Alison Hadley Teenage Pregnancy Unit 2000-2012 The importance of partnership working: supporting young parents Alison Hadley Teenage Pregnancy Unit 2000-2012

Progress on reducing teenage pregnancy What works to improve outcomes for young parents and their children Making the case locally 2

Progress on reducing teenage pregnancy 3

Reduction over the last decade 25% reduction in under 18 conception rate 35% reduction in conceptions leading to birth Lowest rate since 1969 – over 40 years 60,000 more conceptions if rate had stayed the same as 1998 Concerted and sustained effort makes a difference but... 4

But progress needs maintaining and some LAs lag behind national reduction Oldham Milton Keynes Tower Hamlets Hackney Swindon

What works in reducing teenage pregnancy: a reminder of the evidence Vast majority of teenage pregnancies are unplanned 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 No evidence that alternative approaches (e.g abstinence-only/benefit conditionality) are effective

But partnership is essential for effective implementation Strategic leadership accountability & SRE in schools and colleges Young people friendly SH services contraceptive & Clear and consistent messages to young people, parents and practitioners Workforce training on SRE SRE & access to contraception in youth services Targeted SRE and contraception/SH support for young people at risk Local performance commissioning & management of data for Strong use Dedicated support for teenage parents – including SRE and contraception Supporting parents to discuss sex & relationships

What works to improve outcomes for young parents and their children 8

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

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

Poor economic well being 11% of all NEETs 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 poverty Lower academic attainment A higher risk of unemployment and low income in later life Poor economic well being

...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 Health Led Parenting Programme (US) - providing intensive dedicated support – shows long term improved outcomes for young parents and their children. Family Nurse Partnership being evaluated in England with encouraging results for teenage parents and their children. RCT reporting in 2013.

The importance of partnership work: 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 Ages of concern: learning lessons from serious case reviews Ofsted 2011

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 needs 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 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

Illustrations of effective practice 15

Herne Bay Children’s Centres: partnership in action ▪ 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 ▪ 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 ▪ 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

Coming spring 2013 from Best Beginnings…new pregnancy and parenting phone apps for young parents ▪ Personalised information and advice to increase confidence & knowledge, improve health choices, support warm parenting and strong families, improve access to services ▪ Fun, multi-media presentation with functions including a photo diary, a tracker for personal goals, local services ▪ Development of apps supported by multi-disciplinary expert group of health and early years professionals ▪ Use of apps being piloted with young mums and health professionals in South London…more pilot areas welcome

To find out more or to take part in the piloting, contact info@bestbeginnings.org.uk

Making the case locally 19

Improving outcomes for young parents and their children contributes to... ▪ Reducing child poverty : Child Poverty Strategies ▪ Reaching the most disadvantaged children and families: Refocused Children’s Centres ▪ Narrowing educational inequalities and improving skills and employability: Raising the Participation Age, increasing young people in education, training and employment ▪ Address safeguarding issues by getting services right ▪ Narrowing health inequalities and improving public health: Health and Wellbeing Boards

The key importance of Health and Wellbeing Boards ▪ Health and Wellbeing Boards (HWB): HWB in each top tier Local Authority ▪ Statutory requirement on HWB to produce a Joint Strategic Needs Assessment (JSNA) of current and future needs and a Health and Wellbeing Strategy ▪ Health and Wellbeing Strategy informs all commissioning by the LA and the Clinical Commissioning Groups Local HealthWatch: local consumer voice for health and social care to help ensure services meet local need – opportunity to involve teenage parents, teenage mothers and young fathers e.g. in mystery shopping of services ▪ Public Health England (PHE): Director of Public Health in each LA responsible for public health of their local populations, through a ring fenced public health grant ▪ Public Health Outcomes Framework: sets out key indicators for all areas local assessments 21

Public Health Outcomes Framework: the critical contribution of young parent support ▪ Infant mortality rate ▪ Incidence of low birth weight of term babies ▪ Maternal smoking prevalence (including during pregnancy) ▪ Breastfeeding initiation and prevalence at 6-8 weeks ▪ Hospital admissions caused by unintentional and deliberate injuries to under 5s ▪ Children in poverty ▪ Child development at 2-2.5 years ▪ Rates of adolescents not in education, employment or training ▪ Under-18 conception rate ▪ Chlamydia diagnosis in 15-24 year olds ▪ Sexual violence ▪ Proportion of people in long term unemployment 22

In summary... ▪ Great progress on teenage pregnancy but more to do! ▪ Supporting young parents - gives young parents a positive future - narrows inequalities - reduces child poverty - invests in the future health and prosperity of the local area ▪ Partnership working is key to effective support – making every contact count!

A quick checklist for frontline services ▪ Do you know your local teenage pregnancy data – progress in reducing rates, numbers of young parents and high rate wards? ▪ Which part of the care pathway does your service contribute to? ▪ Do you know the details of local services supporting young parents? ▪ Do other services know about you?!

Useful information: http://www.education.gov.uk/childrenandyoungpeople ▪ Teenage pregnancy data by Local Authority ▪ Getting maternity services right for teenage mothers and young fathers – a guide for midwives and maternity staff ▪ Multi-agency working to support pregnant teenagers http://www.ofsted.gov.uk/resources/ages-of-concern-learning-lessons-serious-case-reviews ▪ Ages of Concern: Learning from Serious Case Reviews http://www.bestbeginnings.org.uk/ntpmn Teenage Pregnancy Midwifery Network and newsletter