Transcript Document
Feedback to Leicester City from Teenage Pregnancy National Support Team October 11th 2007 To be covered today • • • • • • • • Themes of Teenage Pregnancy Overall Strengths The Scale of the Challenge Issues and Recommendations by Theme Priority Actions Summary of Support Offered Plenary Session Discussion NST Contact Details Themes Themes of Teenage Pregnancy • • • • Strategy Data and Needs Assessment Communication Implementation • • • • • • • Contraception/Sexual Health Advice and Services Delivery of SRE/PSHE Targeted work Workforce training Youth services Raising aspirations Work with parents Overall Strengths Overall Strengths Leadership, Commitment and Infrastructure • • • • • • Renewed high level strategic and political commitment for teenage pregnancy from Local Authority, PCT and other partners with a recognition of the need to accelerate progress. Enthusiasm and energy from front line workers for addressing teenage pregnancy We commend the Teenage Pregnancy Co-ordinator’s commitment and hard work in driving the agenda forward. We endorse the repositioning of the Teenage Pregnancy Team within the Access, Inclusion & Participation Directorate. The appointment of the Joint Strategic Commissioning Lead for Children and Young People is positive and well placed as Chair of Teenage Pregnancy and Parenting Partnership Board (TPPPB). Some good joint working around teenage pregnancy with Leicestershire County. Overall Strengths • • • Strong and well established involvement of the voluntary and community sector. We welcome the intention to maintain Teenage Pregnancy as an indicator in the Local Area Agreement (LAA). The Local Strategic Partnership (LSP) have prioritised improving the achievement of children and young people. Implementation • • • • Good examples of local research and surveys e.g. De Montfort University and Voluntary Action Leicester. Development of independent nurse prescribers able to fit Long Acting Reversible Contraceptive Implants. Local Integrated Service Trial (LIST) has produced some early indication of positive results. Some good examples of targeted work with vulnerable groups, including Nurture Groups in schools, Re-Ach, Stand Up & Speak Out. Overall Strengths Implementation • • • • • There is huge investment in the Building Schools for the Future Programme (BSF). The rate of increase of attainment at KS3 and 4 is better than national average. Big Match Roadshow to match Not in Education, Employment or Training (NEETs) with offers of education, training or work placements. Good support for teenage parents with dedicated joint funded posts e.g. the City PIPS (Parenting Information and Pregnancy Support) team. Young peoples’ active involvement through the Teenage Pregnancy Strategy e.g. Peer Education Programme. Scale of the Challenge Leicester City Performance 2010 target 1998 baseline Under 18 conception rate per 1000 70 Leicester UA 60 England 50 East Midlands LA 2004 target 40 30 20 10 0 1997 1998 1999 2000 2001 2002 2003 2004 2005p 2006 2007 2008 2009 2010 Year The Scale of the Challenge • • • • • In 2005, Leicester City had an under-18 conception rate of 54.3 per 1000 females aged 15-17 – the 3rd highest rate in the East Midlands and 32% higher than the England average of 41.1 per 1000. Leicester City has been given an ‘amber/red’ traffic-light rating based on comparing its actual under-18 conception trend against expected performance in 2005 to reach the 2010 target. There is a more than a sevenfold difference between the wards with the highest and lowest under-18 conception rates in Leicester City. Nearly half (45%) of the Local Authority’s wards are ‘hotspots’ with rates among the highest 20% in England. Highly mobile population. Short term funded projects and posts contribute to instability. The Scale of the Challenge • • • • • • • • • Recent organisational change within PCT and Local Authority has contributed to difficulties or delays in synchronising organisational effort around teenage pregnancy. One of the lowest school attendance rates nationally and high levels of persistent absence. High levels of free school meals. Over 70% of pupils live in the areas that lie within the 30% most deprived nationally. Almost 50% of pupils are from ethnic minorities. Some of the lowest scores in the country for 5 year olds. KS1 results falling over the last two years in reading, writing and mathematics. Substantial regeneration with the potential to create employment opportunities. Raising aspirations is a huge challenge. The issue is complex as there are a range of factors that are associated with whether a teenager becomes pregnant Looked after children / young people leaving care Behavioural problems Disengagement from school / poor attendance Poor educational attainment Sexual abuse in childhood Social deprivation Lack of confidence in resisting pressure to have sex Mental health problems Emotional well-being Low aspirations Cultural influence Low self-esteem Peer influence Parental influence Alcohol/substance misuse More likely to have sex early Teenage Pregnancy Less likely to use contraception Teenage mother Fear of parents/carers finding out Parents and professionals lack confidence to discuss sex and relationship issues with young people Ethnicity Poor and inconsistent contraceptive use among Lack of confidence young people in mainstream health services Young people lack skills and confidence to make and carry through positive choices Lack of easy access to contraception Poor knowledge and skills among young people in relation to sex, relationships and sexual health risks Low knowledge levels among boys and young men Educational attainment has an impact on conception rates over and above the effects of deprivation Deprived wards with higher educational attainment have lower teenage conception rates 2005 leavers who became parents within 12 months of leaving school. 16 14 12 10 8 6 4 2 0 No GCSE's less than 5 GCSE's 5 or more GCSE's 5 or more A-C's st GCSE 54% left school with no GCSE’s a further 31% left school with less than 5 GCSE’s … on sexual activity under 16 70% 60% % sex under 16 60% 50% 47% 46% Males 41% Females 40% 30% 19% 20% 20% 10% 0% no qualifications w ith qualifications Leaving school at 16 Source: NATSAL 2000 Leaving school at 17+ …and on non-use of contraception % no contraception at 1st sex 40% Males 34% 30% Females 28% 20% 12% 11% 10% 6% 8% 0% no qualifications w ith qualifications Leaving school at 16 Source: NATSAL 2000 Leaving school at 17+ Issues and Recommendations Issues and Recommendations Strategy • • • We would recommend the establishment of a small executive board including Chief Executive of the PCT, Director of Children’s Services, Director of Public Health and the strategic lead for teenage pregnancy. This group should be responsible for driving the teenage pregnancy agenda, performance managing the TPPPB and establishing a downward trend in the teenage pregnancy rate. There is a need to establish a clear vision for teenage pregnancy in Leicester City. A visioning planning session for Chief Executives and senior strategic staff would be beneficial. An outcome of this could be a shared set of principles in relation to the objectives of the strategy. - The NST can help facilitate this. Following the visioning process, we recommend a briefing session for all elected members to ensure they are supported to champion teenage pregnancy issues. – NST can help facilitate this. Issues and Recommendations Strategy • • • • There is a need to review the membership, function and level of seniority of the TPPPB and sub-groups to ensure representation from Headteachers/Principals, Governors, Learning Services, Access, Inclusion & Participation, midwifery, contraception and sexual health, Drug & Alcohol Action Team (DAAT), and Further Education Colleges. All members should prioritise their attendance. - NST can advise on roles and responsibilities. The TPPPB should define the long term strategy, performance manage the action plan, monitor outcomes and make investment decisions leading into commissioning and governance. – The NST and RTPC can advise on this and provide support in developing a performance management framework. Following an evaluation of the impact of short term funded interventions, partners need to address sustainability and mainstreaming. Utilise existing local research to inform commissioning and service delivery e.g. the De Montfort evaluation. Issues and Recommendations Strategy • • • The Teenage Pregnancy Executive Board and the TPPPB need to foster a philosophy of reducing teenage pregnancy being everybody’s responsibility, and avoid over-reliance on the Teenage Pregnancy Coordinator to drive the agenda forward. The Teenage Pregnancy Co-ordinator post needs to be placed at a sufficiently senior and strategic level to engage the commitment of senior colleagues and partners and integrate teenage pregnancy into the wider agenda. – RTPC and NST can provide advice. We recommend identifying teenage pregnancy champions amongst elected members, Head Teachers, Principals and school/college governing bodies. Issues and Recommendations Strategy • • There needs to be consideration of the effective involvement of young people in the development, review and implementation of the Teenage Pregnancy action plan. We welcome the commitment to maintain teenage pregnancy as an indicator in the Local Area Agreement. Issues and Recommendations Data and Needs Assessment • • • There is a need to prioritise data collection and analysis and review the capacity to ensure that this happens. Prioritise the development of a common data set for use by all partners based on the Teenage Pregnancy Unit (TPU) Data Toolkit and building on the recommended East Midlands teenage pregnancy data set. – NST can advise on this. We would recommend the establishment of a data set for every school and college that includes, for example, up-todate teenage pregnancy rates, terminations, ethnicity and post codes - to inform School Improvement, headteachers, principals, governors and the community. This should inform and support appropriate Sex and Relationship Education (SRE) and Personal, Social, Health & Citizenship Education (PSHCE) programmes in schools and colleges. – NST can advise on this. Issues and Recommendations Data and Needs Assessment • • There is potential for analysis combining data collected from different local agencies to inform the targeting of interventions e.g. combining Connexions, school level and other sources of data. – NST can provide support with this. There is a need for an up-to-date local young people’s sexual health needs assessment to identify the most vulnerable groups and hotspot areas. This should feed into the commissioning process on an ongoing basis. We recommend using the NST Sexual Health Needs Assessment ‘How to’ Guide. – NST can provide examples. Issues and Recommendations Data and Needs Assessment • The TPPPB have plans which are positive, to implement work using the social marketing model in order to understand the needs of young people in Leicester City. This work needs to inform the commissioning of services for young people and especially the most vulnerable. - The NST can further support this work through the Social Marketing Unit in the National Consumer Council commissioned by DH. Issues and Recommendations Communication • • • • It is important to develop a comprehensive teenage pregnancy communication strategy. - NST can provide examples of communication strategies and comment on draft strategies. There is a need for regular and systematic communication between the TPPPB, subgroups and those delivering and receiving services and interventions in a variety of professional and service user settings. The communications strategy needs to include an effective reactive and proactive media handling strategy. Clear and consistent messages need to be targeted at parents, carers and young people most at risk, including those in BME and faith communities. Issues and Recommendations Communication • • • The communications strategy should include advertising the availability of sexual health advice, information and services to young people using different media and ensure materials are regularly updated. We would recommend using the national TPU communications CD ROM “R U thinking campaign toolkit” to help communication of the local strategy and publicise the availability of national and local resources and services. We would recommend making full use of the forthcoming national media roadshow (13th December 2007, venue to be confirmed by RTPC) to help with local implementation of the national media campaign. Issues and Recommendations Implementation – Contraception/Sexual Health Advice & Services • • • There is an urgent need to improve access to sexual health services for young people. There needs to be a clear Contraception and Sexual Health Joint Commissioning plan informed by a comprehensive needs assessment. - NST can provide support with this. We acknowledge that there are a range of community based sexual health services for young people e.g. Community Safer Sex Projects, Choices, Beaumont Leys and St Peter’s. We recommend that you review these as part of the commissioning plan and ensure a comprehensive range of services. Services need to be delivered to ‘You’re Welcome’ quality standards, and with the flexibility to be delivered in a range of settings e.g. through Extended Services, 14-19 sector, youth services, community pharmacies and general practice. Issues and Recommendations Implementation – Contraception/Sexual Health Advice & Services • • • • We suggest integrating ‘You’re Welcome’ with the Information, Advice and Guidance (IAG) quality standards which will encourage multi agency working. –The Northwest is developing this. The NST can link Leicester City with this work. All commissioned services need to have clear Service Level Agreements and be performance managed. Regular monitoring information needs to be provided to the TPPPB. We welcome plans to involve young people, using existing groups, in service development, design, review and implementation, e.g. mystery shopper, patient panels. - NST can provide examples. The NST understand that the PCT and UHL is about to purchase an IT system for the Genito-Urinary Medicine (GUM) and contraceptive services. This is essential for improving the reliability of data and therefore capturing the information required for accurate demand and capacity calculations. Issues and Recommendations Implementation – Contraception/Sexual Health Advice & Services • • • There is a need to ensure that the extensive Building Schools for the Future (BSF) programme is utilised to develop a range of venues for delivery of contraception and sexual health advice and services. All pregnant teenagers and teenage mothers should be automatically referred to, and followed up by contraceptive services. - NST can provide examples There is a need to ensure that the commissioning of termination services includes contraception advice and provision of a full range of contraceptives, including Long Acting Reversible Contraception (LARCs). Issues and Recommendations Implementation – Delivery of SRE/PSHCE • • • • Senior management in the Local Authority should provide clear, proactive direction and support to schools to deliver quality PSHCE and SRE with confidence. The partnership groups, including the 14-19 Partnership Group and the Education and Improvement Partnership, offer a good mechanism for working with secondary schools and colleges. There is an over reliance on the Healthy Schools Coordinator for the delivery of the Healthy Schools Programme. Healthy Schools is a key delivery mechanism for SRE/PSHCE and this aspect should be actively promoted and supported through all schools and by every partner. There needs to be clear management and lines of accountability for the National Healthy Schools Standard (NHSS) and SRE staff. Issues and Recommendations Implementation – Delivery of SRE/PSHCE • • • A comprehensive review of all SRE provision is needed to ensure the wide range of SRE initiatives complement each other, to develop practice and policy frameworks, to develop a forward plan which utilises existing routes to schools/college including Learning Services, NHSS, drug and alcohol education. - NST can provide support. As part of the review, the capacity to support SRE should be looked at, including the capacity of the SRE consultant and how SRE is being promoted by all agencies who support schools, including Learning Services. School nurses should play an integral role in the delivery of SRE in line with national guidance. There is a need to review the capacity of school nurses to fulfil this important role and ensure that they have received training and development opportunities to achieve this. - The NST can provide examples of prevention work through schools nurses from other areas. Issues and Recommendations Implementation – Delivery of SRE/PSHCE • • • We recognise that there are a number of local SRE policies, e.g. Youth Services, Connexions, Children in Care. We recommend that a Leicester City-wide SRE approach incorporating policy, training and schemes of work, is developed for schools, post 16 provision and all agencies working with young people to ensure consistency and quality standards. This should incorporate existing local and national guidance. – NST and RTPC can help with this. In accordance with government guidance, all SRE should be culturally appropriate and all policies consulted upon with parents and carers. – NST can provide examples from other areas. We suggest that it is important to formally recognise and celebrate local examples of good practice. Issues and Recommendations Implementation – Targeted Work • • • • • There is some evidence of work with Black and Minority Ethnic (BME) groups and refugee and asylum seekers. This needs to be developed further e.g. SRE with faith communities, addressing female genital mutilation, forced marriage. – NST can offer advice. There is a need to understand conception rates in vulnerable groups, such as Children in Care and Care Leavers, in order to plan targeted SRE and sexual health services and the prevention of second and subsequent pregnancies. – NST can offer advice. There is a need for a consistent co-ordinated approach to early identification of young people at risk. Risk indicators for preventing teenage pregnancy need to be incorporated into the Leicester City Common Assessment Framework (CAF). – NST can offer advice. There is a need to ensure that the Lead Professional addresses teenage pregnancy issues. There is an opportunity through the development of LIST to develop targeted preventative work to address reducing teenage pregnancy. Issues and Recommendations Implementation – Workforce Training • • All those working with young people, including the voluntary sector and faith communities, should have ongoing skills training in relation to talking about sex and relationships to young people, ranging from basic sexual health awareness and signposting training to more advanced training for those working with the most at risk groups. This should be integrated into the corporate workforce strategy and should be mandatory where appropriate. - NST can provide models of training including tiered training. There is a need to review and develop the capacity of the contraception and sexual health services workforce to deliver universal and targeted access for young people. Issues and Recommendations Implementation – Youth Services • • • • Youth services have an important contribution to make in terms of raising aspirations, building self-esteem and focusing on positive activities for young people through Integrated Youth Support Services. We support the review of the Youth Service including planning for Integrated Youth Support Services (IYSS) and Targeted Youth Support (TYS). This should specifically address the role of youth services to deliver the Teenage Pregnancy Strategy and clearly define expectations, roles and responsibilities to ensure a consistent approach across the city. A more joined up approach between Youth Services, Connexions and the Voluntary and Community sector is needed to reduce teenage pregnancy. There is a need to co-ordinate and build upon the good examples of positive engagement and participation of young people. The issue is complex as there is a range of factors that are associated with whether a teenager becomes pregnant Looked after children / young people leaving care Behavioural problems Disengagement from school / poor attendance Emotional well-being Poor educational attainment Social deprivation Mental health problems Low aspirations Low self-esteem Peer influence Alcohol/substance Parental misuse influence Teenage Pregnancy Teenage mother Poor and inconsistent More have s Issues and Recommendations Implementation – Raising Aspirations • • • • It is important for the Local Strategic Partnership and all partners to emphasise the interconnectedness between teenage pregnancy, improving aspirations of young people and the agenda for economic regeneration. This could be incorporated in the local Community Cohesion Strategy through the Community Strategy. Lack of aspiration needs to be addressed through all strategies currently targeting young people and parents and carers. Young people should receive consistent messages from all professionals to raise their aspirations. There is an opportunity to use Social & Emotional Aspects of Learning (SEAL) in secondary schools as a vehicle for developing this area of work. Issues and Recommendations Implementation – Work With Parents & Carers • • • The Leicester City Parenting Strategy and existing parenting programmes need to incorporate SRE so that parents and carers feel confident to address young peoples’ sexual health issues. We recommend that Children’s Centres, Early Years and Extended Services prioritise education for parents and carers on how to talk to their children and young people about SRE, prevention of teenage pregnancy and raising aspirations. The good work on support to teenage parents needs to continue with a strong focus on prevention of second pregnancies. Priority Actions Priority Actions Strategy • • Establish a small executive board; review the membership, function and level of seniority of the TPPPB; and the positioning of the Teenage Pregnancy Coordinator post. – RTPC and NST can provide advice. Following an evaluation of the impact of short term funded interventions, partners need to address sustainability and mainstreaming. Data • There is a need to prioritise data collection and analysis and review the capacity to ensure that this happens. This is particularly important for schools and colleges. – NST can advise on this. Priority Actions cont… Implementation • • • Develop a Contraception and Sexual Health Joint Commissioning plan informed by a needs assessment with clear SLAs and a performance management framework to ensure a comprehensive range of services delivered to ‘You’re Welcome’ quality standards. - NST can provide support. Senior management in the Local Authority should provide clear, proactive direction and support to schools to deliver quality PSHCE and SRE with confidence. Review all SRE provision to ensure the wide range of SRE initiatives complement each other, to develop practice and policy frameworks, to develop a forward plan which utilises existing routes to schools/college including National Healthy School Standard, drug and alcohol education. - NST can provide support. Priority Actions Implementation • • • School nurses should play an integral role in the delivery of SRE in line with national guidance. Review the capacity of school nurses to fulfil this important role and provide training and development opportunities to achieve this. - The NST can provide examples of prevention work with schools nurses from other area. The review of the Youth Service including planning for Integrated Youth Support Services (IYSS) and Targeted Youth Support (TYS) should specifically address the role of youth services to deliver the teenage pregnancy Strategy and clearly define expectations, roles and responsibilities to ensure a consistent approach across the city. It is important for the Local Strategic Partnership and all partners to emphasise the interconnectedness between teenage pregnancy, aspirations and economic regeneration incorporate in the local Community Cohesion Strategy. Summary of support Summary of the Support Offered Strategy • • • • • There is a need to establish a clear vision for teenage pregnancy in Leicester City. A visioning planning session for Chief Executives and senior strategic staff would be beneficial. An outcome of this could be a shared set of principles in relation to the objectives of the strategy. - The NST can help facilitate this. Following the visioning process, we recommend a briefing session for all elected members to ensure they are supported to champion teenage pregnancy issues. – NST can help facilitate this. Review membership, function and level of seniority of the TPPPB and subgroups to ensure representation from Headteachers/Principals, Governors, Learning Services, Access, Inclusion & Participation, midwifery, contraception and sexual health, Drug & Alcohol Action Team (DAAT), and Further Education Colleges. All members should prioritise their attendance. NST can advise on roles and responsibilities. The TPPPB should define the long term strategy, performance manage the action plan, monitor outcomes and make investment decisions leading into commissioning and governance. – The NST and RTPC can advise on this. The Teenage Pregnancy Co-ordinator post needs to be placed at a sufficiently senior and strategic level to engage the commitment of senior colleagues and partners and integrate teenage pregnancy into the wider agenda. – RTPC and NST can provide advice. Summary of the Support Offered Data • • • • • Prioritising the development of a common data set for use by all partners based on the Teenage Pregnancy Unit (TPU) Data Toolkit and building on the recommended East Midlands teenage pregnancy data set. – NST can advise on this. We would recommend the establishment of a data set for every school and college that includes, for example, up-to-date teenage pregnancy rates, terminations, ethnicity, post codes, to inform School Improvement, headteachers, principals, governors and the community. This should inform and support appropriate SRE and PSHCE programmes in schools and colleges. – NST can advise on this. There is potential for analysis combining data collected from different local agencies to inform the targeting of interventions e.g. combining Connexions and school level data. – NST can provide support with this. There is a need for an up-to-date young peoples sexual health local needs assessment to identify the most vulnerable groups and hotspot areas. This should be considered as an ongoing process to feed into the commissioning process. We recommend using the NST Needs Assessment Guide. – NST can provide examples. The TPPPB plans to implement work using the social marketing model in order to understand the needs of young people in Leicester City are positive. This needs to inform the commissioning of services for young people and especially the most vulnerable. - The NST can further support this work through the Social Marketing Unit in the National Consumer Council commissioned by DH. Summary of the Support Offered Communication • There is a need to develop a comprehensive teenage pregnancy communication strategy. - NST can provide examples of communication strategies and comment on draft strategies. Implementation • • There is an urgent need to improve access to sexual health services for young people. There needs to be a clear Contraception and Sexual Health Joint Commissioning plan informed by a comprehensive needs assessment as current provision for young people is limited and fragmented. - NST can provide support with this. We suggest integrating ‘You’re Welcome’ with the Information, Advice and Guidance (IAG) quality standards which will encourage multi agency working. –The Northwest is developing this. The NST can link Leicester City with this work. Summary of the Support Offered Implementation • • • • We welcome plans to involve young people, using existing groups, in service development, design, review and implementation, e.g. mystery shopper, patient panels. - NST can provide examples. All teenage mothers, pre and post natal, should be automatically referred to, and followed up by contraceptive services. - NST can provide examples A comprehensive review of all SRE provision is needed to ensure the wide range of SRE initiatives complement each other, to develop practice and policy frameworks, to develop a forward plan which utilises existing routes to schools/college including National Healthy School Standard (NHSS), drug and alcohol education. - NST can provide support. School nurses should play an integral role in the delivery of SRE in line with national guidance. There is a need to review the capacity of school nurses to fulfil this important role and ensure that they have received training and development opportunities to achieve this. The NST can provide examples of prevention work with schools nurses from other areas. Summary of the Support Offered Implementation • • • • We recognise that there are a number of local SRE policies, e.g. Youth Services, Connexions, Children in Care. We recommend that a Leicester City-wide SRE approach incorporating policy, training and schemes of work, is developed for schools, post 16 provision and all agencies working with young people to ensure consistency and quality standards. This should incorporate existing local and national guidance. - NST and RTPC can help with this. In accordance with government guidance all SRE should be culturally appropriate and all policies consulted upon with parents and carers. – NST can provide examples from other areas. There is some evidence of work with Black and Minority Ethnic (BME) groups and refugee and asylum seekers. This needs to be developed further. e.g. SRE with faith communities, addressing female genital mutilation, forced marriage. – NST can offer advice. There is a need to understand conception rates in vulnerable groups, such as Children in Care and Care Leavers, in order to plan targeted SRE and sexual health services and second pregnancy prevention. – NST can offer advice. Summary of the Support Offered Implementation • • There is a need for a consistent co-ordinated approach to early identification of young people at risk. Risk indicators for preventing teenage pregnancy need to be incorporated into the Leicester City Common Assessment Framework (CAF). – NST can offer advice. All those working with young people, including the voluntary sector and faith communities, should have ongoing skills training in relation to talking about sex and relationships to young people, ranging from basic sexual health awareness and signposting training to more advanced training for those working with the most at risk groups. This should be integrated into the corporate workforce strategy and should be mandatory where appropriate. - NST can provide models of training including tiered training. Plenary Session Discussion • Local Authority and PCT to comment • Questions to clarify feedback points • Comments on Feedback • Any comments on our process • Next steps Teenage Pregnancy National Support Team Contacts Avril Howarth National Delivery Manager [email protected] 07776 244 485 Sarah Carter Associate Delivery Manager [email protected] 07884 473 182 Dane Wiig Project Officer [email protected] 020 7972 3051 NST Office address : Room 221 Wellington House Director’s Office address Cathy Hamlyn Room G18, Richmond House 133-155 Waterloo Road Whitehall London SE1 8UG London SW1A 2NS Fax 020 7972 4700 Fax: 020 7210 5438