Supporting young women in the perinatal period: a realist evaluation of community-based services

Research question: Non-clinical, community-based support for young women in the perinatal period to address the social determinants of mental ill health: What works for whom, why and in what circumstances? Background: Perinatal suicide rates are rising, particularly among young women.

Perinatal mental health problems are estimated to cost the UK around £8.1bn for each annual cohort of births, due to lasting negative impacts for children, including social care involvement.

Community-based services for perinatal young women which address the social determinants of mental ill health, are a promising approach though are under-funded.

There is an evidence gap about what works for young women, and the voices of young mothers have been largely excluded from service design and research.

The proposed research was developed through public and patient involvement activities and in partnership with young mothers, people working in services and policy organisations.

Aim: To develop and disseminate evidence-based recommendations on how to optimally provide social support to perinatal young women to address the social determinants of mental ill health.

Objectives: Undertake an in-depth examination of the delivery of support for perinatal young women in a purposive sample of community-based settings; compare and explain proximal outcomes (e.g. young women accessing support with housing or benefits, attending community activities or seeking advice from local organisations) and more distal ones (e.g. young women engaging more in self-care); examine how a) models of support and b) young women s characteristics may influence the production of sustained, positive outcomes; integrate findings to produce detailed, real-world recommendations for those commissioning, delivering or providing support for perinatal young women.

Methods: A rapid realist review of relevant existing literature (WP1) A realist evaluation of four community-based services providing different models of support for young mothers using case studies (WP2) Data collection at each case study will include: mapping existing services; analysing routinely recorded monitoring data; making informal observations of practice; interviewing staff; focus groups with past service users; and longitudinal interviews with 10 young women using each service three times over nine months.

In line with realist evaluation, the research findings will be analysed by the research team and the advisory groups to refine CMOCs and develop ideas about what works, for whom, why and in what circumstances to improve young mothers wellbeing. Two advisory groups will guide the research, one for young mothers and one for other stakeholders.

We will also work with project partners the Maternal Mental Health Foundation, the Children and Young People s Mental Health Coalition and the Hearts & Minds Partnership. Project timelines: The project will last 27 months from October 2024. WP1 will run from months 0-9 and data collection in WP2 will run from month 4-24.

Dissemination: The project will produce: Local case study evaluation reports Practical tools for voluntary sector organisations including evaluation models Academic papers Two conference presentations Policy briefing Report for NHS Trusts, ICBs, Commissioners and Service Providers Video for young mothers on support needs/how to access support Contribute to training for health professionals End of study dissemination online event