Reach Out: supporting teenage mothers and young fathers through children ’ s centres

1. Reach Out: supporting teenage mothers and young fathers through children’s centres Alison Hadley, Director, Teenage Pregnancy Knowledge Exchange, University of Bedfordshire Alison.hadley@beds.ac.uk

2. Progress on reducing teenage pregnancyWhat works to improve outcomes for young parents and their childrenThe key role of Children’s Centres in supporting young parents: some examples of effective practiceMaking the case locally

3. Progress on reducing teenage pregnancy

4. England progress: 1998-2011 34% reduction in under 18 conception rate Both maternity and abortion rates declining but steeper reduction in births of 42%  >70,000 under 18 conceptions avoided if conception rate had remained the same as 1998 Lowest conception rate in England since 1969 …concerted and sustained effort makes a difference!

5. England: under 18 conception rate 1998-2011

6. Local Progress | 1998-2011 47% LAs have reduced rates more than the England average, 53% less. London has the largest reduction (44%). East and North West the lowest (30%)

7. Reducing teenage pregnancy: a reminder of the evidence Provision of high quality SRE, (Kirby 2007) and improved use of contraception (Santelli 2008) are areas where strongest empirical evidence exists on impact on teenage pregnancy rates Universal and targeted. SRE and contraception provision for all, with more intensive support for young people at risk, combined with additional motivation to delay early pregnancy – ‘means and motivation’ No evidence that alternative approaches (e.g abstinence-only education or benefit conditionality) are effective

8. But partnership is essential for translating evidence into effective local action

9. What works to improve outcomes for young parents and their children

10. Poor child health outcomes • 21% higher risk of preterm birth and 93% higher risk for second pregnancies • 25% higher risk of low birth weight • 60% higher rates of infant mortality Affected by … • Late booking for antenatal care (on average 16 weeks) • Three times higher rate of smoking during pregnancy • A third lower rate of breastfeeding • Poor maternal nutrition

11. Poor emotional health and well being • Three times the rate of post-natal depression of older mothers • Higher rates of poor mental health for up to 3 years after the birth • Higher risk of partnership breakdown and isolation • More likely to live in poor quality housing Affecting the well being of their children and contributing to: • Higher accident rates - such as from falls and swallowing substances • More behavioural problems - conduct, emotional and hyperactivity problems

12. Poor economic well being • 11% of all young people not in education, training or employment are teenage mothers or pregnant teenagers • By age 30, 22% more likely to be living in poverty than mothers giving birth aged 24 or over • Much less likely to be employed or living with a partner • Young fathers twice as likely to be unemployed at age 30 – even after taking account of deprivation Which also affects the economic well being of their children who have: • 63% higher risk of living in child poverty • Lower academic attainment • A higher risk of unemployment and low income in later life

13. ...but poor outcomes are not inevitable with effective partnership working Solution to improved outcomes rests with a range of services working together– health, education, social care, youth support services, housing, the voluntary sector and Local Enterprise Boards • Key ingredients of effective support are: early identification in the antenatal period, dedicated support from a lead professional – coordinating and drawing in specialist services as necessary • Family Nurse Partnership(US Health Led Parenting Programme): intensive support for young parents from family nurse, from no later than 28 weeks of pregnancy until child reaches two. Expansion to 15,000 places by 2015. Randomised controlled trial reporting in 2014.

14. The importance of young parents support:lessons from Ofsted Serious Case Reviews “In too many cases: there had been insufficient support for young parents” Young teenage parents need to be supported in an environment in which they feel comfortable and supported. Adult centred services may not achieve this without additional teenage focused services Both parents need to be supported. The father is as important as the mother and they need support to help them become good parents There should be a joined up (multi-agency) approach to teenage pregnancy and teenage parents with every agency understanding their role within it. Planned and coordinated transfer of care between midwifery services, health visitors and GPs is critical

15. Mind the gap: the importance of a care pathway ▪ Free pregnancy testing, unbiased advice on pregnancy options and swift referral to antenatal or NHS funded abortion services • Sensitive but robust pre-birth assessment in maternity services to identify and address any problems early • Tailored antenatal care and preparation for parenthood for teenage mothers and young fathers, including preparation for postnatal contraception (20% of births conceived to under 18s are to teenage mothers) ▪ Clear referral pathway between maternity services and on-going support services – health visitors, GPs, Children’s Centres or specialist local service ▪ Dedicated, co-ordinated support on health (including sexual health), education, housing, benefits and parenting – with more intensive help for the most vulnerable, and inclusive of young fathers

16. The key role of children’s centres:examples of effective practice

17. The ingredients of an accessible and trusted service You’re Welcome: DH quality criteria for young people friendly services Accessibility: in the right place, open at the right time, near public transport Publicity: well publicised in places where young people go and by other professionals Confidentiality and consent: clear policies for staff and young people Environment: welcoming and young people friendly Staff training, attitudes and values: friendly, non-judgmental and supportive staff Joined up working: co-location of services if possible but all staff up to date with information and referral pathways to other relevant services Monitoring and evaluation by young people

18. Islington: mystery shopping of children’s centres: Young parents have been recruited and trained to assess some of Islington's children's centre’s against the You’re Welcome criteria and make recommendations for making the service more welcoming and responsive to young parents’ needs Two children’s centre's - New River Green CC and Packington CC have now achieved 'You're Welcome' accreditation. The young parents were particularly impressed by the friendliness of the staff and the range of support the children’s centres offered. Since accreditation, numbers of young parents visiting the centres has increased. The young parents' views, gathered through the assessment have been used in on-going training for CC staff around involving young parents and to inform work on confidentiality and information sharing to help ensure consistency and effective inter-agency work The young parent project is part of Islington’s Young Assessors Programme, and has the local strategic support of the Clinical Commissioning Group

19. Warwickshire: mystery shopping of children’s centres: Young parents were recruited as mystery shoppers to assess whether Warwickshire’s children’s centres core services were meeting young parents needs and met the You’re Welcome quality criteria Seven young parents were trained on effective mystery shopping, making an impartial assessment and providing constructive feedback. Childrens’ centre managers were sent a letter outlining the purpose of the project but not told the date of the visit 23 childrens’ centres were visited. Young parents visited in pairs or 3s, and organised their own transport to assess accessibility of the centre The young parents used the same questions for each centre to provide consistency of the mystery shopping evaluation Two de-briefing meetings were held with project manager. 4 Centres were revisited.

20. Hull: integrated support for teenage parents • Partnership care: led by dedicated Teenage Pregnancy Support Service (TPSS) in partnership with midwifery, health visiting, children’s centres, FNP and contraception nurse • Early identification through TPSS (which also offers pregnancy testing and pregnancy options support) and midwifery means majority of teenage parents access support services early in pregnancy • Holistic assessment of need - one for young mother, one for young father. TPSS undertake initial assessment and liase with childrens centres to develop tailored package of care to address education, employment, housing, healthy pregnancy, relationships, parenting, referral to FNP • Group work sessions held in locality children’s centres for young mothers and fathers on: healthy pregnancy in partnership with midwifery; parenting sessions in partnership with health visiting and children’s centre staff. Good take up by both young women and young men. • On-going support (usually after first 6-9 months of parenthood) transfers from TPSS to children's centre which young parents are familiar with as often see TPSS advisor advisor at children's centre • Named teenage parent lead in all children’s centres for consistency of care

21. Warwickshire: mystery shopping of children’s centres: Overall the evaluation was positive. Young parents found the children’s centres welcoming and the staff friendly and helpful. Key issues that needed addressing included: noinformation about children’s centres was provided by midwives, health visitors or GPs; not all children’s centres staff were well informed about the range of support available at the centre or from other services; the opening times of the centres 9-3 made it difficult for young parents at college to attend; there was limited support for young fathers. Each children’s centre was given an individual feedback report and an evaluation form about the mystery shopping exercise All children’s centres felt the mystery shopping and feedback was helpful and motivating – with some asking for additional support to improve services for young parents. All the young parents said they would use the children’s centres and recommend them to others

22. Hull: the impact of integrated care • Improved breast feeding rates • Reduced smoking in pregnancy/increased smoke free homes • Improved birth planning and young fathers involvement • Improved confidence in parenting • Reduced homelessness/tenancy breakdown • Reduced safeguarding concerns - prevented need for teenage parent or their child to become LAC or need a child protection plan • Improved involvement and support of young fathers/fathers to be • Reduction of repeat conceptions – 17% reduced to 13%

23. Blackpool: integrated, coordinated care for young parents Dedicated teenage pregnancy midwife for Blackpool Booking and antenatal care provided at the children’s centre Teenage pregnancy midwife completes early assessment at booking. Full details sent to Early Assessment Team Early Assessment Team reviews individual needs of young parent – drawing in additional information from other databases. Referral on to appropriate CC. Children’s centre allocation meeting refers on to additional specialist services which might be needed. Full family assessment undertaken, liasing with the midwife to ensure coordinated care during the antenatal period. Children’s centre provides a dedicated coordinator for the young parent to provide a single and consistent point of contact. Service mainly funded by the Local Authority with some joint funding from health for the teenage pregnancy midwife and a midwife member of the Early Assessment Team.

24. Integrated support: an example from Herne Bay Children’s Centres ▪All young parents referred by teenage pregnancy midwife at 12 weeks ▪ Antenatal care delivered in children’s centre to coincide with Young Parents Support Groups ▪ Caseloading and home visits by Young Parents Support Coordinator liasing with health visitor ▪ Personal development plans agreed with every young parent with support coordinated across wider services – Early Years Settings, schools, college, housing, sexual health ▪ Young parents invited to support groups but can choose outreach support ▪ Young parents supported in moving on and accessing other services

25. Integrated support: an example from Herne Bay Children’s Centres The impact of a dedicated integrated service ▪ 37 of 55 young parents now in education/apprenticeship/work. Remaining 18 either in maternity stage or volunteering at the Centre. ▪ All engaged with the children’s centres ▪ Key ingredients of success: single point of contact with simple referral pathways, all support on site with friendly and trusted staff, well known to local agencies – and support focused on positive futures ..and transport provided to bring young parents to the children’s centre

26. Supporting Young Fathers‘The father is as important as the mother’Ofsted: Ages of Concern. 2011 Are we nearly there yet, Dad? Supporting young dads’ journeys through fatherhood. Barnardos. 2012 Recommendations for children’s centres • Children’s centres should adopt a culture of asking about the father whenever they have contact with a mother, and keep a record of the young dads that do attend • Children’s centres should refer on to voluntary sector services inthe local area that are able to offer specialist support to young dads • Children’s centres should not assume that young dads will wantto attend the same groups as young mums, but instead introduce targeted activities such as dad and baby days out and sports events • Children’s centres should introduce a weekly drop-in clinic for youngdads to address parenting concerns. Staff at the clinic could also signpost the dads to additional support, for example with housing or employment

27. Engaging young fathers in partnership with the voluntary sector: an example from Southwark • In Southwark, Working with Men has two projects funded to support young fathers. One funded through a charitable trust focuses on 1-1 support for young fathers at risk of becoming NEET. The second, funded by the LA provides a full time Fathers Development Worker attached to three children’s centres • As both projects are in the same geographical area with some overlap of clients, there is a joint approach to planning events and activities to strengthen young fathers’ parenting skills, personal development and aspirations. Engagement with children’s centres is key • Young fathers are introduced to the children’s centres in a variety of ways: accompanied visits, attending generic fathers group with the support worker, or by introduction to other statutory services based in the setting, such as nursery, health visiting or community midwifery • Having more than one professional with a specific focus on young fathers strengthens their trust in using children’s centres and increases staff awareness and confidence in providing positive support for young fathers

28. Making the case locally

29. Supporting young parents: central toChildren’s Centres core purpose Sure Start children’s centres statutory guidance: for local authorities, commissioners of health services and Jobcentre Plus (DfE 2013) The core purpose of children’s centres is to improve outcomes for young children and their families and reduce inequalities between families in greatest need and their peers in: • Child development and school readiness; • Parenting aspirations and parenting skills; and • Child and family health and life chances The core purpose relates directly to the wider duties local authorities have to improve the well-being of young children in their area and to reduce inequalities

30. How children’s centres support for young parents supports wider LA duties ▪ Reducing child poverty: Local authority duty to undertake a needs assessment and have a plan to reduce child poverty ▪ Narrowing educational inequalities and improving skills and employability: Raising the Participation Age – from June 2013, all young people to participate in education or training until the end of the academic year they turn 17. From 2015, this will rise to 18. Statutory Guidance on the Participation of Young People in Education, Employment or Traning: for local authorities. (March 2013) ▪ Narrowing health inequalities and improving public health: Health and Wellbeing Boards and Public Health Outcomes Framework

31. Public Health Outcomes Framework:indicators disproportionately affecting young parents and their children Infant mortality rate (60% higher rates) Incidence of low birth weight of term babies (25% higher risk) Maternal smoking prevalence (including during pregnancy) (x3 smoking rate) Breastfeeding initiation and prevalence at 6-8 weeks (1/3 lower rate) Hospital admissions from unintentional and deliberate injuries to under 5s Children in poverty (63% higher risk) Child development at 2-2.5 years Rates of adolescents not in education, employment or training (11% of all female NEETs are pregnant or teenage mothers) Under-18 conception rate (20% births to under 18s are repeat pregnancies) Chlamydia diagnosis in 15-24 year olds Sexual violence (increased risk of sexual exploitation) Proportion of people in long term unemployment (22% higher rates of poverty for teenage mothers and twice rate of unemployment for young fathers)

32. In summary... Great progress on teenage pregnancy but more to do! Supporting teenage mothers and young fathers: - gives young parents a positive future - narrows inequalities - reduces child poverty - invests in the future health and prosperity of the local area Children’s centres are key to coordinated and integrated support for young parents

33. For more information: Your local teenage pregnancy statistics http://www.ons.gov.uk/ons/rel/vsob1/conception-statistics--england-and-wales/2011/2011-conceptions-statistical-bulletin.html Ages of Concern: Ofsted Serious Case Reviews http://www.ofsted.gov.uk/resources/ages-of-concern-learning-lessons-serious-case-reviews Are we nearly there yet, dad? http://www.barnardos.org.uk/what_we_do/policy_research_unit/research_and_publications/are-we-nearly-there-yet-dad/publication-view.jsp?pid=PUB-1900 Statutory guidance on the participation of young people in education, employment or training http://www.education.gov.uk/childrenandyoungpeople/youngpeople/participation/g00222993/stat-guide-young-people-edu-employ-train