feedback to sheffield from teenage pregnancy nst march 2007

Feedback to Sheffield from

Teenage Pregnancy NST

March 2007

To be covered today• Themes of Teenage Pregnancy• Overall Strengths • The Scale of the Challenge• Issues and Recommendations by Theme - Strategy and Partnerships - Data and Needs Assessment - Communication - Implementation• Top Take-Home Messages• Summary of Support Offered• Plenary Session Discussion

• NST Contact Details

Themes

Themes of Teenage Pregnancy

• Strategy and Partnerships• Data and Needs Assessment• Communication• Implementation

• Young People focused contraceptive services• Delivery of SRE• Targeted work• Workforce training - capacity and capability• Youth services• Raising aspirations• Work with parents

Overall StrengthsLeadership and Commitment

• Commitment and enthusiasm re addressing teenage pregnancy

through PCT and Local Authority• Strong leadership and coordination potential and confidence

in new appointment of Health Strategy Manager• The role of the Assistant Director of Children’s Services (with responsibility for Learning and Achievement, Social Care and Service Districts) enables synergy and effective leadership as chair of Teenage Pregnancy Strategy Board.• Joint DPH appointment with LA provides opportunity for championing issues across health and local authority• There are a number of very positive/good frontline champions

for addressing teenage pregnancy • Reflective and thorough teenage pregnancy self assessment completed

Overall Strengths cont…

Partnership and Infrastructure

• New structures and systems emerging for partnership, coordination, commissioning and accountability.

• Service Districts give great opportunity for collaborative and seamless work with vulnerable young people and their families. 3 Service Districts have already identified teenage pregnancy as a priority.

• Very good data provided by Health Informatics Service and available at neighbourhood level.


Role of Schools and SRE

• 98% of schools have signed up to Healthy Schools Programme and 52% of schools have achieved National Healthy School Status (on target).

• Lead Professionals for SRE will give peer support to schools and shows commitment from Learning and Achievement Service to SRE.

• Healthy Schools creation of SRE good practice guidance CD specifically for Sheffield schools.


Role of Health and Contraception Services

• Good open access to contraception services with examples of best practice e.g. • Options counselling provided as part of

termination service specifically to pregnant teenagers.• Fast track abortion service for young people

to local hospital services.• Availability of early medical abortion within

Young People’s contraceptive services. • Good analysis of secondary school-based services.• Midwifery package of care provided to teenage mothers.

Sheffield Performance

Teenage Pregnancy Trends in Sheffield MCD

% change in rate from baseline 0 5.7 -0.9 4.2 10.9 5.3 7.6 1.5 -8.8 -19.1 -29.4 -39.7

% change in rate from baseline 0 -4.1 -6.4 -8.9 -8.6 -9.8 -11.1 -11.8 -19.5 -27.1 -34.8 -42.4 -50.0Fig. 1

Change in under 18 conception rate 1998-05 2005 conception rate with 95% confidence interval

% change

Upper limit

Lower limit

% change 2005 rate

Upper limit

Lower limit 2004 rate

Sheffield MCD 1.5 15.9 -11.1 1.5 Sheffield MCD 51.3 56.0 47.0 51.3 Significantly higher

Fig. 2

Under 18 conceptions 52.3 53.0 1.3 Sheffield MCD 10.9 42.1 53.0Abortion rate 21.0 22.0 4.8

Maternity rate 31.3 31.0 -1.0

Fig. 4 Fig.5

Last update: 26.02.07

Difference from England rate

2004 target

0

10

20

30

40

50

60

1997 1998 1999 2000 2001 2002 2003 2004 2005p 2006 2007 2008 2009 2010

Year

Und

er 1

8 co

ncep

tion

rate

per

100

0

Sheffield MCD

England

Yorkshire &HumberLA 2004 target

1998 baseline 2010 target

The Scale of the Challenge• A long way to go to meet the 2010 under

18s conception rate target. (51.3 in 2005 1.5 % increase from 1998). Only place in South Yorkshire with an increase, with overall decline of 10.1% for Yorkshire and Humberside.

• The Health gap in Sheffield represented by a gap of 14 years in life expectancy between different parts of the city.

• The financial position of the PCT which is diverting management time.

• Major organisational change in both the PCT and the LA which seems to be delaying some commissioning arrangements.

The Scale of the Challenge cont…

• Although improving, Sheffield remains below average on educational attainment (5 A- C GCSEs) and there is a need to address this particularly in the most deprived areas and with schools who have high teenage pregnancy numbers as well as overall improvement across the City.

• Improving access to employment opportunities and expectations for both young men and women and their families.

• Overcoming the general perception that teenage pregnancy is inevitable in certain areas.

Deprived wards with higher educational attainment have lower teenage conception rates

Educational attainment & teenage pregnancyin 20% most deprived w ards

77.4

63.2

43.4

0

20

40

60

80

100

< 40% 40-60% > 60%

% girls w ith 5+ GCSEs A-C

Educational attainment has an impact on conception Educational attainment has an impact on conception rates over and above the effects of deprivationrates over and above the effects of deprivation

• Girls having sex under 16 are nearly three times more likely to become pregnant under 18 than those having sex at 16 or over….

… on sexual activity under 16

60%

41%

19%

47% 46%

20%

0%

10%

20%

30%

40%

50%

60%

70%

no qualif ications w ith qualif ications

Leaving school at 16 Leaving school at 17+

% s

ex

un

de

r 1

6 Males

Females

Source: NATSAL 2000

…and on non-use of contraception

12% 11%6%

28%

8%

34%

0%

10%

20%

30%

40%

no qualif ications w ith qualif ications

Leaving school at 16 Leaving school at 17+

% n

o co

ntra

cept

ion

at 1

st s

ex

Males

Females

Source: NATSAL 2000

Issues and Recommendations


Strategy-Development of the Commissioning Strategy and Clarifying Responsibilities

• It is essential that there is continuing Director level support for the strategy and its implementation.

• There is a need to develop a transparent, well informed and integrated commissioning strategy for sexual health and teenage pregnancy. This need has been expressed and identified many times to us and endorsed by your own self assessment.

• There needs to be clear commissioning framework arrangements delineating the responsibilities of all the agencies involved, guided by a clear set of shared principles. (DH/DfES guidance may help with the latter.)This has some implications for the design of the new PCT structure, in particular the Public Health and Strategy Directorates and Practice Based Commissioning.

• We support the aspiration to allocate a lead role to a public health specialist to work as part of the Senior Management Team for Children and Young People’s services.


• Strategy-The Teenage Pregnancy Strategy is Everybody’s Business

• The strategy needs to provide tools for all those who work with young people to raise expectations, aspirations and self esteem, and model fulfilling lives for young people in Sheffield.

• The strategy needs to provide ways for all those who work with young people to feel comfortable discussing issues relating to sex and relationships.


• Strategy-Systematic Review

• The strategy and planning process should include a systematic review of all current teenage pregnancy interventions and empower the partnership to change the these where necessary.

• It would be helpful to assess the impact on teenage pregnancy rates ,of all relevant local health and local council policies and strategies. NST could provide support for this.

• There is scope for better targeting of existing resources e.g. in contraceptive and sexual health services. but this can only be done with top level commitment.


• Strategy-Accountability and Performance Management

• Although the teenage pregnancy strategy group is linked to the 0-19 Partnership Board it does not appear to have a high enough profile, particularly given the lack of progress against the target. We recommend that the 0-19 Partnership Board and the PCT systematically performance manage the implementation of the TP strategy.

• Consistent with the JAR report, it would be important to systematically use the scrutiny process to help progress the teenage pregnancy strategy.


• Data • There are strong data on conceptions broken

down to individual areas, on ethnicity and potentially by schools but further improvements could be achieved through the commissioning process. Service Level Agreements could contain requirements for the collection of appropriate data e.g., gender, ethnicity, postcodes and age.

• There is a need to improve data on Children in Care and Care Leavers.

• There appears to be uncertainty about data and information sharing protocols. The NST can provide examples used elsewhere.


• Needs Assessment• We recognise there have been some consultations done to

identify need including the recent Every Child Matters exercise with 4,000 young people.

• However, we picked up a strong need from partners and service providers for more of this, and other intelligence about young people’s needs and views to inform the commissioning process and service delivery/development. The NST can advise on good practice on getting intelligence about the needs of hard to reach young people.

• There is a need for systematic identification of vulnerable young people and their families/carers using risk modelling and a case study approach, whilst respecting their right to confidentiality. There are various examples where this has been done elsewhere about which the NST can advise.


• Communication

• The self assessment and many partners identified the need for an explicit internal and external communication strategy to support the implementation of the teenage pregnancy strategy.

• The communication strategy should include routes for young people, families/carers and professionals to access sexual health services, vocational and other training, careers advice, fulfilling lives, sex and relationships education, counselling and parenting skills etc. The NST can provide support with this.

Issues and recommendations

• Implementation • Everyone in the service delivery system

for young people should be made aware and reminded of the inter-relationship between teenage pregnancy, low aspirations, low self esteem and educational attainment and of their potential impact on the health, social and economic future of Sheffield.

• In other words, implementation is everyone’s responsibility!


• Implementation – Contraception/Sexual Health Advice and Services• All organisations’ potential contribution to

contraception/sexual health should be explicit. It is not just a health responsibility.

• We recommend a systematic analysis of where contraceptive/sexual health services are needed, building on the Dec ‘06 SCASH report: Sheffield Secondary School Activity Towards Supporting the Target to Reduce Teenage Pregnancy. NST could provide advice on this.

• It would be helpful for the commissioners to develop a service specification for young people’s contraceptive services based on good practice, needs and the desired model for Sheffield. The NST could help with this.

• We would support a re-allocation of resources to target services to areas of greatest need.


• Implementation – Contraception/Sexual Health Advice and Services• We recommend a review of the current PGD with

respect to the quality and age-range of emergency contraception services disseminated through pharmacies. (Currently 15-17, where some other areas have no lower age limit.)

• We strongly recommend the provision of all contraceptive methods including LARCs wherever services are provided, including where contraception is provided by GPs.

• All teenage mothers should be automatically referred to, and followed up by, contraceptive services.


• Implementation – Delivery of SRE/PSHE by Schools• SRE and PSHE need to be given higher priority in all

schools with senior level direction and reinforcement through the Learning and Achievement Service.

• The number of teachers who have taken up the certification scheme is low; there should be senior level encouragement for schools to release more teachers to certify, especially in the secondary sector.

• With the expansion of the 14-19 learning agenda and given the relatively high proportion of conceptions in Sheffield at age 17, there is a need to expand services and the delivery of SRE through FE colleges.


• Implementation – Delivery of SRE/PSHE • There should be the same SRE/PSHE curriculum

delivered to children and young people by all providers.

• The apparently emerging strategy to bring together CPD, SRE, PSHE and Healthy Schools should be endorsed at a high level by the responsible organisations in conjunction with the recently published Sheffield CD on SRE in Schools.

• The Learning and Achievement Service needs to monitor the implementation of SRE in conjunction with the Sheffield CD on SRE in Schools.


• Implementation – Targeted At Risk Groups• There is a need to identify how the services and

various agencies should engage with hard-to-reach young women and men. The NST could help identify good practice .

• Early intervention targeted work needs to be prioritised with vulnerable young people and families e.g. through Sure Start, Children’s Centres and Extended Services, and the impact reviewed.


• Implementation – Workforce Training• We endorse the findings of the self assessment,

that there should be basic sexual health awareness and signposting training for all those working with young people.

• There should also be basic skills training to raise the confidence of all those working with young people to discuss sex and relationships.

• We would encourage that both of the above recommendations be made mandatory.

• We also feel that there should be training for all those working with young people, to increase young people’s motivation to realise their potential.


• Implementation – Workforce Training• There is a clear need for more family planning

trained nurses to meet the demand for the contraception services. The NST can advise on the availability of training.

• There seems to be an opportunity with the growing numbers of learning and teaching assistant roles for these staff to undertake appropriate training with respect to sex and relationships.


• Implementation – Youth Services• We would support the intention to review

the contract with Sheffield Futures to ensure better targeting and more effective services.


• Implementation – Raising Aspirations

• The teenage pregnancy strategy needs to link in with other strategies that are being developed for raising aspirations of young people in Sheffield. The NST can help identify good practice methods in relation to raising aspirations.

• There is a need to challenge an apparent attitude by both organisations and communities, of resignation to the low aspirations of some of the young and their families, and that teenage pregnancy is inevitable.


• Implementation – Work with Parents

• We endorse using the opportunities provided by Children’s Centres, Early Years and Extended Services as part of the Core Offer to Children, Young People and Families to work with parents on developing parenting skills including talking to their children about sex and relationships. NST can provide support with this.

Top Take-Home Messages to Sheffield

• It is essential that there is continuing Director level support for the Teenage Pregnancy Strategy and its implementation.

• There is a need to develop a transparent, well informed and integrated commissioning strategy for sexual health and teenage pregnancy, which is systematically performance managed by the 0-19 Partnership Board and PCT.

• Senior level support and training need to be provided for all those who work with young people to raise expectations, aspirations and self esteem and discuss sex and relationships and signpost to relevant services.

Top Take-Home Messages to Sheffield

• There is a need for systematic identification of vulnerable young people and their families/carers using risk modelling and a case study approach, whilst respecting the right to confidentiality.

• We recommend a systematic analysis of where contraceptive/sexual health services are needed, building on the SCASH report: Sheffield Secondary School Activity Towards Supporting the Target to Reduce Teenage Pregnancy.

• SRE and PSHE need to be given higher priority in all schools with senior level direction and reinforcement through the Learning and Achievement Service.

Summary of the Support Offered

• The NST can provide support with assessing the impact of all relevant local health and local council policies and strategies on teenage pregnancy rates.

• The NST can provide examples of data and information sharing protocols used elsewhere

• The NST can advise on best practice in relation to identifying young people’s needs and views to inform the commissioning process and service delivery/development.

• The NST can advise on using risk modelling and a case study approach for systematic identification of vulnerable young people and their families/carers, whilst respecting their right to confidentiality.

• The NST can provide support with developing a communications strategy to include. routes for young people, families/carers and professionals to access sexual health services, vocational and other training, careers advice, fulfilling lives, sex and relationships education, counselling and parenting skills etc

• The NST can provide further advice on developing a systematic analysis of where contraceptive/sexual health services are needed, building on the Dec ‘06 SCASH report: Sheffield Secondary School Activity Towards Supporting the Target to Reduce Teenage Pregnancy.

• The NST can help with identifying model service specifications for young people’s contraceptive services.

• The NST can help identify good practice with respect to engaging hard to reach young women and men.

• The NST can help identify good practice methods in relation to raising aspirations.

• The NST can provide support with using the opportunities provided by Children’s Centres, Early Years and Extended Services as part of the Core Offer to Children, Young People and Families to work with parents on developing parenting skills including talking to their children about sex and relationships.

• The NST can advise on the availability of training for family planning nurses.

Plenary session discussion

• PCT, LA , SHA to comment

• Questions to clarify feedback points

• Comments on Feedback

• Any comments on our process

• Next steps

Cathy HamlynDirector of National Support Team

[email protected]

07867 538287

Daniela Silcock Project Officer [email protected]

0207 972 4264

Kate Quail Delivery [email protected]

[email protected]

0114 271 1184

Avril Howarth Delivery [email protected]

[email protected]

07776244485

Sarah CarterAssociate Delivery Manager

[email protected]

07884473182

NST Office address :Rm 622 Director’s Office address Room G18

Wellington House Richmond House

133-155 Waterloo Road Whitehall

London SE1 8UG London SE1 8UG

Fax 0207 972 4700 Fax 0207 210 5438

Teenage Pregnancy National Support Team Contacts

mailto:[email protected]














feedback to sheffield from teenage pregnancy nst march 2007

Documents

sheffield schools

teenage pregnancy reflective

teenage pregnancy nstmarch

teenage mothers

service districts

achievement service

health informatics service

termination service