1. 11 November 2011 Midwives- making a difference

2. Joyce Leggate Belinda Morgan Family Health Project NHS Fife

4. Aim of the project Through intensive midwifery support from booking until 28 days postnatal to address inequalities in health care that is available to Fife residents. There are distinctive inequalities between health care available in affluent areas compared with disadvantaged areas, including pregnancy outcomes of vulnerable and excluded mothers.

5. Rationale –The rationale for the family health project is based on the premise that health inequalities are set in the very earliest years of a child's life, even before birth. A number of factors can impact on a child’s health for example, nutrition, stress and health harming behaviours of mothers. –The period between 0 and 3 years is a critical window for shaping life chances and is a key area of focus in the Scottish Government's Early Years Framework. – Early intervention approach to reducing health inequalities, and so is particularly aligned with the Early Years Framework.

6. Why pre-birth? Windows of opportunity 95% of the structure of the brain and its development is complete by 3 years of age. Change is easy and quick in the early years and has profound and lasting effects Change is possible later but slower and harder. Children “make the best” of the experiences they meet

7. Outcomes of early neglect & maltreatment Poor cognitive development Poor sensory integration Lack of self-regulation Lack of empathy Persistent belief about self and the world Reduced capacity to make good relationships

8. Optimum learning opportunity

9. Public perception of Fife

10. Reality for many Fife residents

11. Family Health Project Principle Objectives Improve maternal & child health outcomes in the most economically deprived areas of Fife Improve parenting Strengthen parent & child bonding Improve breast feeding rates Reduce maternal smoking Increase multi-agency support

12. The Family Health Team (Lynne missing)

13. Why midwives? Midwives are the first point of contact under KCND Comprehensive medical and social history taken using SWHMR Acceptable to client group especially first time mothers and those with looked after children

14. Why midwives? Scottish health policy demonstrates a clear commitment to early childhood development by identification of high risk children and families. Although initial investments are great, the returns over the long term can be much greater.

15. Process Needs assessed and agreed One to one visits from named midwife Parenting needs identified and support from nursery nurses given Involvement with groups in family centres Integration with local services beyond pregnancy

16. Extended team Housing Officer Consultant Obstetrician Social Worker Mother & baby Health Visitor Family support worker Family members Education services General Practitioner Family Health Nursery Nurse Family Health midwife Community midwife Psychiatric nurse Mellow parenting programme Quit 4 Life midwives

17. Reasons for referral

19. Outcomes Breast feeding rates -14% Average birth weight -3242g Delivery of parenthood education -89% Maternal smoking -29 % 10% referred to Quit 4 Life midwife Mellow bumps, mellow babies and mellow parenting groups accessed Teen mother groups established 35% involved in child protection process

20. Challenges Midwifery colleague resistance Nursery nurse boundaries –letting go! Sharing information – more always wanted! Health visitor resistance initially Lack of appropriate resources Continued funding in current fiscal climate

21. What we did NOT expect! Teenagers well supported by family and school Child protection impact on workload Involvement in groups in family centre Number of referrals due to learning disability Inappropriate referrals Referrals from community midwives escalated Support from social services Genie is out of the lamp!

22. SOME MOTHERS AND BABIES ENJOYING ART & CRAFTS AND HEALTHY EXERCISE

23. More fun and play

24. Joyce Leggate BSc, PG cert. Addictions, RGN, SCM Clinical Midwifery Manager Forth Park Hospital Kirkcaldy KY2 5RA Joyce.leggate@nhs.net