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					                                                                  NHS Rotherham

Board Meeting – 15th December 2008

Teenage Pregnancy Strategy Update

Contact Details:
Lead Director:                         Dr. John Radford               Lead Officer:   Melanie
                                                                                      Simmonds
Job Title:                             Director of Public             Job Title:      Teenage
                                       Health                                         Pregnancy
                                                                                      Strategy Co-
                                                                                      ordinator

Purpose:
To highlight the progress of the Teenage Pregnancy Strategy and actions to
increase access to contraception for young people.

Background:
The National Teenage Pregnancy Strategy launched in 1999, established the requirement
on Local Authorities to reduce the under-18 conception rate by 50% by 2010, from the 1998
baseline of 56.4 (under 18 conceptions per 1000 girls aged 15-17). Whilst the overall
trajectory for Rotherham is downward, there was a slight increase in 2006 and progress
against the target is unlikely to be sufficient to achieve the 2010 target. The under-18
conception rate target is a Local Area Agreement top 35 indicator and included within the
Yorkshire and Humber Strategic Health Authority Vital Signs performance measures. These
targets would require a 27% reduction for 2008/09 and 39% in 2009/10.
A ministerial meeting between the Department of Health (DH) and Department of Children,
Schools and Families (DCSF) was held on 7th May 2008, where a Rotherham team was
required to attend and agree a series of key actions to address poor local progress, based
on current gaps in provision and best practice.

The following priorities for action were identified:
 Targeted interventions with high risk young people
     A more systematic approach to comprehensive contraceptive provision
     Increasing the role of parents in improving outcomes for young people particularly
      around talking to them about sex and relationships.


Analysis of Key Issues:
Progress Update


Please see appendix 1 for details of the Rotherham teenage pregnancy rates from March
1998 to September 2007, which have been compiled by the Office of National Statistics.
A review of the structures and governance of the Teenage Pregnancy Partnership Board
and Sub Groups has taken place and new terms of reference for each have been created.
In addition to this, a refresh of the Teenage Pregnancy Strategy has been completed and the
Memorandum of Understanding between NHS Rotherham and Rotherham Borough Council
is in the process of being updated.


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Data from Maternity Services that is required on a quarterly basis has not been received for
the last two quarters and so a meeting will take place to identify methods to overcome this
issue as well as introduce a more structured approach to data collection and analysis to
assist the planning process and targeting of services.


1.      Targeted Interventions with high risk young people

1.1      Roll out of the Neighbourhood Renewal Fund (NRF) funded pilot project in Maltby has
         begun with the recruitment of 3 WTE youth workers. These workers will all be in post
         by the end of January 2009. They will provide intensive support to young women at
         high risk of teenage pregnancy using a referral mechanism. Of the 63 young women
         supported at the Maltby project, only one became pregnant in the first year. This is
         1.6% of the cohort, compared to 5.4% of all 15-17 year old girls who become pregnant
         in Rotherham each year.1 Statistically, the risk in the Maltby cohort was considerably
         higher than for the borough as a whole. In addition, positive outcomes were achieved
         for school attendance and attainment, and reducing the numbers of young women who
         went onto to become NEET (not in education, employment and training).

1.2      The model utilises 1.5 whole time equivalent (WTE) Youth Workers within a team,
         providing intensive support, aspiration and self-esteem raising activities and advice on
         relationships and contraception. The teams will work closely with local partners
         including the school nurses, education welfare officers, children’s centre and social
         services.

1.3      The two teams will sit alongside two Children and Young People’s locality teams within
         the highest teenage pregnancy ‘hotspots’, which are Valley/Rotherham East and
         Rotherham North. Being located alongside the locality teams, the workers will have
         access to a skill mix of police, youth inclusion workers, Connexions PA’s and senior
         youth workers. Each area will utilise a replica referral system to the Maltby model, and
         will be supported through the Connexions early identification system. Such an
         approach is advocated by the Department for Children, Schools and Families (DCSF)
         and Department of Health (DH) guidance


2.       Systematic Approach to comprehensive contraceptive provision

2.1      NHS Rotherham has made additional provision of funding to support the following
         contraceptive interventions:

         2.1.1 Provision of nursing time to promote the up take of Long Acting Reversible
              Contraception (LARC), in response to best practice guidance2 and increased
              provision of contraceptive and sexual health nursing time at Rotherham
              Foundation Hospital Trust Maternity and Termination services, to reduce
              numbers of second or subsequent conceptions.

         2.1.2 Provision of dedicated nursing time for young people at high risk of unplanned
               pregnancy and poor sexual health, in particular those in pupil referral units, Youth
               offending services, the homeless and young people in care and those at risk of,
               and partaking in, sexual exploitation3.

         2.1.3 Further provision of Youth Clinics, with Youth Worker and Nurse partnership, in
               areas of high prevalence but no existing dedicated young peoples contraceptive
               and sexual health (CASH) service. These are to be developed in Kimberworth,
               Herringthorpe and Aston. This is being taken forward by the Advice and
               Information Co-ordinator, RMBC Childrens and Young Peoples Service with the

1
  Office National Statistics, 2008
2
  National Institute of Health and Clinical Excellence (NICE) (2005) Long Action Reversible Contraception: the effective
and appropriate use of Long Action Reversible Contraception
3
  NICE (2007) Prevention of Sexually Transmitted Infections and under 18 conceptions
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                  use of the additional funding to backfill her delivery time.

         2.1.4 Development of current Youth Clinics to ensure that Long Acting Reversible
              Contraception methods can be offered at all Clinics. There were no clinical areas
              or equipment suitable for implants to be inserted at several of the youth clinics
              venues and therefore amendments to premises or additional equipment will be
              purchased to increase access to LARC within youth clinics. Work has started on
              this already in the hope that all youth clinics will be able to offer implants by the
              end of January 2009.

         2.1.6 Expansion of the Hardwear Condom Distribution Scheme to vulnerable adults up
               to 25 years old as well as the development of a ‘C-card’ scheme to create brand
               recognition amongst young people and improve the availability of free condoms.
               Young people will be issued with a ‘C card’ once they have discussed their need
               for condoms with educational input and advice from the professional including
               demonstration of how to use a condom. The card will ensure that the young
               person doesn’t have to go over the education every time they need condoms and
               the ‘C-card’ lets the professional know the young person has received the
               education and are therefore able to make informed choices. This addition to the
               Hardwear Condom distribution scheme will go live in March 2009.

2.2      Additional funding was received through the Operational Plan for the delivery of a Free
         Emergency Hormonal Contraception Scheme within participating community
         pharmacies for 13 year olds and over, across the Borough. The aim of this scheme is
         to increase accessibility to emergency contraception and advice to girls who may not
         feel comfortable, or do not use, other contraception services with the overall outcome
         of contributing to the reduction of unintended teenage pregnancies. There are
         approximately 55 pharmacists within the Borough, of which 50 have requested the
         training to gain accreditation to run the scheme. This scheme was launched on 15th
         December 2008.

2.3      The launch of a social marketing campaign to increase the uptake of LARC amongst all
         women in need of contraception, targeting teens that are hardest to reach in particular,
         will commence in April 2009. The aim of this campaign will be to identify the motivating
         factors that will encourage girls and women to use Long Acting Reversible
         Contraception or the barriers that are preventing them. From this, recommendations
         will be made and a promotional campaign will take place. A funding allocation has
         been ring fenced for Rotherham by the Strategic Health Authority to enhance the work
         to increase access to contraception and so will be used to run this campaign.

2.4      The Department of Children, Schools and Families (DCSF) have selected Rotherham
         as an area where they will pilot a ‘Want Respect? Use a Condom’ campaign within one
         of the local colleges. This campaign, in Rotherham College of Arts and Technology,
         will promote the use of condoms as well as aim to educate the students around sexual
         health issues within Rotherham College of Arts and Technology. This campaign is
         expected to launch in January 2009.

2.5      The Public Health department is in the process of developing a Locally Enhanced
         Service to provide an incentive for General Practitioners to take a more proactive
         approach to promote the uptake of Long Acting Reversible Contraception amongst
         under 18’s.


3.       Increasing the role of parents in improving outcomes for young people

3.1 Literature is being disseminated to parents in the form of an information advert on folders
      used to send letters home to all secondary school children. This consists of top tips for
      talking to your children about sex and relationships. It also gives them a contact
      number for further advice or to request an information booklet. The same information
      will be available on the NHS Rotherham website and actions will be taken to work with
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    Family Learning at RMBC to create further awareness of these information sources
    and identify methods for engaging with parents in this area.
3.2 The Sex and Relationships Education sub group are revisiting approaches to engage
    parents with the aim of running a pilot project.
3.3 The Parenting Strategy can contribute to increasing the role of parents and therefore a
    meeting will be held with the Parenting Strategy Co-ordinator in the near future to
    discuss this further.

Patient, Public and Stakeholder Involvement:

1.      Targeted Interventions with high risk young people

1.1        These interventions will form a core element of Children and Young Peoples Targeted
           Youth Support and as such will be delivered regardless of additional investment.4

1.2     All locality based staff who work in a support capacity, with young people, are required
        to attend sexual health and condom distribution training, which is offered through
        NHSR and would be expected to attend unless they are strongly against it for
        cultural/religious reasons. They will also be required to attend refresher training as
        necessary. This has been agreed with Youth Service Managers and is in the process
        of being discussed with the RMBC Director of Locality Services.

1.3        All Connexions Personal Advisors are required to attend sexual health and condom
           distribution training offered through NHSR and would be expected to attend unless
           they are strongly against it for cultural/religious reasons. They will also be required to
           attend refresher training as necessary. Through working in partnership with RMBC,
           this requirement has been included in the Connexions service specification that has
           recently gone out to tender.

1.4        Consultation with girls who have attended the Maltby Project has been conducted to
           identify whether the project is providing the support and services they need.

2.         Systematic approach to comprehensive contraceptive provision

2.1 The Youth workers and nurses delivering contraception and sexual health services have
     been approached to identify what they feel is necessary to improve contraceptive
     services.

2.2        The LARC social marketing campaign will provide extensive consultation with patients,
           the public and stakeholders to gain insight to inform the work to be delivered through
           the campaign.

3.         Increasing the role of parents in improving outcomes for young people

3.1        Professionals were consulted to identify communication methods that would reach
           parents. Further work is being developed in this area.




Health, Economic and Equality Impact:
The actions set out under the Teenage Pregnancy Strategy will reduce the risk of teenage
pregnancies and the associated negative health, economic and equality outcomes which
include;
            low birth weights;
            increased risk of infant deaths/injuries and behavioural problems;

4
    DCSF (2006) Youth Matters: Next Steps
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            increased chance of having a subsequent pregnancy;
            increased risk of suffering post natal depression;
            increased risk of living in poverty and less likely to be employed or living with a
             partner;
            increase in the risk of becoming socially excluded.


Financial Implications:
All financial requirements have been agreed and there are no additional funds needed at this
time.
NHS Rotherham has agreed to contribute £120,000 per annum for three years as of
2008/09, which will fund 3 WTE posts to provide targeted support to girls identified as at high
risk of teenage pregnancy, which will contribute to the wider Targeted Youth Support
Agenda.
The Emergency Hormonal Contraception Scheme has received £30,000 in 2008/09 and will
receive £80,000 in 2009/10, which is recurrent.
The Strategic Health Authority has ring fenced £68,000 for NHS Rotherham to increase
access to contraception in 2008/09.
We will achieve comprehensive contraceptive services through £64,000 which has been
allocated to NHS Rotherham by the Department of Health (DH) as well as a £57,000
contribution made by NHS Rotherham. The Strategic Health Authority has also allocated
£87,000 for 2009/10 and again for 2010/11, which NHS Rotherham can apply for to enhance
contraception work.
The Maltby Model located in Wentworth Valley has funding secured from external sources
for 2008/9 to 2009/10, although longer term sustainability is threatened.
Approved by:

Human Resource Implications:
Targeted interventions with high risk young people
Recruitment of 3 WTE workers and management, which has been addressed.
RMBC to include sexual health and condom distribution training into the PDR’s of delivery
workers working with young people.


Systematic approach to comprehensive contraceptive provision
Recruitment of 1 WTE nurse, band 6/7, which will be confirmed when put through Agenda
for Change. The post will be dedicated to promoting Long Acting Reversible Contraception
amongst professionals and young people and to ensure that the gaps in service, identified
by the social marketing campaign, are addressed. They will also provide a contraception
and sexual health service to vulnerable young people within Youth Offending Services, Pupil
Referral Units, homeless and young people in care and those at risk of, and partaking in,
sexual exploitation.

Additional hours required for contraception and sexual health service provision within RFT to
include in depth contraception interventions with 13-18 yr olds who have a termination, who
visit the Pregnancy Advisory Service and, if appropriate, after giving birth. The number of
additional hours required are to be determined.


Increasing the role of parents in improving outcomes for young people
At present, there are no Human Resource implications attached to this area of work.


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Approved by:

Procurement:
           A contract variation with the Contraception and Sexual Health Service is due to be
            implemented.
           A service specification has been created for the Targeted Youth Support work.
           Pharmacists participating within the Emergency Hormonal Contraception Scheme will
            be monitored and payment allocated through existing agreements.
           A service specification has been created for the Long Acting Reversible
            Contraception Social Marketing campaign and will go out to tender.
           A service specification will be implemented for the contraception nurse roles.


Analysis of Risks:
Teenage pregnancy rates for 2007 fluctuate and are considerably off target. There is still
high risk that the Local Area Agreement targets will not be met and so it is essential that a
systematic approach is taken to reduce this risk.


Recommendations:
To note the current position of the Teenage Pregnancy Strategy and accept the actions
identified.


Key Words:
Teenage Pregnancy
Teenage Pregnancy Strategy
Targeted Youth Support
Long Acting Reversible Contraception (LARC)
Emergency Hormonal Contraception (EHC
Social Marketing
Contraception
Sexual Health
Condom
Melanie Simmonds
Teenage Pregnancy Strategy Co-ordinator


Further Sources of Information:
Appendix 1: Rotherham teenage pregnancy rates from March 1998 to Sept 2007, The Office
of National Statistics.
Teenage Pregnancy Partnership Board Terms of Reference
Teenage Pregnancy Partnership Sub Group Terms of Reference
Teenage Pregnancy Strategy Update October 2008
National Institute of Health and Clinical Excellence Guidance 30




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