Strategic overview

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					                  Children and Young
                  People’s                                                   Item
                  Partnership Board
                  TITLE: Teenage Pregnancy Strategic Overview
DATE: June 2009                                                              WARDs

                  SUMMARY: This paper sets out the plans for 2009-10,
                  with targeted objectives based on a detailed analysis of

CONTRIBUTORS      RECOMMENDATION(S): For information only

                                        - 84 -
1.    Teenage Pregnancy Strategic Overview 2009-10
1.1   While preceding years data 1998-2006 has indicated a demonstrable
      downward trend in local rates, provisional data for 2007 identifies a
      concerning increase in the under 18 teenage conception rate for
      Hammersmith and Fulham at 50.7 per 1000 (105 actual conceptions).

1.2   This trend is replicated in data for England at 41.7 per 1000 (40.6 per
      1000 in 2006). Analysis identifies that, nationally, this rise has been
      attributed to conceptions leading to termination, with the birth rate
      remaining constant. This trend is not reflected locally where termination
      rates have fluctuated year on year.

1.3   Comparison with statistical neighbours (Wandsworth, Islington,
      Westminster, Camden) also identifies that half of these Boroughs have
      seen either increased rates or rates remaining constant.

1.4   It is important to note that Hammersmith & Fulham continues to have the
      second largest reduction in London and sixth largest reduction nationally
      against the 1998 baseline at 27%. The increase in the 2007 rates does
      however indicate some potential challenges in meeting the target of 50%
      reduction by 2010.

       Graph showing comparison in reductions of under-18 conceptions
       per 1,000 for England, London and Hammersmith and Fulham and
                  under 16 rates for Hammersmith and Fulham

                                                                 LBHF U18
        60                                                       London U18
        50                                                       England U18
        40                                                       LBHF U16
                                                                 England U16
                                                                 London U16
             1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

                                      - 85 -
        Table showing LBHF under-18 conception numbers, rates and yearly

      Year      Number      Rate       % ending in abortion     % decrease since 98
      1998        139        69                   59                    N/A
      1999        156       76.5                  58                    10.9
      2000        126        60                   74.6                  -13.3
      2001        135       61.3                  64                    -11.2
      2002        137       65.4                  65                    -5.2
      2003        119       56.4                  64                    -18.3
      2004        106       47.5                  53                    -31.1
      2005        93        40.6                  53                    -41.1
      2006        95        43.8                  66                    -36.5
      2007        105       50.7                  59                    -27.0

1.5    Given the above, continued emphasis on delivery in the following areas is
       therefore considered paramount:

            Universal programmes, including the sex and relationship education
             (SRE) programmes in schools and out-of-school settings,
            Ensuring young people have access to youth-friendly sexual health
             (SH) advice, support and services, including condoms and emergency
             contraception (EC).
            Facilitation of training for all professionals who work with young people.

1.6    In addition, there is clear need for targeted provision (see following for
       detail) to ensure that those who are most at-risk are reached.

1.7    This Strategy and corresponding Action Plan was developed with
       contribution from key partners, including frontline and strategic leads,
       during a multi agency Away Day March 2009.

2.     Developing Targeted Approaches

2.1    Hotspot Areas

2.2    Ward conception rate data for 2004-2006 positively highlights that three
       quarters (12 out of 16) of wards in Hammersmith & Fulham saw a
       decrease in rates for this period. Askew, Fulham Broadway, Fulham
       Reach and Palace Riverside wards all identified increased rates.

2.3    In direct correlation with 2003-2005 data, significant reductions were noted
       in: Hammersmith Broadway; College Park & Old Oak; North End; Sands
       End; Town; and Wormholt and White City. Despite this however, rates in
       the following wards remain comparably high: College Park & Old Oak
       (60.7); Shepherds Bush Green (55.2); Munster (51.9); North End (51.5);
       Town (50.3).
                                         - 86 -
2.4      In 2009/10 these key areas geographical areas will require further
         prioritisation in the implementation of activities and facilitation of training
         for professionals.

      Table showing numbers of under-18 conceptions for four periods of 3
           years, alongside under-18 conception rates for 2004- 2006.
          (Highlighted in red are the 3 wards with highest numbers or rates)

                                                                                   Ward U18
                           Number of     Number of     Number of     Number of
Ward                      conceptions   conceptions   conceptions   conceptions
                                                                                   rate 2004-
                            2000-02       2001-03       2003-05      2004-2006
Addison                       18            21            17            14           39.9
Askew                         28            23            23            26           52.1
Avonmore and Brook
                              21            22            15            13           26.9
College Park and Old
                              29            28            28            27           60.7
Fulham Broadway               27             -            11            13           30.3
Fulham Reach                  26            22            23            24           59.0
                              34            38            28            22           45.0
Munster                       21            22            13            12           51.9
North End                     28            28            24            19           51.5
Palace Riverside               9             -             7             9           33.5
Parsons Green and
                              14            13            8             6            17.6
Ravenscourt Park              30            28            20            17           43.0
Sands End                     23            26            16            17           40.1
Shepherd's Bush Green         31            27            26            24           55.2
Town                          18            23            19            16           50.3
Wormholt and White
                              41            42            40            35           43.7
Total                         398          363           318           294

3.       Vulnerable Groups

3.1      Local analysis and consultation with key stakeholders has identified a
         need to prioritise and ensure targeted provision towards the following
         cohorts of young people:

            Looked after children (LAC)
            Care leavers
            Young people at risk of entering the care system
            Black and Minority Ethnic (BME) Communities including refugee and
             asylum seeker young people
            Those living in wards of deprivation
            Those attending the Pupil Referral Unit (PRU)
            Young offenders and,
            Young people with disabilities.

                                          - 87 -
3.2   2009/10 will see continued focus on work with Looked after Children
      (LAC), Care Leavers and young people at risk of entering the care system.
      A recent independent review of the health needs of the H&F LAC,
      completed in 2008/09, identified a need for continued work to develop and
      sustain appropriate referral pathways to ensure the needs of this cohort
      are identified and met.

3.3   Local analysis of teenage mothers and evidence based research has also
      identified that young people with a history (past or present) of experience
      within the care system are at greater risk of sexual health concerns
      including teenage pregnancy.

3.4   Activities and interventions will continue to target deprived estates and
      neighbourhoods. All interventions and strategies will be tailored to ensure
      that practice is sensitive to issues of diversity such as gender, culture,
      class, ability and faith, and competently addresses the needs of young
      people within Hammersmith & Fulham.

4.    Risk-Taking Behaviours

4.1   In addition to the above, it is recognised that unsafe and risky behaviour
      that results in conceptions is not exclusive to the select groups. The
      interface between substance use, alcohol consumption, youth offending,
      poor mental health and unsafe sexual behaviour is a shared concern
      across stakeholders and continued cooperation will be maintained to both
      understand and address the causes of risk-taking behaviour.

4.2   The former sexual health support workers have broadened their remit to
      address the wider health and emotional needs of young people.
      Recommendations to further the rollout of the expanded PSHE/SRE
      programmes to schools, which includes sessions on substance misuse
      and domestic violence (pilot 2 x schools) will also be taken forward.

4.3   Local needs analysis has also identified concerns regarding the
      incidences of unplanned second conceptions. Clear referral pathways and
      timely access to contraception and sexual health advice post termination,
      birth or miscarriage will be a focus of 2009/10.

5.    Teenage Mothers and Fathers

5.1   A comprehensive database and strong referral and information sharing
      protocols are in place with key partners to ensure young mothers and their
      respective needs are identified, and social supports accessed as

5.2   The Department of Health (DoH) estimates that there are 115 teenage
      mothers in Hammersmith and Fulham who are 19 years and under (March
      2009). Currently there are 155 teenage mothers known to the partnership

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      (Teenage Pregnancy Database, April 2009). The reason for this
      discrepancy is that the DoH estimate is based upon conception/birth data
      and doesn‟t take into account population movement. Legitimately
      however, there is also an identified need to undertake data cleansing of
      the Teenage Pregnancy Database to ensure that all records are accurate
      and current, this will take place in June 09.

5.3   The needs and barriers experienced by young mothers in Hammersmith &
      Fulham are identified as multiple and complex, some of which include:

         High prevalence of Domestic Violence
         Mental and emotional health and wellbeing concerns
         Issues pertaining to low income, debt and money management
         Risk of low educational attainment
         Access to suitable and secure housing
         Social isolation
         Poorer health outcomes

5.4   Capacity to address the needs of all young women on the database
      remains a continued challenge, and 2009/10 will see continued focus on
      partnership working and brokering access to both universal (ie. Children‟s
      Centres) and specialist supports as required. In addition, 2009/10 will see
      the implementation of the pilot of the new Family Nurse Partnership
      service within the Borough which will offer intensive support (weekly,
      fortnightly, monthly) to young mothers 19 and under. Young women will be
      eligible for referral with their first 20 weeks of pregnancy and will be
      continued to be supported until their child is 2 years of age.

5.5   Partnership working with Supporting People and Housing to ensure
      access to suitable and appropriate accommodation options remains a
      priority. Additionally, further work and development to increase the uptake
      of Education, Employment and Training (EET) is required.

5.6   Local analysis has identified work with fathers/young fathers as an area
      for development. Key stakeholders will contribute to mapping and data
      collection in Quarter One with a view to identification of fathers/young
      fathers, their needs and preferred service provision model. Mapping will

         Analysis of the age of fathers as detailed in Termination of Pregnancy
         Analysis of data from QCCH Midwifery Service
         Modification of the Teenage Pregnancy Unit Referral Form to include
          detail on fathers including identified demographic detail
         Conduct an identification and consultation exercise with young fathers.
          Key partners to include: Connexions, Youth Offending Service,
          Adolescent Team, Assist.

                                     - 89 -
5.7   This data will be used to inform the commissioning of a young fathers
      service Quarter Two of 2009/10.

6.    2009-2010 Key Deliverables

6.1   Media & Information

6.2   Media Strategy

            Pro-active and reactive media work (inc. radio, press articles etc.)
            Development of a focussed strategy to promote and increase uptake of
             Long Acting Reversible Contraceptive (LARC)

6.3   Communication Strategy

            Development distribution points and resources
            Update of key websites and help lines (Sexwise, NHS Direct etc.)
            Rebrand the Teenage Pregnancy Team to ensure effective promotion of,
            referral to, the full range of services offered
            Secure and regularly update health boards in school and community
            Development of local publicity and information materials including:

      I.      Re-development of Emergency Contraception & Condom Scheme Pens
      II.     Update of “I think this young woman may be pregnant” professionals
      III.    Update of Key services directory for professionals
      IV.     Update of TPP team leaflet & contact sheet (in line with service re-brand)
      V.      Consider development of a website (in line with service re-brand)
      VI.     Development of resources focussed on promotion of LARC

6.4   Training Strategy

            Rolling programme of „Sex Matters‟ training for social care practitioners as
             part of the Local Safeguarding Children Board Training, including issues on
             basic sexual health, communications with young people, sex and the law,
             consent, sexual exploitation, sexuality and difference and supporting young
            Development of mandatory training for social care practitioners on updated
             sexual health and relationships policy for looked after children.
            Development of standardised monitoring and evaluation process

                                        - 90 -
6.5   Lovelife Campaign

         Implement a targeted health promotion campaign and positive activities
          within school and summer holidays with a focus on sexual health, substance
          use, emotional wellbeing and improving general health outcomes for young
          people. Delivery via outreach to estates and other community locations.

7.    Sex & Relationships Education

7.1   SRE in schools

         Continued delivery of SR and Substance Misuse Education (SRSME) by
          Re-integration Officer and team of sessional workers. The team deliver
          SRSME to 7 out of 8 secondary schools, the pupil referral unit, special
          schools and two FE colleges (jointly funded by Substance Misuse
         Extend roll out of expanded programme which includes 2 x sessions
          on Personal Safety/Domestic Violence
         Continue to expand and develop sessional worker pool
         Launch revised SRE Policy and Curriculum Guidance for Schools

7.2   School and Community based drop in services

         Continued delivery by the Health Support Worker and sessional
          workers of ten weekly drop-ins in six secondary schools, the PRU, 1
          FE college, 1 Sixth Form and the Connexions One Stop Shop.
         Roll out drop-in service to the last secondary school and other sites as
         Complete development of the Drop Box Facilitation Manual for
          sessional workers
         Develop standardised evaluation processes for drop in sessions

7.3   SRE for parents

         Ensure distribution and access to information for parents via universal
          and targeted support services

7.4   SRE “Choices” Resource

         Source funding with a view to further development

8.    Sexual Health & Contraceptive Services

8.1   Free Condom Distribution Scheme

         Distribution via health professionals including GPs, nurses and midwives

                                      - 91 -
         Distribution via non-health professionals such as youth                 workers,
          Connexions PA‟s, Social workers etc.
         Facilitation of training and roll out to further sites as appropriate

8.2   Free Emergency Contraception Scheme – Pharmacist PGD

         Continued availability of free emergency contraception via a PGD scheme in
          20 pharmacists across the Borough.
         Ensure sustainability and accessibility via delivery of a rolling training
          programme for pharmacists and continued promotion and marketing.
         Consider recruitment of additional key sites including Westfield Shopping

8.3   Young People Friendly SH services

         Continuation of 3 sessions of Cont@ct 2 YP SH clinic per week
         Continuation of delivery of outreach clinics to key sites including the
          Connexions One Stop Shop and Ealing, Hammersmith & West London
         Roll out „Your Welcome‟ Criteria/Status to 5 organisations

9.    Supporting Teenage Parents

9.1   Young Parents Database

         Maintain young parents database and ensure this is kept up to date to
          ensure accurate representation of needs. Develop further to include
          identification of young fathers and needs

9.2   Support Services

         2.5 dedicated caseworkers offering support to parents under 19 and
          pregnant teenagers. The workers include 1 Re-integration officer and
          Connexions PA‟s.
         Implementation of the Family Nurse Partnership Service including 4 x
          family nurses and 1 x supervisor January 2010 delivering 1:1 intensive
          support to young mothers 19 years and under.
         Queen Charlotte‟s and Chelsea Hospital offer a young mum‟s 121
          midwifery service. A team of 6 midwives offer continuous support to
          young parents throughout the maternity episode.
         West London Action for Children (WLAC) offer 121 counselling
          services to young parents and pregnant teenagers (on a referral basis
          only from midwives or caseworkers).
         A baby massage worker offers 1to1 sessions for parents experiencing
          difficulties with bonding or postnatal depression (on a referral basis
          only from midwives or caseworkers).
         Re-establish facilitation of Bump2Baby Groups, ensuring appropriate
          geographical access

                                       - 92 -
          All pregnant young women and new parents to be sent a information
           pack with information on local services.
          FIS to continue to oversee Care to Learn funding, which allows parents
           and pregnant teenagers under 19 to access money for childcare. FIS
           to continued to offer information and support re: access to appropriate
           childminding services
          Mother and baby temporary accommodation funded by Supporting

9.3    Support for young fathers

          Key stakeholders will contribute to mapping and data collection in
           Quarter One with a view to identification of fathers/young fathers, their
           needs and preferred service provision model. Mapping will include:
           - Analysis of the age of fathers as detailed in ToP data
           - Analysis of data from QCCH Midwifery service
           - Modification of the Teenage Pregnancy Unit Referral Form to
              include detail on fathers including identified demographic detail
           - Conduct an identification and consultation exercise with young
              fathers. Key partners to include: Connexions, Youth Offending
              Service, Adolescent Team, Assist.
          Commission provision for young fathers Quarter Two of 2009/10.

10.    Comments of The Assistant Director (Legal and Democratic

10.1 There are no direct legal implications for the purposes of this report

11.    Comments of Director of Finance

11.1   There are no direct financial implications arising from this report.

                        LOCAL GOVERNMENT ACT 2000
                        LIST OF BACKGROUND PAPERS

No.    Description of Background Papers     Names/Ext. of Holder of   Department/
                                            Files/Copy                Location

                                          - 93 -

Jun Wang Jun Wang Dr
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