1. Sally Johnson, Head of Service (Maternal health) Identifying vulnerability and enabling access to services

2. Aim of the session Sharpen our definition and understanding of vulnerability Consider the issues with identifying vulnerability Share what’s informed our understanding in Wiltshire and work in progress Discussion about challenges and opportunities

3. What is vulnerability?

4. Defining vulnerability Safeguarding Vulnerable Groups Act (2006) – wide ranging definition - anyone in receipt of a regulated activity Wiltshire, Swindon and B&NES Midwifery-Health Visitor Liaison Pathway definition: Age <20 years / Substance misuse / Mental Health and anxiety issues / Homeless or housing issues / Domestic abuse / Child protection issues / Looked after children / Police involvement / Learning difficulties / Recent arrival as a migrant / Asylum seeker or refugee status / Traveller / English as a second language / BME / On Income Support or Benefits / Previous relevant obstetric history / Previous child death / Subject to abuse in childhood / not registered with a GP / neither parent is in work / literacy difficulties

5. Proceed with caution! -ve Labelling Stigma Unfounded assumptions Paternalistic interventions Disempowerment +ve Enables support to be offered to those at greater risk of poor outcomes Needs must be properly assessed. No assumptions made

6. Vulnerability: risk factors in pregnancy and the potential impact

7. Identifying vulnerability

8. Example – Perinatal mental health: a public health concern Affects at least 1 in 10 women Leading cause of maternal death Poorer pregnancy outcomes Affects maternal self-esteem, partner and family relationships Can compromise emotional, social, educational or physical developments in infants / later in childhood £8.1billion long-term cost to society for each yearly cohort of births

9. The experience of women and GPs in relation to perinatal mental health Only about 50% identified despite contact with range of primary care agencies

10. The challenges of identification Issues for GPs Lack of training and confidence Lack of contact with women and inconsistent team work between GP practices, MWs and HVs Time pressures Lack of focus on mother -baby relationship and wellbeing post 6 weeks Issues for service users Poor awareness Women feeling dismissed or overly reassured when discussing problems Stigma and fear of baby being taken away Masking distress – ‘I found it easy to ‘cover up’ the fact that I was suffering from depression by acting when I was out..’

11. Informing our understanding in Wiltshire

12. Learning through close scrutiny: CAF audit Wiltshire’s CAF Pathway for Expectant Young Mother’s designed to ensure: –professionals form a team around the child to support young parents to achieve positive outcomes –young mums receive holistic, timely assessment (midwives) in pregnancy followed up by progress reviews (health visitor) Audit commissioned to understand the quality of the fuller assessment

13. Methodology Random sample - 12 young mothers Facilitated by PH Specialist and WSCB QA Manager Collaborative approach – maternity and health visiting lead for each of the 3 areas. –Reviewed CAF and maternity and health visiting records –Approach enabled greater scrutiny of the young mother’s journey as well as assessing quality of CAF Telephone questionnaire with 9 young mums – HV service lead

14. Case Audits 1)Who completing CAF 2)Timeliness 3)Whether quicker response required 4)Checks prior to CAF completion 5)Evidence of consent 6)Quality of CAF 7)Health visiting involvement and MW-HV communication 8)Registration of CAF and Lead Professional allocated 9)Team around the child (TAC)

15. Key findings and recommendations Positive feedback from young mothers - listened to and helped Some examples of good practice Areas for improvement –Recording and evidencing –Quality of assessment –Action planning –Joint working and information sharing –Making every contact count

16. Working on improvements: better together

17. Review issues together – e.g. MSLC WSCB Local programme data Audit findings + Review Provider actions Monitor Contract meeting Review Provider actions Monitoring Working together Sharing practice Sharing priorities

18. Joined up work in progress Building links between health (maternity and health visiting) and the Early Help service –Training - assessment skills and planning –Establish effective communication links – reactive and proactive –Better support for young parents Planning pan Wiltshire maternity peer learning event – identifying and engaging those who are vulnerable MSLC priorities – collaborative working and identifying vulnerability

19. Any questions?