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Self-Help and Peer Support Strategies in Maternal, Newborn, and Family Health



I Introduction



There has been increasing attention in research, community, and public health settings on the importance of peer-support/self-help strategies for health promotion during periods of life change or transition, including the pre/postnatal and parenting periods. In response, self-help/peer-support programs for the pre/postnatal and parenting periods continue to proliferate in community and public health settings.



The history of self-help/peer support for expectant and new parents is grounded in community settings -- from parks to play groups to La Leche League meetings or community-based parenting centres. Today, more professionals are recognizing the complementary role these informal support networks play during this period of change, adaptation, growth, and learning.



On the more formal side, the Ontario government's most recent mandatory guidelines for the public health units and regional health authorities include social support, peer support, and peer education as required components for Family Health Programs (MOHLTC, 1997). However, there is much scope and variation in the way different health units in Ontario interpret and apply these guidelines and in the types of peer support programs supported and/or coordinated by health units in Ontario communities.



The Best Start Resource Centre (BSRC) provides extensive supports to the health promotion work of public health staff and other professionals working in the area of maternal, infant, and family health. Although BSRC supports programs that include self-help/peer-support strategies, the centre was interested in learning more about the breadth and role that self-help/peer-support strategies can play in this field.



The Self-Help Resource Centre (SHRC) has traditionally worked with a diverse array of self-help initiatives in the informal volunteer and NGO sectors. SHRC's efforts continually aim to raise awareness about community-based (e.g., member-led) self-help and peer-support initiatives among more formal health promoters and public health professionals. In order to enhance these efforts and to broaden the centre's focus to serve more health promoters using self-help/peer-support strategies in public health and other institutional health sectors, SHRC joined efforts with BSRC -- both are members of the Ontario Health Promotion Resource System (OHPRS)-- to explore ways that the two centres could combine their respective expertise and scope and better support the use of self-help strategies in this health promotion field.



Together, they decided to conduct an environmental scan and needs assessment in the winter/spring of 2004. The purpose of the research was

(a) to provide a scan of existing maternal/family health programs using self-help strategies/activities, and

(b) to determine the specific needs of those coordinating/facilitating such activities.



The findings of the needs assessment are being used to assist these two OHPRS centres in effectively tailoring their services to meet the stated needs of those using self-help/peer-support strategies in maternal/newborn/family health programs across the province. New resources have already been developed as a result of the joint initiative (see OHPE 380.2) and more are planned.


II Environmental Scan and Needs Assessment



A. Methodology



The primary data collection method consisted of a key informant, semi-structured telephone survey. Forty interviews were completed with coordinators and facilitators of peer support activities in pre and postnatal settings across the province. The sample aimed to be representative of various regions of Ontario (north, east, central, west, and southwest), a range of types of self help strategies (e.g., member-led and professionally-led support groups, telephone peer support, lay home visiting), and expertise on a range of topics (e.g., breastfeeding, postpartum depression, parenting).



Data was collected about current peer support/self-help activities and on the perceived benefits and challenges faced by program coordinators. The respondents were also asked to identify their priority needs in relation to their work.



B. Results



1. Benefits of Self-Help/Peer Support



Respondents clearly emphasized the benefits of using peer support -- those interviewed spoke very highly (and often very passionately) about its importance. Their commitment to this strategy was evident even when they spoke of the difficulties they faced in doing it.



More than half of those interviewed spoke of the benefit of shared common experience between the volunteer and peer that typically occurs in peer-support contexts. Some emphasized that this is especially important for parents and for women that are new to Canada. More than half of the respondents also mentioned that peer support is a credible form of support. Half of the respondents emphasized the qualitative difference between the kind of support offered by peers versus professionals and the importance of both.



Many identified that peers are often perceived as non-threatening -- "at the same level" -- and easier to relate to than professionals because they share common experience, are in frequent contact, and often engage in practical hands-on types of support that help to build a quicker and deeper relationship with the parent.



Nearly half of the respondents stressed that peer support helps to build social networks and relationships between people that often extend beyond the context of the program. A number of respondents mentioned that peer support leads to people gaining support from or being linked with other services and resources in their community.



2. Challenges of Self-Help/Peer Support



While there were some differences found in the challenges depending on the sector that the respondent came from, there were no significant differences found by region. The majority talked about their challenges with the management or coordination of volunteers. The challenge of determining role boundaries of volunteers and peer workers was significant for the vast majority of those in public health settings and for all of the respondents from Healthy Babies, Healthy Children programs.



Respondents expressed concern that the line between peer and client was often blurry and although no one mentioned a situation where it had become an issue, a few respondents mentioned having concerns about liability in this context. The issue of the volunteer's readiness or ability to take on the volunteer role also arose in this context. Respondents spoke of the challenge for the volunteer of being objective when their own experience is often very similar to those they are supporting. The issue of the volunteer's readiness to volunteer was also linked closely with the issue of the stressors and multiple demands volunteers commonly experience.



Over a quarter of the respondents identified the challenge of recruiting or retaining volunteers. This was a particularly significant issue for those in public health settings. Respondents explained that most of the volunteers/peer workers are parents themselves and also experience added challenges such as parenting multiples, bereavement over pregnancy or infant loss, postpartum depression, being a young parent, and parenting on a low-income.



Some of the respondents talked about the challenges of providing ongoing and emotional support to volunteers especially in the context of limited staff resources. Some respondents also mentioned the challenge of trying to bring the volunteers together for networking purposes or for staff to stay in contact with them and their work. This was often related to the issue of inadequate program funds for staffing, resources, and remuneration for volunteers (e.g., transportation and childcare costs).



One quarter of the respondents identified the lack of program resources as a key challenge they were currently facing.



The challenge of facilitating group dynamics was mainly raised by those who coordinate professionally-led support groups (primarily respondents working in family resource programs and early years centres). Specific challenges included balancing different needs and perspectives of group members, the ongoing nature of the group (members coming and going), establishing guidelines around confidentiality, and conflicts in parenting style between members.



Another issue touched on by some respondents was gaps in service delivery, e.g., challenges in reaching rural areas or specific or diverse ethnic groups as well as a lack of other services (or awareness of services) to refer people to.



Finally, a few respondents spoke about some of the broader societal- or organizational- level influences on their work coordinating peer support. For example, the undervaluing of volunteers or lay home visitors by health providers or organizations respondents worked for, which leads to lack of pay, credibility or recognition, and stress on the part of those providing peer support.



3. Needs of Health Promoters Using Self-Help/Peer-Support Strategies



The majority of the respondents emphasized their need for networking opportunities with those who are involved in similar programs or strategies. This emerged as a need across all sectors and regions.



Of those surveyed, just under half identified the need for receiving more information about volunteer management and support. This was a key priority across sectors and regions.



Resource materials were named by a quarter of the respondents as a priority need (varying in content from resources for parents they are working with to those addressing the topical area they are working in to resources on aspects of coordinating peer support programs).Under a quarter of the respondents also said that they would like training opportunities, fundraising or funding support (mainly self-help organizations), or information on facilitating support groups. Three of the respondents (two from self-help organizations and one from a community-based support program) mentioned the need for publicity or raising awareness about their programs.



Other priority types of support mentioned by a few respondents were

* strategies for engaging parents that are hard to reach/marginalized,

* in-depth conference on postpartum depression,

* recruitment strategies for fathers as volunteers,

* resources for fathers,

* information on peer-support programs with teens,

* information on peer-support programs and ethnoculturally specific groups,

* resources for parents that are locally based,

* training specifically for lay home visitors, and

* information on volunteer-board management and training.



The majority of respondents identified networking opportunities as their top priority. When presented with a list of the various types of support currently offered by the SHRC and BSRC (i.e., print resources, online information, networking opportunities, training, and consultation) and asked to rate them, the majority of respondents reported that all of these types of support would be very helpful. The most highly ranked types of support were online information and print resources.



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III Action Steps



In order to obtain richer information about issues identified by the survey and to take action on supporting respondents' needs for networking, a focus group was organized in June 2004. Eight survey respondents from diverse programs within or near the GTA participated. The focus group helped OSHNET and BSRC test new resource development ideas and assess what types of networking opportunities would be supportive to these health promoters' work. This was followed by an informal meeting which provided a valuable opportunity for participants to further network among their peers regarding program challenges, tips, and resources.



In certain areas, the challenges identified by the needs assessment and focus group could be met by services that the SHRC already provides (e.g., resources and training regarding volunteer recruitment, support, and retention; handling group dynamics; and developing fundraising tools). To meet these needs, a compilation of existing resources was developed and mailed to all respondents. To enhance the resources available, BSRC and the SHRC plan to develop a new navigational tool to help health promoters quickly and easily access information and other resources that are key to this work.



An article highlighting research literature in this area will be made available online at http://www.beststart.org to support the development work of those using self-help strategies as part of their maternal, infant and family health promotion efforts.



To support networking, BSRC and SHRC have published a contact listing of 88 local and province-wide programs using self-help/peer-support strategies for maternal, infant and family health promotion. Print versions are currently available and the contact list will soon go online at http://www.selfhelp.on.ca.



On a policy level, both the SHRC and the BSRC will continue to raise awareness about the importance of self-help/peer support in the field of maternal, infant and family health in order to influence policy makers to provide more resources for this type of work and to include it as a requirement within the Ontario government's Mandatory Health Programs and Services Guidelines.



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IV Conclusion



The findings of the scan and needs assessment confirm that peer support is perceived as a very beneficial and essential strategy for diverse populations and needs within the pre/postnatal and parenting periods. Those coordinating this work are very committed to and passionate about its importance for all involved. Although those surveyed were coming from varying sectors and running different kinds of self-help/peer-support programs, there were several common perceptions of the challenges and needs in relation to this work.



The SHRC and BSRC will continue to explore ways to increase opportunities for networking and sharing information between coordinators, provide better access to information about aspects of self-help/peer support and volunteer management, and increase broader awareness of the importance of peer support for the pre/postnatal and parenting periods.



The complete needs assessment report is available at http://www.selfhelp.on.ca in the online resources section.

V References



Ontario Ministry of Health. Mandatory Health Programs and Services Guidelines. Toronto: Ontario Ministry of Health, Public Health Branch, 1997.