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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