Thurrock Community Mothers

1. Thurrock Community Mothers Growing Skills Growing Confidence Growing Communities Addressing health inequalities by transferring health skills to the community itself

2. ‘My health visitor’s an angel but I couldn’t tell her if I wasn’t coping’ Comment from a local mother Mothers supporting mothers Local people promoting health and early parenting skills within their own communities

3. A Community Mother: • Is informal and non-professional • Shares her experiences, insights and ‘street cred’ • Offers a semi-structured monthly home visiting programme that promotes health and parenting, to ALL local parents with young children

4. Professionals can’t do it on their own Parent-to-Parent Non-stigmatising Informal easy access Partnership working Complements professionals – doesn’t replace

5. Community Mothers improve public participation Parents coping with low income & multiple stresses are at greater risk of being ‘outside the system’: • Difficult to engage • Statutory services don’t easily adapt to their needs • May not seek help • Less able to cope • Suspicion of professionals ‘Health for All Children’ Fourth Addition. David M.B. Hall & David Elliman. Oxford University Press 2004

6. Community Mothers: Rigorous recruitment procedures are crucial Relationships are at the heart of support: “It’s not just about what helpers do it’s also the characteristics of the helper and the relationship developed” Supporting Parents: Messages from Research Prof.David Quinton publ . By Dept of Health and DfES 2004Jessica Kingsley

7. Began 1991: TilburySmall Beginnings • First pilot in UK • Tentative partnership between health visitors & local mothers • Regional Health Authority Quality Assurance Grant • Gradually grown

8. Community Mothers Team Thurrock2005 • Shop Premises: Tilbury High Street • F/T Specialist Nurse co-ordinator • 7 P/T CM Development Workers • 6 P/T Community Mother / Breast Feeding Supporter employees • 20 CM and BF volunteers • Administration staff

9. Semi-structured monthly home visiting programme Health focused basic skills learning support 600 parents supported a year Breastfeeding support

10. Secondary prevention Multi-agency referrals of parents in difficulty Primary Prevention Community Mothers ‘work the patch’ intensively within targeted disadvantaged areas: • Personal visit offered to all new births & parents moving into the area Plus Outreach to Homeless and Travelling Families Skeleton Service only: Rest of Thurrock (referrals only)

11. Operates across Thurrockbut targeted to less advantaged areas Population: 135,000. 300 CM referrals and 300 breastfeeding referrals a year

12. The Recipe

13. A Community Development Programme In the community Outreach By the community Mutual learning Community Participation Builds local skills “The Community Mothers Programme has a national reputation for excellence in the direct delivery of assistance, support, health promotion, learning opportunities, parenting skills, and personal health skills for parents of young children. Its purpose is to address health inequalities by transferring health skills to the community itself.” External Evaluation of Thurrock CMP 2003 Anglia Polytechnic University

14. Outreach & Primary Prevention • Developing early parenting skills • Promoting health: practical & real life context • Nipping early difficulties in the bud • Building confidence • Promoting self help • Early access to health & other services • Access to health information: developing literacy & numeracy skills • Identifying community views & needs

15. Particularly helps parents with: • Low self-esteem • Depressed / isolated / unsupported • Children generally under stimulated • Difficulties coping • Relationship issues • Vulnerable: Parents with past experiences of being poorly parented

16. The Core Home Visiting Programme • High quality semi-structured home visits to other local parents with young children • Visiting materials enable a purpose, direction & focus to each visit • Parents identify own needs • CM & parent explore solutions together • CM enables parent to set own ongoing achievable monthly targets

17. Cartoon illustrated information materials are key to success • Several shared during each visit • Non threatening • Trigger discussion • Overcomes literacy issues • Reminders after the visit Cartoons cover important health and parenting topics. The way they are shared with parents is crucial.

18. ConfidentialityWhat we share together, we keep amongst ourselves

19. Community Mothers receive high quality accredited training Level 2/ 3 Breastfeeding Supporter Introductory Training Programme Level 2 CM Introductory Training Programme Levels 2-4 City & Guild Basic Skills Tutor qualification training pathway Level 3 CM / BF Ongoing Training Programme TESTING NATIONAL OCCUPATIONAL STANDARDS NATIONAL QUALIFICATION

20. CM volunteer to employment pathways Basic Skills Tutors Community Mothers’ Trainer Smoking Cessation Advisers Volunteer Co-ordinator Programme Development Workers Breastfeeding & Community Mother Employees HUGE POTENTIAL FOR FURTHER HEALTH & SOCIAL CARE LOCAL WORKFORCE DEVELOPMENT

21. New off shoot projects have developed in response to the local health needs identified • Breast Feeding Supporters • National Skilled for Health Demonstration Site • Queen’s Nursing Institute Innovation Award to develop outreach to homeless and travelling families

22. Identifying local health needs: Low breastfeeding rates Breastfeeding Supporters introduced in 1995 Mothers requested: • Someone with TIME to give them the help that they needed • More discussion about breastfeeding during the antenatal period • Help with getting the baby attached properly • More information about breastfeeding difficulties and how to overcome them • More contact with other local mothers who are breastfeeding • More home support

23. South Ockendon Breastfeeding Supporters • % of babies being breastfed at 10 days has increased from 24% to 37% (England and Wales: 54%) • BF Supporters particularly help with building low confidence and providing reassurance about frequent feeding patterns

24. Comments from a mother “Had it not been for your support I probably wouldn’t have breastfed my two children at all. I remembered everything from our meeting, which made me determined to keep going!! Out of 9 women in the family I feel very proud that I was the only one who did breast feed. Thank you!”

25. Identifying local health needs: low literacy and numeracy skills National Skilled for Health Pilot 2003 • CMs qualify as basic skills tutors • CMs provide health focused basic skills tuition to excluded parents in own homes • Parents gain access to new health information & services • CMs provide awareness training to front-line health workers • Cross-agency partnership with Thurrock Adult Community College

26. Evidence base & evaluation • 1994 Thurrock Programme local evaluation published Health Visitor Journal • Series of local audits • Continuously externally evaluated since 1998: University of Essex & APU • Dublin CMP: randomised controlled trial published BMJ 1993 & follow-up Journal of Public Health Medicine 2000

27. Improves: Child immunisations Breastfeeding rates Family nutrition Stimulation of children Maternal positive feelings Language development Child safety Health literacy Access to services Reduces: Isolation and depression Child behaviour difficulties Some outcomes

28. Thurrock CMP National Research Project Assesses the Value of a Standardised Evaluation Package for 10 CMPs Operating Across the United Kingdom What works best, for whom and in what circumstances? Results 2006 Funded by the Health Foundation

29. AWARDS • 1993 Essex Area Child Protection Committee Award for Innovative Practice • 1995 Regional Health of the Nation Healthy Alliances Award • 1997 Thameside Community Healthcare NHS Trust Gold Quality Award [Breastfeeding Supporters] • 1997 Professional Practice Development Nurse Forum National Achievement Award • 1999 Queens Nursing Institute Innovation Award • 2000 European Mental Health Strategy Network: one of 6 international models of good practice • 2004 One of 4 European Social Inclusion Projects submitted by Health Development Agency • 2005 Health Enterprise East Innovation Award

30. Delivering ‘Choosing Health’ • Tackles health inequalities • Helps to reduce smoking • Tackles obesity • Improves mental health and wellbeing • Promotes healthier, safer and stronger communities • Develops the local workforce • National Skilled for Health Pilot

31. Choosing Health: Community Mothers synergy with ‘Health Trainer’ model “..a shift in public approaches from ‘advice on high to support from next door’… health trainers will be drawn from local communities” The role will provide opportunities for local people to take the first step on a Skills Escalator…..” Health Trainers need to: • Work with people who professionals have traditionally found hard to reach • Understand the realities/ context of people's lives • Enable easy access to local services

32. [CHOOSING HEALTH: Regarding HEALTH TRAINERS] The skills escalator: “The strategy extends opportunities for the NHS to use its economic power in the local community as a force for regeneration, creating jobs for local people that in turn support improvement in the health across the communities they come from”

33. Obstacles

34. COMMUNITY DEVELOPMENT A model that is not well understood within the statutory health care setting…..

35. Professional control verses community ownership Medical model verses social model Reactive care verses preventative care Short term gain verses long term gain Tokenism verses genuine partnership Tensions within practice development as an NHS led service

36. Insecure Funding Need to mainstream

37. Co-ordinator Overload Professional resistance Lack of local professional input Crisis intervention takes priority Lack of understanding about the practicalities

38. “Quality and training of staff is vital to programme success, as is good support and supervision”A Review of the International Evidence. Policy Research Bureau for DfES No 578 (2004) Professional support is vital: • Monitoring and facilitating • Taking professional action when needed • Clarifying & reinforcing programme boundaries • Delivering the accredited training programme • Developing partnership projects • Preparing and managing bids • Encouraging referrals from co-professionals • Evaluation and dissemination

39. MOVING UPWARDS & ONWARDS!

40. We are planning to build the infrastructure at local level • How to replicate to areas of Thurrock not currently benefiting • More cross agency professional involvement / partnerships • Further development of CM NHS employment roles • Children’s Centres & CM partnerships • Mainstreaming & sustainability • Explore new provider delivery structure

41. Developing the service delivery model: At the moment Thurrock CMP: • Runs ‘set up’ training for new programmes • Has set up a national co-ordinator network • Sells implementation guides • Sells visiting and cartoon resources • Develops new cartoon resources • Transfers their home grown Open College accredited training programme • Now 40 programmes across UK & growing

42. Need to build the infrastructure to disseminate at national level • Protect the quality: disseminate good practice • More robust implementation & support package for all programmes • Cartoon resource co-operative across programmes • National evaluation package: ready 2006 • National CM qualification framework

43. Meeting the increasing demand: Develop a new partnership between Thurrock PCT & a national charity with the capacity to help us take forward the national agenda

44. “The Community Mothers Programme has a central role to play in the future provision of services to families living in deprived areas and will be an important means of reducing health inequalities and promoting social cohesion” External Evaluator [APU] Comments 2003