Recurrent Care Resource Pack: Overview

Published: 22/05/2019

Part of the working with recurrent care-experienced birth mothers resource pack. This section contains an overview of the learning activity including exercises, presentations and learning modules.

Exercises, presentations and learning modules – Overview of learning activity

Section 1: Setting up a service: Messages from research, understanding the local picture and getting going


Learning activity



50 minutes

Exercise 1: Setting the scene: A journey though current provision, using a case study

By thinking about current provision and access to services that women may encounter, this will help build understanding of what the local requirements might be in relation to effective provision for vulnerable parents experiencing recurrent proceedings. The instructions for the exercise are in the resource.

  • Copies of the Amy and Chantelle case studies.
  • Instructions for the exercise.
  • Flipchart paper.
  • Pens or Post-its.

70 minutes

(45 minutes presentation)

(10 minutes film)

(15 minutes reflection/ discussion)

Animated PowerPoint presentation: Birth Mothers and Recurrent Care Proceedings

Film 1: Turning Points: Birth mothers and journeys to change

Presentation introducing research findings from Lancaster University’s research into Vulnerable Birth Mothers and Recurrent Proceedings, presented by Claire Mason. This is followed by a short film of some of the mothers talking about their experiences. (The key points or messages from the study are set out in the resource.)

  • Computer and projector, or large screen.
  • Animated PowerPoint presentation.
  • Film 1: Turning Points: Birth mothers and journeys to change.
  • Key points from the Lancaster study (printed out or on screen).

45 minutes

Exercise 2: Identifying local need

This is to ensure current knowledge about local need is shared and that gaps in information are identified, together with ways of filling those gaps. (During the exercise, or as part of feedback, refer to the Tips from Practice in the resource.)

  • Flipchart paper.
  • Pens or Post-its.
  • The 4 questions to be answered:
    • What do you know already?
    • What do you suspect?
    • What do you need to find out?
    • How can you find out?
  • Tips from Practice (these are set out alongside Exercise 2 in the resource).

45 minutes

Exercise 3: Mapping of services (using case studies and a template)

To develop your thinking about how the response to vulnerable parents in your area experiencing recurrent proceedings can be improved. This involves revisiting the journey map(s) and case studies from Exercise 1 and using a template to record relevant local services that should be retained, services or processes that should be introduced, and services or processes that should be stopped.

  • The visual journey map(s) through services (from Exercise 1).
  • Case studies of Amy and Chantelle (from Exercise 1).
  • Copies of the template ‘Sustain, Start, Stop’.
  • Instructions for the exercise.

50 minutes

Exercise 4: Developing your service

By referring back to the research messages about the different needs of parents caught up in recurrent care and the potential points of intervention, this is an opportunity to think about:

  • Where you might best focus your efforts.
  • What your service would do, and how.
  • Who (ie, professional partners) needs to be engaged.
  • What steps you might take to start the process of service development.

Using a template to prompt thinking, start to record some details about what an effective service response might look like.

  • Two slides (one about need, one about points of intervention) either displayed on a screen or printed off.
  • Copies of the template ‘Designing Your Service’.
  • Pens.
  • Copies of the Tips from Practice on ‘Developing your service’, including ‘Getting going’ (printed out or displayed on a screen).


Section 2: Setting up a service: Evaluation and cost benefits


Learning activity



40 minutes

Presentation: Key points about evaluation

A presentation to help you think about the importance of evaluation at the earliest opportunity (ie, from the start of developing a service), some of the challenges in evaluation, and methods of evaluation.

  • 5 slides: Key points about evaluation.
  • Notes to the slides (these are in the resource).

60 minutes

Presentation: Evaluating local services to reduce recurrent care – examples of two approaches to evaluation

This presentation gives details of two evaluations carried out by Essex University. It covers methods, findings and the ways in which the messages from an evaluation can be used.

  • Slides: Evaluating local services to reduce current care (Positive Choices and PIMHAP).
  • Key learning points from the Evaluating local services presentation (these are in the resource) printed out or displayed on screen.

45 minutes

(15 minutes presentation)

(30 minutes exercise)

Presentation: Outcomes and how to measure them

Exercise 5: Outcomes and how they might be measured

A presentation and exercise to help identify desired outcomes. It covers:

  • Distinguishing between outputs and outcomes.
  • Outcomes for individuals.
  • Outcomes for services.
  • Making use of logic models or theories of change to help with your thinking.
  • Ways of measuring outcomes.
  • 5 Slides: Outcomes and how to measure them.
  • Notes to the slides.
  • Flipchart paper, pens or Post-its.
  • Copies (printed out or displayed on screen) of the list of potential outcomes (‘prompts for discussion’ in the resource).

30 minutes

Exercise 6: Costs, cost effectiveness and cost benefits

This looks at different ways to identify costs and the difference between cost-effectiveness and cost benefits. It includes suggestions of sources of information about costs.

  • 1 slide ( Costs, cost effectiveness and cost benefits).
  • Copy of the notes to go with the slide (these are in the resource).
  • Flipchart, pens or Post-its.

25 minutes

Exercise 7: Review your service model

An exercise to review your service model in the light of thinking about outcomes and how to measure them. It will help you think about what a logic model or theory of change for your service would look like, and to consider data collection and resources and capacity needed for evaluation.

  • The template(s) (‘Designing Your Service’) completed in Exercise 4.
  • Logic model outline.
  • Pens.
  • ‘Key points from this section’ (these follow Exercise 7 in the resource) to prompt discussion and reflection.


Section 3: Workforce development: Reconceptualising ‘non-engagement’ – attachment and complex trauma and its impact; trauma-informed approaches to service design and direct practice



Learning activity



40 minutes

( an optional extra 10 minutes)

Learning Module 1: Reconceptualising non-engagement (attachment)

(4 short films, with optional additional time for reflection and discussion)

The films cover how non-engagement is viewed by professionals, where the reluctance to engage may come from, and how an understanding of attachment theory can help with understanding non-engagement.

  • Films 2, 3, 4, 5.
  • Computer and projector or large screen.

30 minutes

(Learning Module 1) Exercise 8: Understanding non-engagement and attachment through a case study

This exercise uses a case study to explore how an attachment perspective might help in responding to the mother. It will help put into practice learning from the messages given in the four short films.

  • Copies of case study of Tina.
  • Flipchart, Post-its or white board for noting down any key points.
  • Instructions for the exercise.

25 minutes

( an optional extra 10 minutes)

Learning Module 2: Reconceptualising non-engagement (complex trauma)

(1 film, with optional additional time for reflection and discussion)

The presentation explains complex trauma and its impact. It discusses the potential problems arising from a failure to take account of complex trauma, and how its impact can lead to non-engagement or hostile behaviour from parents. It concludes with the basic principles underpinning a trauma-informed approach.

  • Film 6.
  • Computer and projector or large screen.

30 minutes

( Learning Module 2) Exercise 9: Understanding non-engagement and complex trauma through a case study

A case study for you to consider how the information about complex trauma helps you understand this mother’s interaction with services. Does it help you to think about a different approach?

  • Copies of the case study of Amy.
  • Flipchart or white board to record key points from discussion.
  • Pens.

32 minutes

(or 55 minutes if two films being watched)

Learning Module 3: Trauma-informed approaches in recurrent care

(1 film – or 2 films if being done on a different day to Learning Module 2, in which case re-watching Film 6 is recommended)

This film presentation gives information about trauma-informed approaches and discusses how they can be applied in services and interventions for vulnerable parents experiencing recurrent care proceedings.

  • Film 7 (and possibly Film 6).
  • Computer and projector or large screen.

30 minutes

(Learning Module 3) Exercise 10: Thinking about trauma-informed approaches in your work

This is an exercise to help you think about how to put learning about trauma-informed approaches into your practice. Thinking about the presentations on complex trauma and trauma-informed approaches, and taking account of the Tips from Practice (on how the messages from the presentations above can inform practice and service development) discuss how this information might inform your practice and the development of your service.

  • Flipchart paper.
  • Pens and Post-its.
  • Access to, or copies of, the additional resources and links in Background reading.
  • Display or print off ‘Tips from Practice’.


Section 4: Workforce development: Understanding complex grief and the impact on mothers of removal at birth


Learning activity



35 minutes

Learning Module 4: An overview of research, policy, law in relation to removal at birth

(3 films)

These films will enhance your understanding of mothers’ perspectives on removal at birth, the legal framework governing removal at birth, and of loss and grief in the context of recurrent care.

  • Films 8, 9 and 10.
  • Computer and projector or large screen.

45 minutes

(Learning Module 4) Exercise 11: Removal at birth – reviewing local practice

An exercise to discuss and review current practice – in particular, to consider the need for a protocol for pre-birth assessment, think about links between midwives and children’s social care, and discuss availability of placements for mothers and babies locally.

  • Flipchart paper.
  • Pens or Post-its.
  • Prompt questions (printed out or displayed on a screen).

30 minutes

Learning Module 5: The experiences of birth mothers whose babies are removed at birth

(1 film)

A presentation giving the experiences of mothers through photographs and their own words.

  • Film 11.
  • Computer and projector or large screen.

30 minutes

(Learning Module 5) Exercise 12: Understanding the impact of removal at birth

An exercise to reflect on the mothers’ experiences (Film 11) and reflect on your own experiences and those of others in the group. It will also help you reflect more generally on the impact on professionals as a whole.

  • Notes from the resource on prompts.
  • Post-its, flipchart, pens.

25 minutes

Learning Module 6: Supporting isolated women in the perinatal period

(1 Film)

A film presentation from Birth Companions about their work (by volunteers) supporting women in prison and vulnerable women in the community to prepare for birth and removal at birth. The film draws on feedback from the women and the volunteers.

  • Film 12.
  • Computer and projector or big screen.

45 minutes

(Learning Module 6) Exercise 13: Consolidating your learning to optimise your service

A consolidation exercise to help you reflect on and discuss all the film presentations about removal at birth.

  • What is the learning from the presentations?
  • How will it inform service development and practice?

(Take account of the Tips from Practice.)

  • Flipchart paper.
  • Pens or Post-its.
  • Tips from Practice (either hard copies or displayed on screen).


Section 5: Setting up a service: Learning from other recurrent care services – 13 case studies


Learning activity



45 minutes

Reading about recurrent care services

To get a sense of the different approaches currently being taken to the issue of recurrent care.

  • All the information in Section 5 of the resource.

I hour

Reviewing progress on developing a service

This is an opportunity to review and discuss what you have learnt so far and the progress you have made in developing your service.

  • Information from the completed exercises.
  • Information in the resource (particularly Tips from Practice).
  • Theory of change or logic models developed by you.
  • Service outlines developed.


Professional Standards

PQS:KSS - Relationships and effective direct work | Communication | Adult mental ill health, substance misuse, domestic abuse, physical ill health and disability | Promote and govern excellent practice | Developing excellent practitioners | Effective use of power and authority