Teen Parent Conference 24 th September 2014

1. Teen Parent Conference 24th September 2014

2. Timeline • Nicky Skerman Clinical Leader Hawke's Bay Plunket. nicky.skerman@plunket.org.nz • Plunket Nurse Teen Parent Unit • 2010 Master of Nursing thesis • 2011 Vodafone Foundation Pilot • 2012 Overseas Visit Australia,USA and Canada looking at services for teenage parents • 2014 Business as usual

3. Teenage mothers often struggle to cope with the demands of caring for a baby as well as many other complex issues while they are making the transition from adolescence to adulthood. They require additional support from family, partner and services to achieve positive health outcomes. ( Whan, Nissen &Alberg, 2005)

4. Plunket ……

5. Well Child/Tamariki Ora service • There are many other smaller organisations in New Zealand who provide the balance of well child services. • With the current service the Well Child/ Tamariki Ora Nurse receives a referral from the midwife when baby is 4 weeks old and visits the mother and baby by the time baby is 6 weeks old. • This service continues free of charge until the child is 5 years old.

6. Master of Nursing Thesis • What do teenage mothers want from the well child / Tamariki Ora service?

7. Themes ….. • Theme one: The Contact the Teenage Mother had with the Well Child / Tamariki Ora service. • Theme Two:The Information Received • Theme three: Attitudes Towards Teenage Mothers • Theme four: Respect and Caring

8. Recommendations • To employ a WC/TO nurse specialist who had a special interest in teenage mothers and their children • The WC/TO nurse would need flexibility to work in a timeframe that meets the needs of teenage mothers and their children, longer visits if needed. Engaging while mother is pregnant!! • The WC/TO nurse would develop strong links to other community agencies that support teenage mothers and their children.

10. Plunket Pilot 2011 • Funding found…In Practice 21 mothers • One specialist Plunket nurse first visiting in pregnancy 36 and 38 weeks gestation and one early postnatal visit. This same Plunket nurse continues to be the teenage mothers nurse until the child finishes with the service. • Referral to parenting support and education is part of the WC/TO service with parenting group coordinator co-visiting with the WC/TO to form that relationship.

11. Goals of the pilot • To improve the engagement of the Hawkes Bay teenage mothers in the Plunket Well child service and to better met their parenting needs. • This was to be achieved by early engagement by one dedicated Plunket nurse. • Early engagement consisted of two antenatal visits and one early postnatal visit and additional needs based visits all delivered in the home. • Improved Health outcomes for children of teenage parents.

12. Evaluation 2012 and 2014 Evaluations have been carried out by the Eastern Institute of Technology. • The first evaluation was in 2012. The babies in the pilot were 6 months old • The second evaluation in the process of being completed at present the children are 3 years old. • The control group in the research is all babies born to mothers under the age of 20 that had the normal Plunket service.

13. Evaluation Interview Findings 2012 • The open-ended interview questions drew responses about how the teenage mothers viewed the pilot service they were receiving, what they needed from it and what they felt they needed but did not receive. Their responses were overwhelmingly positive. • Their identified needs had almost invariably been met by the service and these were also described as features they liked.

14. Rating the service • The teenage mothers were asked initially to rate the WC/TO service they received on a scale of 1 to 10 (1 = very poor, 10 = excellent). Overall these rating were very high with an average score of 8.9.

15. A key theme was how well the Plunket nurse related to teenagers. • Descriptors such as “young” and “onto it” were used. Other comments were, “she relates well to young people” and “she understands and knows what I’m talking about”. • That she did not “talk down” to themand did not make them “feel wrong” was highly valued. One said, “She treated us like we were just normal mums and not, like, young and we shouldn’t really have babies.”

17. What Mothers liked • Also appreciated was that the nurse had time to meet their needs. One teenage mother said, “she was not just there to do her business and leave.” Instead, the mothers appreciated how the nurse took time to talk, to answer all their questions fully and to provide help. One spoke of the nurse staying with her to help get her baby to breastfeed. Another said, “When things were tough in the beginning and I couldn’t find time to even have a shower, [Nurse] stayed and looked after [baby] while I showered.” • The nurse’s accessibility was also valued. One mother described the Plunket nurse as being “only a text away”, which was very important to her.Another said, “I can text her directly and she’ll respond whereas I had to go through a call centre and leave a message to reach my midwife.”

18. Having their information needs met • Having their questions answered fully and comprehensively was a frequently stated as something the teenage mothers appreciated. They spoke of having the Plunket nurse: “explain everything”; “always having answers if something was wrong with baby”; “give good advice that was easily understood.” • One said she was “never left wondering.” Another described receiving, “lots of information I otherwise wouldn’t have known, such as the risk of cot death.”

19. Referrals to others agencies /services • Several of the teenage mothers indicated that they liked being referred or having access facilitated to other services. This included referrals to counseling services or GPs but most often mentioned was the Plunket ‘Young Mums group’, a regular get-together of “others in the same boat”. • The mothers appreciated the introduction to this group, sometimes being taken to the meetings by the Plunket nurse or receiving free taxi rides to get there

20. Home Visits • Some mothers particularly liked that they were visited at home. Explanations included: “So I don’t have to worry about taking baby out”; “So I don’t have to go anywhere”; “Because I don’t drive.”

21. Teenage mothers rating of the Nurse/ Client relationship • The teenage mothers were also asked to rate,on a scale of 1 to 10 (1 = very poor, 10 = excellent) their relationship with the Plunket nurse delivering the WC/TO service. Their responses to this question show an extremely high average of 9.5.

22. The value of trust • Several indicators pointed to a very high level of trust between the Plunket nurse and her clients. • The strongest of these indicators was the ways in which the teenage mothers described the nurse as someone they could “talk to about anything”, and how she talks “as if she has known me for a long time”. • They liked the consistency of having one, regular nurse with whom they could develop an open and trusting relationship. One explained how this was a good thing, “because the nurse routinely asked at each visit if there’s been any violence and because it’s the same person you build up trust and over time the person might be confident to say so if it was happening.”

23. Comparison with the control group • Although the pilot covered too short a time frame to fully appreciate child health outcomes some positive trends were evident. These included the teenage mothers’ breastfeeding rates, completed infant immunisations and the high level of referrals and recommendations to other health services and agencies compared to those of the control group. • The pilot group receives on average 13 visits in comparison to the control group who received an average of 6.7 visits before the baby was 6 months old. • Ongoing follow-up research on health and other outcomes for the babies in this pilot could confirm how these trends played out in the longer term.

24. Evaluation 2014 • Thirteen mothers from the initial 21 mothers in the pilot have been interviewed. There children are now three years old. • They rated the service 8.9 • They rated their Plunket nurse 9.3 • In the pilot group 17 mothers out of 21 their Plunket Nurse to core 7 ( 2-3- years) ) compared to the control group where 15 out of 22 completed to core 7

25. What teenage mothers said they need from the service • Having someone supportive and non judgmental. Having an outside perspective and holding confidences. • “I can’t think of anything more that I could have needed. Most of the time all I needed was a bit of support, a bit of reassurance that everything was alright to get through it.” • Not being judged. Nurse being available. Being able to text at any time.

26. What mothers said • “Definitely having the same Plunket nurse all the time was really good for us. Because we have home visits we don’t have to leave home. I was having anxiety attacks as well and I wouldn’t drive anywhere. It was really good to have her come. And I always knew it was going to be her. That was definitely big for us. Yeah. Otherwise I probably wouldn’t have gone. So that was good.”

27. “I think my favourite thing was that you got those extra visits when you were pregnant. That’s the thing that stands out to me the most, that’s the most important thing. Because when you’re pregnant you don’t even know what to expect and it was cool building up the relationship with someone before they just came to see your baby... It was a relationship with me“.

28. “She was someone you could trust to talk to with all your problems”. “You didn’t mind texting or calling her when you had problems because you knew she’d listen and she wouldn’t judge you on them”... “Especially when you are a young mum... Everywhere you go you’re judged for being a young mum and especially if you’re on your own not with a partner it’s doubly worse”.

29. “She’d be a 10l. Just her mannerism, I think. Like, she related well to (daughter). (Daughter) felt comfortable. Like if I had a horrible Plunket nurse I don’t think (daughter) would have felt as comfortable... She was able to give me information when I needed it or I could text her something if I had a question and she’d pop some information in my letter box or she’d let me know

30. Currently in Hawke's Bay Young Parent team consists of • Two Plunket nurses • One Plunket Kaiawhina • One PEPE (parenting education) coordinator • Teen Parent Agency Network

31. Conclusion • In conclusion, the formula on which the Plunket pilot extended WC/TO service for teenage mothers was established appears to have proven highly successful.

32. That is, early intervention with three extra visits (including two antenatal) by one, consistent nurse assists the development of a good nurse/client relationship which is considered crucial. • The quality of this relationship leads to high levels of client trust in the nurse and the service, which in turn leads to greater nurse access to teen mothers, their babies and their whānau. • This access results in opportunities to provide an holistic service that can contribute to successful outcomes on health, social and safety measures for babies, their mothers and their families

33. Questions nicky.skerman@plunket.org.nz

34. A Decision that Changed My Life Too young to be a Mum Too immature Just a kid myself Just fourteen years old BUT He changed my life As soon as I saw him I fell in love with him He made me grow up My baby made me a Mum. Tell me a Story 2009 Hawke's Bay school for teenage parents.

36. References • Skerman, N. (2010). What do teenagers want from the Well Child/ Tamariki Ora service? Unpublished Master’s thesis, Eastern Institute of Technology, Taradale. • Ministry of Health. (1996). The New Zealand health strategy. Wellington, New Zealand: Author • Ministry of Health. (2002). The Well Child framework. Wellington, New Zealand: Author • Ministry of Health. (2004). Child and youth toolkit. Wellington, New Zealand: Author.

37. Ministry of Health. (2009). A focus on the health of Maori and Pacific children: Key findings of the 2006/07 New Zealand health survey. Wellington, New Zealand: Author. • Thompson, S., Manhire, K. & Abel, S. (2012). ‘Changing the next generation’. An evaluation of the pilot Extended Well Child/Tamariki Ora service for teenage parents in Hawke’s Bay. Taradale, New Zealand: Eastern Institute of Technology. Collins, B (2004) If I didn't have my baby I don’t know where I would be: Teenagers as mothers. Paper presented at the Ministry of Social Development Conference, Wellington, New Zealand.