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Teenage Pregnancy:
Making the best use of local data sources
10 March 2010
Dilwyn Sheers
Teenage Pregnancy National Support Team, Department of Health
Teenage Pregnancy Unit, Department for Children, Schools & Families
Email: [email protected]
ONS conception statistics
• Conception statistics are compiled by ONS from birth registration and
abortion notification data - both of which are statutory data returns.
• ONS conception statistics provide a robust measure of trends over time and
under-18 conception statistics are used to monitor progress towards local and
national teenage pregnancy targets
• Conception data are available at national, regional, local authority and ward
level
• Annual LA data are released each February. Quarterly LA data are released
at the end of May, August, November and February. Data are disseminated
by TPU on the day of release to all teenage pregnancy co-ordinators. TPU
also provides routine analysis of annual LA data (LA teenage pregnancy
analysis.xls spreadsheet)
• The latest ONS conception statistics can be found on the TPU website:
www.everychildmatters/teenagepregnancy
• Analysis and mapping of ONS conceptions statistics at LA and ward level is
also provided by East Midlands Public Health Observatory (EMPHO)
Why we need to use local data
ONS data good at monitoring trends over time, but does not give a
complete picture:
• Local data can supplement the picture given by ONS data.
Often less robust, but can be more detailed and more timely
• Can inform the targeting of vulnerable groups, geographic
locations or particular institutions
• Allows more timely monitoring of progress and the delivery of
local strategies
• Sharing data and analysis helps to engage partners in the
teenage pregnancy agenda
• Can provide a more powerful and relevant lever for action than
nationally available data
• Provides alternative outcome measures so progress not only
measured by a complex behavioural outcome (teenage
conception)
Current use of local data and analysis
• A growing number of examples of good analysis using local sources
of data demonstrates what is possible. However, a majority of local
partnership areas still identify the use of local data as an issue
where further progress could be made
• Differences between areas in data collection systems, organisational
structures, IT systems, analytical support and attitudes to data
sharing means local solutions are often required
• The latest Teenage Pregnancy self-assessment toolkit (2009)
includes potential indicators, based on local data sources, for
performance managing teenage pregnancy strategies
• Further guidance from TPU/NST on collecting, sharing and
analysing local data sources for teenage pregnancy strategies
available soon
A systematic approach to using local data
Data (A)
• Audit the current availability and collection of data
• Identify any gaps. Are data available from all local partners?
• Are mechanisms in place to share data across agencies?
Analysis (B)
• Estimating teenage pregnancy rates using local data sources
• Analysis for more timely monitoring of the delivery of local strategies
• Analysis to improve understanding and targeting of local strategies
Intelligence (C)
• Is analysis appropriately interpreted & combined with soft intelligence
• Does analysis routinely inform commissioning and planning?
• Is the evidence acted upon and action linked to wider strategies
Potential sources of relevant local data
Organisation
Data
Organisation
Data
PCT PH dept
Hospital episode statistics (SUS) to
identify births conceived under-18
years and NHS terminations resulting
from under-18 conception
Youth
Services/
Connexions
Data on teenage mothers( and
possibly) teenage fathers. Includes
data on employment, education or
training (EET) status; school attended;
educational attainment etc.
Maternity
dept
Births conceived under 18 years
Can include: mother’s date of birth;
postcode; gestation; mother’s country
of birth; previous births; smoking
Status etc.
Schools/
Education
dept
Individual pupil level data including:
educational attainment;
absence rates; free school meals;
provision of PHSE/SRE in schools etc.
Abortion
providers
Terminations resulting from under-18
Conception. Can include: number of
repeat terminations; terminations by
age, postcode area, ethnicity etc.
Children’s
Social Services
and specialist
teams
Can provide data on particular
vulnerable groups, e.g. children looked
after, care leavers, young offenders
etc.
Sexual health
services
Number of young people contacts;
geographical reach of service;
demographic data on service users;
breakdown by contraceptive method;
Chlamydia screening by age etc.
Housing dept
Provision of supported tenancies;
location of housing support etc.
Note: The table above does not provide a complete list of all data that may be available locally
Key principles for data sharing
Experience has shown that sharing data between local partners can often
be problematic. Often a nervousness given the complex legislation and
guidance. But, should note:
•
Most aspects of legislation relevant to data sharing refers to specific data
on individuals. If data effectively ‘depersonalised’ it does not come under
the ambit of the Data Protection Act (i.e. it doesn’t need consent for data
sharing) - therefore, aggregated, anonymised data can be used for
commissioning, strategy development and planning
•
Should also note that better information sharing underpins changes to
children’s services as set out in the Children’s Act 2004 and is encouraged
in the Commissioning Framework for Health and Well-being
•
Use of data sharing protocols, which ensure that confidentiality is not
breached, should be used to formalise the exchange of data
•
Need to recognise that sharing data requires time, effort and possibly
financial resources
Key elements of a data sharing protocol
When sharing data between partners, put in place a data sharing protocol
which has the following elements:
• Context
Outlines key local and national strategies of relevance to the
data sharing protocol
• Purpose
Describes how data sharing will contribute to service
development, performance monitoring and strategic analysis
• Definitions
Defines the specific data items to be shared, named
contact responsible for data collection and frequency
• Security
Outlines the method of sharing data and process for
obtaining consent where required. E.g. secure NHS email
account, encrypted memory stick etc.
• Outputs
Outputs should be depersonalised (by removing
individual identifiers or aggregating data over time or
geography) and data formatted to common software e.g. Excel
Further information on data sharing
•
Data sharing for JSNA (Part 4 of the APHO JSNA Resource Pack):
http://www.yhpho.org.uk/viewResource.aspx?id=1527
•
HM Government Information Sharing Guidance:
A collection of resources for practitioners and managers
http://www.everychildmatters.gov.uk/resources-and-practice/IG00340/
•
ONS Review of the Dissemination of Health Statistics Confidentiality
Guidance:
http://www.ons.gov.uk/search/index.html?newquery=confidentiality
•
Multi-agency working to support pregnant teenagers (April 2007):
http://www.everychildmatters.gov.uk/health/teenagepregnancy/guidance/
Estimating conception rates using local data
Data sources:
1. Maternities: Data from local maternity department(s)/hospital trust(s) IT system
or child health information system
E.g. Sheffield: monthly PROTOS extract since 2002 from Sheffield NHS Trust
Includes: Postcode, DOB mother, DOB child, gestation, birth weight,
occupation, parity, breast feeding and smoking status, BMI, ethnicity.
Births outside Sheffield identified from monthly SUS extract – use 38 wk
gestation estimate
2. Terminations: Hospital Trust data or routine data from local termination providers
(NHS and private). Agreed through SLA with appropriate data sharing protocol
E.g. Sheffield: monthly hospital statistics (ICD O04).
Includes: Sheffield and non-Sheffield trusts, postcode, DOB mother,
date of procedure, miscarriages (ICD O03)
3. Population aged 15-17: ONS mid-year estimates, local populaiton estimates, GP
registered population etc.
E.g. Sheffield: Exeter database – extracts for Sheffield residents registered with a GP
every three months
Advantages: more timely monitoring
SHEFFIELD
Rolling 12 Month ending Feb 2006 onwards. Latest data as at
OCTOBER 2008
Latest ONS data
60.0
50.0
40.0
30.0
20.0
10.0
Conceptions
0.0
Maternities
Abortions
ONS Quarterly (LAD1)
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Rate per 1,000 females age 15-17 yrs
70.0
2002
2003
2004
2005
2006
2007
2008
2009
Year of conception - 12 months ending
Sources: ONS LAD1, Sheffield PHR, In-patient Minimum Data sets and Protos
extract
Public Health Analyis Team (AR), NHS Sheffield
28.10.08
Advantages : Monitoring within LA areas
ALL SERVICE DISTRICTS - RATES
Trends in Under 18s Conception Rates - YEAR of CONCEPTION
Rolling annual rates ending Feb 2006 onwards. Position as at OCTOBER 2008
80.0
Rate per 1,000 females
aged 15-17 years
70.0
60.0
50.0
40.0
30.0
20.0
2006
2007
2008
Mar
Jan
Feb
Dec
Oct
Nov
Sep
Jul
Aug
Jun
Apr
May
Mar
Jan
Feb
Dec
Oct
Nov
Sep
Jul
Aug
Jun
Apr
May
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
0.0
Feb
10.0
2009
Year of conception - 12 months ending
C - Arbourthorne / Manor / Darnall
Sheffield Conception Rate
F - Rivelin to Sheaf
B - Shiregreen / Burngreave
D - Mosborough / Handsworth
G - Hillsborough / Upper Don
Sources: ONS LAD1, Sheffield PHR, In-patient Minimum Data sets & Protos extract
A - Parson Cross / Ecclesfield
E - Greenhill / Gleadless Valley
Public Health Analysis Team (AR), NHS Sheffield
Advantages : Quarterly data by age & outcome
East Sussex births where aged 18 years or less at delivery
18
70
17
60
16 and under
Number
50
Under-18 births in East Sussex
by quarter and single year age
group, April 2006-March 2008
40
30
20
10
0
Q1
Q2
Q3
Q4
Q1
2006/07
Q2
Q3
Q4
Q1
Q2
2007/08
Q3
Q4
2008/09
Period
60
Count
50
Number of NHS funded terminations - BPAS, Jan 07 - March 09
(where aged under 18 at conception)
Abortions resulting from an
under-18 conception in East
Sussex, Jan 2007- March 2009
ESDW PCT
H&R PCT
40
30
20
10
0
Jan Mar
Apr-Jun
2007
Jul Sep
Oct Dec
Jan Mar
Apr-Jun
2008
Jul Sep
Quarter
Oct Dec
Jan Mar
Apr-Jun
2009
Jul Sep
Oct Dec
Advantages : Monitoring relevant indicators
Percentage <18 yr old mothers recorded as Smokers at delivery
2002 to 2006 by Service District.
Smoking status at delivery
by locality in Sheffield, 20022006
70
% of deliveries
60
50
2002
40
2003
30
2004
20
2005
2006
10
SHEFFIELD
Rivelin to
Sheaf
Hillsborough
/ Upper Don
Mosborough
/
Handsworth
Greenhill /
Gleadless
Valley
Parson
Cross /
Ecclesfield
Shiregreen /
Burngreave
Arbourthorne
/ Manor /
Darnall
0
% mothers intending to breastfeed
Source: Protos extracts, Sheffield Health Informatics Service
% Mothers Intending to Breastfeed (recorded at Delivery)
2002 to 2006: SHEFFIELD
Source: HIS (Protos extract)
80.0%
60.0%
40.0%
20.0%
0.0%
<16 years
16 -17 years
Total <18 years
18 and over
2002
45.2%
52.2%
51.0%
70.9%
2003
39.1%
49.3%
47.6%
71.2%
2004
40.0%
43.5%
43.0%
71.8%
2005
52.2%
48.2%
48.9%
73.3%
2006
47.7%
49.8%
49.4%
74.8%
Intention to breastfeed by
age and year, 2002-2006
Advantages: Identifying trends in repeat births
% of < 18 year old Sheffield Deliveries where it was Not the Mothers First
Pregnancy. 2002 to 2007
40.0
% of Deliveries
35.0
30.0
25.0
<16
20.0
16-17
15.0
Total <18
10.0
5.0
0.0
2002
2003
2004
2005
Year of Delivery
Source: Publiic Health Analysis Team (AR), 21.5.08 (Protos data)
extract
2006
2007
Analysis: conceptions in the school year
Sandwell PCT combined birth data from the child health system with data from local
abortion providers to identify timing of teenage conceptions during the school year
140
End of year 11
120
100
Abortions
Births
80
60
40
20
Results showed increasing conception rates (especially those leading to birth)
in months after end of year 11
14~10
14~07
14~04
14~01
13~10
13~07
13~04
13~01
12~10
12~07
12~04
12~01
11~10
11~07
11~04
11~01
10~10
10~07
10~04
10~01
09~10
09~07
09~04
09~01
0
Analysis: Repeat conceptions within one year
The number of repeat under-18 conceptions within a year of the last pregnancy was
estimated in Sandwell using postcode and date of birth as a rough proxy, and assuming
no change of address between conceptions.
25
Birth + birth
Birth + Ab
20
Ab + birth
Number
Ab + Ab
15
10
5
0
<1
1
2
3
4
5
6
7
8
9
10
11
12
Months after end of previous pregnancy
Identified nearly half (49%) of repeat conceptions within a year of the last pregnancy
occurred within 2-5 months.
Analysis: Identifying births by school
M
Sc
ho
ols
K
J
L
Ot
he
r
School attended
H
re
a
Ou
t
of
A
G
F
E
D
C
B
16
14
12
10
8
6
4
2
0
A
Number
South Lancashire used Connexions data on teenage mothers, which included
data on school attended, to identify schools with high numbers of teenage births
Combining school data with local conception data
NHS Sheffield is planning to link CYPD (individual pupil level data) with
teenage births and terminations identified from local NHS systems.
•
Aim: School level analysis of teenage pregnancy rates and associated risk
factors (educational attainment, absence rates etc.)
•
Methodology:
1. CYPD data is extracted for girls aged 11 and over who had been at school
in Sheffield any time between Jan 2005 and Dec 2007
2. CYPD data is formatted then delivered to NHS Sheffield and sent for
batch tracing to add NHS numbers
3. Sourced via PROTOS (the local births data extract) and maternity inpatients, conceptions from Jan 2005 – Dec 2007 are extracted and joined
to CYPD data using NHS number. An anonymised file for analyses will be
constructed
4. Honorary NHS contract set up to release staff from CYPD to NHS
Sheffield to analyse anonymised data without it leaving the NHS systems
5. Analyse data and write report
•
Outputs: Teenage Pregnancy Strategy Board will use the finding to improve
and better target teenage pregnancy prevention and support services.
Using Geo-demographic data
Nottingham PCT undertook an equity audit of the Connexions service by combining
Mosaic geo-demographic profiles with local teenage pregnancy data
Methodology:
To establish need, teenage conceptions from 2003-2005 were grouped by Mosaic profile
based on postcode of residence.
To establish use, postcodes of pregnant women and young parents registered with the
Connexions service in March 2007 were used
Results:
Two mosaic groups accounted for 62% of conceptions (Groups G & F)
Only around one in three teenage mothers were registered with Connexions
Nottingham Equity Audit – mapping the results
Mapping showed equity of
access to the Connexions
Service was generally good, but
also that there were ‘cold spots’
where teenage mothers were not
accessing Connexions
Peterborough: predictive risk profiling
•
•
A predictive risk profile (PRP) assigned a
risk rating to each young person aged
between 5 and 19 based on risk factors for
teenage conception in Peterborough
The profile was adjusted based on feedback
from staff at a local school and a validation
exercise retrospectively checking risk
factors present in girls known to have
conceived
Key Stage 1
High risk
The following data used for the PRP:
 Indices of Multiple Deprivation score for
the young person’s home address
 Attainment - using phase appropriate
attainment scores
 Absence rate (authorised or
unauthorised)
 Current or previous exclusion from
school
 Currently or previously known to social
care
% of Key Stage
-
0.0%
Moderate risk
562
13.0%
No known risk
3762
87.0%
Key Stage 2
High risk
No. of young
people
% of Key Stage
324
3.7%
Moderate risk
1879
21.3%
No known risk
6631
75.1%
Key Stage 3
•
No. of young
people
High risk
No. of young
people
% of Key Stage
242
3.5%
Moderate risk
1207
17.7%
No known risk
5372
78.8%
Key Stage 4
No. of young
people
% of Key Stage
High risk
239
5.2%
Moderate risk
954
20.6%
No known risk
3442
74.3%
Children & young people by risk category and key stage
Service provision by predictive risk profile
Pregnancy options counselling (CaSH, Options)
Children’s Centre
Universal
Support Services
Young People’s Service
Health Visiting
Termination Providers (P&SHFT, BPAS)
Support
Pregnant or
Teenage Mother
195 (16-18s)
253 (16-19s)
TP Midwife
TP Health Visitor
Reintegration Officer
YP Contraception Nurse
Specialist
Support Services
for Teenage
Parents
YPTB Programme - NACRO
YP Housing
Support & Project
Care To Learn Advisor
N.B. Does not include
children without a
school place (WASP),
missing from
education (CME), or
those newly arrived
4327
0-5
8834
6821
5-11
Pre-School
FS
KS2
6947
11-16
Primary
KS1
4635
Secondary
KS3
16-19
19-25
Post 16
Adult
KS4
KS5
Targeted
individuals
identified at risk
Boost
High Risk
481 (KS 3&4)
1002 (KS5)
Substance Misuse Treatment
SHEP
Early Intervention
Moderate Risk
2768 (KS 1&2)
2161 (KS 3&4)
HYPA
PRC (P2P)
LGBT Group
C-Card
Chlamydia Screening Programme
EHC Pharmacy Scheme
No Known Risk
10,393 (KS 1&2)
8814 (KS 3&4)
5945 (KS 5)
Potential to include sexual health
elements in existing work with ‘at
risk’ young people e.g. social
care, YOS, homeless, YIP,
targeted activities programme and
so on
YP’s Contraceptive & Sexual Health Service
School Nursing
Children’s Centre
Play Service
PSHE
Young People’s Service
PSHE
School / College Pastoral Support
GPs, City Care Centre, Pharmacies, GUM
R U Thinking?
Want Respect?
Condom: Essential
Wear
Targeted
localities, schools
etc
Universal
Services (open
access)
SRE provision across all schools
Medway schools analysis
Example from Medway on clearly presenting SRE
provision across all schools within a teenage pregnancy
partnership area
School 1
School 2
School 3
School 4
School 5
School 6
School 7
School 8
School 9
School 10
School 11
School 12
School 13
School 14
School 15
School 16
School 17
School 18
School 20
School 21
School 22
School 23
School 24
Identifying wards with persistently high rates
Example from East Sussex comparing 2000-02 and 2004-06 under-18 conception rates
U18 conception rate for East Sussex wards, 2000-02 and 2004-06
Higher rate than the national 2004-06 rate
160.0
140.0
120.0
Rate 2004-06
100.0
80.0
Any points above the line have seen an increase
since 2000-02 and those below the line have seen
a decrease. The greater the distance from the line
the greater the change in rate.
Central St L
High & increasing
Tressell
Castle
High but decreasing
Sidley
Devonshire
Peacehaven N
60.0
Gensing
England
Hailsham E
40.0
Polegate N
Braybrook
e
20.0
Higher rate than the national 2000-02 rate
0.0
0.0
20.0
40.0
60.0
80.0
Rate 2000-02
100.0
120.0
140.0
160.0
Making it happen….
Medway schools analysis
•
Given differences in partnership arrangements, analytical capacity, IT systems
etc., there is no set way of ensuring that data and analysis effectively informs
teenage pregnancy strategies
•
However, it is clear that making the best use of local data sources requires
resources, partnership working and senior level leadership. In particular,
experience has shown that work usually requires:

A dedicated data lead to develop and deliver a work plan

Establishing a ‘teenage pregnancy data group’ reporting to the teenage
pregnancy strategy group/partnership

Involvement of all partners from the outset

Auditing the availability of local data and agreeing data sharing

Agreeing analysis and outputs

Reporting findings back to all partners

And finally – ensuring evidence is appropriately interpreted, combined with
other relevant intelligence (both qualitative and quantitative) and acted upon