at all
Several days
More than
half the days
Nearly every day
1. Feeling nervous, anxious or on edge 0 1 2 3
2. Not being able to stop or control worrying 0 1 2 3
3. Worrying too much about different things 0 1 2 3
4. Trouble relaxing 0 1 2 3
5. Being so restless that it is hard to sit still 0 1 2 3
6. Becoming easily annoyed or irritable 0 1 2 3
7. Feeling afraid as if something awful might happen
0 1 2 3
Total Score = _________________
Appendix D - continued
38
Appendix E- Session evaluation form
39
Session evaluation
Week no. Date:
Pre-session questions: Q1. Can you describe how you are feeling right now? (see mood sheet for help) Q2. How strong are these feelings (where 1 is not strong at all and 10 is the strongest feeling)
Post session questions: Q3. Can you describe how you are feeling right now? (see mood sheet for help) Q4. How strong are these feelings (where 1 is not strong at all and 10 is the strongest feeling)
Emotion_______________________ 1 2 3 4 5 6 7 8 9 10 (please circle) Q5. Overall, how satisfied were you with the session? Not at all Very Much 1 2 3 4 5 (please circle) Q6. What did you enjoy? Q7. Was there anything you would change?
Appendix F- Support group evaluation form
40
Mums' Comfort Zone - Support Group Evaluation
Name:________________________________
We would appreciate if you could take a few minutes to give us some feedback about the support group overall. It would be very useful to hear what you found useful and not so useful and if you have any suggestions about other topics or changes you would like to see in future groups. Q1. How do you feel the overall programme has helped you manage your problems? Not at all Very much
1 2 3 4 5 Comments:
Q2. Overall how satisfied were you with the support group programme? Not at all satisfied Very satisfied
1 2 3 4 5
Comments:
Q3. Overall how satisfied were you with the group being held at the Teenage Parents Project? Not at all satisfied Very satisfied
1 2 3 4 5
Comments: Q4. Overall how satisfied were you with the time of day the group was held? Not at all satisfied Very satisfied 1 2 3 4 5
Comments:
Q5. Overall were you satisfied that the group leaders communicated topics clearly and in an interesting way? Not at all satisfied Very satisfied 1 2 3 4 5
Comments:
Q6. How useful did you find the buddy service provided by Danielle? Not at all useful Very useful 1 2 3 4 5 Is there anything else you would have liked from the buddy service? e.g more contact, more information on other services? ________________________________________________________________________ _______________________________________________________________________ Q7. How do you feel about the amount of information provided and the number of topics covered in the programme? Too little information Too much information
1 2 3 4 5
Comments:
Q8. Do you feel you had the opportunity to ask questions? Not enough opportunity Plenty of opportunity
1 2 3 4 5
Comments:
Q9. What were the things that you found most useful? Or how do you feel you have benefited from attending the group programme?
Appendix F- continued
41
Q10. Do you have any suggestions for things we could change about the course? Or any further comments about the course. Q11. Please rate your current overall wellbeing Very poor Very good 1 2 3 4 5 Q12. Do you feel you need some more support now that the group support programme has ended? Yes/No (please circle) If yes, would you like Bluebell Nurses to contact you to discuss one-to-one support and other options? Yes/No (please circle) As part of the programme we may want to contact you in future for further feedback. If you do NOT wish to be contacted please tick this box □ As part of promoting future groups we may use information that you have supplied on the evaluation form to inform others of the benefits of attending (anonymously), if you do NOT want your information to be used in this way please tick this box □ Thank you very much for your time and commitment to this group. Your comments are valued and much appreciated.