Organisation submitting example
Barnsley Metropolitan Borough Council (BMBC) - Early Childhood Service / South West Yorkshire Foundation Trust (SWYFT) – Health visiting Services / Barnsley Hospital Foundation Trust (BHFNT) - Midwifery Services / BMBC/SWYFT – Family Nurse Partnership / Voluntary Action Barnsley (VAB) - Breastfeeding Link Worker Project / NHS Barnsley - Public Health (Commissioning)
Local authority/local area:
The context and rationale
'Having a baby', is a redesigned antenatal and post-natal parent education programme for women and their families across Barnsley. It involves moving from a centrally-based programme of support (in hospitals) to a more evidence-based, extended programme that is delivered locally through a multi-agency approach and that is tailored to meet the needs of all client groups.
Driver for action – Barnsley context
Barnsley is the 43/354 most deprived local authority in England (Index of Multiple Deprivation (IMD) 2007), and the 4/21 most deprived in Yorkshire and the Humber. Over half the population live in areas that are in the 30% most deprived lower super output areas in the country. Ten percent (4300) of Barnsley children live in the 10% most deprived areas nationally, which impacts negatively on their life chances, putting them at greater risk of poor outcomes.
Evidence indicates that a focus on improving the life chances of poor children is required to tackle the high risk of the intergenerational consequences of child poverty: increased ill health, unemployment and criminal activity, and the subsequent public service cost, estimated at between £10 and £20 billion.
The Child and Family Poverty Needs Assessment and other soft intelligence and cross-directorate/partnership working tells us that to tackle child poverty, we need to support families to achieve financial independence and inclusion through promoting parental employment and skills development, financial capability, and to improve health, education and wellbeing through early intervention.
Although integrated working in itself is not unique, Barnsley is fortunate to have strong partnership arrangements and some excellent examples of integrated working that has positively influenced our commitment to improve services and outcomes for children and families. Integrated working is actively promoted between the local authority, health services and voluntary agencies and this has been underpinned by the development of robust information sharing protocols and a local Healthy Child programme pathway for 0-19 years. Health needs are identified and locally-based interventions delivered to meet these needs.
Basis of idea
Based on local feedback and the emerging evidence and government drivers around early intervention and effective parenting, we identified the need to redesign antenatal and post-natal parent education provision for women and their families across Barnsley (NCHPP 2009, Billingham K, CPHVA 2011).
Pregnancy and the first years of life are one of the most important stages in the life cycle. This is when the foundations of future health and wellbeing are laid down, and is a time when parents are particularly receptive to learning and making changes. New information about neurological development and the impact of stress in pregnancy, and further recognition of the importance of attachment, all make early intervention and prevention an imperative (The National Child Health Promotion Programme - NCHPP 2009). Effective evidence-based preventive interventions in early life can produce significant cost savings and benefits in health, social care, educational achievement, economic productivity and responsible citizenship.
Local antenatal parent education has historically been provided by midwifery services with some input from the Breastfeeding Linkworker project and Oral Health Educator. The majority of the delivery is based within the hospital and delivered by a core team of midwives. The only session not held centrally was a two hour drop-in session at a Children’s Centre provided by the local midwife. The sessions focused on labour and preparing for birth, with little opportunity to allow prospective parents to fully reflect on the physical and emotional demands and the impact on lifestyle, attitude and behaviours required when transitioning into a ‘parent’. The service is currently unable to meet the needs of all families and fails to engage and utilise the skills and knowledge of other partners involved in the care and support of pregnant women, children and families.
Service demand for parent education is increasing and the courses are always oversubscribed. Families can choose the sessions they wish to attend but not every family is able to access a course, whether due to availability, timing or the fact that they are predominantly held within the hospital. Evidence suggested that the families currently accessing this support are not families from our most vulnerable and disadvantaged areas.
Aim of project
The vision was to move from a centrally-based programme of support (in hospitals) to a more evidence-based, extended programme that is delivered locally through a multi-agency approach and that would be tailored to meet the needs of all client groups as demonstrated in the transition plan. (See diagram in Section 2)
The programme we developed has been simply called ‘Having a Baby’ and is underpinned, evidenced and validated by the Department of Health preparation for parenthood resource (2011) and embeds the learning and positive outcomes from the local and national Family Nurse Partnership (FNP) programme:
• child development/neurosciences
• attachment theory
• understanding infant/baby cues
• strength-focused approach
• focus on early intervention, developing realistic expectations re. what parenthood involves and promoting healthy lifestyles from the start.
Reinforcing the above is the 'making every contact count' approach currently being implemented locally. All staff across the children’s workforce are being trained in Motivational Interviewing. This will support the strengths-based approach and the focus on parents making positive choices and changes in behaviour.
To support the universal provision and to build social and community capacity we have developed ‘Maternity Fayres’. These events provide an opportunity to maintain a constant dialogue with communities which will feed into future service development within children’s services and early years. Whether people are just thinking about starting a family, pregnant or have just had a baby, the ‘Fayres’ provide access to evidence-based information, healthy lifestyle messages and support and advice from a range of multi-agency partners and support services.
To support the service redesign, a working party was established to look at current provision, review the evidence base and develop a new model of intervention/service provision. This was a multi-agency approach including midwifery services, health visiting, children’s centres and our local family nurse partnership. The group were fortunate to develop links with the National Department of Health team via Kate Billingham (FNP lead) who were developing the national resource on preparation for parenthood (2011) which validates and supports the approach and direction we have taken.
Description of practice
Following the initial review period, the group developed a scheme of work and a teaching package to support the implementation and roll-out of the ‘Having a Baby’ programme. Once developed, wider consultation with parents-to-be, existing parents and professionals was undertaken to ensure the programme reflected the needs of our community and would meet the outcomes we had set ourselves.
The programme is currently delivered over three modules and a total of eight sessions.
Module 1 - early pregnancy - focuses on how babies develop, including brain development, and culminates in a marketplace event (maternity fayre) promoting local services and healthy lifestyle and wellbeing messages to both parents and the wider family/community, and is aimed at empowering families to make positive changes for themselves.
Module 2 - late pregnancy - preparing for the new baby, emotional impact of becoming a parent, labour and life with the new baby.
Module 3 – post-natal - bonding and attachment, understanding your baby, parenting guidance and support networks available.
At the end of module 3, the attendees are invited to engage in the care pathway/services offered by their local children’s centre, which include baby massage, baby yoga, breastfeeding groups and nutrition/weaning sessions.
The ‘Having a Baby’ programme relies upon a strengths-based approach to enhance and build upon the skills and knowledge already in place, increase parenting capacity and boost self-esteem/self-confidence. As families are engaged at the earliest opportunity, needs will be identified sooner and intervention will be brokered earlier thereby, hopefully, preventing a later reliance on more specialist support. Learning from current provision and also consultation with parents has highlighted the need to provide a flexible, responsive service to ensure fathers/birth partners can attend. Saturday provision or twilight sessions appear to be the most popular and this is being accommodated through our localised and co-delivered programmes.
Evidence and evaluation - making a difference to children, young people and families
Specific outcomes we were aiming to improve were:
• acceptability of the programme for clients
• reduction in no. of women smoking in pregnancy
• reduction in levels of obesity
• reduced maternal/partner anxiety and depression
• increase in breastfeeding rates at initiation and 6-8 weeks
• increase in no. of parents who state they had a positive birth experience
• increase in normal birth rate
• increase in no. of parents who state they felt prepared for parenting
• increased no. of families accessing parent education from Lower Super Output Areas
• no. of families who state they have changed an aspect of their lifestyle as a result of the programme
• improvement in the no. of women having information re. post-natal care and support including skincare, etc.
Evidence so far
In the initial pilot all the families were first time parents.
Both partners attended the course wherever possible, along with one grandparent.
All attendees stated they had changed their lifestyles in some way as a result of participating in the programme i.e. healthier eating, reduced alcohol, becoming more active.
Two fathers reported they had stopped smoking during the course of the programme.
All families reported feeling better prepared for becoming parents.
A grandma-to-be reported feeling better informed re. changes in practice.
All participants reported positive emotional wellbeing post-natally – reinforced by low Edinburgh Postnatal Depression Scale scores.
All families stated they would recommend the programme to others.
50% of those attending were from a Lower Super Output Area (LSOA) of <20% IMD scores with the remaining 50% living in a Super Output Area (SOA) < 50% IMD
• Having A Baby Pilot - 87.5%
• Current Barnsley Rate - 67% (2011-12)
• Having A Baby Pilot - 87.5%
• Current Barnsley Rate - 61.3% (2011-12)
6-8 week continuation rates
• Having A Baby Pilot - 50%
• Current Barnsley Rate - 29%
Registered to and engaged with Children’s Centre programme
• Having A Baby Pilot - 100%
• Current Barnsley Rate - Registrations 67% of which subsequently engaged in CC 34.48% (Snapshot of last 6 months 2011/12)
Cultural change and benefits - Added value/unanticipated outcomes
The programme has led to an increased understanding and appreciation of roles and has strengthened our integrated/partnership working. Our information sharing agreements have allowed us access to the data we need to be able to track the individual families in order to demonstrate impact and outcomes, both in the short term and longer term.
A key unanticipated outcome was the interest and involvement of grandparents in the programme, with one family actively attending the programme alongside the parents-to-be, whilst others supported by attending the marketplace activities along with wider family members. In recognition of this, and following consultation with families, ongoing developments currently being explored will include a bespoke two hour workshop for grandparents-to-be.
The programme has built upon the ethos of community development and increasing social capacity through the promotion of resilience and self-efficacy. This has been achieved through early access in pregnancy to local services and social support via the marketplace event and these have been positively evaluated by families and the wider community.
The success of the initial programme has been recognised locally by commissioners within public health and non-recurrent funding has been secured to roll out the programme across the borough with a view to embedding this approach. This has allowed us to develop a transition plan aimed at full service redesign which will encompass multi-agency training. This will ensure our children’s workforce have the skills and knowledge to support ‘early intervention’ and understand the evidence base which underpins the work they are doing.
The funding has facilitated the recruitment of a parent education coordinator to support the rollout, undertake quality assurance and deliver training. It is envisaged that the role will be mainstreamed within maternity/children’s services in the longer term to ensure the ongoing implementation and replication of the programme’s impact/outcomes. Embedding of the programme across children’s centres as part of Payment by Results has also encouraged us to explore post-natal parent education in more detail. One concept to be further explored and independently researched, is modular delivery of evidence-based parent education at key stages e.g. now I am 3 months, now I am 6 months and so on, where key developmental stages can be discussed as well as specific issues such as health, nutrition, communication and language development and play and stimulation, which are age-appropriate and relevant to the families at that time and delivered in a evidence-based, proactive and preventative way.
Further benefits have been achieved through joint working with specialist providers who are supporting more vulnerable groups, e.g. teenage parents, young offenders and looked after children (LAC), to enable targeted provision to be expanded and rolled out to meet specific clients’ needs. These developments are in their very early stages, but if they prove successful will enable us to demonstrate positive outcomes for our more difficult to engage and vulnerable families.
The work has recently received national recognition and the steering group has been invited to present a workshop at a National Conference : ‘Education for birth and parenthood: Innovations in Practice’, 11 July 2012, University of Worcester.
Helping others to replicate your practice
Learning from experience
To facilitate the roll-out of the programme, a resource pack/toolkit has been developed which includes the scheme of work and resources and tools required to deliver the programme. Training has been delivered across the agencies to ensure staff have the skills to deliver and support the embedding of this way of working. Whilst exploring the transition, what has become evident is a lack of knowledge of some of the evidence base, so further multi-agency training is being planned and co-facilitated to ensure all frontline staff caring for young children and families have the knowledge base which underpins the programme and the early intervention ethos.
The identification of the families to join the programme has been difficult, due to the early stage of intervention. Often the data has not been available electronically because of the early stage of pregnancy and we have been reliant upon the goodwill of midwives to promote and engage families. To resolve this issue, a booking leaflet has been funded and produced to allow parents to self-refer onto the programme on their first contact/booking with midwifery services.
It is difficult to predict the potential savings to services as a result of this service redesign and early intervention. There is increasing evidence that effective health promotion and disease prevention interventions in early life can produce measurable benefits in health, later educational achievement, economic productivity and responsible citizenship. We acknowledge that during the transition phase costs for delivery are actually increased by continuing current provision alongside rolling out the new programme. However, once embedded, the programme will be delivered more locally to a wider number of families and if the outcomes achieved within the pilot prove to be replicable, then the ongoing cost benefits will be significant.
• Unite to succeed – the right support at the right time
• You can do it – promoting resilience
• It takes a community to raise a child – see the bigger picture.
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