National perspectives on supporting teenage parents: Policy and Implementation Alison Hadley Teenage Pregnancy Unit

«A quick update on prevention «What works to improve outcomes for young parents and their children «Levers for prioritising support «Developing a care pathway

A quick update on prevention

Building on progress «25% reduction in under 18 conception rate (98-10) «35% reduction in conceptions leading to birth «Lowest rate since 1969 – over 40 years «60,000 more conceptions in rate had stayed the same as 1998 « Concerted and sustained effort makes a difference but...

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

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

Strategic leadership & accountability SRE in schools and colleges Young people friendly contraceptive & SH services Clear and consistent messages to young people, parents and pracittioners Workforce training on SRE SRE & access to contraception in youth services Targeted SRE and contraception/SH support for young people at risk Strong use of data for commissioning & Local performance management Dedicated support for teenage parents – including SRE and contraception Supporting parents to discuss sex & relationships...and how to translating evidence into practice A whole system approach: clear actions for different agencies

What works to improve outcomes for young parents and their children

Poor child health outcomes §60% higher rates of infant mortality §25% higher risk of low birth weight 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 ▪ Almost 40% of teenage mothers have no qualifications §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

...but poor outcomes are not inevitable §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.

A whole systems approach: lessons from 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

Levers for prioritising support for young parents

Why teenage pregnancy still matters §11% of all young people who are not in education, employment or training (NEET) are teenage mothers or pregnant teenagers §20% more likely to have no qualifications at age 30 §22% more likely to be living in poverty at 30, and much less likely to be employed or living with a partner §3 times the rate of post-natal depression §higher risk of poor mental health for 3 years after the birth §Children of teenage mothers have a 63% increased risk of child poverty and are more likely to have childhood accidents and behavioural problems §The infant mortality rate for babies born to teenage mothers is 60% higher §3 times more likely to smoke throughout their pregnancy, and 50% less likely to breastfeed §20% of conceptions to under 18s are repeat pregnancies to teenage mothers

Improving outcomes for young parents and their children contributes to... ▪Reducing child poverty : Child Poverty Strategies – an LA statutory duty ▪ 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 – an LA statutory duty (2013) ▪ Address safeguarding issues by getting services right ▪Narrowing health inequalities and improving public health: Health and Wellbeing Boards – an LA statutory duty (2013)

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 including by Clinical Commissioning Groups HWBs can challenge CCGs if out of line with HWB Strategy. 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

Public Health Outcomes Framework: making the case for 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 years ▪Rates of adolescents not in education, employment or training ▪ Under-18 conception rate ▪Chlamydia diagnosis in year olds ▪ Sexual violence ▪Proportion of people in long term unemployment NB! Health Reforms in place from 2013, but new Joint Strategic Needs Assessments are underway

Developing a care pathway in a complex commissioning landscape

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

A complex commissioning landscape! A snapshot: ▪Pregnancy testing and advice commissioned by LAs through public health grant ▪ Maternity services (and abortion services) commissioned by Clinical Commissioning Groups ▪ Contraception and sexual health advice commissioned by LAs through public health grant ▪ Health Visitors and Family Nurse Partnership commissioned by National Commissioning Board until 2015 ▪ Children’s public health 5-19 (including school nurses) commissioned by Local Authorities ▪ Children’s Centres commissioned by Local Authorities

Taking a whole system approach ▪Knowing your local data – numbers of young parents, high rate wards ▪ Mapping their journey from pregnancy testing onwards ▪ Consulting young parents on services and addressing barriers and gaps ▪ Engaging all services to make contact count and prevent young parents falling through gaps

..while remembering the bigger picture ▪ ▪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

Useful information: ▪ 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 lessons-serious-case-reviewshttp:// lessons-serious-case-reviews ▪ Ages of Concern: Learning from Serious Case Reviews Teenage Pregnancy Midwifery Network and newsletter