Transcript Document

Reach Out:
supporting teenage mothers and young
fathers through children’s centres
Alison Hadley, Director, Teenage Pregnancy Knowledge
Exchange, University of Bedfordshire
[email protected]
Progress on reducing teenage pregnancy
What works to improve outcomes for young parents
and their children
The key role of Children’s Centres in supporting
young parents: some examples of effective practice
Making the case locally
Progress on reducing teenage pregnancy
England progress: 1998-2011
34% reduction in under 18 conception rate
Both maternity and abortion rates declining but steeper
reduction in births of 42%
 >70,000 under 18 conceptions avoided if conception
rate had remained the same as 1998
Lowest conception rate in England since 1969
…concerted and sustained effort makes a difference!
England: under 18 conception rate
1998-2011
50.0
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
1998
1999 2000
2001
2002 2003
2004
2005
2006 2007
2008
2009 2010
2011
Local Progress | 1998-2011
30
20
Percentage change in rate
10
0
-10
-20
-30
-40
England
-50
-60
-70
Top-tier local authorities
Doncaster
Milton
Keynes
Bracknell
Camden
47% LAs have reduced rates more than the England average,
53% less. London has the largest reduction (44%). East and
North West the lowest (30%)
6
Reducing teenage pregnancy:
a reminder of the evidence
Provision of high quality SRE, (Kirby 2007) and
improved use of contraception (Santelli 2008) are areas
where strongest empirical evidence exists on impact on
teenage pregnancy rates
Universal and targeted. SRE and contraception
provision for all, with more intensive support for young
people at risk, combined with additional motivation to delay
early pregnancy – ‘means and motivation’
No evidence that alternative approaches (e.g abstinenceonly education or benefit conditionality) are effective
But partnership is essential for translating
evidence into effective local action
SRE in schools
and colleges
Supporting
parents
to discuss sex &
relationships
Dedicated support
for teenage
parents –
including SRE
and contraception
Young people
friendly
contraceptive &
SH services
Clear and
consistent
messages
to young people,
parents and
pracittioners
Strategic
leadership
&
accountability
Strong use
of data for
commissioning &
Local
performance
management
Workforce training
on SRE
Targeted SRE
and
contraception/SH
support for young
people at risk
SRE & access to
contraception in
youth services
What works to improve outcomes for young
parents and their children
Poor child health outcomes
• 21% higher risk of preterm birth and 93% higher risk for second
pregnancies
• 25% higher risk of low birth weight
• 60% higher rates of infant mortality
Affected by …
• Late booking for antenatal care (on average 16 weeks)
• Three times higher rate of smoking during pregnancy
• A third lower rate of breastfeeding
• Poor maternal nutrition
Poor emotional health and well being
• Three times the rate of post-natal depression of older mothers
• Higher rates of poor mental health for up to 3 years after the birth
• Higher risk of partnership breakdown and isolation
• More likely to live in poor quality housing
Affecting the well being of their children and contributing to:
• Higher accident rates - such as from falls and swallowing substances
• More behavioural problems - conduct, emotional and hyperactivity
problems
Poor economic well being
• 11% of all young people not in education, training or employment are
teenage mothers or pregnant teenagers
• By age 30, 22% more likely to be living in poverty than mothers giving
birth aged 24 or over
• Much less likely to be employed or living with a partner
• Young fathers twice as likely to be unemployed at age 30 – even after
taking account of deprivation
Which also affects the economic well being of their children who have:
• 63% higher risk of living in child poverty
• Lower academic attainment
• A higher risk of unemployment and low income in later life
...but poor outcomes are not inevitable
with effective partnership working
Solution to improved outcomes rests with a range of services working
together – health, education, social care, youth support services, housing,
the voluntary sector and Local Enterprise Boards
•Key ingredients of effective support are: early identification in the
antenatal period, dedicated support from a lead professional –
coordinating and drawing in specialist services as necessary
•Family Nurse Partnership (US Health Led Parenting Programme):
intensive support for young parents from family nurse, from no later than
28 weeks of pregnancy until child reaches two. Expansion to 15,000
places by 2015. Randomised controlled trial reporting in 2014.
The importance of young parents support:
lessons from Ofsted Serious Case Reviews
“In too many cases: there had been insufficient support for young parents”
 Young teenage parents need to be supported in an environment in which
they feel comfortable and supported. Adult centred services may not
achieve this without additional teenage focused services
 Both parents need to be supported. The father is as important as the mother
and they need support to help them become good parents
 There should be a joined up (multi-agency) approach to teenage pregnancy
and teenage parents with every agency understanding their role within it.
 Planned and coordinated transfer of care between midwifery services, health
visitors and GPs is critical
Mind the gap:
the importance of a care pathway
▪ Free pregnancy testing, unbiased advice on pregnancy options and
swift referral to antenatal or NHS funded abortion services
• Sensitive but robust pre-birth assessment in maternity services to
identify and address any problems early
• Tailored antenatal care and preparation for parenthood for teenage
mothers and young fathers, including preparation for postnatal
contraception (20% of births conceived to under 18s are to teenage
mothers)
▪ Clear referral pathway between maternity services and on-going support
services – health visitors, GPs, Children’s Centres or specialist local
service
▪ Dedicated, co-ordinated support on health (including sexual health),
education, housing, benefits and parenting – with more intensive help for
the most vulnerable, and inclusive of young fathers
The key role of children’s centres:
examples of effective practice
The ingredients of an accessible
and trusted service
You’re Welcome: DH quality criteria for young people friendly services
Accessibility: in the right place, open at the right time, near public transport
Publicity: well publicised in places where young people go and by other
professionals
Confidentiality and consent: clear policies for staff and young people
Environment: welcoming and young people friendly
Staff training, attitudes and values: friendly, non-judgmental and
supportive staff
Joined up working: co-location of services if possible but all staff up to date
with information and referral pathways to other relevant services
Monitoring and evaluation by young people
Islington:
mystery shopping of children’s centres:
Young parents have been recruited and trained to assess some of
Islington's children's centre’s against the You’re Welcome criteria and
make recommendations for making the service more welcoming and
responsive to young parents’ needs
Two children’s centre's - New River Green CC and Packington CC have
now achieved 'You're Welcome' accreditation. The young parents were
particularly impressed by the friendliness of the staff and the range of
support the children’s centres offered. Since accreditation, numbers of
young parents visiting the centres has increased.
The young parents' views, gathered through the assessment have been
used in on-going training for CC staff around involving young parents
and to inform work on confidentiality and information sharing to help ensure
consistency and effective inter-agency work
The young parent project is part of Islington’s Young Assessors
Programme, and has the local strategic support of the Clinical
Commissioning Group
Warwickshire:
mystery shopping of children’s centres:
Young parents were recruited as mystery shoppers to assess whether
Warwickshire’s children’s centres core services were meeting young
parents needs and met the You’re Welcome quality criteria
Seven young parents were trained on effective mystery shopping,
making an impartial assessment and providing constructive feedback.
Childrens’ centre managers were sent a letter outlining the purpose of
the project but not told the date of the visit
23 childrens’ centres were visited. Young parents visited in pairs or 3s,
and organised their own transport to assess accessibility of the centre
The young parents used the same questions for each centre to provide
consistency of the mystery shopping evaluation
Two de-briefing meetings were held with project manager. 4 Centres
were revisited.
Hull: integrated support for teenage
parents
• Partnership care: led by dedicated Teenage Pregnancy Support Service
(TPSS) in partnership with midwifery, health visiting, children’s centres, FNP
and contraception nurse
• Early identification through TPSS (which also offers pregnancy testing
and pregnancy options support) and midwifery means majority of teenage
parents access support services early in pregnancy
• Holistic assessment of need - one for young mother, one for young
father. TPSS undertake initial assessment and liase with childrens centres
to develop tailored package of care to address education, employment,
housing, healthy pregnancy, relationships, parenting, referral to FNP
• Group work sessions held in locality children’s centres for young
mothers and fathers on: healthy pregnancy in partnership with midwifery;
parenting sessions in partnership with health visiting and children’s centre
staff. Good take up by both young women and young men.
• On-going support (usually after first 6-9 months of parenthood) transfers
from TPSS to children's centre which young parents are familiar with as
often see TPSS advisor advisor at children's centre
• Named teenage parent lead in all children’s centres for consistency of
care
Warwickshire:
mystery shopping of children’s centres:
 Overall the evaluation was positive. Young parents found the children’s
centres welcoming and the staff friendly and helpful.
 Key issues that needed addressing included: no information about
children’s centres was provided by midwives, health visitors or GPs; not
all children’s centres staff were well informed about the range of
support available at the centre or from other services; the opening times
of the centres 9-3 made it difficult for young parents at college to attend;
there was limited support for young fathers.
 Each children’s centre was given an individual feedback report and an
evaluation form about the mystery shopping exercise
 All children’s centres felt the mystery shopping and feedback was helpful
and motivating – with some asking for additional support to improve
services for young parents.
 All the young parents said they would use the children’s centres and
recommend them to others
Hull: the impact of integrated care
• Improved breast feeding rates
• Reduced smoking in pregnancy/increased smoke free homes
• Improved birth planning and young fathers involvement
• Improved confidence in parenting
• Reduced homelessness/tenancy breakdown
• Reduced safeguarding concerns - prevented need for teenage
parent or their child to become LAC or need a child protection plan
• Improved involvement and support of young fathers/fathers to be
• Reduction of repeat conceptions – 17% reduced to 13%
Blackpool: integrated, coordinated care
for young parents
Dedicated teenage pregnancy midwife for Blackpool
Booking and antenatal care provided at the children’s centre
Teenage pregnancy midwife completes early assessment at booking. Full
details sent to Early Assessment Team
Early Assessment Team reviews individual needs of young parent – drawing
in additional information from other databases. Referral on to appropriate CC.
Children’s centre allocation meeting refers on to additional specialist
services which might be needed. Full family assessment undertaken, liasing
with the midwife to ensure coordinated care during the antenatal period.
Children’s centre provides a dedicated coordinator for the young parent to
provide a single and consistent point of contact.
Service mainly funded by the Local Authority with some joint funding from
health for the teenage pregnancy midwife and a midwife member of the Early
Assessment Team.
Integrated support: an example from
Herne Bay Children’s Centres
▪ All young parents referred by teenage pregnancy midwife at 12 weeks
▪ Antenatal care delivered in children’s centre to coincide with Young
Parents Support Groups
▪ Caseloading and home visits by Young Parents Support Coordinator
liasing with health visitor
▪ Personal development plans agreed with every young parent with support
coordinated across wider services – Early Years Settings, schools, college,
housing, sexual health
▪ Young parents invited to support groups but can choose outreach support
▪ Young parents supported in moving on and accessing other services
Integrated support: an example from
Herne Bay Children’s Centres
The impact of a dedicated integrated service
▪ 37 of 55 young parents now in education/apprenticeship/work. Remaining 18
either in maternity stage or volunteering at the Centre.
▪ All engaged with the children’s centres
▪ Key ingredients of success: single point of contact with simple referral
pathways, all support on site with friendly and trusted staff, well known to local
agencies – and support focused on positive futures
..and transport provided to bring young parents to the children’s centre
Supporting Young Fathers
‘The father is as important as the mother’
Ofsted: Ages of Concern. 2011
Are we nearly there yet, Dad? Supporting young dads’ journeys through
fatherhood. Barnardos. 2012
Recommendations for children’s centres
•Children’s centres should adopt a culture of asking about the father
whenever they have contact with a mother, and keep a record of the young
dads that do attend
•Children’s centres should refer on to voluntary sector services in
the local area that are able to offer specialist support to young dads
•Children’s centres should not assume that young dads will want
to attend the same groups as young mums, but instead introduce targeted
activities such as dad and baby days out and sports events
•Children’s centres should introduce a weekly drop-in clinic for young
dads to address parenting concerns. Staff at the clinic could also signpost the
dads to additional support, for example with housing or employment
Engaging young fathers in partnership
with the voluntary sector: an example
from Southwark
• In Southwark, Working with Men has two projects funded to support young
fathers. One funded through a charitable trust focuses on 1-1 support for
young fathers at risk of becoming NEET. The second, funded by the LA
provides a full time Fathers Development Worker attached to three children’s
centres
• As both projects are in the same geographical area with some overlap of
clients, there is a joint approach to planning events and activities to
strengthen young fathers’ parenting skills, personal development and
aspirations. Engagement with children’s centres is key
• Young fathers are introduced to the children’s centres in a variety of
ways: accompanied visits, attending generic fathers group with the support
worker, or by introduction to other statutory services based in the setting, such
as nursery, health visiting or community midwifery
• Having more than one professional with a specific focus on young fathers
strengthens their trust in using children’s centres and increases staff
awareness and confidence in providing positive support for young fathers
Making the case locally
Supporting young parents: central to
Children’s Centres core purpose
Sure Start children’s centres statutory guidance: for local authorities,
commissioners of health services and Jobcentre Plus (DfE 2013)
The core purpose of children’s centres is to improve outcomes for young
children and their families and reduce inequalities between families in greatest
need and their peers in:
Child development and school readiness;
Parenting aspirations and parenting skills; and
Child and family health and life chances
The core purpose relates directly to the wider duties local authorities have to
improve the well-being of young children in their area and to reduce inequalities
How children’s centres support for
young parents supports wider LA duties
▪ Reducing child poverty: Local authority duty to undertake a needs
assessment and have a plan to reduce child poverty
▪ Narrowing educational inequalities and improving skills and
employability:
Raising the Participation Age – from June 2013, all young people to
participate in education or training until the end of the academic year they
turn 17. From 2015, this will rise to 18.
Statutory Guidance on the Participation of Young People in Education,
Employment or Traning: for local authorities. (March 2013)
▪ Narrowing health inequalities and improving public health: Health and
Wellbeing Boards and Public Health Outcomes Framework
Public Health Outcomes Framework:
indicators disproportionately affecting
young parents and their children
Infant mortality rate (60% higher rates)
Incidence of low birth weight of term babies (25% higher risk)
Maternal smoking prevalence (including during pregnancy) (x3 smoking rate)
Breastfeeding initiation and prevalence at 6-8 weeks (1/3 lower rate)
Hospital admissions from unintentional and deliberate injuries to under 5s
Children in poverty (63% higher risk)
Child development at 2-2.5 years
Rates of adolescents not in education, employment or training (11% of all
female NEETs are pregnant or teenage mothers)
Under-18 conception rate (20% births to under 18s are repeat pregnancies)
Chlamydia diagnosis in 15-24 year olds
Sexual violence (increased risk of sexual exploitation)
Proportion of people in long term unemployment (22% higher rates of poverty
for teenage mothers and twice rate of unemployment for young fathers)
In summary...
Great progress on teenage pregnancy but more to do!
Supporting teenage mothers and young fathers:
-
gives young parents a positive future
-
narrows inequalities
-
reduces child poverty
-
invests in the future health and prosperity of the local area
Children’s centres are key to coordinated and integrated support for
young parents
For more information:
Your local teenage pregnancy statistics
http://www.ons.gov.uk/ons/rel/vsob1/conception-statistics--england-andwales/2011/2011-conceptions-statistical-bulletin.html
Ages of Concern: Ofsted Serious Case Reviews
http://www.ofsted.gov.uk/resources/ages-of-concern-learning-lessons-serious-casereviews
Are we nearly there yet, dad?
http://www.barnardos.org.uk/what_we_do/policy_research_unit/research_and_publicat
ions/are-we-nearly-there-yet-dad/publication-view.jsp?pid=PUB-1900
Statutory guidance on the participation of young people in education, employment or
training
http://www.education.gov.uk/childrenandyoungpeople/youngpeople/participation/g002
22993/stat-guide-young-people-edu-employ-train