1. 1 Exploring your role and working with other agencies

2. 2 Exploring your role The Maternal and Early Years service offers a support service to women and their families and should be seen within the wider context of mainstream maternity and child health services, Children’s Centres and other services available locally. As you develop in your role you will develop a range of relationships with other health professionals and services to support their role in the client’s pregnancy and to support the work that you do with your client. It is important to recognise the areas of your role that are cross-cutting with other professionals, areas that you are responsible for and where you would need to refer onto other services or professionals for information or support.

3. 3 Thinking about your role Thinking about what you have learnt so far, and your understanding of your role and the service, and complete the “Thinking about your role activity”.

4. 4 Working Together There is a wealth of legislation aimed at increasing interagency working since the 1980’s including a whole system approach to obesity prevention highlighted in Healthy Weight, Healthy Lives: A cross-government strategy for England –Children: healthy growth and healthy weight. –Promoting healthier food choices –Building physical activity into our lives –Creating incentives for better health –Personalised support for overweight and obese individuals

5. 5 Working together Benefits for Families Widely promoted as being a more effective and cost effective way of working with families  Quicker access to services  Better relationships  Reduced duplication and more appropriate responses  The right services at the right time  Reduction in conflicting messages

6. 6 Working together Benefits for Health Care Providers Supports other health professionals in completing their roles and responsibilities. Added benefits:  fellowship and affiliation,  assistance or resources  Supports resolution of difficult situations  Removes feelings of isolation or inability to make a difference  Job satisfaction: morale, stress, broader perspective

7. 7 Practitioner Guide Who are the key stakeholders in my locality and where are they located?  How do I go about making contact with them?  What information do I need about them? Which groups/resources should I sign-post ? How do I refer to key agencies  What referral criteria should I be using?  What information should I be exchanging?  How should I record my decisions The community as a whole The Population outside the family Family health Maternal and infant health Environmental Agencies Education and schools Local Authorities Support groups Health and Social Services Leisure facilities Voluntary Groups

8. 8 Getting to know services around you Complete the Exploring Local Services activity.

9. 9 Midwives The midwife is allocated to the mother from the point of booking. They are responsible from the date of booking (around 10-12 weeks) until they discharge the baby after birth (around 14-28 days) Arrangements for care do vary from Trust to Trust – for example, some will have a named Community midwife who works with them throughout their pregnancy. Others will need to visit a midwifery clinic with a number of midwives. You should have explored local arrangements at the beginning of the session.

10. 10 Midwives Key responsibilities for the midwife: Health and wellbeing of the baby during pregnancy Provide information on: foods to avoid, healthy start, antenatal classes (parentcraft), breastfeeding Support the mother after the birth Ensure there are no concerns with the baby in the first days/weeks Clinical role – deals with medical queries and concerns, organise screens, scans and tests May be supported by Maternity Support Workers who are trained to undertake some midwifery tasks Meets the mother at regular points during pregnancy to check health, blood pressure and monitor the baby

11. 11 Health Visitors Health Visitors are responsible for the health and wellbeing of the child from around 14 days to 5 years. In some areas where the Child Health Promotion Programme has been developed, this responsibility is from birth to 19 years. Health Visitors are qualified to level of a Registered Nurse or Midwife but with specialist training in Community Health. They are responsible for child health, health promotion and education. They are often based in teams co-located with GP surgeries and include other workers such as nursery nurses. You should have learned about how they operate in your area in the earlier activity.

12. 12 Health Visitors The role of a Health Visitor is to offer support and encouragement to families through the early years from pregnancy and birth to primary school and beyond. Health visitors work closely with others such as Speech Therapists,Social Workers,School Nurses, & District Nurses. We are also involved in: Working in partnership with families to tailor health plans to their needs Coordinating child immunisation programmes Organising and running baby clinics Health promotion groups, Breast feeding support groups, Parent support groups, parenting courses

13. 13 Health Visitors Key responsibilities of Health Visitors The child’s growth & development Common infections in childhood Common skin problems Behaviour difficulties. Sleeping, eating, potty training, temper tantrums and teething. Breastfeeding, weaning, healthy eating, hygiene, safety and exercise Postnatal depression, bereavement and violence in the family

14. 14 Children’s Centres Children’s Centres offer a variety of services targeted at certain geographic ‘catchment areas’. They offer services for children under the age of 5 and their parents. They may be run by the NHS, Local Authority, Charities or a combination of all of those. Services provided will depend very much on individual centres but the core offer should include: Family Support and outreach for hard-to-reach families Childcare – although in some centres this may be supported by voluntary/independent provision Access to other services You will have found details of local services in your earlier activity.

15. 15 Other Services There are a multitude of other local services that may benefit your clients – some of which will be located within Children’s Centres, others may be provided by the NHS Trust or Local Authority. You will be familiar with most of these services after undertaking the Exploring Local Services activity. Key areas to be aware of include: Access to Physical Activity – through Leisure Centres, NHS Activity advisors, etc Quit Smoking services Breastfeeding support groups and services Family Support, Social Services and Safeguarding Cook and eat, supermarket tours and weaning advice

16. 16 Voluntary Organisations There are also a number of voluntary or community organisations that will be useful in supporting your work: National Childbirth Trust – NCT – check their website Breastfeeding Network – www. Netmums Local Mother and Baby or Parent and Toddler Groups You should have found a list of local groups as part of your exploring your area activity earlier in the session.

17. 17 Working together - Challenges Although there are many benefits to working together, it often poses challenges to both individuals and organisations.  Communicating across geographical divides  Communicating without the same language  Agreeing on the same message  Overcoming assumptions and prejudges  Organisational barriers and different ways of working  Role confusion  Multi agency inertia

18. 18 Overcoming Challenges Almost all of the challenges of working with others identified can be avoided, with good communication skills, clear expectations set at the very beginning and by being patient and tolerant when working with other health professionals and across organisations. However, sometimes challenges appear even if we have set clear guidelines and boundaries. As a HWA you need to be able to set clear expectations as well as be able to have strategies to deal with conflict that may arise.

19. 19 Ingredients for good practice  Shared Vision and purpose  Knowing own and others roles and responsibilities, and acknowledge strengths  Clear (justified) communication  Clear line management  Joint training  Evaluation

20. 20 Good practice: Communication Communication with other agencies requires:  Listening skills  Consultation and Negotiation  Compromise  Building relationships and operating with respect Opportunities for dialogue  formal and informal meetings, regular feedback, protocols for information sharing, record keeping referral systems Confidentiality and ethics

21. 21 Good practice: Coordination For a family who needs support from an interagency team –It can be very confusing seeing many professionals –Lack of clarity around roles may hinder effective delivery

22. 22 Good practice: Shared Vision  A shared and predictable response to particular issues  A value system  Helps to reduce conflict What are the common or binding principles of obesity prevention? What might create interagency conflict or disagreement?

23. 23 Good practice: Know your own role To motivate and help people to set goals by developing personal health plans, give practical support to carry out those plans and identify with the individuals their barriers to change. How might others see you?

24. 24 Know your own role As you are working with clients and part of your role is to develop supportive relationships with them, you will need to set clear boundaries at the very beginning and continue to review them as you go along. When you work very closely with a client it is sometimes difficult to maintain a professional ‘distance’ and ensure that they are aware of what does fall within your role – and the things that do not. When thinking about your role and the limitations to your practice, it is worth considering how you will refer clients to other services, who you will contact and when.

25. 25 Safeguarding Children and Families One area that you need to develop will be a more detailed and specific understanding of local safeguarding arrangements to support and protect families in your area. This should be done in consultation with your line manager/supervisor. Key points to note: Seek advice from your supervisor if anything during a consultation causes you concern for the mother, baby or other children You have a duty to pass on information with regards concerns – it may seem something small but other agencies may also be involved.

26. 26 Safeguarding Children and Families If you need to share information about your client with other services, you need to make sure that you follow well established protocols – referring to your supervisor for guidance.  Is there a legitimate reason for your agency to share this information?  Does the information enable the person to be identified?  Is the information confidential?  Do you have consent to share?  Is there a statutory duty to share the information?  Are you sharing the right information?  Have you properly recorded your decision? (Adapted from Every Child matters: change for children 2006)

27. 27 Knowing limitations of your role Complete the “Exploring Boundaries Case Study” activity.

28. 28 Knowing limitations of your role Knowing the limitations of your role is something you will need to continually reflect on as you develop working relationships with clients. There are some key points to remember: Your role is to support not save The client has to own their decisions – they are not yours to make There will be many things outside of your area of expertise – it is ok to say you don’t know and to seek information or support from someone else

29. 29 Resolving ‘difficult’ situations There will be some occasions where working with clients you feel outside of your areas of expertise, feel that your haven’t got the relevant experience or knowledge – or that you feel you need to reflect on information. There may also be occasions when you find working one-to-one with clients more difficult. Complete the activity “Resolving Difficult Situations”.

30. 30 Resolving ‘difficult’ situations Some of these examples are real life examples – but don’t worry that all of your clients will have huge dogs, or disruptive relatives. In the main, the clients the service has worked with to date have been motivated and grateful for the help and support offered by the service. But it is worth being aware that you may get some ‘awkward customers’ along the way and for you to consider how you would deal with them before you have to think on your feet.

31. 31 Knowing limitations of your role The service you offer to pregnant women and those with babies is one part of the services available locally. It is important to develop good relationships with other services and health professionals to promote the service well and ensure that you both benefit from your roles and expertise. There are many areas that you can provide support in, develop positive relationships, give information and give practical help in assisting behaviour changes. Good Luck!