Breaking the Cycle of Despondency and Vulnerable Mothers

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The POWSThe Pregnancy Outreach Worker Service (POWS) was first commissioned through Birmingham Health and Wellbeing Partnership in 2006.

It was one of a range of interventions commissioned in response to the Floor Target Action Plan (FTAP) for Infant Mortality.

POWS was set up to provide psycho-social support to women in deprived circumstances who were at a higher risk of infant mortality.

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Up to date - 2016

POWS work with 400 women a year and take referrals from a range of sources however since April 2015 women must meet the criteria of “most complex” (I will explain the definition on the next slide)

Those women who don’t meet the criteria are signposted to alternative support

POWS can work with a woman from the point where she finds out she is pregnant, all the way through her pregnancy, and up to eight weeks postnatally

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Most ComplexOur work is linked to a range of outcomes contained in national outcome frameworks for pregnancy and birth but our focus is now those outlined in CG110 Pregnancy and Complex Social Factors. Any one of these factors or “risks” being present would categorise the woman as being “most complex”:

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Homelessness or living in temporary accommodationSubstance misuse (including alcohol)Safeguarding issues (for her or her baby)Meets Troubled Family/Think Family criteriaRecent OffenderUnsupported teenExperiencing Domestic AbuseEither a diagnosed or short term mental health conditionRecent arrival in UK

Reducing Risks Most of the women we work with don’t just have one “risk” but 2

or 3. They have other issues too, risks that don’t qualify as most complex, like financial hardship or social isolation

We use a model that reduces risk (eliminating where possible) and adds protective factors. So the Pregnancy Outreach Worker knows that their objective is to work with the women to address the issues and at the same time build her resilience

40% of women supported saw their overall categorisation reduce as a result of the POWS intervention

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Safeguarding One of the most common risks we encounter is that the woman is engaging with Social Services, this can be that she meets the Adult Social Care definition of “vulnerable” herself e.g. she has a diagnosed and poorly managed mental health conditionLast year this was 3% of the women we supported

Usually though it is her unborn baby that is subject to the Social Services involvement and in this case the baby will be subject to a child protection plan. Last year this was 20% of the women we supported.

In a number of cases it is the POW that initiates Social Services involvement.

This can be for a range of issues but always stems from the view that the baby could be harmed or neglected due to the known behaviour of the mother (or father/partner/another member of the household), substance misuse, mental ill health, having a previous baby removed, homelessness, violence (including dv), schedule 1 offences.

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When the outcome is positive

Last year POWS supported 77 women who were also engaging with Children’s Services. 21 of these women had previously had a baby or child taken into care.

In the case of 18 of these 77 women the safeguarding issue was resolved at the point our service ceased. This means it had been decided that baby would remain with Mum.

In a further 23 cases the outcome was still undecided, although as in many of these the baby was in Mum’s care it was likely they would remain.

And in a few cases we lost touch. The woman engaged for a time but then decided that support should cease.

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Risk resolvedThere are some issues, despite being serious that are in general easier to resolve than others, so long as the woman is willing to engage there is a greater chance of her keeping her baby.

Nasreen was referred by her midwife due to domestic abuse. Her POW helped her leave and found her a place in a refuge but due to this a referral had to be made to social services. However there was no suggestion of Nasreen’s parenting ability so as she was willing to live independently she was rehoused in a flat where the POW assisted her in preparing for the arrival of her baby.

Elise was an unsupported teen, when we met her she was sleeping on a friends sofa. The POW helped her secure a place in a hostel and to start attending her appointments. Due to being a teenager social services were involved. After some weeks her partner committed to supporting her and the baby. He had a job so despite also being young he started saving for a flat. Before baby arrived they had moved into a flat and the POW was assisting with one to one parent craft sessions.

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When the risks aren’t resolved

In the case of Child Safeguarding there are risks that are more difficult to overcome:

• Substance misuse (often leading to poor mental health, sex work, financial hardship, accommodation issues)

• Having had a previous baby/child removed• Diagnosed and then unmanaged mental health condition

With these issues it requires substantial lifestyle/behaviour changes to be made and despite women usually wanting to do what it takes some don’t manage it but some do, as in the case of Stacey* (show video of Catherine the POW talking about the support provided)

(*name changed)

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When the risks aren’t resolved

We know in the case of 11 of the 77 women that their babies were removed.

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The voidOnce the baby has been removed, what can have been a high level/intensity of support and attention disappears.

Social Services withdraw – their focus having been the safety of the baby (the only exception is if the mother is also a vulnerable adult, in which case she’ll retain her social worker but the threshold is quite high).

A new mum would in normal circumstances expect support from her midwife, Health Visitor and her local Children’s Centre (most likely via a Family Support Worker) but this support is linked to the baby, so no baby, no support

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StatisticsResearch by the University of Lancaster shows in the last 7 years 46,094 women appeared before the Family Court, the same piece of research shows that 1 in 4 will return and this rises to 1 in 3 if the mother is a teenager.

1 in 4 women who have had a baby removed will be pregnant again within 18 months.

The number of babies being removed has drastically increased over the past 5 years with the 2013 level being almost two and a half times the level in 2008.

In a piece of research commissioned by the PAUSE programme a cohort of 49 women had a total of 205 children removed in the space of 5 years

Although teen pregnancy has hugely decreased in the period of time since 2008 a woman who is a LAC or Care Leaver is still 3 times more likely to become a teen mother

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