Partnership: Theme:
Enfield Strategic Partnership Health – Under 18 Conceptions Expected Direction of Future Travel
Rating 2005 Assessment Self-assessment 2006 Agreed assessment Amber / Green Green
Floor Targets:By 2010, to reduce the conception rate among Under 18s in the worst quintile of wards by at least 60%, thereby reducing the level of inequality between the worst quintile and the average by at least 26% by 2010.
Teenage Pregnancy Under 18's conception rate per 1000 (15-17 year olds)
Eng.
2002 NRF LBE wards
2003 NRF Eng. LBE wards
2004 (provisional) NRF Eng. LBE wards
On target?
Narrowing the gap
42.6 55.6
42.1 57.5
41.5 51.1
Yes
Note: under 18’s conceptions are based on comparison of the ratio of the Enfield rate to
England’s at the earliest and latest time points shown
Under 18's conceptions
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Rate per 1000 15-17s
55 50 45 40 2002 2003 2004 England Enfield
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Evidence Of Performance Improvement Enfield is assessed against its U18 conception rate. The U18 conception rate fell by 11% in 2004 compared to 2003 – the 3rd biggest fall in outer London and the 7th biggest fall in all of London. The Teenage Pregnancy and Parenthood Strategy is a 10 year strategy, and a partnership between Enfield Primary Care Trust and Enfield Council, with Haringey Teaching Primary Care Trust and Haringey Council. It has been in place since 2001. The Enfield and Haringey team deliver a range of innovative projects that have been widely recognised across the London region and in Government documents as pioneering work. The projects include: project, providing sexual health advice and information to young people in clinics, community-based drop-in sessions and through a mobile unit ( bus). The project has continued to grow in size and has maintained high quality standards, with drop-ins targeted to wards of high conception rates. A Teenage Pregnancy Coordinator for Enfield was appointed in March 2006. Sexual Health Education Project – subsumed into , with a team of educators working directly with young people on the bus or at drop-ins in either school or nonschool settings. 16 new sessional educators have been recruited to work on this project Provision for teenage parents (NRF project) Emergency Hormonal Contraception Scheme delivered on a consultancy basis funded from Pharmacy. Over 1300 EHC contraceptives were distributed in 2004. Media work - Media and Participation Manager recruited and started in post in February 2004. Two floating Support Schemes for teenage parents have been developed; one by Step Forward (Metropolitan Housing Association) and the other by Patchwork Housing Association. They have been supporting 24 young parents. Work with young fathers was begun through the work of the Young Men‟s development worker and it is planned to be subsumed into the 4YPP project. The 4YP bus continues to provide outreach sessions each week. Progress Against All Milestones Conception rates for under 18 year olds in Enfield steadily increased from 2001 to 2003. However the rate of increase slowed in 2003 (up by 1.9 from the previous year) and in 2004 dropped by 11% to 51.1. This was the 3rd highest fall in Outer London and the 7th highest fall in London. Although this still represents a 10.2% increase from the 1998 baseline rate it is hoped that this downward trend will now continue.
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Change In The Gap/Changes At Floor Target Level The conception rate in Enfield was the 19th highest in London in 1998, the 14th highest in 2002 and the 10th highest in 2003. In 2004 it was once again the 19th highest.
Trajectory Analysis Trajectory required to meet 2004 & 2010 target Year Rate (*/1000) Change from 1998 Rate 2004 51.1 10.2 2005 46.8 1.0 2006 42.6 -8.2 2007 38.3 -17.4 2008 34.0 -26.6 2009 29.8 -35.8 2010 25.5 -45.0
Use Of Neighbourhood Renewal Funding Introduction To ensure good practice – by having an open and transparent system of agreeing and implementing projects to be funded by Neighbourhood Renewal - the Enfield Strategic Partnership moved to a commissioning process at the start of 2004. Each Thematic Action Group produced a commissioning plan which defined interventions required to improve the quality of life in deprived areas, based on identified needs. Neighbourhood Renewal funding (NRF) was principally used to set up 26 projects designed to address perceived problems in the Neighbourhood Renewal area, comprising Upper Edmonton, Edmonton Green, Lower Edmonton and Ponders End and to deliver better outcomes for local people. A proportion of NRF was also used as match to draw in European Union and National Lottery funds to set up projects designed to increase the provision of high quality open spaces in an area lacking public spaces and projects offering training programmes in IT and health related disciplines to enhance employment opportunities for local people. 4YPP (For Young Parents Project) Provision for teenage parents in Enfield was delivered by 4YPP (4 Young Parents Project) and managed by Enfield PCT, with significant funding from the Neighbourhood Renewal Fund, which was guaranteed until March 2006. The project offered individual and group support to young parents, with access to ante natal and post natal care, parenting skills training, and on site referral to information and advice on childcare, housing, welfare benefits, education, training and careers advice. The project provides a weekly lunch club for pregnant teenagers and young mothers and offers a programme that is educative, supportive and fun. Specialist health visitors, a nursery nurse and a youth worker run the sessions. Other agencies such as Sure Start, Connexions, and a housing advice worker regularly attend. Each session
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offers exercise and relaxation class to improve feelings of well-being and reduction of stress, anxiety and feelings of depression. Mothers presenting with low mood can be offered a referral to counselling services. Lunch sessions focus on healthy eating for both mothers and babies and advice on weaning and cooking on a low budget. Afternoon activities include sexual health advice to prevent further pregnancies, drugs awareness, first aid, arts and crafts, songs and activity roundup at the end of each session. Other services provided are a toy library, second hand baby clothes and outings for parents and babies. The second strand of the project has been a research into the sexual health needs of young refugees and asylum seekers, following the high number of referrals to the programme. The findings of this research will help to deliver appropriate education programmes which will contribute towards the reduction of teenage conception rates. It also facilitated peer support and aimed to develop a young person-centred service that involved them in service planning and delivery. A commitment has been confirmed by LBE and the PCT to mainstream the project within Enfield PCT. In accordance with its aims, 4YPP provided a number of support services for teenage parents in Enfield which are summarised below: Home Visit assessment. One-stop shop for advice for education, training, employment, housing and welfare benefits. Advocacy for teenage parents in supporting their health and welfare needs. A weekly teenage parents support group (4 Young Mums Group) with programme of planned activities and contributions from professional external support (e.g. Connexions, Play-Workers, Housing Advisers). One-stop-shop for advice and support. Baby massage. Toy library. Equipment scheme for essential baby care. Befriending scheme (with Age Concern). Sex FM Theatre In Education Project The Sex FM project has toured Enfield Schools providing sexual health and contraception information, as part of the wider 4YP project. This project has been further developed in association with the Family Planning Association and is to be launched nationally as a model of excellent practice.
SexFM toured to 14 schools including 2 Special Schools.
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SexFM was performed to approximately 2430 Students in Enfield and 100 teachers.
Staying Safe Child Protection training has continued to be a core element of 4YP staff and educators training and has been included in SRE training offered to non-schools staff. Additionally, training on identifying, supporting and preventing domestic violence have taken place. All SRE work is directed towards safeguarding young people and promoting their sexual health. 4YPP have co-ordinated inter-agency planning to meet the needs of particularly vulnerable young parents such as care leavers, those released from custody and young asylum seekers and refugees. The Teenage Pregnancy Partnership Board has monitored progress in this area. Sexual health information and advice has been provided through safe environments and activity for young people. SRE Training SRE training has been offered to staff working both in and out of schools. Training has reflected the need to include self-esteem building and the development of negotiation skills. This training has been run alongside the implementation of the SRE Policy for non-schools settings. A wide range of opportunities for training and support has been offered to teenage parents to promote their social inclusion. Impact of Project Activity 43.6% of all clients came from BME communities. Monitoring data shows increased use of services from 4YP (For Young People) clinics, 4YP bus and emergency contraception schemes in pharmacies. A significant proportion of those teenage parents referred to 4YPP have been young parents seeking asylum in the UK; 12% of referrals to 4YPP were from asylum seekers. As one might expect given this data, a significant proportion (5%) of teenage mothers referred to 4YPP needed interpreting services. The Teenage Parents project has identified 30% of teenage parents in Enfield are asylum seekers (some pregnant through rape) and Enfield has the highest rate of asylum seekers in all the London Boroughs (2005). An evaluation of the 4YPP has been created and the views of teenage parents have been included in this work. Teenage Pregnancy work was analysed on numerous occasions by Health Scrutiny in 2005 and a number of reports presented by the PCT.
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Listening 2 U This Project‟s actions have been aimed at preventing mental health breakdown by addressing the problems of potential and actual post-natal depression by offering regular counselling sessions. It provided specialist services to young refugee and asylum seeker mothers as well as working with parents to enhance positive attachments to their babies, and encourage family support by working intergenerationally. This project has worked closely with the Teenage Pregnancy Project, providing referrals and linking to other services provided for young mothers or those with family issues. Impact of Project Activity The Listening 2 U Project has delivered services to young mothers and families from many backgrounds. The most recent client files show that 13% of the clients came from “African / Caribbean / Other Black” backgrounds and 4% came from “Kosovan” backgrounds. The client files show us that only 11% of clients came from “White English” backgrounds. Referrals for this project have been made at 4YPP, from the busy Fore Street premises located directly in the heart of the NRF area. External Factors Affecting Performance The national and local strategies are relatively recent and require a sustained longterm approach to changing levels of awareness and behaviour patterns in young people in order to produce results. High conception rates are linked to poor educational attainment and lack of employment opportunities, which are very high in particular wards in Enfield. Although the figures for teenage pregnancy are high in Enfield, there are a number of contributing factors which impact on this. There are a large number of refugees and asylum seekers who come into the country who are already pregnant. This, coupled with the changing demographic profile of areas such as Edmonton Green and Upper and Lower Edmonton, has resulted in increased levels of teenage pregnancy. Other contributing factors include high levels of deprivation, low educational attainment and school attendance, all of which prevail within the NR areas. However, there are other NR projects that are seeking to address some of these issues. Although numbers are small it is also noticeable that a substantial percentage of teenage conceptions within Enfield are to married couples. There is recognition that we need to do more to target conception rates in „hotspot‟ wards – those with an under-18 conception rates among the highest 20% in England. This includes Bowes, Edmonton Green, Ponders End, Haselbury, Enfield Lock, Jubilee and Turkey Street in Enfield. The Sexual Health Education Project is also to be reviewed to ensure stronger emphasis on working with schools and education services. 6
Patchwork Housing Association are developing 8 new mother and baby units for teenage parents. Two floating Support Schemes for teenage parents have been developed; one by Step Forward (Metropolitan Housing Association) and the other by Patchwork Housing Association. They have been supporting 24 young parents. Impact In NRF Wards/Impact Among Disadvantaged Groups In terms of neighbourhood renewal areas there is no time series data available for the target diseases. Similarly, because the numbers are often so small the Teenage Pregnancy Unit (TPU) does not release annual ward level data, rather it is aggregated into 2 year data. Ward level data for 2003 and 2004 has not been released making it impossible to determine whether health inequalities are being reduced. However, teenage pregnancy services are targeted towards conception „hotspots‟. There is a clear link between the rates of teenage conceptions in Enfield and localities showing a high index of deprivation score; areas with a high percentage of non-white British residents and areas with a high percentage of young women achieving no qualifications or Level 1 qualifications. This is implicit in the other sections. Particular support is given to young people from refugee and asylum seeking communities. Main Service Changes By Key Partners In Response To Challenge/Support Through ESP Structure (Local Coordination And Partnership Arrangements) Implementation of the local Teenage Pregnancy and Parenthood strategy and progress towards targets for 2010 is now referenced in the Community Strategy, Interim Children and Young People‟s Plan 2005/06, Health Improvement Action Plan and Enfield Council‟s CPA Improvement Plan. The strategy is also integrated into the Local Delivery Plan, Corporate Objectives and Sexual Health Strategy of Enfield Primary Care Trust. All key partner agencies are signed up to the targets and have incorporated actions into their own planning processes. Local co-ordination and partnership arrangements have been agreed to dovetail with the overall aim of migrating the work of Enfield Teenage Pregnancy Partnership into Children‟s Trust arrangements and integration of the Teenage Pregnancy and Parenthood Strategy within the Children and Young People‟s Plan from April 2006. ESP Commissioned Activity The ESP Board received a presentation on teenage pregnancy on 18th May 2005 and discussed the issue in detail. „Listening 2 U‟ is a further NRF intervention which offers a counselling service for children and young people up to the age of 20 including teenage mothers and fathers and asylum seekers (60% of current service users are asylum seekers from the NRF area). The counselling is a mix of short and long term activity – some are outreach involving home visits and are very successful. Referrals can be made to services e.g. GPs and mental health services. Work is also done with Age Concern befriending
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volunteers, especially with young mothers and volunteers from the BME communities. The Enfield Observatory This permanently staffed information service and website was launched for use by the Partnership on 3 May 2005. It is funded by the Partnership and was commissioned to build its capacity to use evidence and intelligence to formulate targeted and effective interventions. The website acts, in part, as a data repository to assist the Partnership in monitoring changing socio-economic conditions and the impact of public services on them, including neighbourhood renewal projects. To that extent it assists with the performance management of the ESP. The service has assisted with the evidencing of floor target progress and the website has a link to the Neighbourhood Renewal Unit's Floor Targets Interactive site, downloads of the NRU's floor target profiles and separate datasets for the floor targets pursued in Enfield. It thereby supports the production of floor target action plans and will include the plans as downloadable documents. It will also be a reference resource and simplified presentation tool for the baselines and outcomes against all 193 targets in Enfield's Local Area Agreement. The website was made fully public on 28 April 2006 and so the ESP has further increased its accountability to residents and stakeholders. The website is:
www.enfield-observatory.org.uk/enfieldobservatory
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