Sandwell Teenage Pregnancy Strategy 2000-2010 by Alex Hawley

Together we made a difference Sandwellâ&#x20AC;&#x2122;s Teenage Pregnancy Strategy 2000-2010

contents Page Introduction and Overview

The Last Ten Years

A Final Word by Anna Sewell

1: PREVENTING Teenage Pregnancy

2: IMPROVING ACCESS to advice and contraception

3: IMPROVING SRE in schools and non-school settings

4: SUPPORTING: Pregnant teenagers and young parents

5: HELPING Vulnerable Young People

6: HOW Young People Support Us

7: WHAT the data tells us

What Next? Reflections and Thoughts from Dr John Middleton

A Final Word, Cllr Maria Crompton

References

Key Documents

Roll of Honour

Authors and Contributors

Want to know more?

introduction By Janine Brown Welcome to this report – or ‘legacy document’ as we should call it – marking the end of the ten-year strategy for teenage pregnancy in Sandwell. This comes at a time of great change in public services and in the approach, nationally and locally, to teenage pregnancy prevention. So this makes it an important time to ensure we record the work that has been done over the last decade – and to celebrate the many achievements over this time. As Children and Young People’s Commissioning Director for Sandwell Primary Care Trust (PCT), I had the pleasure of chairing the Teenage Pregnancy Board from 2003 until we incorporated the work into the Successful Young People’s Board in 2009 and it really has been a pleasure. There has been true partnership and commitment to work together to achieve our aim. From the imaginative and creative commissioning team – comprising Sarah New, Teenage Pregnancy Co-ordinator, Cindy James and Anna Kaur – to the many managers and staff across the different organisations involved. All have worked tirelessly toward the same aim: To prevent as many young people as possible from unwanted early

pregnancy, while ensuring that those young people who became parents were supported in caring for their children and not be disadvantaged by their early parenthood. The passion and commitment I have encountered from all of these people throughout this time has been remarkable and this positive approach has ensured that many excellent services have developed and positive outcomes achieved for young people in Sandwell. All of these are a real lasting legacy that I hope you’ll enjoy reading about here. At this time of change it is even more important that we learn from this fantastic legacy to ensure that this decade of learning isn’t lost, as we move to more integrated support for young people vulnerable to negative outcomes. It should, instead, offer a template and foundation to build on for future success. I would like to take this opportunity to thank Sarah, Cindy and Anna and all the many staff, some still working with young people in the area and some who have moved on, for their hard work, commitment and passion. It really has been a privilege to work with you all.

Be proud of what you achieved.

Ja n ine An n a

S a rah

C in dy 3

the last ten years By Sarah New Sandwell’s Teenage Pregnancy Co-ordinator, Senior Commissioning Manager, Sandwell Primary Care Trust (PCT). I have a difficult task in trying to sum up ten years of work by the Teenage Pregnancy Strategy (the Strategy) given the huge amount of work undertaken by a large number of people, but before I go any further it’s important to simply state our original aims – and just how far we have come towards achieving them.

Our Aims In 2001, the Sandwell 2000 – 2010 Teenage Pregnancy Strategy was established and a number of challenging aims were set. These were:

l To reduce Sandwell teenage conceptions by more than half – 55% – by the year 2010 to a target rate of 31.1 (per 1,000). This was from a 1998 baseline rate of 69.1 l To improve support for pregnant teenagers and teenage parents

Have we achieved our aims? Confirmed conception data for 2010 is not available until summer 2012 due to the time delay receiving information from the Office for National Statistics. But based on 2001 to 2009 data it is unlikely we achieved this ambitious target. But we should not be downhearted or feel that we have failed: Quite the opposite. We have a lot to be proud of and to celebrate – as you will see in this report – and we are proud that we have achieved a massive 24% reduction since 2001. The achievement of the original target was always highly ambitious. We must acknowledge that Sandwell had a higher starting point than some areas. On top of this there are high levels of deprivation in the borough and poor health and wellbeing outcomes across a range of different

indicators – not just teenage conceptions. The latest annual report of Sandwell’s Director of Public Health states that Sandwell is fairly uniformly deprived and that 17 out of 24 electoral wards are amongst the 255 most deprived in the country. Given the rate of inequality and poverty in Sandwell, we are particularly proud that we managed to address inequalities. We have done this by using a targeted approach in wards with high conception rates. In 2009, a total of 75 fewer young women conceived than in our baseline year of 1998. Young people themselves should be congratulated for heeding messages and for choosing alternatives to teenage parenthood. A huge variety of work carried out by staff has had a positive impact on this. Much of it has been about addressing the underlying issues affecting young people’s risk taking and decision making – things such as confidence, self-esteem and aspirations. Many young people who became young parents also worked hard to achieve on top of the challenges and demands of young parenthood itself. Many have improved their skills and training, acquired qualifications or gone to university. You’ll read some of these inspiring stories within this report.

So what have we achieved? l 75 fewer young women conceived in 2010 than in our baseline year of 1998 l Between 1998 and 2009 we saw a 24% reduction in teenage conceptions. This was a bigger reduction than achieved at a West Midlands level (17.4%) or the whole of England (18.1%) l Rates in our high conception rate wards fell over the years to meet the Sandwell average, thereby reducing inequalities l Real improvement in young people’s contraception services with review and development of new young people’s services based on the views of young people themselves l Improved sex and relationships education (SRE) in school and non-school settings, including the expansion of the successful APAUSE programme from just four pilot schools to the majority of High Schools and pupil referral units l Education and outreach services have targeted high-risk groups including black and ethnic minority (BME) young people, Looked After Children (LAC) and those living in high conception rate wards l More support for pregnant teenagers and teenage families through better antenatal care and support services l Better support and education for teenage parents to support them in education, training and employment

You’ll find out more about all of our achievements in all these areas as you read through this legacy document and we have tried, where possible, to give real examples and personal stories that help bring our work to life. Despite our achievements we have to acknowledge that we are still facing challenges in relation to teenage pregnancy and young people’s sexual health. We may have reduced conception rates but our abortion rate has remained pretty static and sexually transmitted infections (STIs) continue to be of concern. The current economic climate – with an increasing number of young people unemployed – will also have a real impact, not least on aspirations. Throughout the Strategy we have worked hard to address young people’s aspirations and to encourage them to consider delaying first sexual intercourse and to delay parenthood. But we have now begun to see rises in conception rates in the West Midlands and this may also be reflected in Sandwell in future. The challenge now is to maintain focus on supporting young people in a climate of cuts in public spending and major reorganisation of public sector services at a national and local level. We need to keep young people on the agenda. Investing now in improving the outcomes for children and young people will save money in the long-term for public sector services – be it health, support services, or welfare.

...24% reduction in teenage conceptions

l Better engagement with young people so they have an input into strategy development and the review of services l Increased awareness of, and investment in, teenage pregnancy by Sandwell PCT and partners such as: Sandwell Council; Sandwell Neighbourhood Renewal; Greets Green Partnership and Sure Start Plus

Together we have made a difference Everything we have achieved has been done by working closely with others. Effective partnership working has been crucial to the success of the Strategy and you’ll see how we have made a difference together as you flick through these pages. But, simply, we have worked with a wide range of partners including: Health; Contraception and Sexual Health Services; Education; Social Care; Voluntary Sector; Youth Services; Connexions; Welfare Services; Maternity; Health Visiting and School Nursing Services. Throughout the lifetime of the Strategy key staff from across partner agencies met and worked together as a Teenage Pregnancy Virtual Team – holding regular meetings to provide support to each other, facilitate joint work and share good practice. The commitment and enthusiasm of these staff is admirable and they were a key factor in the success of the Strategy through their determination to overcome barriers and ensure the needs of the young person came first. Whilst my job has certainly been challenging over the years, I feel very fortunate to have worked with so many committed, creative and motivated staff across the agencies, without whom the Strategy would not have been as successful. I am proud of what we have achieved together. It is immensely satisfying to look back on the past ten years and see how both the Strategy and local services have developed from, in some areas, a baseline of no service provision at all. Young parents and young people have benefited from these new services. I have every admiration and respect for the young people and young parents that have worked with us to make the Strategy and local services better, often juggling family or

academic commitments. Their contribution has been invaluable in guiding the Strategy and developing local services and they demonstrate that young people themselves are our greatest asset. Our challenge in future is to continue to commission high quality and effective services that enable young people to achieve their full potential in a context of less money and fewer staff. This will require innovative and integrated approaches. We have had considerable strategic leadership and commitment from a wide range of managers across partner agencies over the years. They played a crucial role in determining local priorities and developing integrated and innovative solutions to needs, gaps and problems identified as members of our Teenage Pregnancy Partnership Board (TPP). This was disbanded in 2009 to reflect changing structures in the Children and Young People’s Partnership. The TPP and teenage pregnancy as a whole was incorporated into the Successful Young People Programme Executive’s priorities. This meant our key partners were able to consider teenage conceptions in a broader context: to address other reasons preventing young people becoming successful such as offending behaviour, substance misuse and not attending school, training or employment. I now work very closely with the Council’s Young People’s Commissioner, Carol McCauley and partners on the Building Resilience Group that provides opportunities to develop more integrated services and obtain better value for money by maximising opportunities for joint commissioning.

The evidence is clear...... Our Strategy has been informed by analysis of local needs and has been, where available, based on evidence. Our colleagues in Public Health have supported us throughout. Their important work has identified what needed to be done and provided information to help us commission services to meet those needs. Just one example is the extensive review undertaken by Public Health Consultant Dr David Pitches (see Note 3 in References, page 90) that highlighted the local trend of conceptions amongst Year Eleven girls. As a result, the Raising Aspirations and Promoting Alternatives to Teenage Parenthood Programme was developed and commissioned from Sandwell Connexions. In 2008, further analysis by Public Health identified that the local birth rate for those under 17 years was highest among black population, followed by the white. The Asian population had the lowest conception rate. This information enabled the Teenage Pregnancy Commissioner to target available resources to specific black and minority ethnic (BME) services more effectively.

The future Following government changes to strategic planning and financial grants to councils and PCTs, teenage conception is currently an acknowledged local priority for Sandwell Councilâ&#x20AC;&#x2122;s new Health and Wellbeing Board and is one of its future priorities when it takes on its new responsibilities for Public Health. Sandwell has achieved a significant reduction in its teenage conception rate and it is crucial the focus is maintained to ensure that every child in Sandwell has the best possible start in life and young people are supported and enabled to maximise their capabilities and have control over their lives. Reducing teenage conceptions is a priority for the current government and has been included as a key indicator for health improvement within the recently published Public Health Outcomes Framework for England. It will be a Health and Wellbeing Board responsibility to ensure appropriate action is undertaken at a local level to ensure a continuing downward trend of teenage conceptions.

Until 2010 we had to review our Strategy and develop an action plan every year. We received feedback on this from regional Teenage Pregnancy Co-ordinator and the National Teenage Pregnancy Unit â&#x20AC;&#x201C; and this was helpful in challenging us to do better in certain areas and confirming where our Strategy was doing well.

...teenage conception is currently an acknowledged local priority

Sh a n ie k a n d b a

by L ati v ia

A final word By Anna Sewell Regional Teenage Pregnancy Co-ordinator, 2006-2010 Sandwell has worked consistency hard over the period of the ten-year Strategy and led the region in developing work with BME groups and in providing support to young parents. The reduction in its teenage conception rate of 24% from 1998 to 2009 was testament to the hard work of the professionals who had made significant steps towards embedding the Strategy within mainstream services. This needs to be maintained and integrated within all future work on health and wellbeing and child poverty in order to continue the downward trend and make future financial and social cost savings in a time of extreme economic challenge

About us The previous government had a national strategic approach to tackling teenage pregnancy â&#x20AC;&#x201C; the National Teenage Pregnancy Plan. This was driven between 2000 and 2010 by the National Teenage Pregnancy Unit (TPU). Here in Sandwell, we launched our own Strategy as part of the governmentâ&#x20AC;&#x2122;s overall national plan. It was tailored to suit the needs of the borough and has guided all of our work. Our challenging aim was to reduce by 55% the number of teenage conceptions in Sandwell by 2010. To try and achieve this we worked with young people themselves and all of those organisations that can offer support and expertise. In this report you will find out more about the people we have worked with, the huge variety of projects we have supported and the successes that have been achieved.

...reduce by 55% the number of teenage pregnancies 8

Our principles and values Through our Strategy and our partnerships, we have developed principles and values that underpin all of the work we do. We are committed to: Being young people-centred

l Working together with different organisations and professions l Targeting our work to address the inequalities between different areas and groups of people l Having a long-term, sustainable approach l Basing our practice on what works best

PREVENTING teenage pregnancy

Teenage pregnancy doesn’t just affect the young people involved but has far-reaching effects on the wider community. So how do we prevent it? Unfortunately there is no quick fix. It is a complex issue that takes many years to have any kind of effect involving everything from education to changing behaviour and improving aspirations. That is why the Strategy was set up ten years ago. So what it achieved in Sandwell over the last decade? You’ll find out as you read through this report and see the variety of different projects we’ve put ‘under the spotlight’.

In this section You’ll learn more about who we are and more about the things that really affect teenage pregnancy rates – so you can see the scope of our work and the size of the challenge we have faced.

Why teenage pregnancy matters Why does it really matter if young people become parents? The majority of teenage pregnancies are unplanned and around half end in abortion (see What the Data Tells Us, page 80) This costs – not just the NHS – but emotionally to all those involved. But there are other, wider, effects as well. Evidence shows that having children at a young age can damage young women’s health and wellbeing – and severely limit their education and career prospects. And while young people can be competent parents, studies show that the prospects for children born to teenagers are less likely to be good and, in later life, they are up to three times more likely to become a teenage parent themselves.

The majority of teenage pregnancies are unplanned 10

What actually works in reducing teenage conception? This is the crucial question – and there are a number of different things that can have an effect on reducing teenage pregnancies. The main things are:

Effective sex and relationships education (SRE) This helps young people to deal with the pressure to have sex and gives them knowledge to avoid unplanned pregnancies and sexually transmitted infections (STIs). All of this will only work if it is supported by easy access to contraceptive and sexual health services that young people are comfortable with.

Addressing the risk factors Deprivation and parental aspirations are a powerful combination when it comes to teenage pregnancy. But there are other factors that, combined with these, will affect conception rates. A detailed assessment of these can be found in What the Data Tells Us, on page 84. Addressing all of the risk factors and improving sex education – the things that really work – is what has driven our Strategy for the last ten years and what this legacy document has tried to capture. It has been a challenging job but has been inspirational and rewarding – not just for young people themselves but for those working for us as well. You’ll discover their own stories and personal feelings about the work as you read through this document and see our Strategy come to life.

IMPROVING ACCESS to advice and contraception

The majority of young people having sex DO use contraception. Fact.

Our achievements

For the minority that don’t – or who don’t use it effectively or regularly – we

Overall, the Strategy has helped in the development of a range of services and provision that better meet the needs of young people and all of these have had a much sharper focus on prevention.

do everything we can to make things easier for them to change. We call this ‘improving access’ – and it includes things like making sure young people have the right information about contraception that’s easily understood and easy to get hold of when they need it. We consult widely with young people for their views of local contraception and sexual health services and tailor what we do according to what they say. You’ll find out much more about how we do this in section 6 of this report (page 65). It’s important we do all of this – not just to prevent unwanted pregnancies – but also to make sure young people keep as healthy as possible and feel empowered to make responsible decisions.

In this section We spotlight the different ways we have tried improve access to advice and contraception. This includes the brilliant work at Brook, how we communicate with young people to get information to them in the best ways and how all of this needs to be underpinned by a clear strategy to secure future success. Planning what we do and how we do it – or ‘strategy’ – is absolutely vital and the Teenage Pregnancy Commissioner has worked closely with the PCT’s Sexual Health Commissioner to make sure our Strategy and the Sexual Health Strategy are complementary and have clear, consistent messages for young people and staff – while making best use of available resources.

There are a number of great examples of this, such as:

l The expansion of the Morning After Pill (MAP) Scheme led by the PCT’s Pharmacy Lead Elizabeth Walker. This invaluable scheme enables women who may have been at risk of unintended pregnancy to have rapid access to emergency hormonal contraception from pharmacies across Sandwell This type of service links perfectly into main stream Contraception and Sexual Health Services as well as more general services offered through GPs. Plus: delivery through community pharmacies also ensures significantly less stigma for young women using the service and enables provision that is geographically closer to them, so improving accessibility.

l The development of a Specialist Contraception and Sexual Health Service for Under-25s.

The Teenage Pregnancy Commissioner ensured that the voices of young people were heard in the review of contraception services. Their views were incorporated into the development of a new service model and young people were involved in the tendering process for the new service, launched in 2011. This service is fully focused on the needs of young people – including those who are more vulnerable. It is drop-in or appointment-based, including evenings and weekends and also offers advice via text message and telephone as well as outreach-based education and contraceptive provision. It is supported and promoted by Youth Services, schools and colleges. Clinics are provided across Sandwell’s six towns – including a centre on West Bromwich High Street. Evaluations from young people have already been positive and the service offers enormous potential for the future – not just to further prevent teenage pregnancy and improve sexual health, but to improve young people’s general health and make a strong contribution towards reducing health inequalities for some of our most vulnerable communities.

Sexual Health Strategy By Paul Sheehan Sandwell PCT’s Sexual Health Commissioning Manager Sandwell PCT has made considerable investment in young people’s Contraception and Sexual Health Services because it recognises that providing high quality services – that are ‘young people friendly’ – is key to reducing teenage conception and improving sexual health. This is on top of services provided by the Family Planning Service, the Dartmouth Genito-urinary Medicine Clinic and, of course, those provided by GPs. Specific examples of how sexual health commissioning has supported the Strategy include:

l Improving young people’s access to free condoms through the Sandwell C-Card Condom scheme. This gives young people confidential access to free condoms from more than 30 different organisations across the borough. This is a significant improvement in access to one of the most effective forms of contraception. It has also helped reduce the stigma attached to sexual health and enabled services that may not have traditionally been involved in teenage pregnancy prevention, or in working with young people around sexual health, to do so. It has also boosted the confidence of frontline professionals, built capacity and has ensured that young people can access services at places and times more convenient to them l Improving access to Long Acting Reversible Contraceptive (LARC) l Improving joint working across sexual health service providers through the Positive Action on Sexual Health (PASH) forum and PASH newsletter.

l Ensuring that the needs of young people are addressed by encouraging sexual health service providers to adopt ‘You’re Welcome’ quality standards l Improving access to pregnancy advice and counselling and termination of pregnancy services l A pilot outreach contraception service at Sandwell College

The teenage pregnancy strategy Sandwell’s Strategy has delivered a lasting impact that has been felt, not only in terms of a substantive reduction in the number of teenage pregnancies across Sandwell, but also in its influence on the design and provision of associated Sexual Health and Contraceptive Services. The Strategy has helped enable a reshaping of these services and their provision across the borough. The lessons learned include wide-scale and on-going consultation with young people and key stakeholders. I am very proud of the achievements made by the Strategy over the last ten years and the ‘legacy’ it will leave.

...helped reduce the stigma attached to sexual health 13

Challenges for the future Although we can be justifiably proud of these achievements, we are all aware that the needs of young people are constantly changing. Modern, accessible provision to reduce teenage pregnancy and improve wider sexual health must also evolve to meet these needs – otherwise we run the risk of losing the valuable health improvements we have seen over the lifetime of the Strategy. We live in a time where a global financial crisis has affected everything we do. Investment in teenage pregnancy prevention and sexual health is proven to be both cost effective and costsaving over the longer term. Although there will be a scarcity of resources for the foreseeable future, it is important we make the case for the financial benefits of investment. In addition to the benefits to young people’s health and the impact of reducing health inequalities, the knowledge and awareness of effective – and cost-effective – new services must continue.

agreed by all. This should set out the commitments we will honour and steps we will take to continue to progress. The new Public Health Outcomes Framework features the key things that should be delivered to have an impact on determining people’s health, health improvement and health protection. Teenage pregnancy prevention and improving sexual health are key components of these. Achieving them will be dependent on an approach that involves a wide range of professionals and agencies working to agreed and clearly defined objectives. Our challenge remains great, but the progress since 1998 demonstrates that dramatic improvement can be achieved. We owe it to young people across Sandwell to continue to ensure that this improvement is maintained, ensuring that our responses meet the diverse and unique needs of our communities.

The development of LARC contraception methods – such as injections, implants and intrauterine devices – offers women a wide range and choice of contraceptive methods beyond the contraceptive pill. But take-up of these amongst young women in Sandwell remains relatively low, despite the fact that most users find them more tolerable than other methods and that these methods are generally more effective at preventing pregnancy than the Pill. We should ensure that LARC provision becomes a key point of service delivery across specialist and primary care settings and this will be very important if progress is to be maintained. But key to future success lies in our planning and strategy. If the main agencies can work more closely, this will mean more effective care and service provision – on top of the potential to increase efficiency in the agencies themselves. It has long been an ambition to move towards more integrated provision of genitourinary medicine, contraception and sexual health services in Sandwell. This ambition needs to be realised if services are to continue to meet patients’ needs and improve value for money. To do this we will need a clear, overarching strategy based on an assessment of need and

Promo t ing p o s it

ive se x u a l h e a lt

Brook

Outreach and Education and Clinical Services by Keren Hodgson Brook is a free and confidential clinic offering all kinds of information on anything to do with sex and sexual health for under-25s. It provides a wide variety of services across Sandwell to improve young people’s access to, and understanding of, contraception and sexual health issues and offers two types of service: outreach and education and clinical. It supports the aims of the Strategy and delivers some of its services, including the new town-based clinics and outreach and education targeting vulnerable young people at risk of conception. This is in addition to the Contraception Nurse Outreach Service for vulnerable young people and services for young parents to reduce second conceptions.

‘Outreach’ is a word that gets used a lot by different organisations – but not everyone really knows what it means exactly. So here’s a definition: ‘outreach’ means going out to people and making connections. In other words, not expecting people to come to you. That’s really important when it comes to sex education because we can’t expect young people to find us and know what we can do for them. We need to get out there and tell them so they have the information they want and need to make informed choices and stay healthy. So – that’s my job! As an Outreach and Education Worker it’s amazing being able to go into so many different settings and deliver sexual health information in so many different ways to suit the needs of young people. To know that an hour group session, half an hour, one-to-one or a ten-minute informal chat can give that young person the confidence to make their own choices about their own sexual health can mean a lot – especially when you know they may never have had the opportunity to find out anything about sex before. Outreach and education in Sandwell started in 2001 and is run through Brook. We’re based right in the centre of West Bromwich – and have just opened a brand new shop to make ourselves easier to reach and more appealing to those who might want our help.

e o p e n ing o C e le b rat ing t h

f Bro o k

But as Outreach Workers, we really like to get out and about and work with other organisations delivering sex education in settings where young people may have not previously been able to access it.

Achievements l Going into training providers, colleges, schools, youth facilities and supported housing l Helping colleges to promote positive sexual health to students at various events, including Sexual Health Week l Helping young people to communicate appropriately with professionals l Working alongside other professionals to deliver sex education l Supporting Brook clinics in promoting and identifying places where young people might need outreach and education sessions l Delivering information sessions from large groups to one-to-ones l Delivering chlamydia screening in all outreach sessions and events l Supporting young people when attending Brook, Family Planning and clinics for termination of pregnancy l Working with groups and individuals who have learning disabilities or special needs l Designing and developing our own resources to suit groups and individuals l Developing a sexual health activity manual, helpbook and mini version of the helpbook for professionals, groups and venues around Sandwell l Producing a regular newsletter for young people and professionals l Promoting the Sex: Positive campaign in West Bromwich town centre l Attending the V Festival every year and handing out up to 10,000 condoms l Working with agencies such as Barnardoâ&#x20AC;&#x2122;s, Sandwell Leaving Care, Looked After Children Education service (LACE) and Playhouse Theatre l Attending residential courses aimed at supporting young people in care Brook provides a vital service throughout Sandwell. We offer free and confidential information and advice and staff within the clinic and the Outreach Team talk to young people in a way which is non-judgmental. We understand that every young person who enters the clinic or the classroom has their own needs which need respecting.

NUMBER CRUNCHING 1,424 The number of young people we saw in outreach and education sessions across Sandwell in 2007

2,089 The number of young people we saw in outreach and education sessions across Sandwell in 2010

The teenage pregnancy strategy Over the years there may have been changes in the team and structure, but the aims have always been the same â&#x20AC;&#x201C; and every worker within the team has done their bit to support the reduction of teenage pregnancy. At Brook we have continued the work in outreach which started right at the beginning of the Strategy and we hope will continue for a long time to come. We really want to play our part in reaching vulnerable young people most at risk of teenage conception and STIs as well as developing and delivering contraception education that will enhance SRE to young people in school, training and further education. We want to help promote a positive sexual health message across Sandwell so our young people get all the information and help they need to make informed choices and take control of their lives.

Praise for Brook’s Outreach and Education “(I learnt about) how to make decisions in different situations.” 14-year-old female

“there’s a lot more to relationships than what I thought.” 15-year-old male

“it was packed with information, we did different activities it was all good.” 14-year-old female

“I enjoyed the games and the group working.” 14-year-old female

“I learnt what my options were if my partner was having an abortion I learnt practical information that I can pass on to others.” 16-year-old male

Brook Clinical Services for Young People in Sandwell by Sharon Walters What are ‘clinical services’? Well this really means any kind of health service that you might get in a clinic. When it comes to young people and their sexual health, there are loads of different kinds of help and support needed – from emergency contraception to pregnancy counselling across Sandwell – and it’s my job to make sure it’s available. So what do we do? Well, we offer a wide range of free, confidential services for all young people in Sandwell to help them make safe choices about their sexual health. The aim is to provide a service that meets the needs of the young people directly – and we do this in a non-judgmental way.

Our services include

l ‘Clinic in a box’ – where a nurse goes out to different sites like colleges and youth clubs to issue contraception Clinical Services for Young People in Sandwell started life in Brook at Toll End Road in Tipton in the early 1990s, but in 2010 we won the contract to provide a Young People’s Contraception and Sexual Health Service across Sandwell. Now we have a main clinic in West Bromwich, as well as the Tipton site and we also have ‘satellite’ clinics, including: l Windmill Super Youth Centre, Smethwick l Millennium Centre, Friar Park

l Free and confidential advice and information

l Youth Only Zone (YOZ), Blackheath

l Emergency contraception

We also have specific clinics set up for users of the following services: l Hobart Road – supported housing for pregnant teenagers and young parents

l Contraceptive methods including LARC l Condoms

l Pregnancy testing

l Pregnancy counselling

l General counselling for young people around sexual health-related issues l Chlamydia testing and treatment l STI information

l Domiciliary service –when a nurse delivers a contraceptive service directly to young people who need it in their such as pp o rt t suenvironment g th e righown n ti t e G school, home or in supported housing

l Information about other services

l GAP project – supported housing for pregnant teenagers and young parents l Nacro – training provider

l Batmanshill – pupil referral unit (see page 32) l Sandwell College

Communications and engagement By Anna Kaur Commissioning Officer for Sandwell PCT It’s really important that young people know about the services and support available to them – and how to get it. That’s where I come in. I help to get information across to the very people who can really benefit from the huge variety of services and information on offer. We follow the Department of Health You’re Welcome quality guidelines that help health services – both in the community and in hospitals – ‘get it right’ and become ‘young people friendly’.

G e t t ing th e me

All young people are entitled to receive appropriate healthcare wherever they can get it. A quality Contraception and Sexual Health Service should provide young people with appropriate information and advice to help them make safe, informed choices about their sexual health and wellbeing. This should include helping them to develop the confidence and skills to delay early sex and resist peer pressure. It should also offer young people the opportunity to get hold of accurate and unbiased information about pregnancy options and support – including referral for antenatal care. My role involves commissioning support, engagement, participation and social marketing for various health areas to make sure this happens. When it comes to teenage pregnancy, the specific areas I cover are media, communications and social marketing. This involves working on campaigns locally and nationally to raise awareness of the importance of using contraception to prevent an unexpected pregnancy or STI. It also means raising awareness of all the local services available to young people.

s s age r igh t

Achievements l Improved information for young people and staff through annual sexual health campaigns and web-based information

l Campaigns include our joint teenage pregnancy and DECCA (Drug Education, Counselling and Confidential Advice) summer campaign – ‘Need protection, use contraception’. It was a seasonal campaign because rates of teenage pregnancy are high at that time of year l Worked with DECCA to help commission the joint www.ourguideto.co.uk – a website aimed at ensuring young people have access to information on sexual health, teenage pregnancy, drugs, alcohol and other services available to them The site won an award in 2007 from Children and Young People Now (the industry magazine). This is a national award sponsored by the Children’s Workforce Development Council

Young people are the focus of our work, but it’s important that we also inform professionals, colleagues and partners about strategies, services, training and updates from the Teenage Pregnancy team. To do this, we use newsletters, e-mail, websites, promotional goods, radio adverts, bus and Metro advertising, Voice 21 young people’s magazine, community events and social networking. I really enjoy my job – but the part I most love is involving young people in the work I do by listening to their views, comments and ideas and then ensuring these are taken into account in my work. One example is an interactive sexual health quiz produced with the participation of young people and featured on the www.ourguideto.co.uk website. By involving young people themselves, I hope we are able to provide them with accurate, unbiased information that will help them make informed choices about their own health.

IMPROVING SRE in schools and non-school settings

What does ‘SRE’ mean? It stands for Sex and Relationships Education – or what most of us just call ‘sex education’. It’s carried out in primary and secondary schools and it’s all about helping young people get the FACTS about sex and contraception – so they can make important decisions that are right for them. Simple.

In this section We put the spotlight on some of the great work going on in SRE in the last few years – with real feedback from those involved. There are a number of different ways that we do this work and the aim is to help children and young people to be healthy, safe and happy. Ultimately, we hope this will help them play a positive role in their communities and be financially secure.

What do we do? We want to help young people understand how to protect themselves from infections and pregnancy when they do decide to have sex – but we also want to give them the knowledge and skills they need to experience positive relationships and good sexual health. SRE can help to explain the potential benefits of delaying having sex until young people are emotionally and physically ready. SRE is also about trying to banish some of the myths and tales that still exist around sex, fertility and abortion. There have been real improvements in the information, advice and support that we provide – but some damaging myths still hang around. As a result, awareness of the full range of contraception is low and a significant number of parents lack the knowledge or confidence to talk to their own children about sex and relationships.

APAUSE Sex and Relationships Education Programme By Jackie Haden Sex and Relationships Education Co-ordinator You’ve heard the saying ‘Pause for thought’? Well nothing could be truer when it comes to having sex – no matter how young or old. Here in Sandwell we run a successful sex education programme in schools called APAUSE – which actually stands for ‘Added Power And Understanding in Sex Education’. But the idea of pausing before acting is all part of being in control of your own life. The APAUSE programme is delivered in schools by trained teachers and School Health Nurses.

choices about their sexual health, sexual behaviour, personal relationships and parenthood. Phew! Plus it is an evidence-based programme developed and quality-assured by the APAUSE team at Exeter University. It is cited as good practice by the National Teenage Pregnancy Unit. So how do we do all this? Well in loads of different ways. We make sure we have the right staff in place – like School Health Nurses, trained teachers and a specialist Sexual Health Nurse – and we run different types of sexual health sessions and send out information updates. On top of this we organise chlamydia testing at HPV vaccination sessions, train teachers and School Health Nurses and train sixth-formers to deliver SRE to other students.

The programme started life in 1999 as a pilot scheme at four High Schools. Others agreed to take part when they saw how positive and successful the programme was. Since the very start, it has been a roaring success with more and more schools wanting to be involved. Now the scheme is run in 15 out of 18 of them, plus pupil referral units like Batmanshill. The only schools not involved are those that have their own religious ethos or approach to sex education and we have worked with them to develop their own programmes that meet their school’s ethos. The Catholic school in Sandwell decided to continue with a programme recognised by the diocese. So what is APAUSE? Well, its aims are huge and varied but, in a nutshell, it’s all about giving young people the information, confidence, skills or equipment to help them make informed

Achievements

l Delivering a ‘Speakeasy’ programme to teenage parents at Batmanshill

l Delivering enhanced sessions to pupils with specific learning needs

l Completing a theatre in education course to deliver health education l Devising an APAUSE competency for School Health Nurses

l Setting up a database for APAUSE-trained staff l Providing sexual health updates

l Devising alternative sexual health sessions for schools and alternative sexual health sessions for those with special educational needs l Workshops on sexuality/homophobia for healthy schools conferences

l Training teachers and School Health Nurses to deliver APAUSE l Distributing condoms at Sandwell College Freshers’ Fair

Praise for APAUSE “The visit provided valuable information which will contribute to our national evaluation and reporting. The overall effectiveness (and achievement in Personal, Social, Health and Economic Education (PSHEE) was judged to be outstanding. Students have an impressive knowledge of issues relating to sex and relationships education, drug education, leading healthy lifestyles and how to look after themselves and stay safe. “ “By the time students leave the school, they are socially adept, empathise with others, form positive relationships, are able to express opinions and have developed the skills to be assertive. Training for staff to deliver PSHEE is thorough, regular and meets the needs of individual staff and the changing PSHSEE curriculum.” Ofsted: (Inspection report following inspection at St Michael’s Church of England High School)

The whole APAUSE programme is worth celebrating. If it didn’t exist, some schools wouldn’t deliver any kind of sex education at all. APAUSE really raises awareness around teenage pregnancy and is helping to give young people the tools they need to take control of their lives and thrive. The programme can only be maintained by the commitment and support of the School Health Nurse Team and their dedication and flexible approach to meet the needs of schools and their pupils. With their knowledge of local areas and relationships with schools, their input is essential to provide a fair and equal sexual health and relationships service for Sandwell’s young people and provide follow-up with them at their drop-in sessions. It’s really great when pupils tell you after APAUSE sessions how much they’ve enjoyed them and it’s brilliant when we receive positive evaluations from School Health Nurses and teachers after successful APAUSE training.

“I’d like to say a big ‘thank you’ for your help and input to ‘Let’s Talk About Sex’. I was very pleased with the positive feedback received from attendees who enjoyed both workshops and made use of the screening service provided. I learnt many new things I didn’t know about – along with many other people! The event would not have been possible without you and I’m very grateful.”

African Caribbean Health Improvement Service (ACHIS)

“Thank you for delivering a successful workshop at our annual conference. The event was a huge success and everyone thoroughly enjoyed the different workshop choices. The feedback was very positive.” Healthy Schools Sandwell

Sexual Health Services in Schools By Carole Ann Collins Young Persons Sexual Health School Nurse How do we get information to young people so they make informed choices about their sexual health? Wouldn’t it be simple if there were one answer? Because there isn’t, we have developed lots of really different ways to do this – from theatre to football! Sandwell is one of the UK’s most deprived areas – so young people living in the borough don’t necessarily have the best start in life. Services which help them to be safe and achieve their true potential are invaluable and anything we can do to promote positive sexual health information can only be good. So what are we doing? Well, our latest project is to develop enhanced School Health Nurse ‘drop-in’ sessions at High Schools in Sandwell where young people can come along and pick up information about contraception, or any sexual health issues, or just have a chat with a School Health Nurse. But the ‘drop-ins’ are just part of the story… Initially I worked within the Family Planning Service before returning to School Nursing and I have been in my job since 2005. since then I have been involved in lots of innovative work taking the sexual health and contraception message out to young people in a variety of ways and targeting specific groups that that need special attention, like young men or those who are vulnerable.

Achievements

l Theatre in education sessions to promote Contraception and Sexual Health Services This also involved training young people to be mentors. This work was presented at the Institute of Education in London with the help of St Michael’s High School and was praised by Caroline Flint MP as an example of good practice

l Teaming up with West Bromwich Albion FC to deliver condoms to more than 1, 000 young men via three Premier League football matches. I was then given permission by the club’s Board to use their distinctive badge on packaging, to specifically target young men and ‘normalise’ condom use l Working with the Teenage Pregnancy Midwife to deliver contraception services to teenage mothers-to-be via antenatal clinics to reduce second pregnancies for teenage mums l Working with the APAUSE programme to:

lDeliver SRE and contraceptive teaching sessions in non-school settings and pupil referral units for the first time lDeliver a Contraception Education Programme in High Schools

l Working ‘one-to-one’ with young women showing risk-taking sexual behaviour. This was to minimise the risks they were taking and promote positive relationships

l Contributing to the creation of Sandwell’s C-Card Condom scheme by developing a training scheme for multi-agency professionals

l Developing and delivering a training programme for pharmacists on ‘how to communicate with young people’. This played an important part in their Emergency Hormonal Contraception training for the Sandwell Morning After Pill (MAP) scheme

The teenage pregnancy strategy All of this work has contributed to the aims and objectives of the Strategy by providing services to the most vulnerable young people, preventing second pregnancies and using innovative actions to target young men. Our outreach services have allowed contraception and sexual health provision to reach the most vulnerable groups, contributing to the appreciable fall in teenage pregnancy figures since 1998. The positive reactions received from staff and young people make all the hard work worthwhile and the satisfaction gained from developing services that make a difference is immeasurable.

On personal level

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I qualified to fit reversible contraception implants under the skin and I also qualified as a nonmedical prescriber so I can provide easy access to contraception for more vulnerable young people.

Praise for School Nursing Services â&#x20AC;&#x153;School Health Nurses are a key part of ensuring children, young people and families get extra help and support when they need it. They will offer â&#x20AC;&#x2DC;early helpâ&#x20AC;&#x2122; (for example through care packages children with additional health needs, for emotional and mental health problems and sexual health advice) through providing care and/or by referral or signposting to other services. Early help can prevent problems developing or worsening." Department of Health (in: Getting it right for children young people and families: maximising the contribution of the School Health Nursing Team: vision and call for action) (April 2012)

Caroline Flint MP praised the theatre in education at the Institute of Education as an example of good practice.

"The commitment of the School Health Nursing service in Sandwell to the APAUSE programme and the recent development of enhanced drop-in services in high schools, to contribute to the Teenage Pregnancy Strategy is noteworthy."

Amanda Leishenring, Community Matron, Adolescent Health

West Bromwich Albion FC offered its full support to our work and mentioned the condom distribution initiative in their match programme.

SUPPORTING pregnant teenagers and teenage parents

Our Support Strategy By Cindy James Commissioning Manager Having a baby and being a parent are life-changing events. It’s hard enough to cope with when you are older, but when you are a teenager you need all kinds of extra support. In this section Our Commissioning Manager explains more clearly how we support pregnant teenagers and teenage parents and we put the spotlight on a variety of really innovative, successful and inspirational projects and people who are helping our young people not just to cope, but to develop and thrive as young adults. Having a baby at a young age shouldn’t be a barrier to success in life. We want pregnant teenagers and young parents to fulfil their potential – and that is the aim of the Young Parents Support Strategy. It aims to help them increase their aspirations by providing a range of services that offer support so they can really achieve the best future for themselves and their children. Like all parents, teenage mothers and young fathers want the best for their children and some manage very well – but it is really hard. Juggling the demands of caring for a baby at a time when they themselves are making the difficult transition from adolescence to adulthood cannot be underestimated. In Sandwell, as everywhere else, some need more help than others. The majority of teenage mothers and young fathers are well supported and have a good network of family and friends around to help them but for some it can be different story entirely. They may just need a bit of help and advice – or they may need a whole tailor-made care package of support from a number of agencies to help them achieve good outcomes for themselves and their baby. Our Teenage Pregnancy Support Strategy began back in 2001 when Sandwell was awarded a grant to implement the Sure Start Plus programme.

Using this, we employed a named Teenage Pregnancy Midwife, Health Visitor and Careers Advisor to work with teenage parents on a one-to-one basis and run a number of initiatives such as young parents support groups and training taster sessions. Since then our work has continued to expand with the introduction and development of new services and initiatives, many of these being delivered together with both statutory and voluntary organisations. These include: the Young Parents Antenatal Clinic; Welfare Rights Support; Young Fathers Project; Young Mums To Be and Parents with Prospects programmes to name just a few. Our most recent developments have been the introduction of the Family Nurse Partnership and the Young Parents Children’s Centre. It’s impossible to mention by name everyone that has contributed to the success of the Young Parents Support Strategy but I’d like to thank here everyone that’s been involved. Their amazing support, continued motivation and commitment has helped to improve and make a difference to the lives of Sandwell’s young parents and their children over the past ten years. I’d also say a big ‘thank you’ to young parents themselves – who have made, and continue to make, an important contribution to our support strategy be it through our ‘Young Parents Speak Out’ conferences, maternity services liaison committee meetings or via young parents forums.

Krunch by Derrick Gordon (Young Fathers Worker) and Jon Grant (Director) When young mums are learning to look after a baby, continue their education and learn how to support themselves, it’s easy to forget that dads have needs too. That’s why the Krunch Young Fathers Programme was set up. It started off as a two-year pilot project in 2008 and in 2009 we linked up with Connexions and Brook – as well as Batmanshill pupil referral unit where most of them have partners (see page 32). It proved so successful it continues today, supported by funding from Sandwell Council and still working closely with Batmanshill. The Programme supports eight young fathers at a time and helps them with their personal evelopment and to be the best dad and partner they can be. Many have said that without the support of agencies such as Krunch they would not have had the motivation or willpower to develop as positive role models to their child or children.

In a nutshell, we help them: l Improve or gain new skills to make them more employable l Understand how they can contribute to the wider community

l Get responsible by taking their parenting role seriously and enjoy the rewards that being a dad can bring l Be a confident hands-on dad and get the support they need to flourish

The best part of our work is when we see changes in young people and the way they begin to plan and map out their lives so they can do this. As a member of Krunch and a lead Young Fathers Worker, I have felt very proud to support young parents and young people in general.

But there’s so much more to Krunch than the parenting and relationships stuff. It’s about the wider development of these young men as well: team work; respect; motivational experiences and skills – things that will have a real positive impact on their lives, help them get jobs and become responsible citizens.

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Achievements We’ve seen some great achievements since we started in 2008. Most recently, three young fathers gained Level 1 Motor Vehicle Maintenance and two young fathers have gained full-time employment. Previously, we’ve seen three young dads gaining Level 1 and 2 in Maths and English l Young dads went on a peer mentoring and team-building residential with the Teenage Pregnancy Young Peoples Board

l In 2009 the young dads had a personal invitation to Birmingham City Hospital’s new Birthing Unit

l A peer mentoring and young parents’ award ceremony was held in 2009 to celebrate young people’s achievements throughout the year and their completion of peer mentoring training. This was a collaboration between Krunch, Batmanshill and Brook

c ase s t ud y Dav id C o lc lo ugh a g e d 19 David has a 17-month-old daughter. He splits his time living with his parents and his girlfriend who lives with her parents. David has dyslexia and when he was at school he was anxious about what other people might think and this led to poor attendance and low self-esteem. After finishing school, David worked for a year, during which time his daughter was born. Then he was out of work for six or seven months and was referred to Krunch through Connexions. He joined a 12-week course for young fathers that gave him the chance to meet other young dads and take part in activities such as music, drama and workshops on drugs and sex education. During this time he also gained a qualification in food and cooking and was

The teenage pregnancy strategy The Young Fathers Programme was funded by the Strategy in order to meet an important need that sometimes gets overlooked. Work in this area has grown as more and more young dads between the ages of 19 to 24 have sole custody of their child or children. We at Krunch are proud to have contributed to the Strategy’s aims and objectives. It demonstrates the success of agencies working together and sharing resources. We have witnessed the positive progression that the Strategy has made over the years and how young people have felt they have been listened to and allowed to develop in their own right.

referred to a course run by the crime reduction charity Nacro that focused on English and Maths. Now David is a Krunch volunteer helping out at another young dads course and at a weekly youth club. He has relished the chance to help and support other young dads who recognise he has similar experiences. He has also been appointed as a sessional youth worker at a Barnardo’s project. He said: “I was really nervous about the Barnardo’s interview. But I had talked to one of the workers here, who just told me to sell myself – make sure they know everything that I’ve done. And it must have impressed them, because I got the job! “I’ve always had a feeling about working with people, but the staff here helped me think more and suggested that I volunteer to get experience. Now I’m looking at training, maybe even university. I would never have thought about that but now I can see that it’s possible. My mum’s pleased too. She thinks I’m doing well. I’m not just sitting at home – I’m trying to get on with my life. “This project has given me confidence, help to think about what I want to do, loads of experience and I’ve learned new things.”

c ase s t ud y Dav id H a r r is o n a g e d 22 DH was referred to Krunch by Trident Reach supported housing because of issues around his self-confidence and low self-esteem. With his partner due to have their first child in January 2012, the first thing we did for DH was to get him onto the Developing Parenting Skills course, as he wanted to learn as much as he could about being a positive and hands-on dad. Krunch staff supported him in this and also with one-to-one confidential support. Working with Derrick over four weeks, DH learned how to: prioritise his time; discipline and set clear boundaries for a child;

recognise good communication and also the rights and needs of a child, parents and wider family members. This included what is lawful and what is not. His knowledge of the law surrounding children and parents was sparse, so this element was of real benefit to him. He also took part in a SRE group session, where dads got the chance to try out condom demonstrations with ‘beer goggles’ – which give the wearer the effect of drunkenness and attempting to have sex. He also learned more about STIs – how they can be caught and the effects they have on the body. DH has aspirations of becoming an interior designer or selling houses abroad and we are trying to find a painting and decorating course for him while encouraging him to take realistic steps towards his goals as he appears very capable of achieving them. It’s obvious that being on the Programme has really helped him with his confidence and he has made new friends along the way.

Derrick Gordon (centre behind slide) with some young fathers.

Batmanshill Pupil Referral Unit by Anne Savage, Head of Unit Batmanshill is a success story. It’s a nationally-recognised referral unit that has won awards and plaudits but, most of all, it has made a really positive difference to the lives of students – and their children. I am extremely proud of everything this team has achieved over the years for the many young lives they have had the honour in touching. To make a difference or to get positive reactions is a superb feeling. Making a positive and sustainable difference in someone’s life is the greatest gift. This is an establishment where the young women and their children can achieve an education as well as be fully supported in all aspects of their life. Working here makes me feel very humble. It never ceases to amaze me the strides these young women make with their children in the face of, in some cases, extreme deprivation – whether that be economic, social, emotional and, before they got to us, educational. What do we do? So many things: there really isn’t enough space! But simply put, we offer everything under one roof to help young mothers aged up to 19 years with education, parenting, maternity and antenatal support and anything else that pregnant teenagers and new mums might need. And if young mums want to remain in, or go back to, mainstream education, we have a special Consultant Teacher for Young Parents to help them. We want our students to: be healthy, stay safe, enjoy life and achieve, understand how to support their family financially and make a positive contribution to their community.

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Achievements l Rated “Good” by Ofsted, with many ‘outstanding’ features

l Our examination results year-on-year continue to improve. All young women, if they stop here for at least a year, will now walk away with at least five Level 1 qualifications. This is therefore achieved in half the time of national expectations – which is amazing when many will also have had eights weeks of maternity leave in that academic year l In the last two years, three young women have gone to university l Constant evaluation of the curriculum to keep it relevant for students l New programmes set up or delivered, including: l Stop Smoking Clinic

l Physical Activity Programme

l Emotional Health and Wellbeing Programme (Chin-Up) l Breastfeeding Baby-Friendly initiative

l Working with young men via Krunch

l Fab Tots – providing really useful information about food and nutrition

l Young women and the Unit were featured in a professional DVD training programme l Our Chlamydia Clinic gained recognition from R U Sure Black Country Chlamydia Screening l Students not in education, employment or training educated in nationally-accredited awards

l Achieved the Platinum Healthy Schools Award

l Our work has been featured in the media locally and nationally – from Radio Four’s Woman’s Hour to Marie Claire, BBC Radio WM, the Birmingham Post and French TV l Two of our girls had highlights of plays they had written published in Birmingham Repertory Theatre materials, some helped with research for a production by Birmingham-based theatre in education company Loudmouth and we also worked on an intergenerational project with Asda and Educational Business Partnership Other lasting achievements include:

l Being a national forerunner in setting up the Re-integration Officer support role (now Consultant Teacher for Young Parents) l Parenting programme linking with our own nursery

l Securing and maintaining transport to the Unit with a Social Inclusion grant from the government in conjunction with Centro and Community Transport to begin with

The Teenage Pregnancy Strategy Over the ten years of the Strategy the young women at the unit have benefited greatly and their lives have been touched by it. During that time we have achieved so much and have made a really positive contribution towards the educational aims of the Strategy, which in turn supports the Education Strategy of Sandwell Council that funds us. All students gain many nationally-accredited awards while being able to have their child on-site and gain invaluable parenting skills. In addition, we have led the way in many areas of our work and others have followed our example – so that now we are one of lead units in the country for educating female parents up to 19 years.

l Working with the Teenage Pregnancy Commissioner to set up and secure the future of counselling, sexual health, welfare rights and money advice clinics, plus the existing antenatal support l Introduction of support workers in the Unit to ensure holistic support for all the young women and their families

ti o n : o re th a n e duc a m is l il sh n a tm Ba wome n fo r li fe g n u o y s in a tr it

p e o p le th e G e t ti ng yo u ng h e lp th ey nee d

“Working with you and your team and the people you help was a profound experience for us – not least because of the huge amount of effort and care that it’s clear you all put into your work.” Full Range Media Company

Praise for Batmanshill “You have built and sustained a fantastic provision which is a role model.” Southwark Children’s Services

“Thank you so much for everything you have all taught me. I would not be where I am now if I didn’t have you all behind me.” Student

Gemma Butler aged 18 I found out about Batmanshill through a friend who’d come here and my mum also came here when she’d had me. Even though I was 17 and had left school, I knew it would be a good place to come and do my GCSEs and be with other girls who were in the same situation as me. Everything you need is at the centre and everyone who works here is amazing. All the staff treat us like adults and they go out of their way to help and they support us in whatever we want to do. Coming here has definitely made me a better mum to Paris and I don’t think I’d have coped as well, or had the same opportunities if I hadn’t come. The parenting GCSE has helped me a lot and other courses like first

aid and nutrition, as well as the careers advice, have been really good as well. I’ve worked harder here than when I was at school because I want to do well. I’m studying for six GCSEs and am going to college next year and then to university because I want to be a midwife. It’s because of Batmanshill that I’ll do it. It’s a brilliant place.

Ashley Hickman Studying BA (Hons) in Education and Professional Studies with Art and Design, Newman University College I was just taking the last of my A Levels and completing my application for uni when I found out I was pregnant. Because the baby was due in the January I knew I wouldn’t be able to catch up with the work, so I was worried and stressed. I was told I could defer going for a year, which was great, and then I heard about Batmanshill. It was a bit scary going there at first, but I feel a real sense of gratitude to everyone because they motivated me, supported me when I had Gabriel, and helped me to get other qualifications I’d never have got otherwise. It was important for me to do a few courses because I wanted to keep my brain active and keep up my confidence before I started uni. I did an ASDAN* in personal and effective skills and a young mums-to-be course. I also did a mentoring course so I could help some of the younger girls.

My partner Ryan also went to Krunch and did mentoring and got a sex, health and relationship qualification so he could help other young dads there. I’m always telling people what a great place Batmanshill is because I realise how lucky I was to be able to go there.

* a charity promoting education programmes and opportunities to help young people develop skills for life.

Laura Davis aged 16 I was 15 weeks pregnant when came to Batmanshill. I’d missed half of Year 8, so it was important for me to come here because I knew it was my chance to get the qualifications I’d need to get a good job later. If it wasn’t for Batmanshill I don’t think I’d have had a proper education and I don’t think I’d have coped at all. But because of the staff here, I’m doing really well and am studying for six GCSEs. I want to go to college and be a youth worker and I know I’ll do it because of the opportunities I’ve had here. The staff can’t do enough for you. I knew I had to grow up fast and learn how to be responsible when I had Shazad and with their help I’ve done just that because they’ve helped me to feel really positive about myself. The parenting classes have been amazing. I’ve learned everything I need to be a good

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mum and it’s meant I don’t have to keep asking my mum all the time about how to do things. I’ve also enjoyed the cookery classes as well because I can cook healthy meals for me and Shazad. It’s brilliant.

Roxanne Fuertado Studying an HND in Performing Arts at Birmingham Metropolitan University If it wasn’t for Batmanshill, I honestly don’t think I’d be where I am now: studying at university. I found out I was pregnant when I was 16 and just starting my GCSE exams. I was scared, but one of my teachers told me about Batmanshill and said she thought it would be a good option for me. Because I’d finished school I didn’t have to go, but it sounded like a good place: somewhere where I could get support and talk to other girls like me. I’m so glad I went because I really enjoyed it. It wasn’t like school; it was far more relaxed and friendly. My daughter Makayla was looked after while I did different courses in English, food, young mums-to-be and art.

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It gave me the confidence to start a performing arts course at Sandwell College and Batmanshill looked after Makayla and arranged transport so I could get there and back. I couldn’t have done it without them and when I became pregnant with Teigan, I knew I’d get all the help I needed. Now I’m at Birmingham Metropolitan University, studying an HND in Performing Arts. It’s thanks to Batmanshill that I’m there because they encouraged me when I couldn’t see how it could be done.

The Consultant Teacher By Kate Proctor Consultant Teacher for Young Parents Things have changed considerably over the last ten years for school-age young women in Sandwell who become pregnant. It’s no more a case of ‘one size fits all’ when it comes to their education – now they have more choice and have lots of support to make sure they make the choice that is right for them.

When someone is referred to me we arrange a meeting, usually in school, and discuss what their preference is and look at what would work best for them in their circumstances – they don’t get told what to do. Students get the chance to look around Batmanshill if they want to, before making their minds up, but they can stay on at school if they prefer that, knowing they will have all the right help and support.

If they prefer to stay at school and be with their friends throughout the pregnancy they can and my role is to help organise that. However, if they prefer to go to the dedicated unit at Batmanshill and be with other young parents instead, then again, I can help organise that. They may even be able to have a mix of the two if that works.

If a young woman does transfer to Batmanshill then I organise this and arrange for as smooth a transition as possible between school and the Unit. Once there, I’ll attend any relevant meetings that involve them and I will also keep links with the mainstream school as appropriate. If they choose to stay in their mainstream school, I arrange meetings with the school at crucial points throughout the pregnancy so that timetables can be reduced as the pregnancy progresses.

My job as Consultant Teacher is to help young mums through all of this and so they get the support they need to reach their full potential while coping with the major life change of becoming a parent. There are now lots of different choices available for their education and we know that what is right for one person isn’t necessarily right for another. My role was created nationally in 2000 following the government’s 1999 Social Exclusion Report. Before then, it was automatically assumed that whoever became pregnant left school to transfer to Batmanshill. If they didn’t want to do this, or were poor school attenders anyway, they often didn’t finish their education. As the years have gone on this, thankfully, has become a thing of the past. As my role has developed, childcare funding has been introduced and there is much rt inclusion in righ t su pp oand more emphasis one attendance G e t ti ng th schools.

Sometimes, for those young women who stay in mainstream school, it is possible to link into sessions at Batmanshill so they can be involved with parenting lessons there from the National Childbirth Trust. This depends on a lot of organisation from the school, Batmanshill and myself but when it does work out it is a good way of being able to meet other young parents while still staying mainly with their own friends in their own school. It also helps them get to know the staff at Batmanshill if they decide to go there for their post-16 education. Once the baby is born the young woman won’t return to education, either in school or Batmanshill, until they have had their postnatal check-up which is usually after six to eight weeks. If they are at Batmanshill they may be able to return full-time right away after this but in a large

mainstream school they may start with a part-time timetable for a couple of weeks, as they usually have more to organise and have to get used to new travelling and childcare arrangements. At Batmanshill, young women will bring their child with them for the nursery there. This is such an advance from what used to happen and it makes such a positive difference to young people’s lives – having the choice to remain with their friends in school if they want to and feeling ‘wanted’ by their schools, instead of being expected to transfer to Batmanshill. It can be very significant in their future success to make a choice that is right for them. In my role I also meet with other relevant professionals for weekly or monthly meetings. These include people like the Specialist Midwife and Connexions Team Leader. Together we can ensure that all the right help is being given and that young people are responding to appointments and support. I also refer any who asks to the Benefits Advisor and attend other meetings with people like the Family Nurse Partnership and social workers, if either of these are working with a young parent, to make sure we cover everything. As a local authority teacher with an office base at Batmanshill, it’s a really rewarding job. At the heart of it is the desire to see young people achieve, despite the odds sometimes being against them. It’s so satisfying to see so many young women achieve qualifications, gain confidence and grow as individuals. I encourage all students to think how they can use their experience to their advantage and success. If they can present a set of good examination results to a future employer – but also add that they have achieved that despite having a child to look after – they are showing they could be a very reliable, dedicated, multi-tasker for that employer. If my role didn’t exist there would be less co-ordination of education for all expectant and young parents, professionals would have no central link in education and schools could cease to be as accommodating or as inclusive as they should be. This is particularly relevant over a period of time with new staff coming into posts who would be unaware of ‘normal’ protocol that has been established. In addition, really important information, such as figures, data and reports that affect future developments, would not be done.

It is rewarding when schools contact me and invite me in when they have a new pregnancy because it shows they value the support and advice. I also get genuine appreciation for the support on offer from families who had been worried about whether pregnancy meant the end for their daughter’s education.

The Teenage Pregnancy Strategy The Strategy is often only connected with reducing the number of teenage pregnancies because these make the news headlines. But half of the aim of the national strategy was to support the inclusion of expectant and young parents. With my role, this is to make sure they are supported for their inclusion in education. This often gets ignored because the figures are more difficult to understand by comparison – and ‘good news’ doesn’t often make good stories for the papers. But the achievements and strides made in identifying and supporting all expectant and young parents and co-ordinating the support for them has been outstanding over the last ten years and this role clearly plays a part. Being successful in education will contribute to young parents’ future success in life and the choices for themselves and their child. To continue in education, despite the pregnancy, will be a more positive role model for attendance at school for their child. As parents themselves, young parents will hopefully understand the importance and expectation of attendance in education. To be included in society despite the early pregnancy and parenthood, and to have the support to do this, is a major part of the support side of the Strategy and my role has been to make education inclusive.

NUMBER CRUNCHING 35-40 The average number of new referrals I receive each academic year that are statutory school age

410 The number of school-age expectant and young parents I have worked with between September 2000 and August 2011 37

Young Parents Maternity Support Service By Fiona Rochelle Specialist Midwife for Young Parents We want every young mum and her family in Sandwell get the help and support they need to have a happy, healthy life that sees them all thrive. That’s why my colleagues and I, in the Young Parents Maternity Support Service, are here. With our non-judgmental support, we try to help young parents feel really confident in their new roles as mums and dads and learn the things they need to know to really maximise their chances of a positive parenthood. I have a rewarding and sometimes very challenging role, but I feel privileged to have the chance to help make a difference to young people using our service. It is extremely rewarding to empower young women to make positive decisions about their health and lifestyle choices. I took up my role in 2007 when the Strategy had been up and running for a few years. I had a ‘blank canvas’ for the job – which at the time was extremely daunting! When I first started I was extremely enthusiastic and passionate about working with young parents. I had a vision of how Maternity Services should be for young people in Sandwell but I was realistic: There was a huge challenge ahead to achieve this. My role was to lead on key issues for teenage parents within Maternity Services and be the point of contact and support for other midwives and the wider multidisciplinary teams.

G e t ti ng th e rig

h t su pp o rt

The most rewarding aspect of my job is when particularly challenging young women, who have needed help from one or more agencies, turn their lives around. It just shows that with the right support they can have really positive outcomes of pregnancy and a great start to parenthood. The Service is well-received by young parents and only one young mother has declined it – but when she realised what support was on offer, she did work with me. Looking now at what we’ve done between 2007 and 2009, I’m so proud of what’s been achieved by the Young Parents Maternity Support Service in this short space of time – and how far we’ve progressed towards my original vision.

Achievements l Developing the Young Parents Support Service – providing specialist support to young parents under the age of 19

l Developing a weekly ‘one stop shop’ at Sandwell antenatal clinic. Here, young mothers could get: antenatal care; a scan; blood tests; an assessment of their needs and a package of support devised for them This was supported by members of the Virtual Teenage Pregnancy Team (see box below) – such as Welfare Rights, Connexions, Young Fathers Worker, smoking cessation and contraceptive services. The clinic was a roaring success with 100% attendance and very positive feedback from the young mothers and other professionals working with them

l Identifying all young parents living in Sandwell so they were known to the appropriate services and offered support

l We did this by holding monthly meetings with multidisciplinary teams (these still continue) and developing strong links with the Virtual Teenage Pregnancy Team to share information with the appropriate services so support could be offered. This is on-going today and is a great success

l Providing home visits to young mothers living in Sandwell but choosing to have their baby at a hospital outside the borough l Support for young parents becoming embedded within general Maternity Services

l Developing a weekly outreach antenatal clinic at Batmanshill so pregnant young mothers who were attending school got antenatal care and parent education that didn’t disrupt their education. School-age mums choosing to re main at school received home visits out of school hours l Developing clear guidance for other agencies meeting with pregnant young mothers so they know how to refer young women into the service l Adding a Maternity Support Worker to the team to enable our Service to reach more young parents to offer and deliver further support

On a personal level l In 2007 I was nominated for the Mamas and Papas Midwife of the Year award. I was also nominated for the Royal College of Midwives award under the category of Innovative Practice l In 2009 I was runner-up in Sandwell and West Birmingham Hospital Trust’s staff awards for Patient Engagement

The Virtual Pregnancy Team This team began life as a way of supporting and bringing together teenage pregnancy staff who often worked on their own. It was set up by the Teenage Pregnancy Commissioner and Strategy lead and originally aimed to reduce the isolation that some staff faced in the early days of the Strategy, when they were often working as the only teenage pregnancy worker within their organisation. It has developed into a really important way of bringing different professionals and agencies together to meet and share ideas and good practice, develop joint work and plan campaigns and joint training. Original members included a selection of health professionals plus representatives from various mainstream agencies and included: a

Midwife, Health Visitor, Social Worker, Youth Worker, School Health Nurse, welfare rights, education, Connexions, Family Planning and Brook. Regular meetings enabled staff to solve problems and provide support to overcome some of the barriers faced in the early days. In the latter years of the Strategy when ‘teenage pregnancy’ as an issue became ‘everybody’s business’, whole organisation approaches were developed and the team continued. After a couple of years these professionals returned to their organisation to embed the Strategy in their service.

c ase s t ud y De b

c ase s t ud y G e mm a

‘Deb’ was another young mother with poor attendance at school and poor attendance at health appointments. Deb had complex social issues and required a lot of support. When she realised what was on offer to help her, she worked together brilliantly with health and support services. After her child was born she enrolled at college on a Health and Social Care course (with the help of the ‘Care to Learn’ package). She is now living independently with her daughter and is doing really well. I still receive texts from her from time to time.

‘Gemma’ was a young school-age mother with a poor school attendance record and didn’t want to leave home without another family member being with her. She was referred to us and, after much emotional support and multi-agency working, she eventually did go to school: firstly on a part-time basis and gradually building up to full-time. She achieved good exam results and accreditations, is a great mum and is working full-time now her child has gone to school.

c ase s t ud y M a rs h a

‘Marsha’ was another young mum with extreme complex social issues and no family support. She was living rough and we stumbled upon her by accident when she accompanied a friend for a health appointment. She needed intensive support from the service immediately but as a result, she managed to turn her life around positively. With the correct help and support, and her own effort, she is now living in supported accommodation with her child and continues to work well with different services. She is a good mother putting her child’s needs first – but it could well have been a very different story.

The Teenage Pregnancy Strategy I have been a midwife for many years with a diverse background in all areas of midwifery care and I love the role of Specialist Midwife for Young Parents. To see how Maternity Services for young mums have altered, so they are treated no differently to older mothers, is amazing. When I reflect on the guidelines set out by Department Of Health in ‘Getting Maternity Services Right for Teenage Parents: ‘Who Cares?’ and ‘Every Child Matters’, it feels good to be able to tick boxes and say ‘Yes: we are achieving all this in our Trust.’ This legacy document shows how we have achieved it all. My hopes for the future of the Young Parents Maternity Support Service is that it continues to offer a fair and impartial service to young parents in Sandwell, that it continues to raise the profile of Maternity Services offered at Sandwell and West Birmingham NHS Trust and that any changes that take place are as a result of listening to what the young parents themselves want. We should continue to work together to support our young parents and empower them to make good decisions on lifestyle and positive parenthood.

NUMBER CRUNCHING 1,019 The number of young parents notified to the Young Parents Maternity Support Service between June 2007 and Dec 2009

140 The number of young mothers seen in consultant clinics

374 The number of young mums seen in the midwifery-led Young Parents Clinic

375 The number of home visits for support carried out

417 The number of assessments carried out of young parents’ needs

199 The number of consultations with young mothers seen in outreach clinic at Batmanshill

- Yo u ng y l l i e R i Vic k l l e ag ue ke r o c r e h o rt Wo r nd p a p u a S n o y i F it M a te r n Pa re n t s 41

Teenage Pregnancy and Young Parents Health Visitor By Rhonda Bird I joined the Health Visiting Service and Teenage Pregnancy team as a Young Parents Health Visitor in September 2003. My job was to provide confidential advice and support to vulnerable young people in Sandwell in a way that would appeal to them and was culturally sensitive. Young people could refer themselves to the service or could be referred by Batmanshill, if they gave consent. The service operated until 2007 when pregnancy support then became the responsibility of the Specialist Midwife for Young Parents. Additional support was provided for those with complex needs via the Family Nurse Partnership (see page 47). So what was the service all about? Well, it was a way of helping young people find out more about the wide variety of support available and give them a helping hand to access it, as most were unaware of what was available. To start off with, myself or a colleague visited them at home to find out what help they might need – everything from information about pregnancy and contraception to finances, education and housing. From all this information we put together a personalised care package to meet their needs effectively.

Our Achievements l Informed all young mums about the benefits of breastfeeding and the support available to help them successfully breastfeed. We gave them free breast pumps if they wanted them along with ‘Welcome Packs’ containing health promotional information; breast pads, nappies and information about local clinics. Smoking cessation support was also offered to those who wanted to quit l Through contact with us, young people were able to get support from other professionals like School Health Nurses, Nursery Nurses, GPs and midwives. In situations where some young parents sadly lost their babies, close work with the Bereavement Midwife provided maximum support l Helped with accommodation support for homeless young people and those living in abusive environments through partnerships with Sandwell Homes, Supported Housing at Bromford Housing Support Service and the GAP Project

l Our Maternal Mental Health Lead Health Visitor helped mothers with postnatal depression, post traumatic stress and other forms of mental illness to access a structured support group in Oldbury from wherever they lived in Sandwell. Transport and childcare was funded by a Teenage Pregnancy Grant l Worked with a Community Psychiatric Nurse to enable mothers to have mental health assessments and appropriate support. This meant swift access to further assessment and action for those who needed it

l Many young people lived in poverty and were unaware of their benefit rights so we referred them to the Welfare Rights Anti Poverty Unit Worker

l Established a Pregnant Teenagers and Young Parents Operational Forum to improve communication and enable consultation work on referral forms, assessments and a ‘Teenage Pregnancy and Young Parents Care Pathway’

l Helped young parents make their voices heard by working with the Youth Service and helping to develop Young Parents Groups and Young Parents Forums across Sandwell where views could be expressed. Young parents were then linked into the Teenage Pregnancy ‘Speak Out’ conferences and the Teenage Pregnancy Partnership Board

During my time as Teenage Pregnancy and Young Parents Health Visitor I was very privileged and humbled to share in some of the everyday difficulties and experiences that pregnant teenagers and young parents face. I found them almost always respectful and extremely grateful to receive support. There were challenging times but witnessing young mothers develop confidence in providing positive parenting; escape domestic violence; breastfeed; or stop smoking was very gratifying. To see a homeless young father return to school to complete GCSEs then obtain employment – plus another’s determination to stay out of prison and away from drug-related friends and environments – was the ultimate reward.

l Helped reduce many young parents’ feelings of isolation by linking them in to Sure Start programmes and Children’s Centre activities such as behavioural support groups that helped them feel ‘a sense of belonging’

l In 2006 all pregnant teenagers were routinely referred to the Teenage Pregnancy and Young Parents Health Visitor by the Midwifery Team Leader after ‘booking’ at Sandwell’s antenatal clinic. After consultation with the Safeguarding Children Service, Health Visitors were notified of all Sandwell teenage pregnancy bookings l Child protection concerns were referred to Social Services and we provided support to parents in Child Protection Plans to keep children safe

l Optimum support for young parents and children leaving care through partnership working with the Leaving Care Team, Sandwell’s Teenage Pregnancy Social Worker and the Looked After Children’s Health Visitor. Links were also made with Sandwell’s Common Assessment Framework Co-ordinator to ensure optimal support l Provided support for young parents from culturally diverse and multi-ethnic groups through partnerships with Barnardo’s African Caribbean and South Asian Development Workers, Asylum Social Workers, British Red Cross and Brush Strokes l Education, training and childcare support provided through close work with Black Country Connexions Personal Advisors and Parents with Prospects Co-ordinator

l All Health Visitors trained to carry out holistic needs assessments and provide care packages tailored to meet young people’s needs

l Multi-agency workers provided with training in basic awareness of the Strategy

Sandwell Wefare Rights and Anti-Poverty Unit By Samantha Creary and Nicole Armstrong (pictured) Welfare Rights Officers Worrying about money is the last thing you want when you are pregnant or have just had a baby. Times are tough for everyone at the moment, so it’s really important that young people and their families get the help they need to claim the benefits they are entitled to. Our unit is here to help them do just that, as well as supporting them with their education, accommodation and employment needs. Basically we help with all the things they need to feel secure and happy so they can get on with their lives and flourish. Getting positive reactions from the different teams that we work with is brilliant. To see young parents happy and supported and to see them being able to achieve their aspirations and be positive about their futures is fantastic. The satisfaction that is gained in seeing a young person grow into a parent and being able to see them still progress in life and still achieve their aspirations and their independence is an inspiration. We have been supported by the Strategy, who initially commissioned the service, since 2006, and have made a huge contribution to it. We work closely with the Batmanshill and Connexions as well as a whole variety of other professionals such as fathers workers, teenage pregnancy staff, midwives and health professionals. This network of trained people means that every young person who needs our support will get referred to us.

So, in practical terms, what do we actually do? Well, simply, we:

l Advise and help young people claim benefits whilst pregnant and after the birth of the baby l Advise young people (under 16) who are pregnant and still living with parents, where parents will need to make additional claims l Direct them towards help for education and employment l Provide support and training for teenage pregnancy staff

l Provide support on benefits during midwife surgeries The substantial number of young people and their families we have helped have benefited financially and many have also been helped with living independently in the community; staying in education; returning to education; training and/or employment. It’s really important that young people and their families get the support they need and that they are entitled to and are directed to organisations that can help them with all kinds of things – from education to housing. There are already millions of pounds of unclaimed benefits every year – and we can help make sure young people in Sandwell don’t miss out.

The Teenage Pregnancy Strategy Team manager Neil Cox said: “The importance of a child receiving a good start in life can’t be understated so this project is of major importance, not only for assisting teenage parents to cope more effectively with the natural pressure and expense that can come along with pregnancy, but also the long-term development of their children. “The way in which the Project has been set up and the partnership working that has been carried out has served to support the longer-term aspirations of parents while supporting them with immediate financial support. Parents haven’t been supported to access welfare rights entitlements and then left to become dependent on them – they have been supported into education and training as well which will hopefully enable them to lead happy and prosperous lives in the future. This Project has been hugely important and very successful in the support that it has delivered.”

NUMBER CRUNCHING 2003 Sandwell Welfare Rights and Anti-Poverty Unit set up (originally called Young Women)

22 Number of young people helped

£31,787.86 Additional benefit achieved on their behalf

2006 Sandwell Teenage Pregnancy Strategy supports the project

72 Number of young people helped

£216,227.62 Additional benefit achieved on their behalf

2010-2011 273 Number of young people helped

c ase s t ud y S a rah a g e d 17 Sarah was 17 years old and 30 weeks pregnant when she was referred to me by a Specialist Midwife. She was struggling to claim benefits at the Jobcentre, was living with her parents and had been out of education since leaving school. I helped her with claim Income Support, Healthy Start Vouchers and a Sure Start Maternity Grant that gave her a weekly income of £53.45 (as well as a £500 grant). I also referred her to Connexions for the Young Mums To Be Programme. After the birth of her baby I helped Sarah with her Child Benefit and Child Tax Credit claims that together increased her income by £80.30 weekly in total. Sarah then moved into a private rented house with her boyfriend, who was working, and I helped them both with claiming Working Tax Credit as well as Local Housing Allowance and Council Tax Benefit. With her benefits in place Sarah was then in a position to think about what she wanted to do in the future. When her daughter was six months old Sarah felt ready to go back to education and enrolled on a college course where there was childcare available for her daughter. My work with Sarah and her partner enabled them to live independently with their child, manage their finances and gave Sarah the opportunity to focus on her own aspirations. (Sarah is not her real name)

£702,359.27 Additional benefit achieved on their behalf 45

Young Mums To Be and Parents with Prospects By Annette Ward Project Co-ordinator These two projects are a great example of Sandwell leading the way for the rest of the country as one was hailed as an example of best practice and rolled out nationally. Together the two programmes complemented each other by helping young people develop basic skills, become independent and thrive – despite what life might throw at them at them. They helped young parents develop life skills like budgeting, health and safety in the home and contraception and supported young parents and mums-to-be to improve their confidence by working towards an accredited qualification. Young Mums to Be, which launched in 2000, was funded by the Strategy and the European Social Fund and was originally based at Sandwell New Horizons (sadly now closed). Parents with Prospects, also funded by the Strategy, began life as a pilot project in Sandwell and was then rolled out across the country after national recognition. Both programmes aimed to support and educate young mums-to-be in their pregnancy and young parents with their children from birth to five years – while helping them overcome barriers to take part in education, where appropriate. They operated on an outreach basis from venues such as Connexions One Stop, Sure Start, Brush Strokes and Meadows School to name a few.

I was really proud to be the co-ordinator of the projects – helping young people realise they have potential and can achieve, despite the negative things that may have been said to them. It has been great to see them stand on their own feet and be good parents. I was also very proud that our project was recognised by the National Basic Skills Agency as an example of good practice and promoted around the country.

Achievements l In 2006 Parents with Prospects was held up as good practice by the National Basic Skills Agency. It was also involved in the production of a DVD aimed at helping professionals across the country improve literacy and numeracy skills l Worked closely with all agencies from the wider teenage pregnancy team, to ensure young people benefited from the vast amount of expertise available

l The programmes were extremely successful and young parents progressed well. This work made an enormous difference to young people’s lives, giving them an opportunity to take part in an education programme specifically for their needs l The young mums-to-be and parents gave lots of feedback that they really enjoyed it. They felt it gave them a platform to move forward and continue with their education Some of the young people moved into Apprenticeships, further and higher education

Family Nurse Partnership By Kerris Percival Family Nurse Supervisor Every parent wants to be the best mum or dad for their child but some need more support than others. The Family Nurse Partnership (FNP) is something fairly new in Sandwell and it was set up in 2009 as an intensive home visiting programme for vulnerable first-time parents. Since it began it has helped 108 young people. There are currently five nurses on the team and each one works closely with clients, visiting them at home every two weeks and offering tailor–made support to suit their many complex needs. Each nurse delivers the programme from early pregnancy until the child is two years old.

Young people are referred to us in many different ways – from places like Youth Offending Teams, the Drug Action Team, midwives, school or they can refer themselves. The best way to really understand what we do ‘in action’ is to read the real-life case studies below, that show the extent to which some young people really need this support. Each ‘case study’ has been written by a nurse about one of their real clients – although we have changed the names for their protection.

Every case can be really challenging due to their own difficult life experiences. There can be many ways in which young people need support – and that’s what the nurse is there to do, creating a bond with each parent and linking in with other professionals, if needed, to help them change their lives or learn new skills so they can be the parents they want to be. Our support means our clients get all the help they need from the Midwifery and Health Visiting services.

c ase s t ud y L u cy a g e d 19 19-year-old Lucy was 26 weeks pregnant and about to leave care when she was referred to us by a Lead Nurse. She met with a supervisor and agreed to join our programme to help her with many complex issues. She had been in care for many years and suffered a very abusive childhood due to her alcoholic parents. She had a crack cocaine habit, worked as a prostitute to pay for it and her baby’s father was her pimp. Unsurprisingly, she found it difficult to trust people and develop relationships with professionals. We spoke with midwives and found she wasn’t really keeping in touch with

When Samantha was referred to us in 2009, she was living in a hostel. Her room was littered with beer cans and cigarette ends. The support worker at the hostel reported that there were numerous men coming into the property and the midwife had also expressed concerns for her unborn child. She had spent much of her early life in care, had mental health problems and was under the care of a psychiatrist. After several meetings, Samantha’s unborn baby was placed on a Child Protection Plan with the view they would be offered a mother and baby placement after the birth. During the pregnancy, the Family Nurse visited Samantha – but often she had moved elsewhere and took some time to find. William was born in June 2010 – but a mother and baby placement had not been found so Children’s Social Care wanted to place the baby into foster care without Samantha – but she refused to let her baby go into care without her. As a result Samantha and William stayed in a postnatal ward for two weeks.

them and there were concerns about her baby’s health. We persevered and eventually a midwife was able to see her. Things really progressed after they got involved and she began taking an interest in her baby, admitting she was really scared that there was going to be something wrong with it. From this day we noticed a change in Lucy and she began to talk more about her feelings about her baby. A Child Protection Plan was put in place and Lucy was given time to attend her appointments, prove herself and work with professionals – otherwise the baby would be taken into care at birth. Lucy eventually gave birth to a healthy baby girl and remained with her in hospital for several days. She now has contact with her baby three times a week. She also sees her mother and sister but has no contact with her father. We are continuing to support her at contact centres and are helping her to manage her lifestyle better, develop support networks and understand how to budget, among other things.

Eventually, they were both placed at a foster carer’s together in East Birmingham and the Family Nurse visited them there. After 12 weeks, mother and son returned to Sandwell to live in supported housing.

c ase s t ud y S am a n t h a a n d Wil li am

Since William’s birth, Samantha worked well with the FNP. Although there are still many issues to address, including therapy for the abuse suffered in her past, her life is now less chaotic. Her parenting skills have developed by using the facilitators and educators from FNP and additional FNP tools like Partners in Parenting Education. William has reached his developmental milestones and Samantha gives him a wide range of foods. She only goes out once a month when a foster carer has William overnight. The amount of alcohol she drinks is now minimal and she has reduced the amount she smokes to fewer than 10 cigarettes a day. She has recently asked about Stop Smoking services.

c ase s t ud y Le o n a a g e d 17 Leona had recently completed an NVQ Level 2 course in Hair and Beauty and intended to progress onto Level 3 following the birth of her child when we first met her. She was referred to us by the Midwifery Service in December 2009 and lived at home with her parents. To begin with, her participation in FNP during pregnancy was good and during her visits we covered many issues such as educational aspirations, personal health and relationships. Leona told us her partner was an alcoholic and that he had been in trouble with the police but she denied any abuse. In March 2010 Leona gave birth to a healthy baby boy. She continued to live with her parents and appeared to be managing well with her new role, achieving her goal to breastfeed and being at home for really productive visits from the Family Nurse. But by August 2010 things changed. She was not home for visits and the child’s grandparents said they were worried Leona’s partner was being physically abusive. They also thought her mood and behaviour had changed drastically and that it was putting extra pressure on the other household members. At the next Family Nurse visit, Leona told us her partner had been occasionally violent when drunk. I discussed a referral to Women’s Aid but she declined. Ten days later Leona’s dad called to say he had reported both mum and baby as missing persons with the police as he had not seen or heard from then for five days. We referred her case to Children’s Services. Four days later mum and baby returned home. Children’s Services briefly opened a case because of Leona’s ability to safeguard the baby – and they told her that her partner was a heroin user. As such, he was deemed a risk around children. Leona denied any knowledge and said her relationship with him was over so the case was closed.

Leona moved into a supported housing project for young parents. Family Nurse visits went well to begin with then she began to deny access in February 2011. Staff at the project raised concerns that Leona stayed home less frequently and was looking tired, withdrawn and unkempt. Children’s Services were made aware and again opened the case but Leona was not seen by any agencies throughout March. In April the housing project contacted us to say she was in hospital due to a heroin overdose and was enrolled on the methadone programme. We visited her but Leona was almost unrecognisable from her former self. She discussed her drug issues and told us that her drug abuse had started before becoming pregnant. She had started by smoking heroin and was currently injecting. During May and early June, Leona was reported missing three times. On the last occasion she was found unconscious at her parents’ home and was admitted to hospital. Care of the baby was given to the grandparents and the partner was charged and jailed for unlawfully administering a Class A substance. Leona eventually returned home to her parents but was then re-homed in a project for young people with drug misuse issues. She remains on the methadone programme but has tested drug-free since July. Her baby is now 18 months old and continues to live with his grandparents under a Care Order. Leona visits daily and she conducts all of the parenting during her visits. Her co-operation with the FNP has increased now and she has been in touch with Women’s Aid, Drug Services and Sure Start and is just about to re-enrol to college to finally complete that Level 3 qualification. Leona knows she still has a long way to go until the care of her son is fully returned to her, but she is making an excellent effort to turn her life around for the sake of her child. During Family Nurse visits, she often reflects on how fortunate she feels and how things could so easily have turned out differently for her and her son if she had not had the support from her family and the agencies involved. As a family they have six months left on the programme Hopefully Leona will continue to progress so she can take parental responsibility for her son during that time.

Praise for the Family Nurse Partnership “I have always found the team to be professional and supportive of my role. Our roles complement each other and we have met over this period of time in several ways. “I have found that students (we had in common) gained much from the programme and built up confidence with their respective Family Nurses. I have appreciated the consistency of support that this has given the students and have been pleased to see that even some of the more ‘difficult to engage’ were not ‘given up on’ by the Family Nurse assigned to them and the Family Nurse would, for extended periods of time, make strenuous efforts to contact them.” Consultant Teacher for Young Parents

“Thank you for asking me to let the nurses know what a good job they’ve done with our daughter. It has made all the difference. I have mental health problems and with her getting pregnant so young we thought she’d end up losing the baby to Social Services or getting depression like I did. She is the first in our family to go to college and she is still with her boyfriend. I am so proud of her and the nurses that helped us. “Can you let them know how much I love being a grandmother and what a good mum my daughter is?” Grandparent

“The Krunch Young Fathers Programme works with a variety of agencies such as FNP, the Community Midwife, Children’s Centres and Batmanshill. FNP plays an integral role in the Krunch Programme, as they refer fathers and fathers to be to us.” Krunch

Young Parents Childrens Centre By Holly Galloway Young Parents Children’s Co-ordinator

We are the first and only Young Parents Children’s Centre (YPCC) in Britain – and we want to inspire others around the country to do the same as us. So what do we do that’s different? Well, we are a Sure Start Children’s Centre but have a very specific remit: to support young parents and their children in Sandwell.

On top of this we run weekly Young Parents Groups from different Children’s Centres so young parents can meet up and support each other.

We want to make sure no young families ‘slip through the net’ – but receive all the support they need, when they need it.

Parents have said: “I really enjoyed the CookWell course and the recipe books we helped to make!” Another said: “My little boy just started talking and he’s made loads of friends at the group… I have too!”

To do this, we pull together lots of different organisations who can offer all kinds of help and support to families – all under one roof. This could be everything from helping with qualifications to health clinics and child assessments. Although we are an operational Children’s Centre we don’t have a ‘building’ like a conventional Children’s Centre. Instead we deliver our services out of local Children’s Centres and have been doing this since the start of 2010. The YPCC complements the work of the Strategy to support young parents and we aim to ensure a consistently high level of support for young families throughout Sandwell. Young families receive a comprehensive, individual support package – developed using the Healthy Child Programme. They choose and agree to it at the beginning of their support and it includes specialist child development screening and assessments carried out by our Early Years Teacher to promote child development.

Th e C o o kWe ll c o u rs e p r p o p u la r o ve d

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We spend a lot of time talking to young parents. In fact, this is the lifeblood of our service. Everything we do is shaped by what they tell us they want or need. We have lots of different ways of communicating with them – and take every opportunity to ask them what they think of our services! We have a monthly newsletter that has a ‘You Said, We Did’ section for feedback and comments. As we aren’t based in our own physical building, in the last year we have been developing a distinctive brand image so everyone knows who we are, what we do and where we do it. As part of this, we got young parents involved in helping to create characters for use in our marketing materials. We used the real-life experiences of young parents in Sandwell to develop the characters’ ‘life stories’. These characters have been used in our monthly newsletter and in postcards to dispel common myths around teenage pregnancy and posters promoting contraception and open communication within families. We have also developed an Agony Aunt character, Auntie V, who answers questions via email and sends out the monthly newsletter to our partner agencies and young parents.

We want to make sure that support for young families is a priority in Sandwell – so we are also supporting the development of our own staff. We have delivered an ABC-accredited Level 1 Introduction to Youth Work course to staff to which included a supervised youth work placement and portfolio completion, to enhance their skills. The success of training we provided to Children’s Centres has also led to us offering training and knowledge-building sessions to staff from our partner agencies This has covered issues facing young families such as money management, risky behaviour, social networking and starting school. These sessions will help Children’s Centre staff, and other staff, to support young families to live independent, safe and successful lives.

We want to make sure that support for young families is a priority in Sandwell

HELPING vulnerable young people

Different young people have different needs – but those who are vulnerable or ‘at risk’ need some special attention. All teenage pregnancy prevention services are required to address the needs of all young people so we have to do things differently to meet those who are vulnerable. What do we mean by ‘vulnerable’? Well, it’s a whole range of young people. It could be those missing or excluded from school, young offenders, young people with disabilities or Looked After Children (LAC) – those who may live in foster or care homes, or who are on Care Orders. It could also include those from BME backgrounds who are at risk of missing out on important help and support because of language or cultural differences. We used the teenage pregnancy grant to commission specific services for BME young people and Looked After Children to make sure we targeted vulnerable young people effectively. It’s complex work but we want to make sure that everyone gets the right advice and information in a clear, non-judgmental way.

In this section We explain more about how we do all of this and what we’ve achieved – from developing support for those with disabilities through Changing Our Lives to promoting alternative life choices to teen parenthood through Raising Aspirations.

...everyone gets the right advice and information

Changing Our Lives By Lucy Dunstan Project Co-ordinator Changing Our Lives supports people with disabilities of all ages to speak up for their rights and take control of their lives and we’ve had some notable achievements with this in the last year. We supported young people with disabilities to research for us their experiences of health and teenage pregnancy. It was an eye-opening piece of work – and one that has led to real change..

Peer Researchers; Ricky, and Gemma.

So what did we do? Well, we worked specifically with young people through an initiative called Young Voices. This is a network of 150 young people in Sandwell schools aged between eight and 25 years. They meet every two months to raise the issues affecting the lives of young people with disabilities and also meet at other times to work on projects.

We were shocked about how little these young people understood about sex and relationships and how they felt unable to talk about this. We were horrified by some of the myths that people had heard and believed – especially as these things put vulnerable people at an even greater risk. The attitude seemed to be that ‘if we don’t talk about it then it won’t happen’.

We asked them to carry out a project on adolescent health and teenage pregnancy.

It’s important to recognise that young people are more vulnerable and at risk of being abused if they are not educated so they need to be empowered to make the right choices and stop abuse happening.

Three young people, all with learning disabilities and autistic spectrum disorder, led the project and talked to other young people in Sandwell schools to find out what they knew and understood about their health – and their experiences of local health services. They gathered the views of 47 young people with learning and physical disabilities aged between 12 and 19 years (22 girls and 25 boys). We were stunned by the results. Most did not know about the health services available to them in Sandwell and often didn’t understand the information they did get because it didn’t have easy words and pictures. They had lots to say about their experience of hospitals but unfortunately most of these were negative due to difficulties in communication and a general lack of understanding and respect.

This piece of work not only highlighted the issue, but also set in motion changes that we hope will improve things. The researchers presented their findings to the Teenage Pregnancy Commissioner and professionals from children’s and healthcare services – those responsible for informing these young people about health and pregnancy issues. Their recommendations have now been developed and work is due to start to support them in designing and developing a sexual health awareness training package delivered by young people with disabilities. What a result!

Raising Aspirations Promoting Alternative Life Choices to Teen Parenthood

By Claire Anderson & Peter Holtham Team Leaders One of the reasons often given for high levels of teenage pregnancy in the UK is a lack of aspiration in young people – a sense of ‘making do’ rather than one of aiming high and wanting to achieve. Turning that around doesn’t happen by magic – especially in an area like Sandwell that suffers from some real deprivation. Here it can be hard to see what there is to aim for – which is why Raising Aspirations was established. The Programme was set up by Stacy Moss at Connexions in 2007 as a direct result of work done to try and help young people to aspire and reach their full potential. Connexions worked specifically with young parents, supporting young mums and dads to make the transition to adult life, focusing on education, work and training. They were supported by Personal Advisors who worked with them in one-to-ones and groups, visited them at home, out in the community, or in places like Batmanshill and Nacro Training. The Advisors advocated and helped young people and also aimed to identify any ‘gaps’ in services and how they could be filled. Connexions specifically worked at local housing projects such as GAP and Bromford Housing Hobart Road, to maintain their tenancies by working on their life and social skills – covering everything from looking after babies and children to cleaning the house and budgeting.

We o rg a n is e re s id b re a k s t o b u ild e n t ia l ac t i v i t y s k il ls a n d c o n f id e nce

From all this work, Raising Aspirations was born. The idea of the Programme is to help young people ‘aim high’ by giving them the information confidence and support to make informed choices about their lives – choices that offer an alternative to teenage parenthood. It helps young people in all kinds of different ways: from organising residential activity breaks to build skills and confidence, to holding one-to-one information sessions on sex and relationships and helping them get back into education, training or work. After starting life at Connexions, the Programme and staff moved, as part of council re-structuring, to the Youth Service as a Teenage Pregnancy Team before more recently becoming part of Targeted Youth Support Services.

The people who work on the project aren’t ‘suits’ – quite the opposite. They understand what many young people are experiencing – because they’ve been there themselves. We think this helps to make the work we do more successful because it means our young people identify with and trust those supporting them. You can see what we mean by reading the personal stories of a couple of our own staff, (starting on page 59). The team pulls together support from other organisations like Connexions and health professionals, so it can offer young people all the help they need to develop and aspire to a happy and healthy future. Success comes in all kinds of positive ways: from the things young people don’t do, like become young parents or re-offend – to the things they do – like find work, achieve qualifications or even get married!

Welfare Rights Worker, Sally Box advising a young mum

Achievements l Because of this work hundreds of young people and young parents have been given information, advice and guidance to enable them to be successful in life. They have been given intensive support, encouragement and opportunities they would otherwise never have had. All of this meant many achieved qualifications and a chance to reach their full potential

l Connexions contributed towards the Strategyâ&#x20AC;&#x2122;s aims and objectives by working closely with other organisations and professionals to improve the health and wellbeing of children and young people from birth to 19 years of age. It also supported young people to prevent unwanted early pregnancy and provided support on a whole range of individual personal and social issues

l One particular young person had been estranged from her family and was living independently at 16 years of age with one child. On meeting her she had little confidence and very little self-worth. She completed the Young Mums To Be Programme, followed by Parents with Prospects Programme. This gave her a renewed confidence and self-belief. Six years later she was in the third year of her Nursing degree. When congratulated, she said: â&#x20AC;&#x153;I did it because you told me I could, when no-one else believed in me.â&#x20AC;? Comments like this make us feel very proud that we have played a part in helping this particular young person achieve her goal and become successful.

Pauline Jackson, Peter Holtham, Stacey Moss and Annette Ward.

Young Fathers Worker then Young Mens Worker

By Peter Burton My job is to support young men specifically so they make the best choices they can in life to be happy and healthy. To begin with, my role was based at Connexions and I worked there with around 125 young men, setting up training opportunities with Nacro, attending hospital appointments, DIY classes and arranging residential courses. My role was on both one-to-one and in groups. In 2009, I moved into Targeted Youth Support at Sandwell Council and since August of 2011 I have worked with around 80 young men in a variety of settings, looking at ways of preventing teen pregnancy and all of the associated factors. I work closely with their families and school and co-ordinate support from whatever professions or agencies are needed. This might be sex education, pregnancy, or contraception or referrals to specialist services like counselling or social care, employment and training.

l Setting up Big Brothers/Big Sisters mentoring groups aimed at mutual support and confidence-building for young men and women at risk. They have now been supported by project staff to work independently and the Big Sisters project gained runner-up prize at the Sandwell STAR (Sandwell Teenagers Achieve Recognition) Awards run by Sandwell Council l Helping to reduce conception rates and raising awareness of associated issues through SRE workshops and individual support

Achievements l More than 50 young people have been ac credited through ASDAN â&#x20AC;&#x201C; a charity promoting education programmes and opportunities to help young people develop skills for life. This gives them more confidence and opportunities l No young men have become teen parents while I have worked with them from October 2009

l Taking a young offender who was tagged on a residential course. To date he has not re-offended and, although not with mother of child, still has contact and is involved

My Personal Story As a single father whose wife died when my son was four and my daughter nine, I have seen how difficult it is to be a parent. Working for the Teenage Pregnancy Strategy has shown me just how important role models can be and how easy it is for young people to be labelled and to become disengaged. It has been an honour and a pleasure to disprove these myths and to prove to the young people themselves that they can achieve and that they are valued. The Project has a proven

track record on reducing all of the recordable outcomes but this pales into insignificance when proving professionals wrong time and time again. This is shown by the number of young men I have worked with who have not become teen dads and have not entered the criminal justice system – they have stayed in education. The Strategy has given these young people an opportunity to be heard and I feel that their voice is what has underpinned the success.

Praise for Pete “Our son has come on in confidence and gained so much from working with Pete. He now attends a youth group and gets involved with more social activities outside of school. He has a better outlook now and has managed to get a part-time job.” Parents of one young man

“Pete has worked on the Raising Aspirations project as a Young Fathers Worker which then changed to become a Young Mens Worker in April 2010 offering his support to all young people referred to the project. He has been the only male worker directly working on the Project and has had a positive impact on a number of young males throughout his time. His knowledge of the subject area and ability to put it in to practice has allowed and influenced a number of males to have a positive influence in their children’s lives together with gaining qualifications and experience through activities and progressing on to positive outcomes for themselves.”

Pete’s Manager

Senior Officer for Young people By Rachael Hopkinson I help develop and deliver young parents groups across the six towns of Sandwell, including prevention work in five areas where teenage pregnancy rates are high. I actively involve teenage parents, young people and the local community in the delivery and evaluation of the Strategy by delivering a Young Parents Forum and helping them get access to information on relationships, STIs, pregnancy, contraception and local services. I also support group work sessions in education and community settings, work with vulnerable groups of young people in groups and support young people to delay their first sexual experience.

Achievements l Setting up seven Young Parents Groups across Sandwell

l Achievements for young people: accreditation, employment and college places

l Two young parents getting part-time jobs through the Youth Service

l Helping to establish the Teenage Pregnancy Virtual Team in mainstream organisations and making it ‘everyone’s business’

l 10 young parents completing the Introduction to Youth Work course (Level 1)

l Nominated for the Sandwell STAR Awards

l Positive feedback from young people and parents/carers

l All Youth Service staff trained in basic SRE delivery, condom distribution and chlamydia training l Achieving accreditation from ASDAN

l Running the Big Sisters and Big Brothers Peer Mentoring Project l Organising the Tall Ships Residential (a weeklong boating residential break)

My Personal Story I’ve been in this job for seven years, starting off in the Youth Service’s Teenage Pregnancy Team. Personally, working for the Strategy in Sandwell was a dream. There is a reason why I am driven to do this job – and why I enjoy it so much: I was a teenage parent and had personally experienced the prejudice and negativity. I had a passion to

make a difference to the lives of other teenage parents and to have the opportunity to develop and deliver support groups for teenage parents was a challenge – but definitely worth the hard work. When you build relationships with parents and support them through their own challenges it makes the job extremely satisfying and fulfilling.

Praise for Rachael “As Rachael’s manager over the last six months, I have found her to be a passionate and dedicated member of the team who, through her own experience, has been inspired to support and help young people in terms of sexual health and teenage parenthood. Her knowledge has expanded through the different projects she has been involved in and allowed her to pass this on to individual young people, families and agencies she has worked with. “

Rachael’s manager

Praise for Raising Aspirations “The work you and your colleagues have done for T has been great. You have provided a number of activities that have been helpful but in a fun way. T has been a totally different person with your help. She has had help with her anger which is what T needed and she also has had fun working with your team. Thank you all so much.”

D (mother)

Services for Black and Ethnic Minority (BME) Young People We commissioned specific services to support BME young people after a Public Health analysis of teenage conceptions data found that some of them were more at risk of teenage conceptions. Over the years a number of agencies have delivered these services for us, including the African Caribbean Resource Centre, Barnardo’s and the Terrence Higgins Trust.

Achievements l In 2007 Hansa Patel-Kanwal OBE, an independent consultant and advisor to the National Teenage Pregnancy Unit and government Race Equality Advisory Group, was commissioned by the Teenage Pregnancy Commissioner to evaluate the work commissioned by the Strategy for young people from South Asian and African Caribbean Communities in Sandwell. The review highlighted that the West Bromwich African Caribbean Resource Centre and Barnardo’s were producing examples of creative and innovative work with vulnerable and marginalised young people living in an area experiencing multiple deprivation issues – and producing impressive results around reducing first and second pregnancies with the young people being targeted through these initiatives. l South Asian Teenage Pregnancy Project’s ‘Inspiration Shines Through’ DVD. This aimed to show young people from the South Asian community the services and advice open to them around sexual health and pregnancy in a brilliant Bollywood-style blend of acting, dance and music. It was supported by the

Strategy, Sandwell PCT and children’s charity Barnardo’s and was produced in response to young people and their community

l A support pack with fun but informative work for the young people to think about supported the DVD. Alongside this, a sexual health work shop training pack was also developed and training was delivered to professionals in the Teenage Pregnancy Team, youth and community centres, service providers, midwives and teachers. This addressed awareness of South Asian religious attitudes on sexual health as well as how to engage young people and parents from the targeted community

l Local children got the chance to star in the DVD, filmed at locations all over Sandwell with pupils at schools across Sandwell auditioning for roles. All participants were given a certificate in recognition of their hard work and a separate album was created of all the featured music. 200 of the 20-minute DVDs, along with educational packs, were distributed to schools and community groups.

l West Bromwich African Caribbean Resource Centre was commissioned between 2004 and 2010 to deliver a preventive service targeted at African Caribbean and Dual Heritage young people, while contributing to existing preventive services through raising awareness of cultural diversity to other practitioners. The Centre provided a specialist worker who ensured the delivery of SRE sessions to young African Caribbean/Dual Heritage people and teenage parents and directed them to appropriate services. The project also ensured that the views and needs of these young people/parents were effectively captured. Training for staff working in children and young people’s services was also incorporated into this work to raise awareness of teenage pregnancy and cultural diversity developmental areas through partnership work and attendance at community events

l Mini Artistic Sexual Health Deliverers (MASH’d). This Creative Arts Youth Forum was a group of dedicated young people trained by Barnardo’s to co-deliver sexual health workshops in a creative way across Sandwell. MASH’d was involved in various projects, such as the Mystery Shopper Project. Those involved gained skills and knowledge within the field of sexual health and then delivered training to other young people, acting as role models to others on sexual health.

Looked After Young People from the Leaving Care Team and young parents were welcomed as members by MASH’d who got them involved in activities including a DJ’ing course in Smethwick

l Terrence Higgins Trust (THT), the UK’s leading HIV and sexual health charity, established a BME Teenage Pregnancy Prevention Service in Sandwell. Its aim is not just to contribute to reducing the under-18 conception rate and the risk of a STIs, but also to raise aspirations and promote alternatives to teen parenthood. It provides information and clear messages to parents and carers to support their sex education and encourage young people to ‘aim high’ and reach their potential. It also aims to develop the role of preventive services for all by providing training and support to raise awareness of teenage pregnancy and cultural diversity and to promote the Strategy and local services As part of this work, THT has developed close links with BME community leaders and service providers throughout Sandwell

Supported Housing By Martin Duffell Sandwell Homes Supporting People fund two supported housing schemes for young families offering housing and support for up to two years or until the young person demonstrates that they are ready to live independently. These are located at the GAP Project in Oldbury and Hobart Road in Tipton. They aim to support vulnerable young families to live independently and promote positive outcomes for young parents and their children.

SHARP (Sandwell Homelessness and Resettlement Project) manages the GAP project. It provides 30 one bedroom self contained flats for young people aged between 16 and 21 years and is staffed 24 hours a day, 7 days a week. GAP was awarded Level A of the Quality Assessment Framework when reviewed in 2011. Bromford Housing Group manages Hobart Road. It provides 9 two bedroom self contained flats for young people aged between 16 and 25 and is staffed between 9.00 and 5.00pm Monday to Friday. Hobart Road was awarded Level B of the Quality Assessment Framework when reviewed in 2011. Referrals must be processed through the SRP (Single Referral Process) details of which may be obtained from Sandwell Homes, Vulnerable People Housing Service on 0121 569 5238. Young People have access to long term independent accommodation via the Sandwell Move On Process. With funding reductions, Bromford’s Floating Support Service was decommissioned but supported accommodation has been safeguarded to prevent further reduction to much needed housing.

L & M were referred as L was homeless; living between her parents and friends houses, sleeping on the sofa and D, their son was sleeping on a mattress on the floor. D didn’t have a set routine which was impacting on his eating and development.

c ase s t ud y H ob a rt R o ad

M was living with his parents and was desperate to live with his son and partner to be a family unit. They both had a lot of debt which they kept ignoring. Their benefits weren’t being paid correctly which meant that the family barely had any income. L wasn’t sure what she wanted to do with her life, the only thing that she was interested in was floristry but had no idea how to get into the industry. M struggled to look for work as he was too worried about finding somewhere for his family to live. Since moving to Hobart Road L & M have been able to give their son the home and set routine that he needed and he is beginning to thrive and be a happy 18 month old little boy. L & M have payment plans with their debtors and are on their way to being debt free. Their benefits are being paid correctly and they even received back payments. L has registered herself on a flower arranging course and is really excited as she hopes to start her own business. M has been successful in securing a placement for work experience as a drivers mate with a possibility of a permanent job. L & M said that without Hobart Road they are unsure where they would be living, possibly in a private rented property, but they would of struggled to find the money for a deposit, the most likely outcome would be that they would either still be homeless or have taken out a loan to pay for a deposit. D would still be without a set routine and failing to thrive, L would be still unsure about what to do for a career and M would be claiming JSA but struggling to find work to apply for.

The GAP Project By Denise Martin GAP Co-ordinator Young people who move into the project are often isolated with little or no support from families, have no income due to lack of knowledge, have given up on their education, may be in abusive relationships, lack parenting knowledge and any structure or guidance of family values in their lives. If the project ceased to exist all of the above would continue to escalate with the outcome being an extra strain on the local community and services resulting in very costly intervention. This project is important in assisting young people and families to break the cycle. Our work helps build self-esteem, develop life chances, encourage interaction between parent/child/families, and provides support to young vulnerable parents who feel isolated. We encourage good parenting with links to Children’s Centres and Young Parent Services e.g. KRUNCH. We help raise the expectations of young parents giving them choices for the future and provide opportunities for continuing their education and training through links with Batman’s Hill Unit PRU, colleges and training establishments. We have received young parents onto the project who have led very difficult lives, some with social services input, it is therefore very rewarding when they go on to achieve and to witness the difference this makes to their confidence, parenting and relationships. When a young person or family achieve their goals both myself and staff feel we have achieved a positive outcome for the young person and their family.

K came to live at GAP however failed to engage so went to a mother and baby unit. As K had her child removed, it was agreed that if K came back to GAP and worked to an agreement this would enable her daughter to be placed with her to see how she parented. The child is currently registered with the LAC Team. In relation to this staff carried out observations on a daily basis in order to observe K’s parenting. K needed help to develop her parenting skills, build her confidence and improve her budgeting. K cooperated with all services offered and has been able to budget efficiently ensuring she is up to date with her payments. K has completed a Triple P parenting course.

c ase s t ud y GAP Pro je c t

K has gained awareness of health and safety and maintains her property to a high standard ensuring it’s safe for her daughter. K ensures that she and her daughter have a balanced diet and enjoys going swimming and walking with her daughter on a regular basis. K has started going to the library to help her daughter to read. K has applied for a Hair and Beauty Course. K still needs support to build her confidence as she does not make friends easily, however she has gained in self-esteem, her parenting has greatly improved, and she has strengthened relationships with family members.

HOW young people support us

We don’t go round telling young people what to do. We try to offer information, support and guidance so they make their own informed choices. And do you know what? They do the same for us, too. Really. They work with us, give us their time, energy and feedback and help us to shape our work – so that it really does meet their needs. They have a really powerful voice – and we try to encourage that because what they say matters and affects how decisions are made by people like the council and health chiefs. It has been important from the very beginning of our Strategy to listen to and involve young people. Over the course of the last ten years we have been very grateful to a large number of young people who have given their time so generously and freely and shared their thoughts to help us develop and review our Strategy and the services we commission. Far from being reluctant to be involved, we have found that young people are very willing to help and have valuable insight and skills that have made a fantastic contribution to our Strategy.

In this section We put the spotlight on the different ways we have worked together with young people and exactly how they have helped us and we have highlighted some of our recent achievements to start with. Over the life of our work we have consulted and met with many of them in a variety of different ways – but we haven’t been trying to reinvent the wheel! As well as setting up our own Young People’s Board we also used existing youth forums such as the shOUT lesbian, gay bisexual and transgendered (LGBT) youth forum and the Looked After Children (LAC) Board.

Recent Achievements l Three young people with learning disabilities were supported by Changing Our Lives to undertake a research project. This resulted in 60 young people with a physical or learning disability sharing their views and a new project that will continue to involve young people with a learning disability in development of a sex and relationship project

l Three young people were supported by Young People in Focus to undertake peer research to identify more than 50 young people’s views on adolescent health including teenage pregnancy

l Production of a DVD for schools and youth centres on the specific needs of Asian young people. The project, supported by Barnardo’s, encouraged participation from young Asians via its Mash’d forum as well as conferences and events for Asian young people

l As well as the Teenage Pregnancy Young People’s Board (TPYP) (see page 68), we have also made sure young people’s views have been heard throughout the life of our Strategy via Young Parents Forums, supported by the Youth Service and Young Parents Children’s Centre. The views of young fathers are being listened to through Krunch and fed into our strategy and priorities

l Annual (Teenage Parents) Speak Out Conference. The teenage pregnancy commissioning staff, Youth Service and support services such as Connexions and Batmanshill worked together to hold this popular event that attracted at least 50 young parents and their children A crèche was provided to enable full participation and the conference gave attendees a chance to express their views on local services and on future priorities. It was also a chance for participants to meet staff working in support services and have some time out and fun while their children were safely looked after.

c ase s t ud y Mys te r y Sh o pp e r Barnardo’s was commissioned to undertake a Mystery Shopper Project. It trained and supported TPYP Board members to “mystery shop” Sandwell’s Contraception and Sexual Health Services and pharmacists providing emergency contraception to teenagers. Their job was to identify what they thought a ‘young person friendly’ service should be like and how they would like to be treated by staff when they visited a service. They went ‘undercover’ and visited local services anonymously recording their findings on each visit. A report was then compiled for each service highlighting good practice and recommendations for improvement where young people had concerns. This was fed back to the services by commissioners as part of performance management processes and young people received feedback on how their recommendations were being addressed by commissioners and service providers.

The Teenage Pregnancy Young People’s Board (TPYP Board)

By Tariq Karim Area Manager, Young People’s Service The TPYP Board has been a really important way for young people to influence the design and provision of services that affect their own health and wellbeing. Sandwell Youth Service was commissioned to set it up to create an effective way of talking to young people and getting their views – and help us develop the right services for them. As a result it has played a key role in the development, implementation and review of the Strategy – particularly the prevention of unwanted teenage pregnancy and sexually transmitted infections among young people. The Board acts as a kind of ‘voice’ for young people, helping to develop and deliver reviews of local services through Mystery Shopper projects. It also helps ensure new services are developed appropriately by helping in commissioning processes. Members work with Youth Service staff on the design and delivery of all kinds of services, such as SRE, and give regular feedback so they can best meet young people’s needs. The Board also actively promotes the discussion of teenage pregnancy and sexual health with other forums, such as the Youth Cabinet and Looked After Young People’s Board and develops and delivers SRE workshops to other young people.

Achievements l Joint TPYP Board and Teenage Pregnancy Partnership Board ‘away days’ to review strategy and agree priorities for annual action plans

l Involvement in commissioning. The Board was involved in the review of ‘young people friendly’ contraception services – and helped the Teenage Pregnancy Commissioner to develop a new specification. A young person representing the Board was involved throughout the tendering process – including interviews of prospective service providers and scoring of applications

l A specific young person’s Sex and Relationships Education Forum helped guide and advise the Youth Service on development of SRE Policy and SRE delivery l On-going advice to the teenage pregnancy media and communications lead on the development of resources for young people, including annual campaign materials and marketing materials for services

l In 2009 the TPYP Board was involved in a scrutiny review of teenage conception and pregnancy in Sandwell looking at prevention, SRE and support for young parents

l In 2008 Board member Kerry Payton won the Brightest Star Award at the annual Sandwell STAR Awards run by Sandwell Council. She was recognised for her services to young people. Her nominator said: “Kerry is an exceptional young woman and parent who is dedicated to making a real change for young parents in Sandwell. The most remarkable thing is her dedication to making such a difference to her own life and the life of her children. Despite all that life has thrown at her, this young woman is a brilliant mother, a fantastic role model and an inspiration.”

l Nathan Ledger, another Board member, was runner-up in the Sandwell Young Star Awards for Youth Voice in 2010.

Adolescent Health Project By Shafaq Hussain Youth Officer This innovative project used creative arts to really get young people involved in understanding all aspects of adolescent health – and to promote a positive message of being young and proud to be healthy. To do this, we worked with local artists to create really enjoyable opportunities for young people to get involved in learning about and positively promoting messages about health issues affecting young people. We aimed to give young people practical experience and background knowledge from specialists in health services to serve as an example for others to follow. We started by building awareness and understanding of the wider health issues affecting adolescents by creating a library of information through literature, health campaigns and films.Then we held interactive information taster days for young people to participate in. These ‘taster days’ helped raise interest and understanding of health issues from obesity to emotional wellbeing.The days helped to identify and prioritise the main health issues for young people in Sandwell and who could benefit from taking part in specific or tailor-made services. Taster services were offered to those assessed as being ’at risk’ of developing health problems.

The end result was a number of Young People Network and Showcase Events. Young people organised these to show their experiences and demonstrate the different arts they took part in. They used drama, film, research and individual performances to celebrate their achievements and promote the work of local talent to service providers, peers, media representatives and local community. A DVD illustrating the different aspects of the project areas was produced, with the help of those who were involved, and we also held a celebration event demonstrating young people’s achievements. This had very positive feedback from young people, parents and invited guests including the Teenage Pregnancy Commissioner.

Interactive training workshops were then organised with local artists to encourage young people to broaden their outlook in adolescent health and focus on areas affecting young people and explore ways of passing on what they had learned to other young people.

Looked After Young People and Care Leavers By Daljit Gill Social Worker/Co-ordinator for Looked After Young People and Care Leavers The Teenage Pregnancy Strategy ensured our most vulnerable young people were included in every way possible – from helping them to make their voices heard to developing policies and initiatives with their specific needs in mind. My job, from 2005 to 2010, was to support a number of different and innovative initiatives designed to do all of this, so the Strategy reached and supported all of our young people equally and appropriately. We have successfully met targets set for us by the Strategy year-onyear, within financial limitations which is something to be proud of. There have been so many projects carried out that it’s impossible to list them all here, so I’ve picked a few that really highlight our achievements over the years – from establishing policies and setting up a ‘crisis flat’ to meeting the specific needs of vulnerable young people at risk of conception or sexual exploitation.

We have successfully met targets set for us.... 72

Achievements Policy The Personal Relationships and Sexual Health Policy was launched in March 2006. This was no boring policy launch! Young people themselves presented the policy, putting together and presenting their views through song/lyrics, drama, personal testimonies and PowerPoint presentations. Development and delivery of a training programme for the Policy in Sandwell was rolled out to social care professionals; foster carers, social workers; leaving care and residential staff and embedded into the yearly training programme for professionals We also distributed Personal Relationships and Sexual Health Policy packs to Looked After Young People and Care Leavers. This included one-toone support sessions being offered to young people so they could discuss and explore sensitive issues in a safe learning and nurturing environment.

Parenting Support/Needs Assessment We contributed to a Needs Assessment for vulnerable young people and ensured the results were implemented, so appropriate support would be available to all young mums and dads throughout their care planning via pathway plans.

Building young people’s confidence and skills Weeks and weekends at outward bound and drama/dance facilities for both young men and women were carried out throughout each financial year. These focused on personal relationships and sexual health but were underpinned by the aims of raising self-esteem, self-worth and confidence and raising aspirations. The overall aim of the residential trips was to support young people to make positive informed decisions and choices about personal relationships, sexual health and maintaining a positive outlook on life through raised personal ambitions and aspirations. Young people boosted their confidence and skills and also raised their aspirations by taking part in the Leaps and Bounds Initiative for vulnerable groups of young people in the Black Country. This resulted in many Looked After Young People and Care Leavers participating in two productions: ‘Ballet Hoo’ and ‘Chasing Fate’.

ce le brat Usi ng dram a to achievemen ts

Other drama productions were created and toured by our young women and a DVD was also produced. The Looked After Young People and Care Leavers Service was a partner agency in a Working Neighbourhoods Fund Peer Education and Mentoring project where a number of places were allocated to our young people. Other peer education programmes were completed with Birmingham’s 16-plus team and Sandwell Youth Service/Connexions. These resulted in young people achieving both BTEC and ASDAN qualifications.

Workshops A wide variety of workshops were delivered to both young men and women. Topics included: sexual health; sexually transmitted infections; condom teaching; love/sex/lies/dishonesty/ trust; personal relationships; self-esteem and pregnancy and contraception choices. Specialist workshops on sexual exploitation, specially tailored for the needs of Looked After Young People and Care Leavers, were also delivered.

e th ei r

Improving services We worked closely with the education and outreach workers from Dudley Brook to make sure vulnerable young people were specifically catered for through their services and a weekly sexual health drop-in facility was provided through the Nurse Practice Manager from Brook. Within the Leaving Care Team, a condom project was set up giving young people the chance to access advice, condoms and information about services. Training was provided to staff working with this vulnerable group of young people. In addition, pregnancy testing, support and advice was offered to the most vulnerable young women who were not accessing mainstream services. Working together with the supported lodgings team, we set up a Teenage Pregnancy Flat which was financed through the Leaving Care Team. The flat provided accommodation in times of crisis for any young parent or pregnant young person within the service.

Involving young people In order to make sure we understood what young people wanted – and they had a chance to tell us – we organised a number of activities to get them involved. Consultation events were held to hear young people’s views about how they would like services and initiatives delivered, to ensure they really got the chance to tailor what we offered to suit their needs and requirements. Young people from this service were also actively involved in a Mystery Shopper project, run through the Virtual Teenage Pregnancy team. Looked After Young People and Care Leavers continue to be involved in the review and development of the Teenage Pregnancy Strategy through their representation on the Young People’s Teenage Pregnancy Board.

Saying thanks We really appreciated the time and effort our young people took to get involved with our work so we rewarded them with yearly Christmas parties, with support from the Strategy team. The parties aimed to both reward young people for the work undertaken throughout the year and further promote the work of the Teenage Pregnancy Strategy.

Youth Cabinet member Mohammed Rohim Managing Director of Sandwell Young Advisors It’s really important for organisations working with young people to understand what it is that we want and need. I’m MD of Sandwell Young Advisors and we help organisations ‘youth proof’ everything they do – from policies and strategies to commissioning services. We’re a group of 16 to 21 year-olds who want to make a difference and make young people’s voices heard where it matters: with those who make decisions that affect us. We run as a social enterprise and we are all trained to be consultants in social action, regeneration and renewal so we can help deliver projects, consult with young people, design best practice models and roll out services through effective marketing. We work as a team and people call us in when they want our expertise. Health and wellbeing covers such a wide range of topics that it can be really confusing. We find that many young people are not aware of services that are available to them or clear information about health – or even what is really meant by the word ‘health’. Most think of ‘being healthy’ in quite a limited way including: not binge drinking, or taking drugs; exercising regularly; having good personal hygiene; not getting pregnant at a young age and being happy. That’s fine as far as it goes, but usually we have to mention a few services like their GP or local contraception centres to really get them thinking about the subject in a wider sense – like who provides services, how to get them and what’s actually available.

I think there are a number of reasons for this. Poverty and deprivation definitely has an impact and this, in turn, affects rates of teenage pregnancy and health and their understanding of health issues. I also think the media also affects how young people behave and what information they have as they are constantly reminded of an image they should aspire to be. Unfortunately many fall into this trap. We try to talk directly with young people and get them involved in local health projects and we make sure their thoughts and feelings are considered by different organisations. We also help these decision-makers understand the best ways to attract and maintain young people’s interest. There have been a lot of improvements in education and teenage pregnancy support for the older teens and early 20s and I’d like to think we have helped with this. But there is still a way to go. We have come far in terms of support for young mums but more needs to be done to support young fathers and I hope we can help with this.

Praise for Rohim

I think we’re pretty successful at what we do and have won some top awards including: l Sandwell STAR Awards Runners Up (two years) – ‘Dedication’ and ‘Youth Group’ award l Princess Diana Awards (twice)

l Community Award – Sandwell Academy

l Community Development Award from Confederation of Bangladeshi Organisations We’ve also worked (through networking) with some influential people like: Labour leader Ed Miliband; Labour MP David Miliband; businessman and Dragons’ Den star James Caan; Baroness Benjamin and the Chief Constable of West Midlands Police, Chris Sims. I love what I do and I hope other young people might feel inspired to join us, too.

“Rohim is an exceptional young man who has achieved a lot both for himself and for other young people. He is also a great advocate for his peers and is always willing to represent their views and voices in issues affecting them such as the cuts to services for young people. As well as being dedicated Rohim is a very motivated young person who always strives to improve his own skills and those of others. He is always taking on and trying new things, developing projects and ideas that help to improve things for young people in his local area.

Tariq Karim, Area Manager, Young People’s Service

WHAT the data tells us

What the data tells us by Dr Ishraga Awad Consultant in Public Health Medicine

and Ralph Smith Head of Information and Intelligence

In this section We look in-depth at the facts and figures relating to teenage pregnancy in Sandwell and the relationship between the wider determinants of health and teenage pregnancy. The report updates a 2009 report, ‘Teenage Conceptions Across Sandwell and Its Determinants’, commissioned by Sandwell PCT.

Ralph Smith

Background The background to Sandwell’s Teenage Pregnancy Strategy is detailed at the start of this legacy document but, in a nutshell, 1999 saw the launch of the first teenage pregnancy strategy for England, in response to the government’s view that teenage pregnancy rates in England were too high. Sandwell produced a local Teenage Pregnancy Strategy and set a target to reduce teenage conceptions by 55% by the year 2010 to a target rate of 31.1 ( 364) from a1998 baseline rate of 69.1 (379) Since the launch of the national strategy, the under-18 conception rate for England has seen a steady decline and has fallen by 13.3 per cent. Births to under-18s are down by almost 25 per cent over the period of 1999 to 2008. In Sandwell the under-18 conception rate has fallen by 24% from the 1998 baseline rate of 69.1 to a rate of 52.7 in 2009. In ‘Teenage Pregnancy Strategy: Beyond 2012’ the National Teenage Pregnancy Unit sets out the progress that has been made in reducing England's teenage pregnancy rate between 1998 and 2008. It presents a review of the evidencebase on what works in reducing teenage pregnancy rates, including examples of effective practice in local areas.

Through research and the work of the government’s Teenage Pregnancy Unit, we know the key underlying factors that increase the risk of teenage pregnancy: poverty; low educational attainment; poor attendance at school; nonparticipation in post-16 learning and low aspirations. Other predictors of teenage pregnancy include: being an offender; a child of a teenage mother and having a mother with no qualifications. The latter two double the risk of being a teenage mother. It is believed that, for a variety of reasons – such as lack of knowledge, lack of confidence to resist pressure, poor access to advice and support and low aspirations – around 40,000 young women become pregnant each year. Around three quarters of those pregnancies are unplanned and half end in an abortion. For conceptions that end in a birth, there are often costs too: poorer child health outcomes; poor maternal emotional health and wellbeing and an increased chance of both teenage parents and their children living in poverty. These all contribute to health inequalities and child poverty.

Teenage Conception Rates Sandwell’s teenage pregnancy rate in 2009 was 52.7 (per 1,000). Rates have been on the decline but are still higher than the West Midlands region and England. Figure 1 shows the teenage conception rates for Sandwell, West Midlands and England over five years from 2005 to 2009. The rates for Sandwell over the period 2005 – 2009 have been higher than West Midlands and England.

Figure 1 Teenage conception rates (per 1,000) for Sandwell, West Midlands and England Teenage Conception Rates 2005 - 2009

40.5

38.2

41.8

40.6

41.3

50.9

49.3

53.1

52.5

52.7

56.4

58.2

62.7

61.9

Conceptions Per 1000 15 - 17 Females

20 10 0

Sandwell

England

West Midlands

Source: Teenage Pregnancy Unit

Locality 2005 Rate

2006

2007

2008

2009

Figure 1 and table 1 show that the conception rate across all three areas has been decreasing. The decrease in Sandwell’s teenage pregnancy rate has been the greatest, seeing a 14.9% reduction from 2005 to 2009. West Midlands has witnessed a 6.1% decrease and England a 7.5% decrease. Sandwell has seen a reduction at double the rate reduction seen in England. Over a 12-year period (1998 – 2009) Sandwell has seen its teenage conception rate decrease by 24%. In the same period, both West Midlands and England have seen a reduction of 17.4% and 18.1% respectively but again both at a slower pace compared to Sandwell.

Table 1 - Reduction in teenage conception rate (%) Rate reduction 2005 - 2009

Rate reduction 1998 - 2009

Sandwell

14.9%

24%

W.Midlands

6.1%

17.4%

England

7.5%

18.1%

Over the period 2007 – 2009 the decline in teenage conception rates also mirrored a decline in the birth rate as seen in figure 2. The abortion rate over the period 2007 – 2009 has remained constant. During the same period 2007 – 2009 conceptions for all ages increased by 6.3%. The birth rate also went up by 9 %, as shown in figure 3. Abortion rates remained constant. Conception rates and abortion rates across all ages give an indication of the trends across the whole female population and comparisons to be made with the teenage age groups. It can also be an indication of cultural and social changes in pregnancy, attitudes towards sexual behaviour and access to services

Figure 2 Under 18 Conceptions and Abortions Trend 2007-2009

Rate per 1,000 Females Aged 15-17

70 60

58.2

56.4 52.7

50 40

34.6

33.1 29.7

23.6

23.3

Rate 2007

Rate 2008

23.0

20 10 0

Rate 2009

Year Source: Dept of Health Statistical Bulletin

Sandwell Conceptions

Sandwell Births

Sandwell Abortions

Figure 3 Conceptions and Abortion Trend 2007-2009 (all ages) 110 100.7 99.3

100 93.4 90 79.4 80

78.7

72.2

Rate per 1000 Females Aged 15-44

70 60 50 40 30 21.2

21.3

Rate 2007

Rate 2008

20.6

20 10 0

Rate 2009

Year Source: Dept of Health Statistical Bulletin

Sandwell Conceptions

Sandwell Births

Sandwell Abortions

Abortion Sandwellâ&#x20AC;&#x2122;s abortion rate for women aged under 18 in Sandwell was 23 per 1,000 in 2009 and ranked as the fourth highest when compared to the rest of the West Midlands (Figure 4). It was higher than the national rate (17.7 per 1,000) and the West Midlands rate (20 per1,000). When compared to neighbouring Black Country PCT areas, it was lower than the Walsall rate (27 per 1,000) but higher than both Wolverhampton 22 per 1,000) and Dudley abortion rates. (16 per 1,000).

Figure 5 shows abortion rates broken down by age group. Abortion rates are higher in all age categories in Sandwell when compared to the West Midlands and England rates. Figure 6 shows Sandwell ranked as the third highest in the West Midlands for repeated abortions, with 36.71% of all abortions being repeat abortions, compared to 33% in both England and the West Midlands.

Figure 4 Abortion for women under 18 years old, West Midlands PCTs - 2009 Worcestershire

13.5

Solihull

15.4

Shropshire County

15.5

North Staffordshire

16.4

Dudley

16.8

Herefordshire

17.4

PCT

Warwickshire

18.1

Stoke on Trent

19.0

South Staffordshire

19.8

Wolverhampton City

22.0

Telford & Wrekin

22.0

South Birmingham

22.1

Heart of Birmingham Teaching

22.3

Sandwell

23.0

Birmingham East & North

25.1

Walsall Teaching

27.3

Coventry Teaching

28.2

West Midlands

20.1

England

17.7 0

Abortion rate per 1,000 conceptions Source: Dept of Health Statistical Bulletin

Rate per 1000 women 15-44 (ASR)

Figure 5 Abortion rates by age group for Sandwell, West Midlands and England 2009 50 40

37.6

35.3 26.7

23 20

33.5

31.8

30.2

24.3 18.7

22.9

20.1 17.7

17.1 7.2

15.8

6.9

6.7

Sandwell

England

West Midlands

Source: Dept of Health Statistical Bulletin

Age

Under 18

18-19

20-24

25-29

30-34

35+

Figure 6 Repeated abortion, % of all abortions by West Midlands PCTs - 2009 Telford & Wrekin

28.4

Shropshire County

28.8

North Staffordshire

29.3

Stoke on Trent

30.1

Herefordshire

30.1

Worcestershire

30.2

South Staffordshire

30.4

Walsall Teaching

32.2

Heart of Bâ&#x20AC;&#x2122;ham Teaching

32.5

Warwickshire

32.6

South Birmingham

33.6

Solihull

34.9

Wolverhampton City

35.4

Bâ&#x20AC;&#x2122;ham East & North

35.6

Sandwell

36.7

Dudley

37.4

Coventry Teaching

38.4

West Midlands

33.3

England

33.8 0

Source: Dept of Health Statistical Bulletin

% of abortions 83

Female Teenage Population (15-17 years old) Figure 7 shows that since the year 2000 the female teenage population had seen a gradual increase peaking in 2006. Since 2006 there has been a more rapid reduction in this population group returning to the numbers seen in the year 2000.

Figure 7 Sandwell Female Population 15-17 years old 6000 5900 5800 5700 5600 5500 5400

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

Year Source: Office for National Statistics (mid year population estimates)

Female Population 15-17 years old

Conception by Ward The numbers of conceptions in each ward are very small and therefore it is not usual to find that they fluctuate from year to year, making assumptions based on short-term trends is unwise. To say with confidence that any particular ward has a low or high conception rate requires several yearsâ&#x20AC;&#x2122; worth of data, and therefore takes into account the likelihood that any changes are due to factors other than chance. Previous analysis identified Tividale (88), Rowley (81), Langley (61), Old Warley (60), and Friar Park (60) as having the highest teenage pregnancy rates. Since then, Tividale has continued to emerge as having a worsening teenage conception rate (97.8) followed by Hateley Heath (84), Soho and Victoria (72), Rowley (71), Friar

Park (70), Princess End (70) with another five wards having a rate of 60 and above. Table 2 shows that conception rate for teenagers across Sandwell dropped from 75.2 per 1,000 to 59.1 per 1,000 over a period of nine years from 1999 to 2008. Conception rates increased in two wards, Great Barr and Old Warley. The biggest increase was in Old Warley, with the rate more than doubling over the nine-year period from 30.8 in 1999/2001 to 62.9 in 2006/2008. The biggest drop was in Great Bridge followed by Princess End and Smethwick. The least change was seen in West Bromwich where the conception rate seems to have remained static.

But when analysing the data over a shorter period there has been an upward trend in teenage conceptions. Over the four-year period of 2005 to 2008 the conception rate has gone up from 56.5 to 59.1. Individual wards have seen greater changes in teenage pregnancy rates with 19 of the 24 Sandwell wards showing an increase in rates. Many wards that had shown a downward trend between the years 1999 and 2007 are showing an upward trend between 2005 and 2008. The biggest increases were in Hateley

Heath, Soho and Victoria, St Pauls and Wednesbury South. All four of these areas show an increased rate of over 20 per 1,000. In the same period the wards that did show a reduction in conception rate, showed a smaller change compared to previous years. The biggest reduction was seen in Smethwick, which was by 9.9 per 1,000.

Table 2: Conception Rates for Sandwellâ&#x20AC;&#x2122;s Wards Wards (2004 Boundaries)

1999 2001

2005 2007

2006 2008

Change in rate from 99-01 to 06-08

Change in rate from 05-07 to 06-08

Abbey

33.6 76.5 64.2 69.2 68.1 78.2 41.2 121.9 57 111.3 57.4 61.4 30.8 66.4 113.3 80.1 88.2 79.6 71.7 71.5 115.3 73.8 63.6 66.2 75.2

36 52.3 42.8 37.9 44.9 60.7 30.6 52.7 30.5 58.3 61 32 60.2 34.7 77.9 81.1 54.3 42.9 29.1 50 88.8 52.1 36.5 57.9 56.5

32 62.7 48 56 52.8 70.4 45.6 65 50.2 84.2 51.5 35 62.6 36.7 69.7 71.7 44.4 72.3 58.5 52.8 97.8 64.2 58.5 66.4 59.1

-1.6 -13.8 -16.2 -13.2 -15.3 -7.8 4.4 -56.9 -6.8 -27.1 -5.9 -26.4 31.8 -29.7 -43.8 -8.4 -43.8 -7.3 -13.2 -18.7 -17.5 -9.6 -5.1 0.2 -16.1

-4 10.4 5.2 18.1 7.9 9.7 15 12.3 19.7 25.9 -9.5 3 2.4 2 -8.2 -9.4 -9.9 29.4 29.4 2.8 9 12.1 22 8.5 2.6

Blackheath Bristnall Charlemont with Grove Vale Cradely Heath and Old Hill Friar Park Great Barr with Yew Tree Great Bridge Greets Green & Lyng Hateley Heath Langley Newton Old Warley Oldbury Princes End Rowley Smethwick Soho & Victoria St Pauls Tipton Green Tividale Wednesbury North Wednesbury South West Bromwich Central Sandwell Source: ONS - Neighbourhood Statistics

Relationships Between Teenage Conception and Wider Determinants of Health The following section explores the relationship between wider determinants of health and teenage pregnancy. The data explores the relationship between educational attainment, poverty and crime with teenage pregnancy at a ward level. These have all been shown to be factors that are associated with high rates of teenage pregnancy.

Educational Attainment Figure 8 shows the relationship between teenage pregnancy and GCSE attainment levels based on the proportion of children getting five or more GCSEs between A-C grades. The data shows there is an indication of a negative relationship between educational achievement and teenage conception. Those wards with higher numbers of children achieving five or more GCSEs have lower rates of teenage conceptions.

Figure 8 Relationship between educational attainment (%5 + GCSE) and teenage conception by ward (2010) Conception rate per 1,000

120 100 80 60 40 20 0

25%

30%

35%

Source: Research Sandwell, Sandwell MBC

40%

45%

50%

55%

% with 5+ GCSEs

60%

65%

70%

Poverty Figure 9 shows the relationship between the proportion of children living in child poverty and teenage conceptions analysed at ward level. The data shows that there seems a positive relationship between areas that have higher rates of child poverty and teenage conceptions. Figure 10 shows the relationship between teenage conceptions and deprivation measured using the Index of Multiple Deprivation score (2010). The data shows that there seems a positive relationship between deprivation and teenage conception. In areas with higher deprivation there are higher rates of teenage conceptions.

Figure 9 Relationship between poverty and teenage conception Conception rate per 1,000

120 100 80 60 40 20 0

15%

20%

25%

Source: Research Sandwell, Sandwell MBC

35%

30%

40%

45%

50%

% children in poverty

Figure 10 Relationship between deprivation and teenage conception Conception rate per 1,000

120 100 80 60 40 20 0

20%

25%

30%

Source: Research Sandwell, Sandwell MBC

35%

40%

45%

50%

55%

60%

IMD score 87

Crime (Offenders) Figure 11 shows the relationship between crime expressed as rate of offenders (age 10 – 17 years) per ward and teenage conceptions. The data shows that there is no relationship between crime amongst young people and teenage pregnancy.

Figure 11 Relationship between crime (expressed as offender) and teenage conception Conception rate per 1,000

120 100 80 60 40 20 0

Offender rate per 1,000

Summary Sandwell’s teenage conception rate in 2009 was 52.7 (per 1,000). Sandwell’s teenage conception rates have been on the decline but are still higher than the West Midlands region and England. Over a 12-year period (1998 – 2009) Sandwell has seen its teenage conception rate decrease by 24%. Over the period of 2007 – 2009 the decline in teenage conception rates also mirrored a decline in the birth rate. The abortion rate over the period of 2007-2009 has remained constant.

The data shows that there is a relationship between teenage pregnancy and low educational achievement, deprivation and poverty. It does not show a relationship between offending and teenage pregnancy but a Home Office report estimates that around 39% of young women under the age of 21 in prison are mothers and 25% of young men are fathers. More work to establish if there is such a relationship in Sandwell is recommended.

What Next? Reflections and thoughts from Dr John Middleton Sandwell’s Director of Public Health Efforts to reduce teenage pregnancy in Sandwell have been going on for many years. They began with the HIV/AIDS campaigns in the 1980s and then two reviews of teenage pregnancy in the early nineties. Since then, Sandwell has invested in sexual health services and developed a range of innovative strategies to prevent teenage pregnancy. These have all been co-ordinated by the Strategy covered in this document which clearly lays out the notable achievements made over the years. During the lifetime of the Sandwell Teenage Pregnancy Strategy there has been a massive 24% reduction in teenage pregnancies from the figure it was faced with in 1998. Things could have been even better we believe, but the inevitable effect of economic recession, coupled with the loss of opportunity and hope for young people, put paid to that and is now preventing us from making further inroads into the teenage pregnancy rate here in the borough. However, there are signs of hope as rates rose by just nine births in 2010 and we must ensure that the issue remains high on the list of priorities for the Health and Wellbeing Board and future children’s health strategies.

It clearly took the view that setting such a target would stretch people’s expectations, challenge service providers and deliver a lot more than would otherwise have been the case. It established a national teenage pregnancy strategy and Sandwell contributed to this by its involvement in the Cabinet Policy Advisory Team visit in 1998. It established its own Teenage Pregnancy Strategy to support the national plan in 2001. Through the national strategy, the intergenerational risk – that young mums beget young mums – was recognised and the Labour government set out to break that cycle. Sure Start services and maternity grants and other support for young single mums were established with the explicit aim of breaking the long-term repetition of early pregnancies. Backing this up were other evidence-based policies of the early Labour government that had a real impact, such as increasing the minimum wage, New Deal for Employment and the overall policy that took more than half a million young people out of poverty during the 2000s.

As we mark a decade of Strategy here in Sandwell, it’s worth remembering how it originated. From 1998 to 2010 the Labour government’s approach to the issue was to set an ambitious, even unrealistic, target of a 55% reduction in conceptions in the under 18s.

We know now that the major influences on teenage pregnancy appear to be related to education and to hope and the expectation of a good life and career. In 2006, we undertook some detailed studies of teenage pregnancy in Sandwell electoral wards. The strongest predictor of a high rate of teenage pregnancy by electoral ward was the poor educational achievement of boys. The better the GCSE results for boys, the fewer teenage pregnancies. I believe the massive improvement in Sandwell's educational achievement and the expectancy we have for our young people has been a crucial factor in reducing teenage pregnancies. Improved educational outcomes can be traced back to the 1990s when Sandwell invested heavily in early years programmes: services for three to five year-olds who went through multi-agency centres and family education and training centres. This was followed up by generations who enjoyed the children’s centres. This meant they were much better prepared for life, for relationships and for achieving educationally. In addition to this, Sandwell Council and health service partners should be praised for, over the years, being completely consistent in their use of the evidence base and holding true to the Teenage Pregnancy Strategy – despite blind panic and much wringing of hands when rates increased in 2006. There was huge pressure to change course and get in new policies – but we all held to the Strategy, demanding more of general education, use of the outstanding sex education programme APAUSE and providing emergency contraception and better ‘young people friendly’ contraception services.

Make no mistake about it – Sandwell has made a major achievement in reducing teenage pregnancy as much as it has over the last 12 years. This did not happen by accident and it is not guaranteed to continue. If there is further damage to the Sandwell economy and further loss of hope and opportunity we will see the teenage pregnancy rates going up again. We must ensure this does not happen In order to do this, Sandwell Council will continue to offer all the expertise and support it can to local schools to foster and encourage learning, ambition and expectation for each new generation of school-age children. This is the biggest form of protection we can offer to prevent teenage pregnancy. Alongside this, health services will continue to develop and expand sensitive, caring and expert advice on contraception and relationships to enable young people to say ‘no’ when they don’t want sex – and to practise safely when they do. When teenage pregnancy does occur we will operate sensitive services that support and do not stigmatise young people – so we can avoid the cycle of teenage mothers giving birth to the next generation of teenage mothers.

Dr John Middleton

A Final Word By Councillor Maria Crompton Chair of the Childrenâ&#x20AC;&#x2122;s and Young Peopleâ&#x20AC;&#x2122;s Scrutiny panel During 2009/10 the Children and Young People Scrutiny Panel, which I chair, undertook an in-depth review of teenage conception and pregnancy in Sandwell: Prevention and Support. During this piece of work my panel recognised the highly important work around teenage pregnancy and made 20 recommendations to further develop this agenda and make continued improvement. Throughout this piece of work we talked to a wide range of partners, but more importantly to young people themselves about their experience of teenage pregnancy, SRE and PHSE. One area that we stressed needed more focus was around PHSE and SRE for disabled young people. As changes take place within the health services and the teenage pregnancy strategy it is imperative that we do not lose sight of the excellent work that the Teenage Pregnancy Strategy achieved and that at the heart of moving forward must be our young people and understanding their needs and listening to their voice. Teenage pregnancy and supporting our young people is important to our borough as a whole and we must not forget that.

References Key references, reviews and needs analyses that informed our Strategy 1. Social Exclusion Unit (1999) Teenage Pregnancy. London: (HMSO), (National Statistics (2010) (England under-18 conception statistics, 2008) 2. Teenage Pregnancy Strategy: Beyond 2010, (Department for Children, Schools and Families and Department of Health) 3. Analysis Of Teenage Conception Data In Sandwell 1998-2005, Dr David Pitches, Sandwell Primary Care Trust, 2007 4. Teenage Conception Across Sandwell And Its Determinants, Richard Wilson, Sandwell Primary Care Trust, 2009 5. Sandwell Teenage Conceptions – What The Data Tells Us, I Awad and R Smith, Sandwell Primary Care Trust, 2010 6. Public Health a New Asset, 2010/11 Annual report of the Director of Public Health, Sandwell Primary Care Trust, Sandwell Metropolitan Borough Council 2010 7. Young Fathers Needs Assessment, Stuart Gill, Sandwell Health Authority, 2001 8. Sandwell Sexual Health Needs Assessment, Sarah New, Sandwell Health Authority, 2007 9. An Evaluation of Welfare Rights Advice For Teenage Parents, Neil Bateman, 2007 10. Research on Lifelong learning for Pregnant Young Women & Young Parents in Sandwell, Kirsty Reid, Gayle Letherby and Young Parents Peer Researchers Laura Mason, Emma Burke, Claire Taylor and Amy Gough, 2005, Centre for Social Justice, Coventry University 11. APAUSE, sex education Year 11 Evaluation, Exeter University 12. Striving For Excellence With Teenage Pregnancy Initiatives In Sandwell: An evaluation of teenage pregnancy work with Asian and African – Caribbean young people in Sandwell, Hansa Patel-Kanwal, 2007 13. Arts Based Youth Consultation – Teenage Sexual Health, Dynamic Arts, 2005 14. Review of Sexual Health and Contraception Services for Young People in Sandwell – Key Findings and Recommendations, Michelle Diaz, MD Consultancy UK Ltd, 2009 15. Sandwell Adolescent Health Needs Assessment. A report by Kerry Devitt and Dr Debi Roker from Young People in Focus, with research undertaken by Sandwell Young Researchers Group: Sidonia Dooley, Katie Horton, Rohim Mohammed, Ryan Mullings, Kerry Payton, Alex Russell, 2010 16. Adolescent Health & Teenage Pregnancy Peer Research Report – Changing Our Lives, Peer Researchers Gemma Caffrey, Ricky Nicholls, Sarah Bentley. 2011

Key Documents Key guidance and policy documents produced by Teenage Pregnancy staff and partner agencies to support Strategy implementation Sex & Relationships Guidance for Schools Margaret Storrie, Education, Sandwell MBC Sex & Relationships Guidance for Youth Workers Sue Wilson, Youth Service, Sandwell MBC Sex & Relationships Education Guidance for Looked After Children Daljit Gill, Leaving Care Service, Sandwell MBC Policy on the Education of School Age Expectant and Young Parents Kate Proctor, Sandwell MBC Best Practice Standards for Delivery of Enhanced Drop-in Services in Sandwell High Schools Carole Collins, Young Persons Sexual Health Nurse, Glebefields Health Centre Risk Assessment Tool to identify young women at risk of conception Stacy Moss, Sandwell Connexions Emergency Contraception Pharmacy Scheme: Guidance for Pharmacists Elizabeth Walker, Sandwell Primary Care Trust Young Parents Care Pathway Cindy James and Teenage Parents Support Staff

Dr Middleton

Roll of Honour

Joy Newey

Maria Hopkins

Jo Hazeldene David Pitches

Amarjit Ballagan Alice Cruttwell

Sarah Farmer Bruce Kirk

Alison Hadley

Robert Drake

National Teenage Pregnancy Unit

Sandra Fitzpatrick Reeta Choudry

Shawinder Basra

Catherine Evitts Swain

Amanda Leishenring Sadie Sutton

Debbie McAndrew Jane Walters

Jackie Haden

Carole Collins

All School Health Nurses All Health Visitors

Family Nurse Partnership Staff

Kerris Percival

Sandwell New Horizons Staff

Young Parents Childrenâ&#x20AC;&#x2122;s Centre

Krunch

Rebecca White

Derrick Gordon

Margaret Storrie

Healthy Schools Team Joyce Lawson

Jon Grant

Krunch Young Fathers Shirley Portman

Anne Savage

Kate Smith

Val Griffiths

Sandwell Homestart

Kate Proctor

Judith Smith

Heather Vickerman

Community Mums

Louise Pinner

Lynsey Mathews

Batmanshill Young Parents

Jon Bull

Sarah Colclough

Batmanshill staff

Stacy Moss

Annette Ward Peter Burton

Maggie Bowles

Peter Holtham

Maxine Dennis

All Connexions staff Sally Box

David Hughes

Sandwell College Welfare staff

Nacro staff

Murray Hall Trust staff DECCA staff

Young People in Focus Greets Green Partnership

Neighbourhood Renewal Partnership Wednesbury Learning Community

Councillor Simon Hackett Diane Bowman-Wright Pauline Withey

Nicole Armstrong

Welfare Rights Service

Pam Hesson

Dr Harris

PASH Group members

Vicki Reilly

Sue Whalen

Paulette Duzan

Val Shaw

Town Team staff

Fiona Rochelle

Alex Ridley

Lydia Nestor

Karen Wilkinson

Sandwell & West Birmingham NHS Hospital Trust Maternity staff

David Wright

Sharon Nanen-Sen Tariq Karim

Helen Williams-Young

Nikki Sroy

Rachael Hopkinson

Stuart Payne Sue Wilson

Louise Andrews

Sultan Ahmed

Mark Lamsdale

Elaine Newell

Sue Baker

Black Country Training Group providers

Jane Leeson

Lucy Dunstan

Young Voices at Changing Our Lives

Penny Barber

Voice 21

All Birmingham Brook staff

Anna Gillespie

Frank Maloney

All youth workers

Bromford Housing Project staff

Denise and Mike Martin

The GAP Housing Project staff Rachel Snade Martin Duffel

Debbie Harris Peter Forth

Childrenâ&#x20AC;&#x2122;s Centres

Patricia Leonard

Donna Harris

Steve Pritchard Helen Fielden Dalian Poole

Keren Hodgson

All Sandwell Brook staff Dr Ray

Charmaine Brown

All Dartmouth Clinic staff

Jean Foster

Dany Partridge All Family Planning Service staff Daljit Gill

Nicky Smith nee Stokes

Monica Anderson

Lorna Tull

Andy Knight

All social care staff

Sandwell PCT Communications Team Ravi Lal

Laura Mainwaring Paul Russell

SMBC Communications Team Nicola Plant

Susan Devi

Joanne Jackson

Tharmista Patel

Carol McCauley Mark Gibbs

Phillip Lydon

Charlie Spencer

SMBC Targeted Youth Support staff

Hugh Sherrife

Pauline Blake

Jagruti Duggal

MASH’d young peoples group Barnardo’s staff

Linda Martin

Adrienne Parker

Edwina Smart

Gill Collins

Shane Ward

Shane Parkes

African Caribbean Resource Centre staff

Iain Blair

Rosie Thomas

Suzanne Callum

Summit House staff

YMCA staff

Susan Edwards

David Evans

Exeter University APAUSE staff

Ann Marie Morris Kerry Garbett

Richard Jones

Nathan Moore

Nadia Peart

Charmain Peart

All PCT Peer Educators Jo Hazeldene

Stuart Connor Dali Kanth

Eve McCollum Jane Morrell

Terrence Higgins Trust staff

Victor Aiyedun

Jyoti Atri

Councillor Maria Crompton, Adam Hadley

Young people and members of Children & Young People Scrutiny Panel

Sandwell Young Peoples Teenage Pregnancy Board

Sandwell Young Parents Forums

Teachers and staff delivering the APAUSE SRE programme in schools and Pupil Referral Units

Staff delivering the ‘Living and Growing’ primary schools sex and relationships education programme

Catherine Hewitts

Community and voluntary organisations participating in the community condom scheme Keisha Clarke

Elizabeth Walker Jenny Harding

Community pharmacists providing free emergency contraception to young people

GPs and primary care staff providing advice and contraception to young people Holly Galloway

Louise Andrews

Hansa Patel-Kanwal Mohammed Rohim

Sandwell Young Advisors, Nikki Sroy

Sarah New

Cindy James Anna Kaur

Janine Brown

All young people and young parents who contributed to the strategy.

Authors Carol Hassall â&#x20AC;&#x201C; Red Cat Communications Sarah New â&#x20AC;&#x201C; Sandwell Primary Care Trust

Contributors Janine Brown

Carole Collins

Dr John Middleton

Derrick Gordon

Cindy James

Jon Grant

Anna Kaur

Kate Proctor

Paul Sheehan

Fiona Rochelle

Rhonda Bird

Annette Ward

Samantha Creary

Kerris Percival

Lucy Dunstan

Holly Galloway

Claire Anderson

Rachael Hopkinson

Peter Burton

Daljit Gill

Tariq Karim

Ishraga Awad

Shafaq Hussain

Ralph Smith

Mohammed Rohim

Martin Duffell

Anne Savage

Denise Martin

Sharon Walters

Emily Hill

Keren Hodgson Jackie Haden

Want to know more? To refer young people at risk of teenage conception for advice and support or contraception services contact: Sandwell Brook on: 01384 239001 To refer pregnant teenagers or young parents to services contact: Fiona Rochelle Teenage Pregnancy Midwife on: 0121 507 2726 or 0776 6466 792 Kerris Percival Family Nurse Partnership on: 0121 521 1545 or 0781 7263 722 Kate Proctor Consultant Teacher on: 0121 521 1542 or 077304 38646 Young people can find more information locally at www.ourguideto.co.uk For more information about the Sandwell Teenage Pregnancy Strategy contact: Sarah New – Senior Commissioning Manager and Public Health Children’s lead at: sarah.new@sandwell-pct.nhs.uk Cindy James – Young Parents Strategy Co-ordinator at: cindy.james@sandwell-pct.nhs.uk Anna Kaur – Communications lead at: anna.kaur@sandwell-pct.nhs.uk For more information about housing: Sandwell Homes Vulnerable People Housing Service Tel: 0121 569 5238

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