Luton Parenting Education Programme: Luton STEPP (Strengthening Together Every Parenting Partnership)

Themes this local practice example relates to:

  • Early Years
  • Families, Parents and Carers
  • General resources

Basic details

Organisation submitting example

Luton Borough Council/NHS Luton

Local authority/local area:

Luton Borough Council/NHS Luton

The context and rationale

The aim of this partnership project is to develop a whole system parent education programme underpinned with a staff training/education and audit model. The project will assure professionals that parents have access, across the locality, to a range of effective, quality assured programmes that meet the needs of Luton families.

The Luton Maternity Services Liaison Committee (MSLC) highlighted concern that parents had reported inconsistent support and advice from professionals across the locality that lead to confusion, lack of trust and disengagement with services. In response to the concerns raised agreement was reached to develop a whole system parenting education programme for parents in Luton. It was agreed the format of the programme would be based on the Department of Health (DoH) model Preparing for Pregnancy Birth and Beyond and delivery of the Healthy Child Programme. It is envisaged that the programme will:

• bring together all parental courses/support sessions delivered across the locality under one umbrella to ensure quality and efficiency
• ensure equity and consistent support and advice across the locality
• be underpinned by a training/education and audit model
• be supported by referral pathways
• support aligned clinical pathways.

Responsibility for the development of Luton's Parent Education Programme sits within the Maternity Services Quality Innovation Productivity Prevention plan. The plan has been agreed and developed with all relevant stakeholders e.g. health, social care, voluntary organisations, local community, and education. 

Luton has the fifth highest fertility rate in England – 80.6 births per 1000 women aged between 15-44 years of age. In addition, Luton has a very young population – approximately 28% of the town’s population is under 19 years of age whilst 8% of the population is under 4 years of age (based on current projections these figures will increase by 2021). On the Income Deprivation Affecting Children Index (IDACI) Luton has 16 areas amongst the 10% most deprived in England. Luton also has an ethnically diverse population with approximately 35% of the population comng from Black and Minority Ethnic (BME) communities, whilst 43% of children aged 0-15 years are from Black and Minority Ethnic (BME) origin.

In Luton, around 20 babies under the age of one year die each year (5.6 per 1000 live births – 2008). Over the last decade Luton has seen an improvement in infant mortality rates (IMR) but there are real disparities between the different Luton areas with the IMR in the more deprived areas being 6.2 per 1000 live births compared to 3.9 per 1000 live births in the least deprived areas. The Luton Children and Young People’s Trust, supported by Public Health have an evolving action plan that determines the direction to reduce the infant mortality status in Luton. A proportion of this work is dependent on high quality maternity care provision and a strong collaboration between organisations and agencies.

Knowledge Base
The National directive for maternity care stipulates the framework for developing contemporary maternity services. 
• The National Service Framework (NSF) for Children, Young People and Maternity Services sets out the shape for the delivery of maternity services for all women and their families, which will enable the best start in life for every child. The NSF sets the standard for developing high quality, supportive, flexible services and places the woman and child at the centre of service design and delivery. A key theme of the NSF is ensuring that services are equally accessible and tailored to meet the needs of all women, especially those who are more vulnerable or disadvantaged. The aim is to give women and their families a wider choice of type and place of maternity care, thereby creating an environment that supports and encourages women to have as normal a birth as possible in a place of their choice.

• Maternity Matters reinforces this vision focusing on four national choice guarantees that will be available for all women during pregnancy, labour and birth as well as throughout the postnatal period.

• Healthy Lives, Brighter Futures strategy is to ensure that parents get the information they need to support their children’s health and ensures that the right services, support and advice are available for all parents, and that more intensive support is given to the most vulnerable. 

• The NHS Operating Framework priority is ‘keeping adults and children well, improving their health and reducing health inequalities’.

• The Healthy Child programme promotes the health and development of children and supports parents to protect and promote their children’s health. A multi-disciplinary health and agency approach facilitates the programme and directs the pathways. 

• To provide women with easy access to standardised, safe, equitable, supportive, high quality parent education services, designed around their individual needs and those of their babies and responsive to cultural diversity of the local population.
• To reduce health inequalities.
• To provide advice on and embed good parental healthy lifestyle choices (e.g. nutrition, obesity, smoking cessation, alcohol consumption, infection and infant care including feeding).
• To provide women and their partners with knowledge and skills to prepare them for parenthood in line with best practice standards and improve parent/child relationships.
• To be conversant with clinical outcomes, which will inform future planning of services ,as well as direct the training and development agenda. This will engender a positive approach to knowledge and skills acquisition by health professionals appropriate to service needs.

• Improve the health and well being of women, babies and families in Luton.
• Promote an awareness of health problems caused by obesity and promoting a healthy lifestyle for women and families.
• Improve health outcomes for vulnerable women and their families, including teenage parents.
• Increase access to pre-conception support and advice for all women, in particular for women with existing medical conditions, such as diabetes.
• Reduce the number of women smoking during pregnancy and after baby’s birth.
• Increase access by parents to ‘preparing for parenthood’ education.
• Enhance choices for women – where to receive antenatal/postnatal care. 
• Support women’s decision making about infant feeding choices.
• Increase breast feeding initiation supporting continuation of breastfeeding and increasing breast feeding prevalence at 6-8 weeks.

The practice

A project management approach was adopted in partnership with local systems that included development of a project charter, terms of reference and governance framework.

A steering group was set up to oversee the implementation of the project and monitor all performance milestones. The steering group includes representation from NHS Luton; Luton Borough Council; Cambridge Community Services; Luton & Dunstable Hospital NHS Foundation Trust; Voluntary organisations; and Children’s Centres. Governance for the group will be via the Maternity Services Liaison Committee and Child Health Steering Group.

The steering group agreed an action plan to develop a parent education programme spanning an age range of 0-19 years. The programme is split into three sections namely, 0-5 years; 5-10 years and 10-19 years. The group has focused on the 0-5 years section and completed the antenatal stage of that phase. Ongoing development relates to modules for birth-5 years; 5-10 years and 10-19 years.

The action plan identified work leads and trajectory for completion of key milestones that included:
• Complete gap analysis/mapping exercises to identify what parent education courses/sessions are being delivered across Luton, where and by whom. Complete cost analysis to evidence value for money.
• Agreed format of the programme based on DoH model Preparing for Pregnancy Birth and Beyond and delivery of the Healthy Child Programme.
• Agreed programme sections to consist of 0-5 years; 5-10 years; 10-19 years.
• Agreed a phased approach to the roll-out of the programme. Phase 1: 0-5 years, Phase 2: 5-10 years and Phase 3: 10-19 years. 
• Agreed to focus on Phase 1 the 0-5 years section. Phase 1 would provide the governance framework and format for the whole programme. It is envisaged that Phases 2 and 3 would ‘bolt on’ to Phase 1 to complete the education programme.
• Agreed format for lesson plans for each education session to be based on national/local guidance to ensure quality of key messages.
• Secured funding for ‘branding’ of the programme.
• Agreed audit programme to ensure delivery of a quality service.
• Agreed outline of training and education model to ensure all staff are appropriately trained, have the necessary skills/competency to deliver the programme.
• Develop clinical, referral and patient flow pathways to underpin the work. These pathways 
ensure staff, once trained, would know why, how and where to refer the families for additional expert support. 
• Align clinical and referral pathways and agreed matrix for management of pathways. 
• Align Luton STEPP Key Performance Indicators (KPIs)/Outcomes with Early Intervention KPIs/Outcomes and reporting of same.

Phase 1: 0-5 years Section
The outcome of the mapping exercise highlighted areas of best practice across children’s centres and specifically in established antenatal classes. Building on this success the group agreed the format of the lesson plans would be based on the existing evidence based midwifery led antenatal classes to Luton parents. Two group members, a Children’s Centre Manager and a Public Health Lead, were key to the delivery of this work that included:
• The number of sessions and content included in Stage 1: the antenatal education section of the programme.
• Proposed facilitator e.g. Midwife, Health Visitor, Children’s Centre Staff.
• Guidance for facilitators
- Learning outcomes
- Key messages 
- Proposed tasks
- Materials required to deliver the session.

Lesson Plans
From the outset the intention was to develop a simple format that does not make excessive demands on the programme facilitators whilst providing key information and guidance for running the sessions to ensure quality of the messages delivered whilst allowing flexibility for the facilitator’s ‘style’ of delivery. An example of an antenatal breastfeeding lesson plan is available from the C4EO team at the NFER

It was believed that the branding of the programme would influence parent’s ‘up-take’ of the education sessions.

• A consultation exercise was undertaken with parents attending children’s centres across the locality to gain their views of the proposed programme format and potential programme name. The programme format was supported by parents and a group of teenage parents proposed Luton STEPP, Strengthening Together Every Parenting Partnership, as the programme name, which was formally adopted by the Steering Group.
• Funding was secured to work with a designer to develop a programme logo and artwork for each section. Parents were consulted and this influenced the final design of the programme sections.
Synchronised development of the birth to 5 years sections was crucial. This work is ongoing and includes input from all members of the steering group. It is anticipated that the Phase 1: 0-5 years section will be completed by end March 2013.

As this project is still in its infancy a cost analysis has not as yet been completed. The steering group agreed there was a need to undertake a ‘mapping’ exercise of all current parent education sessions/courses currently held across Luton. The aim is to reduce duplication, identify evidence-based sessions/courses that meet KPIs, improve outcomes and implement a process to align with the proposed Children Centre Payment by Results scheme if/when it becomes mandatory. A comparison of current provision versus the proposed education programme will be undertaken to evidence value for money. It is intended that this work will be completed by end March 2013.

Evidence and evaluation - making a difference to children, young people and families

In line with the agreed plan to adopt a phased roll-out of the programme, the antenatal education section of the programme is currently provided in 10 children’s centres across Luton’s five neighbourhood areas. The services are offered 6 days per week including one evening session.
The alignment of the Luton STEPP KPIs/Outcomes with Early Intervention KPIs/Outcomes and reporting of the same is still under development. Evidence of impact on key outcome measures are available from the C4EO team at C4EO team at the NFER 

Helping others to replicate your practice

We aim to ensure that the needs of children, young people and families who experience poor outcomes are identified early and that those needs are met by agencies working together effectively and in ways that are shaped by the views and experiences of the children, young people and families themselves.

Our intention is to align this initiative with other key Luton Borough Council initiatives namely, Team Around the Family and Troubled Families. Adopting an integrated approach we will align the key strategies to encompass both health and local authority service outcomes together with each organisation’s national and local performance indicators. It is envisaged that the team will develop a partnership performance report for this initiative.
Joint working will assist with the breaking down of professional barriers, improve communication, efficiency and enable successful working together by skill sharing and reducing variation in clinical practice across different access points of the care system.

Challenges have included:

• Completion of work in line with agreed timescale caused some concern due to existing workload and conflicting priorities. It became clear that ‘work leads’ struggled to deliver agreed tasks and required assistance with realignment of priorities. This realignment was addressed at the Steering Group as part of the re-evaluation of the action plan’s priorities.

• Undertake a comprehensive mapping of parent education programmes currently being delivered (over the past 12 months), to gain a clear understanding of the principles and outcomes of each parenting programme. This has proved to be a huge commitment and the group has struggled to complete the work within the agreed timescale. The steering group has secured the services of an assistant to undertake the work as a mini project.

Core Leadership Behaviours 
The following eight core behaviours have been identified as part of successful elements of leadership (see National College for Leadership of Schools and Children’s Services/C4EO (2011). Resourceful leadership: how directors of children’s services improve outcomes for children. Full report. Nottingham: NCSL see here

All of the eight leadership behaviours below apply to this project.

1. openness to possibilities

2. the ability to collaborate

3. demonstrating a belief in team and people

4. personal resilience and tenacity

5. the ability to create and sustain commitment across a system

6. focusing on results

7. the ability to simplify

8. the ability to learn continuously.

The key to the success of this project has been due to the strong collaboration between the stakeholders and the development of the governance framework which included processes governing project leadership and performance reporting. The project has not been without its challenges and the team has consistently demonstrated the ability to anticipate and avert problems that would jeopardise achieving the objectives. Steering Group members were committed to championing the project’s cause, and has proven to be the supporting driving force. Led by the project manager, the group has maintained focus on the desired outcomes by prioritising competing responsibilities and completing the work within the resource available. 

C4EO Golden Threads
The C4EO Golden Threads for this example are:

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