Organisation submitting example
Local authority/local area:
The context and rationale
As part of the Teenage Pregnancy Strategy, the Government launched the Sure Start Plus pilot programme in 2001, aiming to improve poor health and social outcomes for teenage parents and their children by providing better antenatal and pos-natal care and increasing involvement in Education Employment and Training (EET). The programme provided funding for the provision of targeted support to this vulnerable group of young people in the 20 local authorities with the highest rates of teenage pregnancy. Rochdale was among these 20 and was therefore allocated funding for a Sure Start Plus pilot project.
Prior to the advent of the Teenage Pregnancy Strategy and the Sure Start Plus grant, services in Rochdale for pregnant teenagers and teenage parents were not coordinated. There was no specific remit for agencies around engaging with teenage parents (TP) and consequently TPs often failed to receive full services due to their disengagement with existing processes. This resulted in late antenatal care, high rates of smoking and lower birth weight babies.
In 2001, Sure Start Plus funding was used to employ 1 full time manager, 1 ½ full time midwives and one ½ time support worker to work specifically with pregnant teenagers and their partners in ways that were more acceptable and accessible to them – e.g. home working and working from community venues and schools.
In 2008, funding for Sure Start Plus ceased. The Teenage Pregnancy Strategy Group was keen to maintain a good quality service for teenage parents and there was a very strong and committed sense of partnership. The challenge for the next 12 months was to maintain the quality of service within the context of changes in the NHS and Local Authority.
The Teenage Pregnancy Strategy Group considered that it was vitally important to the continued improvement of outcomes for young parents that a specialist service be sustained, despite the withdrawal of the Sure Start Plus funding. Once the decision to withdraw Sure Start Plus funding was known, the Teenage Pregnancy Strategic Group began a process of negotiation with partner agencies in order to try to maintain services and agreed that the Teenage Pregnancy Strategy Manager would act as Project Manager through the service transition.
The original aims of the Sure Start Plus pilots were determined by national priorities under the headings ‘Improving Health’, ‘Improving learning of teenage mothers and fathers and their children’, ‘Strengthening families and Communities’ and ‘Improving Social and Emotional Wellbeing’.
They were measured by:
• increase in numbers of pregnant teenagers in contact with health services by 14th week of pregnancy
• reduction in numbers of teenage mothers smoking during and after pregnancy
• increase in percentage of teenage mothers participating in education and obtaining a qualification at NVQ Level 1 or above
• increase in the percentage of teenage mothers who report involvement of their family, father of their child, or partner in their child's upbringing
• increase identification and appropriate support of all teenage mothers with post-natal depression
Each pregnant teenager (and their partner if they had one) received an individual assessment of their holistic needs lasting one hour or more, completed by the specialist teenage pregnancy midwife at the young person’s home or wherever she felt comfortable. Sometimes this led to assessments being undertaken in cafes, schools or friend’s houses at the young person’s request .
The midwives were trained and skilled in asking questions outside the health remit including those about housing, benefits, relationships, education, support networks and childcare. The midwife would be able to complete the necessary hospital paperwork to ensure the young person did not have to attend duplicate appointments, and was also able to perform medical check-ups as necessary. This was entirely different to the service the pregnant teenager would have usually received where she would have been expected to attend the hospital or clinic.
At the initial visit, the midwives would gain consent for the support worker to complete follow-up visits based on the needs assessment. These would frequently be used to assist with filling in applications for benefits and grants, get in touch with other services such to support with specific aspects of the young person’s needs, advocate on behalf of the young person with other organisations, support in continuing to attend school and help with housing issues.
For the first time, pregnant teenagers and their partners were given the opportunity to access an antenatal group specifically for people their age for one afternoon per week at the local supported housing project for young mothers. This was cited as innovative practice in the 2005 Social Science Unit document Reaching Out to Pregnant Teenagers and Teenage Parents.
The other role of Sure Start Plus was to raise awareness of the issues of teenage parents with potential partner organisations and this was carried out by the Sure Start Plus Manager who led on training for partner organisations, supported by the other members of the team. The manager also advocated on behalf of teenage parents with the lead contacts from other services, for example housing and benefits, to ensure that teenage parents were getting a fair deal and that organisations understood their specific needs and issues. Frequently, this meant that where once the organisation would have written the young parent off, they now took the time to be persistent and try harder to engage the young person, eradicating the prevailing “three strikes and out” mentality of the time.
Teenage Pregnancy Strategy Group
The Sure Start Plus programme ran until 2008 and the outcomes achieved against the National priorities by 2007 can be viewed here.
NB: Where proportions are stated they refer to incidence rates.
The Teenage Pregnancy Strategy Manager acted as Project Manager through the service transition and Children and Maternity services commissioners in the PCT agreed to pay the salary of the Teenage Pregnancy Midwife, (due to priorities around antenatal outcomes in this hard-to-reach group).
One of the strategic priorities for Sure Start Children’s Centres was to extend services to the most vulnerable families, including teenage parents, however they had previously had limited success in engagement. The service manager for Children’s Centres agreed to fund the appointment of two young parent workers and create a team which would include two2 Children’s Centre parent empowerment workers whose remit was to engage young parents. The four workers would have parity of status and pay and would have the title ‘Young Parent Support Worker’.
Children’s Centres would also be used to house the team, with one Young Parents Support Worker in each of the four townships of the Rochdale Borough: Rochdale, Heywood, Middleton and Pennines.
A Senior Young Parents Worker, whose remit was the operational management of the team and intensive work with the most complex cases, was recruited on a secondment basis from the Child and Family Support Team and funded and managed by the Parenting Support Team.
In addition, Connexions, who had previously contributed one day a week of three different workers time (to cover three of the four townships), now offered to employ a single worker specialising in teenage parents for three days per week to be co-located with the rest of the team. This post was then made up to full time through LSC funding.
The team is now known as the Young Parents Support Service and the current structure can be viewed here.
The outcomes remain broadly the same as they were for Sure Start Plus and improvements since the reconfiguration have been consistent. The team has gone from having one full time manager, one full time midwife and a half time support worker, with additional support for three days per week (not co-located) from Connexions, to having one full time manager, one full time midwife, four full time support workers and one full time Connexions post in a co-located hub and spoke model. This gives the equivalent of four extra full time posts which frees up the midwife to concentrate on health and increases the capacity to provide extra services, such as groups and education, in addition to one- to- one support.
When a young woman chooses to continue with her pregnancy, she is given the opportunity to be involved with the Young Parent Service, as is the father of her baby. The Teenage Parent Midwife works only with young women who are under 18 at the time of conception and their partners, and is trained to deal with the complexities of young pregnancies. As well as running antenatal clinics and classes, the TP Midwife visits young parents in their home. The Young Parent Workers cover the four townships in Rochdale, offering support through young parent groups and one to one work, addressing any issues affecting young people and parents; benefits, housing, school and relationships. The team’s Connexions Personal Advisers (PA) provide specialist guidance specific to helping young mothers and fathers pursue education, employment and training.
Young people can be seen by one or all of the team on a one off basis, or more frequently, as their needs require. This support continues intensively for young parents up to the age of 18 and usually on a less intensive basis, dependent on need, up to the age of 21. Young parents are supported to access mainstream services during the time they are worked with.
Evidence and evaluation - making a difference to children, young people and families
A review of the new services was conducted in September 2009, one year after the cessation of Sure Start Plus and the inception of the new Teenage Parents Support Service Model. This drew on statistics collected by the TP midwife and on focus groups and interviews completed with young parents.
10.5% (n=11/104) of pregnant teenagers seen in 2007 quit smoking during pregnancy as a result of support by the specialist midwives and smoking cessation service. By 2008, this percentage had increased to 12.5% (n=14/112) meaning that 62% (n=69/112) of pregnant teenagers in this year had either never smoked or had quit before their baby was born.
The number of young women breastfeeding on the labour ward increased from 32.6% (n=34/104) in the final year of Sure Start Plus (2007) to 41.9% (n=47/112) in the first year of the new Young Parents Support Service (2008).
Strengthening families and communities
In 2007, the final year of Sure Start Plus, the proportion of all newly seen pregnant teenagers and teenage parents in Rochdale supported by their parents, extended family or partner was 77.7% (n=80/104). By the end of the first year of the service reconfiguration, this rose to 84.8% (n=95/112) of all teenage parents newly seen in that year.
The Young Mum’s To Be (YMTB) course was run as a part time venture by Sure Start Plus in one of the Children’s Centres. This provision is now delivered in partnership with the local FE college on a full time basis. This will ensure that anyone attending the provision will be classed as EET and increases the capacity of the programme which s now offers qualifications up to level 2.
Of the nine individuals who attended this provision in 2009/10, eight are progressing on to the BTEC Childcare qualification and one1 into an Apprenticeship in Childcare. The number of new starts for September 2010 currently stands at 17. The new programme will be based within the Town Centre Campus of the FE college, rather than in a Children’s Centre, and childcare provision is currently being organised closer to home for these learners. Provisionally, this now has the potential to move 26 NEETs into EET from September 2010.
The Connexions service in Rochdale reports a figure of 50% of young parents aged 16-19 in Rochdale in Education Employment or Training (2011), compared with a national average of around 32%.
Groups and wider support
There is now at least one session of provision specifically for young parents) available in a Children’s Centre in the borough every day from Monday – Friday, compared to the provision offered one afternoon per week by Sure Start Plus. Young parent groups are now hosted at 11 out of the 20 Children’s Centres in the Rochdale Borough. Young people’s antenatal groups are run at a supported housing scheme for young parents, Children’s Centres around the borough and at the town centre hospital, increasing this aspect of provision fourfold.
Voices of young parents
Young parents were consulted via interviews and focus groups. They described the support they had received with practical and health issues, and the emotional support they had gained from the team. Young women reported feeling better supported, having increased opportunities to access education and benefits, and better access to midwifery care during their pregnancies. They appreciated the opportunities for social interaction that the groups provided, and those young fathers who were involved also stated that they benefit from the service provided.
Feedback from service users can be viewed here.
The staff team was given the opportunity to be involved in an action research approach via an away day where they identified areas for development by the team. These included working with young fathers, training all staff in brief in intervention for smoking cessation and training wider professionals (such as non-specialist midwives) in the needs of young parents. The staff also had the chance to look at young parents’ comments and these were evaluated to confirm staff feelings for areas of development or to suggest new ideas. In some cases, it was not possible due to lack of capacity for the young people’s wishes to be carried out. For example, one young woman stated:
“I didn’t want everyone else knowing about my personal pregnancy… I want one midwife I can talk to about it … That will actually be there … not all different midwives...”
(Mother, 18 years old)
In this case, having the information from young people enabled the staff team to think about how they create realistic expectations of the team and how they can train other staff coming into contact with young parents to meet their needs more effectively.
The ongoing evaluation of the work has also enabled wider issues to be picked up by service commissioners. For example, the teenage pregnancy midwife’s statistics showed that the number of repeat conceptions to young mothers aged under 18 was high, therefore the Teenage Pregnancy Strategy Group suggested increased efforts be directed to supporting girls to access reliable contraception via a timely post-natal visit from the teenage pregnancy specialist midwife. The teenage pregnancy midwife received training as a family planning nurse (including fitting contraceptive implants) and was given an extra seven hours per week in which to deliver contraceptive sessions in the home, in conjunction with the PCT Contraceptive and Sexual Health (CASH) service, as part of this commission. This gave young women the chance to discuss contraception in a venue they felt comfortable in and with someone with whom they already had a relationship and whom they would trust to signpost them to other services, something which had previously been identified as a barrier.
In addition, the expertise of the team has been developed and so child protection issues are identified and dealt with earlier, the number of CAFs completed has increased, and support has been offered to young parents who are victims of sexual exploitation, in partnership with the Police, sexual health services and children’s social care.
Services are increasingly connected and incorporate young parents into their mainstream and targeted provision. The partnerships are robust and challenging and the effectiveness of the services continues to be evaluated and developed.
Service Level Agreements with the Hospital Trust (midwifery) and PCT (CASH services) have been implemented and pathways to include services not directly commissioned, but essential to the care pathway, such as the Crisis Intervention/Sexual Health Improvement Teams, have been developed. Links with smoking cessation and public health services have been expanded, and those with mainstream parenting support - Children’s Social Care, the Youth Offending Team, the Voluntary Sector (specifically Rochdale Connections Trust and Action for Children), Sure Start Centres and the Youth Service, have been strengthened.
The Teenage Parents Support Service is now embedded within Rochdale and all services are aware of referral pathways into the team, and the availability of expert advice and guidance for teenage parents. This has enabled schools, colleges and other services to better support this vulnerable group within their own service settings.
The changes made to the team moved the service for teenage parents from external into mainstream funding, thereby providing increased stability for the service and making it sustainable. Support for teenage parents is now seen as a priority in Rochdale and the value added by the Teenage Parents Support Service has been acknowledged. This is evidenced by the service being prioritised to continue despite the local authority cuts, and partners demonstrating full commitment in spite of having to make significant savings. This has included the continued funding of the specialist Teenage Pregnancy Midwife post and the Connexions PA, when other parts of the NHS and Connexions services are taking large financial hits.
In relation to outcomes such as smoking cessation, breastfeeding and group work, the team continues to develop practice in these areas, such as being trained in brief intervention, promoting breastfeeding using the “Be a Star”promotional website and developing groups according to the wishes of young parents, e.g. stay and play, crafts, summer activities, and antenatal and traditional baby clinics. Some young fathers are now engaged in a NEET project delivered in partnership with a local voluntary sector organisation which has increased engagement with this group.
Sustaining and replicating your practice
In 2009, progress against outcome measures was evaluated, using a combination of action research, interviews and focus groups with young parents, and quantitative data. This evaluation was completed by the Teenage Pregnancy Strategy Group and was disseminated to relevant partners. It clearly demonstrated the value of the team in improving both hard and soft outcomes for young parents.
The main costs associated with running the programme are in relation to staff. Buildings, telephone lines and computers are provided in kind through existing structures – mainly the Children’s Centres, but also in appropriate third sector-provided spaces and in the local hospital. The total staff bill for the programme prior to 2011 was in the region of £230,000 per annum. Around £73,000 of these staffing costs are footed by partner agencies. The number of teenage pregnancies leading to a maternity each year is around 120, and young women can be worked with up to the age of 21 years by the team. There are approximately 720 young parents aged between 16 and 21 in Rochdale at any one time, meaning that the programme averages out at £319 per teenage parent per year.
In 2011, the team will be reduced to contribute to the efficiency savings. This will mean the loss of the Senior Young Parents Worker (whose secondment has ended), seven hours of the midwife post and half of the Connexions post, meaning that the staff bill will now decrease to £170,527 per annum and the average cost per teenage parent to £236 per annum.
The transfer of services from Sure Start Plus to the Teenage Parents Support Service was not a cheaper option, but one which recognised the importance of the provision of services to this vulnerable group and which was invested in more heavily as a consequence of this recognition by partners.
Barriers and challenges- 2011
Despite Local Authority cuts, the Supporting Young Parents Service remains relatively unscathed but current financial considerations jeopardise the level of investment and impact on the infrastructure of partnerships supporting this initiative.
Working with young parents in itself can be challenging, but can be overcome by having staff with relevant and mixed experience, a proactive programme of staff development including skills audit, a good management structure and strategic vision. In Rochdale, this has led to a strong team with a diverse skills mix and abundant energy and enthusiasm for the work it does.
Golden Thread 1: The role of the specialist midwife
Golden Thread 2: Sharing a common core of skills
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