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Teenage Pregnancy and Parenthood Strategy

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					                                                 Report to Scrutiny

                                            Item Number:10



 Subject of report            Teenage Pregnancy
 Responsible Officer(s)       Judith Finaly, Interim Director Social Services
                              Jennifer Nsubuga
                              Teenage Pregnancy and Parenthood Strategy
 Author(s)                    Co-ordinator
                              Location: Second Floor North West, Perceval House
                              Telephone: 020 8825 8563
                              Children and Young People Strategic Partnership
 Portfolio(s)
                              Teenage Pregnancy and Parenthood Strategy Board
 For Consideration By         Health and Social Care Panel
 Date to be Considered        2nd November 2005

 Keywords/Index               Teenage pregnancy

                                  Reason for report
 Programmed, periodic report (as set out in the Overview and
 Scrutiny Committee’s/Standing Panel’s forward plan)


1.    Report Summary

This report provides an update to the Health and Social Care Panel on the
recommendations on Teenage Pregnancy made by the Community Scrutiny
Committee to, and agreed by, Cabinet in November 2003 (Appendix C).

The report also provides an update on the national and local data and outline key
current issues.
2.       Background

2.1      Current position

This update is given during the final year of ring-fenced funding for teenage
pregnancy in 2006 and a push to mainstream funding on successful
interventions. It is also presented at a time of the development of the single
children’s plan which raises issues of how teenage pregnancy will be
incorporated and its contribution to the delivery of the five outcomes of Every
Child Matters. It is therefore important that scrutiny considers how in the light of
these changes all agencies and the Teenage Pregnancy and Parenthood
Strategy Co-ordinator are challenged to ensure teenage pregnancy support and
prevention work remains a high priority.

The scrutiny process for Teenage Pregnancy in Ealing originally focused on the
following:

     How to make teenage pregnancy a local priority
     School-based information and advice services
     To forward suggestions for each of the strategic areas on which work is
      focused
     The impact of cultural influences on teenage pregnancy
     An assessment of the strategy against set targets

Subsequent reports on teenage pregnancy to scrutiny have been updates on
how recommendations have been taken forward. The last update to scrutiny was
on 26 January 2005.

2.2 Teenage pregnancy - National context

The National Teenage Pregnancy is set out in the Social Exclusion Unit’s report
on Teenage Pregnancy, launched by the Prime Minister in 1999. The national
strategy targets are to:
     halve the under age 18 conception rate by 2010 and set a firmly established
      downward trend in under 16s

     increase the participation of teenage mothers in education, training or
      employment to 60% by 2010 to reduce their long term social exclusion

The target to reduce the under 18 conceptions by 50% by 2010, as part of a
broader strategy to improve sexual health, is a joint Public Service Agreement
between the Department of Health and Department for Education and Skills, and
a National PSA for Local Government. The first target is also one of two cross-
cutting indicators included as part of the Comprehensive Performance
Assessment which determines the performance rating of local government,
giving a score of excellent, good, fair, weak or poor. There is also a national
Health Inequalities ward-level target to narrow the gap between those wards with
the highest teenage pregnancy rates and the average by 2010.


2.3 Teenage pregnancy - Local Context
Teenage Pregnancy is a key target within the PCT Local Delivery Plan as well as
an essential Local Authority target.        Ealing’s Teenage Pregnancy and
Parenthood Strategy was developed in 2001. The strategy outlines how local
services work together in response to tackling teenage pregnancy. The strategy
has to main aims:

   To reduce the under 18 conception rate by 15% in 2004 and by 45% in Ealing
    by 2010
   To reduce the risk of social exclusion amongst teenage parents increasing the
    participation of teenage mothers in education, training or employment by 60%
    by 2010

Since the introduction of a local strategy, Ealing has seen a downward trend in
the rates of conceptions by 21.3% to a rate of 34.8 per 1000 in 2002, surpassing
the 2004 reduction target of 15%. In 2003, there were 203 conceptions amongst
Ealing females aged 15-17 years. The rate of under 18 conceptions in Ealing
have risen from 34.8 per thousand 15-17 year old females in 2002, to 38
conceptions per thousand 15-17 year old females in 2003. It is, however, worth
noting that although the rates of conception rose in 2003, the number of
conceptions between 2001 and 2003 have remained lower in relation to the
years between 1997 and 1999. Further, Ealing achieved a 14.6% decrease in
2003 since 1998.

Teenage Pregnancy Unit has used a ‘traffic light’ assessment to rate Local
Authorities progress in reducing under 18 conceptions. Ealing has been rated as
Amber-Green. This means that Ealing’s strategy has a good chance in meeting
the 2004 interim target of 2004 – a 15% decrease in conceptions by 2004 based
on 1998 figures (under 18 conceptions to be published in February 2006).
Appendix A gives a detailed explanation of this assessment.


Table 1: Under 18 Conceptions in Ealing
           1997     1998      1999      2000          2001       2002      2003
Number     200       222       193      203           198        185       203
Rate       38.9     44.3      38.5      40.3          37.7       34.8       38
Source: ONS (2005)
Table 2: Outcomes of Conceptions in Ealing
Ealing LB             1997-99 2000-02 % change
Under 18 conceptions    40.6     37.6      -7.4
Terminations            22.7     21.3      -6.2
Maternities             17.8     16.2      -8.9
Source: ONS (2005)


Conceptions for 15 – 17 year old girls were three (3) times less per thousand in
2000-02 than there were between 1997-1999. In 2003, there was a slight
increase in the ratio of terminations to maternities.
Graph 1 illustrates how Ealing’s rates of conceptions compare with the London
and National average. It can be noted that Ealing’s under 18 conceptions overall
were below both London and National average.


Graph 1 – Under 18 conception rate split by age group


                                                      60


                                                      50
                     Rate per 1000 girls aged 15-17




                                                      40

                                                                                            16-17
                                                      30
                                                                                            <16

                                                      20


                                                      10


                                                       0
                                                           Ealing LB     London   England


                                                             16        16 - 17
                     Ealing                                  6.7       30.9
                     London                                  10.1      40.8
                     England                                 8.3       34.6

                 Source: ONS (2005)
Ethnicity for all under 18 conceptions is not available. The table 3 provides
ethnic breakdown for teenage mothers in 2003 for Ealing and the whole of
England. The figures illustrate the need to develop an approach to diversity
issues in developing support and prevention programmes in tackling teenage
pregnancy.


Table: 3 Ethnicity of Teenage mothers in Ealing – 2003

                                  Ealing       England
      White British               35.1%         89.3%
      Irish                        2.2%         0.5%
      Other White                  4.5%         1.2%
      White and Black              6.7%         1.5%
      Caribbean
      White and Black African      2.2%         0.3%
      White and Asian              2.2%         0.4%
      Other (mixed)                2.2%         0.4%
      Indian                       5.2%         0.5%
      Pakistani                    6.7%         1.9%
      Bangladeshi                  2.2%         0.7%
      Black Caribbean             12.7%         1.7%
      Black African                4.5%         0.8%
      Source: ONS (2005)

2.4 Under 18 Conception rates for Ealing Wards
Between 2000-2002, wards with the highest rates of conception for under 18
were Northolt West End and Ealing Common. The wards surrounding these two
areas also had quite high rates of conception.
The North West of Ealing has been an area with high rates of Under 18
conception for the past 6 years. In 2000-2002 Walpole had the third highest rate
in the Borough at 58 per thousand females aged 15-17 but has now been
overtaken by rates for Ealing Common with 60 conceptions per thousand.
U18 conceptions were highest in Northolt West End with a rate of 57 per
thousand. Also high were Dormers Wells, Greenford Broadway, Hobbayne and
Norwood Green with rates of 34 per thousand.

Although Ealing has demonstrated a steady decline in conception rates since the
launch of the National strategy in 1999, the borough faces considerable
challenges in addressing teenage pregnancy, which includes the need to
        accelerate this decline if the 2010 rate is to be achieved. Graph 2 illustrates
        trends in Ealing’s conceptions and the trajectory required to meet the target of
        reducing Ealing U18 rate of conceptions to 24.4 per thousand by 2010.


        Graph 2: Under 18 trends for Ealing, London, England and Trajectory for
        Ealing

                                           1998                               2004                              2010
                                      60   baseline                           target                            target
  Under 18 conception rate per 1000




                                      50

                                      40                                                                                    Ealing LB

                                                                                                                            England
                                      30
                                                                                                                            London
                                      20

                                      10


                                      0
                                      1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
                                                                         Year
        ,
        Source: ONS (2005)

        Table 4: U18 Trends for Ealing and Trajectory for Ealing

                                                                                                     Trajectory required to meet
                                                  Actual Under 18 conception rates
                                                                                                         2004 & 2010 target

         Year                              1997   1998   1999   2000   2001     2002   2003   2004   2006   2007   2008   2009     2010

 Rate of
Conceptio 38.95 44.29 38.45 40.31 37.68 34.85 38.02 37.65 33.22 31.01 28.79 26.58 24.36
     ns
% change
  in rate
                 0.00 -13.18 -8.99 -14.94 -21.33 -14.17 -15.00 -25.00 -30.00 -35.00 -40.00 -45.00
   from
 baseline
   Source: ONS (2005)
2.5 Delivering Ealing’s Teenage Pregnancy and Parenthood Strategy – 2006
and beyond
Significant National policy developments currently          influence   the   future
implementation of the Teenage Pregnancy Strategy:
   Conception data over a period of time (1998 – 2002) necessitating focus on
    vulnerable groups within high rate neighbourhoods
   The Children Act legislation and the Change for Children Programme

The Children Act 2004 provides the legislative framework for a whole system
reform of universal and targeted support for children and young people. The Act
places a statutory duty on Local Authorities and their partners to work together
on local needs assessment, joint planning and commissioning to meet the five
outcomes set out in Every Child Matters: being healthy, staying safe, enjoying
and achieving, making a positive contribution and achieving economic well
being. Reducing the under 18 conception rate and the rates of sexually
transmitted infections among under 16s and 16-19s are specific targets and
indicators under the ‘Being Healthy’ outcome. The Strategy also contributes to
the other four outcomes, including the education, employment and training
participation target which is under the ‘Achieving Economic Well Being’ outcome.
(See appendix B).

The Change for Children Programme, which includes the implementation of the
National Service Framework for Children, Young People and Maternity Services,
requires Local Authorities to draw up a single Children and Young People’s Plan
to meet the five outcomes, by April 2006. As a national Public Service
Agreement, the local teenage pregnancy strategy is expected to be an integral
part of the plan.

2.6 Key issues for 2006 and beyond

   Although available data has provided a local picture of conceptions over time,
    this data is two years old and greatly affects the development of effective
    targeted prevention programmes. The Teenage Pregnancy and Parenthood
    Partnership Board have prioritised the collection of robust data. A working
    group to is to be set up to look into this. It is anticipated once the system is
    set up data will be available at least three months after conceptions have
    occurred. With the establishment of the data-base it is also anticipated that a
    greater number of teenage mothers and fathers will be known and supported
    into Education, Employment and Training.

   The Change for Children Programme brings in new arrangements for the
    planning, commissioning and funding of work with Children and Young
    People, with greater multi-agency working, pooled budgets and joint
    inspection arrangements. The result of this new approach will mean the end
     of a specific ring-fenced teenage pregnancy grant from April 2006, although
     money to support the strategy will continue to be included within the broader
     Children and Young People services budget. The achievements and
     developments of the past few years of the local delivery of the strategy needs
     to be sustained if Ealing is to achieve 45% decrease in conceptions by 2010.
     The investment in Ealing’s universal programmes including sex and
     relationships education (SRE) programmes in schools and out-of-school
     settings, ensuring youth-friendly sexual health advice, support and services,
     including condoms and emergency contraception needs to continue.
     Similarly, investment in targeted approaches for vulnerable groups such as
     looked after children, refugee and asylum seekers, young offenders, and
     young people with learning disabilities need to ensure that there is sufficient
     capacity to provide prevention initiatives and appropriate support.

    Linked with the development of the single children’s plan is mainstreaming of
     teenage pregnancy. The Teenage Pregnancy and Parenthood Partnership
     Board have acknowledged the need to hold discussion on mainstreaming.
     What is needed is to agree an agenda on how to progress integration of the
     strategy.

     Mainstreaming covers a number of processes concerned with ensuring
     effective projects, programmes or approaches become part of core services.
     In the context of teenage pregnancy mainstreaming suggests the need of key
     organisations focussing on the following:

      Considering resources and budgets
      Focussing on and targeting areas with high conception rate and
       vulnerable groups of young people
      Re-shaping services, e.g. by ensuring they are perceived by young people
       as friendly
      Co-locating multi-agency support
      Learning from good practice
      Effective training and organisational development
       (HDA, 2005)

A lot has been achieved in the delivery of Ealing’s teenage Pregnancy and
Parenthood Strategy. There however remain lots to be done. With the
integration of teenage pregnancy into the Single Children’s Plan, Scrutiny may
find its role beneficial in facilitating effective teenage pregnancy policies, services
and initiatives at its future meetings.

3.      Financial Implications

        Ealing currently receives funding from Department for Education and Skills
        towards the local implementation of the strategy. This funding is currently
        ring-fenced until March 2006. Department of Education and Skills will
         continue to provide funding for the local implementation of the strategy. A
         local decision will however be made about how this funding will be
         allocated in 2006 and beyond. Additional resources to support the
         delivery of the strategy have been received by local stakeholders from
         varied sources. Some of this funding has been for a limited period. For
         example funding available to NAZ to deliver work targeting boys and
         young men will cease in December 2005. West London YWCA funding
         for young parents group in Acton comes to an end in March 2006. Staff
         costs currently come from the teenage pregnancy budgetary allocation.
         With the council deciding on what posts to fund in the future, the panel
         may want to express a view to cabinet about financing future work.


4.       What the Panel is asked to conclude

         In addition to noting progress on the recommendations of the original Task
         Group and noting the current profile of teenage conceptions in Ealing (and
         how these compare nationally and at a pan-London level), the Panel may
         wish to note and comment on the following:

            That teenage pregnancy prevention and support remains a high priority
             and that progress is continually monitored and evaluated
            That Teenage Pregnancy and Parenthood Strategy Board present a
             plan for mainstreaming teenage pregnancy in Ealing
            Request a further report on teenage pregnancy prevention and support
             in May/June 2006.

5.       Background Papers

        HDA (2005) Teenage pregnancy and health scrutiny: a briefing paper,
         London
        TPU (2005) TPU Guidance on 2004/05 annual review of progress with
         local Teenage Pregnancy strategies and forward action plan
        ONS (2005) Conception data for under 18s
        Community Scrutiny Committee Task Group report ‘Teenage Pregnancy
         in Ealing’ May 2003
        Cabinet Minutes 11th November 2003
        ‘Teenage Pregnancy Task Group’ progress report on recommendations to
         Health and Social Care Panel – 26th January 2005
ANNEX A: ASSESSMENT OF PROGRESS WITH LOCAL TEENAGE
PREGNANCY STRATEGIES AND FORWARD ACTION PLANS

‘Traffic light’ rating
Mid-way through implementation of the ten-year strategy and with five years of
data to measure progress, this year a traffic light system has been used as a
performance management framework for local teenage pregnancy strategies.
This reflects the percentage difference between your 1998 baseline under 18
conception rate and the latest 2003 data:

      Areas showing an overall increase in rate or static high rate areas are
       assessed as red;

      Areas with a reduction between 0-10% are amber-red; although rates are
       going in the right direction they are behind the trajectory needed to meet
       the 2004 interim target;

      Areas with a reduction between 10-15% are amber-green; rates are going
       in the right direction and there is a good chance of meeting the trajectory
       needed to hit the 2004 interim target; and

      Areas with reductions of over 15% are green.

‘Prospects for the future’ rating
In addition, the feedback includes an assessment – on a four point scale - of the
prospects of your strategy to achieve your local reduction target (with ratings of
‘good’, ‘promising’, ‘unclear’, and ‘poor’). This assessment draws on three main
sources of evidence:

      i) progress to date and the extent to which local actions reflect strategic
       objectives and targeted work;

      ii) the engagement of key partners; and

      iii) the extent of planning towards mainstreaming.


Source: Teenage Pregnancy Unit (June 2005)
APPENDIX B:

Teenage Pregnancy’s Contribution to Every Child Matters (ECM): 5 Outcomes For Children


ECM OUTCOME               CONTRIBUTION OF TEENAGE PREGNANCY STRATEGY
Being Healthy             The Being Healthy outcome is about children and young people enjoying good physical, mental and
                          sexual health and living a healthy lifestyle. The joint DH/DfES PSA target to reduce under 18
                          conceptions by 50% by 2010 as part of a broader strategy to improve sexual health is listed as a
                          target under the ‘sexually healthy’ aim. The diagnostic rate of new episodes of STIs among under
                          16s and 16-19 year olds is a further indicator under this aim. In relation to the Teenage Pregnancy
                          Strategy the Being Healthy outcome includes the following:

                                All young people receive quality Sex and Relationships Education within Personal Social and
                                 Health Education in schools and out of school settings including those in post 16 education
                              Parents feel confident and skilled in talking to their children about sex and relationships
                              All young people know about sexual health and contraceptive services in their areas
                              All young people have access to young people friendly contraceptive and sexual health
                                 services appropriate to their needs in statutory and non- statutory settings
                              All young people have access to free pregnancy testing and counselling and speedy referral to
                                 NHS funded abortion or maternity services
                              Teenage parents have access to antenatal and postnatal services tailored to their needs to
                                 improve the physical and mental health outcomes for them and their children
Staying Safe              The Staying Safe outcome is about children and young people being protected from harm and
                          neglect and growing up being able to look after themselves. In relation to the Teenage Pregnancy
                          Strategy it includes the following:

                                All services and practitioners working with young people around sexual health understand their
                                 duty of confidentiality to young people but are able to identify abuse and exploitation of young
                                 people and refer appropriately - linked to the Common Assessment Framework.
                                  Support for young parents experiencing domestic violence.
                                  Support for young parents to help their children thrive and develop.
                                  All under 18 lone parents are provided with accommodation with support in a safe
                                   environment.
Enjoying and Achieving     The Enjoying and Achieving outcome is about children and young people getting the most out of life
                           and developing broad skills for adulthood. In relation to the Teenage Pregnancy Strategy it includes
                           the following:

                                 All young people have opportunities to build self-esteem and aspirations to fulfil their potential
                                  and minimise risk-taking behaviour

Making a Positive          The Making a Positive Contribution outcome is about children and young people making a positive
Contribution               contribution to the community and to society. In relation to the Teenage Pregnancy Strategy it
                           includes the following:

                                 Young people representative of the local community are involved in the needs assessment,
                                  planning, delivery and monitoring of work to prevent teenage pregnancy, improve sexual
                                  health, and support teenage parents.

Achieving Economic Well-   The Achieving Economic Well-being outcome is about supporting children and young people to
being                      achieve by offering education and training appropriate to their needs. The Teenage Pregnancy
                           Strategy target to increase the participation of young mothers in education, training and employment
                           to 60% by 2010 contributes to the DfES PSA target to reduce the proportion of young people not in
                           education, employment or training by 2 percentage points by 2010, set out under the Achieving
                           Economic Well-being outcome. In relation to the Teenage Pregnancy Strategy it includes the
                           following:

                                 All teenage parents are provided with a co-ordinated package of support.
                                 All young parents of school-age are supported to continue their education to meet their full
                                  potential.
   All young parents 16 and over are supported to continue or re-engage with their education and
    training to meet their full potential
   All young parents under 19 in education or work-based learning have appropriate childcare to
    meet their needs.
   All lone parents under 18 who cannot live at home are provided with accommodation with
    support to make a successful transition to independent tenancies.

				
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