Unit 2: Understanding and Using the HOPE Boxes

At the heart of the Giving HOPE offer are the HOPE Boxes, a therapeutic resource co-designed with mothers with lived experience. While the Core Training covered the contents of the HOPE Boxes in detail, this section serves as a refresher. It highlights the core values that should guide their use and points to key considerations when offering HOPE Boxes to mothers facing separation.

In Unit 2, you learnt about:

1. The content of the mother and baby HOPE Boxes, and their meanings.
2. How you and other practitioners might use the contents of the HOPE Boxes to support mother and baby during their journey across the system.
3. How the HOPE Boxes can continue to support mothers and baby with identity and life-story work if court decisions lead to longer-term separation.

The HOPE Boxes’ Content

The HOPE Boxes contain items to support mothers and babies during care proceedings, and provide comfort and therapeutic support going forward, if longer-term separation is the outcome of care proceedings. These items are listed below:

The following items are ONLY in the Mother’s Box

• The HOPE Letter: before showing the HOPE Box to a mother, let her read this letter. Written by our HOPE Mothers, the letter explains the Boxes, their purpose, and that the mother is not alone, to Hold On, as Pain Eases.
• The HOPE Poem: a sealed envelope containing a poem written by the HOPE Mothers offers an opportunity, when the mother feels ready, to connect her to other women who have experienced separation.
• Family Rights Group Leaflet: this leaflet provides a free and confidential advice line for parents with Children Social Care involvement.
• HOPE Leaflet: the leaflet provides information about possible sources of independent advice and support including national helpline numbers.
• Notebook and Pen: As well as offering an outlet for difficult emotions, the notepad may simply help the mother to organise her thoughts or to record the wealth of information she is expected to process at this acutely difficult time.
• Certificate of Life: many mothers will never have a copy of their baby’s birth certificate. Having such mementos of their baby’s birth may help the mother hold on to her maternal identity when her baby is not in her care.
• Baby Bands and Cot Cards: each Mother Box contains replica bands and cot cards for the midwife or another practitioner to complete to ensure that every mother has the opportunity to keep these important items.
• Wisp of Hair Box: to add a wisp of baby’s hair, taken before separation or at a first haircut. This is an intimate and personal memento of her young baby.

The following items are ONLY in the Baby’s Box:

• Foster Carer Letter: included in the HOPE Boxes is a letter to foster carers, explaining the purpose of the Baby Box, and how it can be used to support the child with their life-story work.

The following items are in both Boxes:

• Hello Baby Book: the Hello Baby book has been designed by the HOPE Mothers to help capture important early memories and ‘firsts’ that might otherwise be lost. There is one in each box so that they can be swapped to share information following separation.
• Hand and Footprint Kits: there is a clay cast kit and frame in each box, chosen so mother and baby can keep a print of each other, keeping connection post-separation.
• Inkless Wipes Kits: similarly to the clay cast kits, these wipes can be used to create mementos of hands and footprints.
• SD Cards: SD cards has been added to help mothers and babies hold onto what are often very precious photographs, as well as recordings of the mothers voice.
• The Elephant: the soft elephant toy is a gift; from mother to baby and from the HOPE Mothers to the mother, that can be swapped at family time to trade scents. The elephant is symbolic as elephants never forget.
• Candle and Candle Holders: the candles provide a comforting ritual that the mother and baby can share, no matter how far apart.
• Blankets: the cellular blankets provide comfort and can be used to swap scents, creating a sensory connection. The blankets are rolled by our volunteers with a lilac ribbon, a symbolic colour chosen by the HOPE Mothers.
• Forget Me Not Seeds: A comforting ritual for both, which can provide something for mothers to nurture post-separation. The flower chosen represents the timeless nature of maternal love.

Offering the HOPE Boxes

The way in which the HOPE Boxes are introduced to the mother is key to ensuring a positive impact. Please remember the following points:

• Emphasise CHOICE, that it is up to the mother if she wishes to accept the HOPE Boxes.
• Show the mother the HOPE Letter first, before introducing them to the other contents of the Boxes. Consider whether she may need support to read the letter.
• Emphasise that the HOPE Boxes are not an assessment tool, they are there purely to support her and her baby, and it is the mother’s choice whether to accept and use the Boxes.
• Let her know that the Boxes are resource, but also a gift of support from mothers with lived experience, connecting her to other women – that she is not alone.
• The HOPE Boxes are not a one-time offer, the mother should have the opportunity to change her mind later in her journey.
• When offering the HOPE Boxes, focus particularly on how the HOPE Boxes might support the mother to keep connection to her baby and share information about her baby whilst they are apart.

Using the HOPE Boxes

The items included in the HOPE Boxes are designed to be used during care proceedings, to support connection between mother and baby, and to support long-term life-story and grief work, if long term separation occurs.

The cellular blanket and the soft elephant toy can be exchanged during family time, helping mother and baby to maintain a sensory connection through the smell of one another. This may provide comfort and reinforce a sense of closeness whilst physically apart.

The certificate of life and cot cards offer mothers an important memento, particularly if the mother does not receive a copy of the birth certificate. These items help to affirm her maternal identity.

The HOPE letter is designed to provide connection to other women with lived experience, written by the HOPE mothers. It is a powerful reminder that she is not alone and other women are thinking of her. It also reinforces that she has the choice of whether or not to accept the HOPE Boxes.

The SD card may be used as a more permanent storage of photographs. It also an option for the mother to record herself reading a favourite story or singing a lullaby that can both be played to the baby to help settle in placement but also as an ongoing connection to their birth mother in the event of a longer term separation.

The candles and the forget-me-not seeds provide shared rituals for mother and baby, which provide comfort and connection. The seeds in particular give the mother something to nurture and help grow, which can help maintain a sense of maternal identity post-separation.

Unit 3: Thinking about Trauma, and Trauma Responses

The Born into Care research, which underpins the Giving HOPE Project, highlighted the multiple adversities faced by many parents whose babies are subject to care proceedings. In Unit 3, we explored how trauma affects both parents and practitioners, and why a trauma-informed approach is essential when working with women and babies separated close to birth.

In Unit 3, you explored:

• The wide-reaching impact of trauma and its psychological signs and symptoms, both in mothers and in yourself as a practitioner.
• The specific importance of trauma-informed practice for women whose new-borns are, or may be, subject to care proceedings.
• The diverse ways trauma may present in survivors, and how this can influence their interactions and relationships with you.
• Key skills for supporting mothers who may be emotionally dysregulated.

This knowledge forms a foundation for compassionate, safe, and effective support.

Several frameworks can support trauma-informed care in practice. These include:

1. The Three E’s of Trauma: This framework encourages us to understand trauma by considering the event, the individual’s experience of that event, and the effect it has on their wellbeing.
2. The Four R’s of Trauma-Informed Practice: Practitioners are encouraged to:

• • Realise the widespread impact of trauma,
  • Recognise the signs and symptoms,
  • Respond by integrating this understanding into practice, and
  • Resist re-traumatisation through thoughtful, informed approaches.

Understanding these frameworks can help make sense of a mother’s reactions and behaviours in the context of trauma. This, in turn, can help build connection, offer appropriate support, and provide comfort during a deeply distressing time.

Trauma and adversity can condition strong fight/flight responses and can make it difficult for trauma survivors to manage emotions. As a result, they may develop self-protective behaviours which may be viewed by practitioners as challenging. An approach that is trauma-informed, and trauma responsive, is fundamental in supporting women facing separation from their babies close to birth.

Unit 4: Thinking about Grief and Loss

Many mothers facing separation from their babies experience significant mental health challenges. Compared to other mothers, those involved in care proceedings show far greater health risks, highlighted in the MBRRACE reports.

Feelings of grief and loss, complicated by shame and stigma are common to mothers’ experiences following a separation from their babies, and the HOPE Boxes can be used to help support and comfort mothers, reducing the pain of grief and loss.

Unit 4 covered:

1. The different types and understandings of grief and loss and their relevance to working with mothers and babies separated close to birth.
2. How the HOPE Boxes might be used to support grief and loss.
3. Practitioners’ reflections on using the HOPE Boxes to support grief and loss work.

Whilst research focussing specifically on grief and loss responses associated with separation close to birth remains small, there are important messages to be drawn from other experiences of peri-natal loss, for example miscarriage and still birth. Whilst learning from this research was important in the development of the HOPE Boxes offer, the differences from other forms of perinatal loss are equally significant and underline why a bespoke offer is needed.

Here are some of the key differences:

• Separation often carries heavy societal stigma, leading to a fear of judgement that can make it difficult to access formal or informal support networks leading to isolation. The stigma can also introduce a sense of failure as a parent, intensifying the feelings of loss.
• Interactions with child protection services can create feelings of mistrust or conflict with authorities and can exacerbate feelings of helplessness and frustration.
• Unlike other forms of perinatal loss, separation is complicated by the hope of future reunification. While hope can be healing, it can also make processing grief and loss more difficult.
• Mothers who experience separation from their baby due to safeguarding concerns may face a higher risk of prolonged psychological distress and trigger previous traumas.
• Mothers report receiving less empathetic support from professionals compared to those facing other forms of perinatal loss.
• Being a mother without a baby in your care can be very challenging psychologically and damaging to a mother’s sense of identity. This difficulty can be heightened by the hormonal and physiological changes that pregnancy induces.
• Care proceedings are complicated, stressful and overwhelming processes that place a lot of pressure on a mother during an already difficult time.

Models of Grief and Loss

Three models of grief and loss can deepen our understanding of mothers’ experiences and help guide the sensitive use of the HOPE Boxes, described below:

• Disenfranchised Grief refers to an experience of loss does not have the social validation and support of other forms of grief. Mothers experiencing separation close to birth are stigmatised, and they are often isolated from the support and acknowledgement that other forms of grief receive.
• Ambiguous loss refers to feelings of grief that lack closure and definitive resolution. Separation is a form of loss that maintains possible reunification and therefore can be harder to process.
• Prolonged grief disorder is a psychological condition defined by intense and persistent grief for an extended period of time. While we recommend caution in relying on a overly psychological framework, this concept can help support buy-in if needed.

Each model offers valuable insight into the complex and often hidden nature of grief following separation close to birth, particularly for mothers whose loss is not always publicly recognised or supported.

Unit 5: Looking after Yourself, Supervision and Support

Practitioners often feel insufficiently supported when working with women facing separation from their babies close to birth. The Born into Care research discusses how feelings of burnout and emotional distancing are common in the current system. Compassionate care requires that we sufficiently support ourselves and reflect upon our own needs and experiences.

In Unit 5, we considered:

1. The importance of training, supervision and support.
2. How to consider the impact of this work on your emotional wellbeing and support needs through examples from practitioners.
3. How we can resource ourselves as practitioners.

When reflecting on your support needs, consider the following questions:

1. What do you need from your organisation?
2. How can supervision help?
3. How can peer group learning help?
4. What self-care strategies can you use?
5. How could you build these strategies and techniques into your everyday practices?

Working with trauma-experienced mothers can elicit strong emotions in practitioners, no matter how experienced. Understanding trauma and the impact of trauma can really help us not to take the mothers’ reactions personally and help us to avoid defensive practice. Practitioners need time and space to reflect on their thoughts, feelings and own emotional needs. When considering your own practices, and the HOPE Box Pathway in your area, make space and time to support yourself and your fellow practitioners where you can.