1 Bournemouth Planning Day What are the causes and consequences of risk taking behaviour? The impact and local context. What are the contributory factors? Where are we now? What are future priorities? Sophia Callaghan Consultant Public Health NHS Bournemouth and Poole Lisa Cousins Teenage Pregnancy Coordinator Bournemouth Borough Council September 2010

2 Outline of the session At risk behaviours what's the evidence? Local context North Bournemouth example Teenage pregnancy Context Local overview Discussions

3 Risk taking Behaviours set the Scene Consistency in the relationship between features of early parental care and child intellectual, behavioural and emotional outcomes. Responsive care in early months of a child life is important ( communication, interpretation, response, infant attachment). For the child to display signs of a secure infant, exhibiting better behavioural and emotional adjustment later in life Kitzman et al (2007)

4 AFFECT A behavioural expression of emotional regulation, a set of processes to manage expression and accomplish goals AFFECT last to mature in development All ‘gas no breaks’ Increase risk of adverse health outcomes

5 Review of AFFECT Childhood adversities and effect on psychological disorders – low specificity, limited evidence Nurse family partnership, targeting mother infant bond to affect AFFECT later on – Strongest evidence for nurses in family homes –study of limited quality and a service rather than intervention Incredible years programme – parent teacher and social training components – strong evidence of expected change in evaluation

6 Review of AFFECT Aban Aya youth project, ‘stop think act technique’ –evidence to reduce risk in that cohort, not transferable to other population groups Home visit programmes – no clear conclusion Positive parenting – multi level with universal, selective components target parent child relations and reduced emotional symptoms and parent stress – some evidence of effectiveness

7 Teenage pregnancy and social disadvantage What known- sex education alone does not reduce TP rates needs to be a whole system approach Systematic review adds – childhood intervention/youth development programmes and structural level measures to tackle social disadvantage can lower TP rates. Improve enjoyment of schools, raise expectations, ambitions for future. Policy move to compliment school ethos with sex education and sexual health services in targeted areas Oakley et al BMJ

8 Summary Access to Core Contraception Services SRE in schools as part of a wider programme Targeted youth development and outreach Specific, targeted Parenting programmes mainstreamed School ethos development for aspirations and ambitions

9 National Teenage Pregnancy Drive No-one should wait for national directives as there won’t be any at this stage. Local champions should be very active in maintaining core teenage pregnancy work. Teenage pregnancy work represents value for money. Teenage pregnancy prevention will be vital in reducing health inequalities and child poverty, addressing the coalition government’s priorities Ofsted has called for improvements in PSHE. A report released on 23 July 2010 said the quality of PSHE teaching was ‘variable’

10 The Economic Argument Cross organisational issue The cost of Teenage Pregnancy to the NHS alone is estimated to be £63m a year Benefit payments to a teenage mother can total £25000 in the three years following birth This can continue long term Every £ spent on the strategy saves approximately £4 to the public purse

11 The Current Picture Locally Recent annual figures showed that since the baseline figure in 1998 the Teenage Pregnancy rate in Bournemouth has fallen by 25.3 per a greater reduction than the national figures of 13.3 per 1000

12 Statistical Neighbour Analysis Under 18 conception trends as defined by DCSF statistical neighbours Bournemouth has experienced the greatest reduction in rates since Baseline amongst statistical neighbours

13 Next Steps Cross organisational approaches Keep improving access to contraceptive services Consistent quality SRE Targeted Intervention Education and support for parents/ carers Tackle wider determinants of health What’s our local context and direction?