Children and Young People Committee

Inquiry into Parenting Action Plan

Response From Cwm Taff NHS Trust

This inquiry contribution has been prepared in relation to the services provided by the Obstetric, Gynaecology, Sexual & Reproductive Health Directorate, Cwm Taf NHS Trust. The directorate provides obstetric, gynaecology, sexual and reproductive health services to the population of Rhondda Cynon Taf and Merthyr. The directorate works closely with other services within the Trust and its partners with the aim of providing holistic healthcare.

Delivery of the Parenting Action Plan

How effective do you consider the implementation of the Parenting Action Plan to have been? The table below lists 3 of the 4 aims of the Parenting Action Plan and provides examples of how the aims have been addressed within the Obstetric, Gynaecology, Sexual & Reproductive Health Directorate:

AimExamples of Directorate activity

Raising the profile of parenting among policy makers and service providers in Wales.Work originated and led initiating strategic consideration of teenage pregnancy and parenthood in Wales with the Welsh Assembly Government

First Welsh conference planned and hosted on teenage pregnancy and parenthood: ‘Young Parents & Young Parents to be – A Welsh Perspective’

Work instigated and led with the Welsh Assembly Government related to enabling a Wales-wide approach to routine enquiry into domestic abuse with pregnant women / new mothers. Work presented globally and model of enquiry implemented in A&E and women’s health settings across Wales

Local development of comprehensive maternity health records including robust antenatal health and social assessment, model being refined and considered by Welsh Assembly Government for all Wales use. Work led working with the Welsh Assembly Government related to perinatal mental health Working together with the Framework for Parenthood designing and commissioning a robust piece of work that has developed into a teenage pregnancy, parenthood and sexual health strategy. Implementation plan currently being developed.

AimExamples of local activity

Further the development of policies and services that support mothers, fathers and carers in their caring role

Close work with Flying Start services locally to provide seamless care to pregnant women and parents in Flying Start areas

Designated midwifery service developed specifically related to young women under 18 years who are pregnant and vulnerable women including those who misuse substances, are victim of domestic abuse, have significant mental health problems or have complex social issues.

Specialist knowledge developed related to benefits and housing in relation to young parents Dedicated parentcraft classes provided for young parents aged under 18 years Service supported by policy, referral criteria with formal links with other agencies well established.

Peer group support sessions established for young women under 18years providing practical help with healthy eating on a budget, smoking cessation and other health related topics. Partners and extended family encouraged attending. Regular contribution to statutory education for young pregnant women who are under 16

Make connections with other policies and activities that have an impact on parenting

Targeted service postnatally enabling speedy access to long acting contraception for vulnerable women Integrated sexual health service provision developed locally increasing access to contraceptive, sexual health and abortion services

Peer reviewed and published under 16s risk assessment developed to help health professionals in assessment and decision making for young people accessing sexual health services Project development of targeted sexual health service provision to parents and others who misuse substances

As illustrated above, the implementation of the Parenting Action Plan within the Obstetric, Gynaecology, Sexual & Reproductive Health Directorate has been in part successful. Since the merger of Pontypridd & Rhondda NHS Trust and North Glamorgan NHS Trust in April 2008, opportunities for extending existing services across he new Trusts catchment area enabling equitable service provision have presented. The recently appointed Directorate Management Team recently will be forward planning in terms of service redesign and development.

Has the amount of support available to parents increased

The amount of support to parents has increased both directly and indirectly as a result of some of the developments listed above. Improved assessment processes and implementation of the NICE guidelines related to antenatal and post natal care means that more support as staffing resource is redirected to parents most in need.

Is support accessible to all parents

Support is available to all parents through generic midwifery services. Targeted intervention can be accessed through self or other referral to dedicated midwifery teams who have a specified remit to work with vulnerable groups.

Is support getting through to the parents who need it most

Support is available through dedicated teams who have a specific remit for working with women identified as vulnerable or requiring extra intervention.

Do parents receive more information, and is positive parenting effectively promoted?

Parents receive verbal and written communication to help them make choices in the antenatal and postnatal periods. The Trust is currently short-listed for a Twf Award for its work with promoting the Welsh language. The Trust received a Baby Friendly Award for promotion and enabling of breast-feeding, known to aid mother baby bonding and therefore promote positive parenting.

All women are discharged postnatally with information related to infant feeding and prevention of sudden infant death. Close work with health and partner organisations underpins the directorate’s approach to positive parenting by aiming to provide services to parents that most meet their needs based on joint assessment and care planning.

Do parents participate more in planning services and in schools?

Parents are encouraged to participate in planning services by providing their views on the care they received through their pregnancy and early parenthood. An evaluation of maternity care received is undertaken with every woman to ensure that women and partners views are listened to and used to inform service design and delivery.

An established maternal and child health forum exits and the home birth forum enables parent’s proactive contribution to service planning Regular feedback from young people who receive the dedicated service enables changes to be implemented with regard to this specific client groups’ requirements.

Are you aware of barriers experienced by parents in accessing support services and information sources? What are the key reasons for theses barriers?

The geography and public transport provision within Rhondda Cynon Taf and Merthyr is not always conducive to speedy access to services. Young women under 16 who are pregnant do not always have access to education as per statutory requirements. Young fathers are not always enabled to play an active part in their new baby’s life, reasons are varied. Many young people’s only means of telecommunication is via pay-as-you-go mobile telephones – often they have no credit or change networks/numbers frequently sometimes making communication with professionals difficult.

Can you provide any examples of innovative practice in ensuring that services and information is accessible and barriers can be overcome?
- Having a dedicated service specifically for young people. Health professionals who become experienced in managing the specific type of issues young people can face as new parents can provide a well rounded holistic service. Young parents can have particular needs in term of claiming benefits, maintaining education etc.
- Using text messaging as a means of regular communication with young parents.
- Providing transport to parentcraft/peer group support/clinic settings where vulnerable parents can access a multitude of health related services, e.g. a ‘one-stop shop’ approach to parenting.
- Post natal telephone assessment for suitability of long acting contraception and liaison between services.

Continued work on parenting

What do you consider to be the key parenting issues still needing to be addressed by the Welsh Assembly Government? The Welsh Assembly Government needs to consider more explicitly teenage pregnancy in Wales, providing a position statement related to its views in terms of whether teenage pregnancy is an issue for Wales and if so further develop policy in terms of its strategic policy direction.

What has worked and what hasn’tAre you aware of any examples of good practice in supporting parents? Can you detail these and explain why these examples have been successful?

The development of a health care support worker role enables the consistent implementation of pre-agreed parenting intervention with families. The postholder works under the direction of a qualified midwife and with families to help resolve any issues identified on assessment. The service is provided in a community setting in the antenatal or immediate post natal period. This development has been successful because introducing skill mix into a team increases that team’s capacity to work with more families at greater depth. It also enables greater responsiveness to need expressed by parents.

Can you identify areas of the Parenting Action Plan, which you consider to have been successfully implemented, and any that have not? Why have these areas been successfully implemented or not?

In relation to this directorate’s position, this question has been addressed in the information provided above in relation to what has been successfully implemented. Some of the challenges locally include:

The need to access universally available, quality assured information for women in the antenatal period related to parenting
Strengthen links with agencies that can ease the return to education or employment for young parents
Development of an information pack for young people who are pregnant.