Review of Teenage Pregnancy in Buckinghamshire Lynda Ayres December 2012
CONTENTS 1. Introduction 2. Summary of Key Outcomes and Achievements of the Buckinghamshire Teenage Pregnancy Strategy 3. Recommendations 4. Background 5. Why Teenage Pregnancy Matters 6.Teenage Conceptions in Buckinghamshire 7. The Buckinghamshire Teenage Pregnancy Strategy 7.1 Prevention of teenage conceptions and sexually transmitted infections 7.2 Support for teenage parents Appendix Conception Charts and Graphs Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 2
Review of Teenage Pregnancy in Buckinghamshire 1. Introduction This review will provide an overview of the progress of the work of delivering the Teenage Pregnancy Strategy in Buckinghamshire from 2000 to 2010 and will consider the way forward. It is intended to inform colleagues and partners across all services working with children, young people and families in Buckinghamshire. It will be presented to partnership forums across the county including the Children and Young Peoples Trust Board, Local Children & Young People s Trust Boards, Health and Well Being Board and the Buckinghamshire Sexual Health Network. The review has been prepared with information submitted by, and the support of, the members of the Buckinghamshire Teenage Pregnancy Reference Group who represent a range of services who work with children, young people and families including maternity, community and sexual health services, education, social care, youth service, Connexions, Children s Centres and voluntary organisations This document demonstrates that effective partnership working has resulted in improved services which have contributed to enhancing the life chances and outcomes for children and young people in Buckinghamshire. The services which have collaborated to deliver the aims of the Buckinghamshire Teenage Pregnancy Strategy include: NHS Buckinghamshire and Buckinghamshire Healthcare NHS Trust (Public Health, Commissioners, Genitourinary Medicine (GUM), Contraceptive and Sexual Health Services (CaSH), Maternity Services, Children & Young People s Community Services, Primary Care GP and Pharmacy Services), members of the Buckinghamshire Sexual Health Network, Education Services (Healthy Schools Team, Reintegration Service) Schools and Colleges, the Youth Service, the Voluntary Sector (Sexual Health, Youth Services and Substance Misuse Services), Connexions and Children s Centres. Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 3
2. Summary of Key Achievements of the Teenage Pregnancy Strategy There has been significant progress since the launch of the Teenage Pregnancy Strategy key achievements in Buckinghamshire include: Healthy Schools supported 87 practitioners from schools, health service and partner organisations to achieve the PSHE certificate. Sexual health awareness training (Sex Matters Tier 1) was delivered to over 1,500 practitioners since 2003. RU Ready principles around delaying first sex and consent are included in staff sexual health training and work with young people. The Buckinghamshire Sexual Health website provides a single portal for sexual health information and services; the site was visited by 6,906 people in 2011-2012. A Personal Relationships and Sexual Health Policy for Children in Care was published in 2011. Approximately 50 practitioners across statutory and voluntary services are trained to distribute condoms and to perform pregnancy tests every year. The C Card condom distribution scheme registered 1445 new contacts in 2011-2012. Health Zones, young people s health drop-ins, have been launched in 6 schools / academies and 6 community settings. The Youth Bus provides a Health Zone on the Road to young people who have difficulties in accessing other services. Outreach Contraceptive and Sexual Health (CaSH) have developed and extended their reach as a result of commissioning Tier 2 services 38 pharmacies participate in the Emergency Hormonal Contraceptive (EHC) scheme; over 500 young women are seen each year. 18.8% of the eligible population of young people aged 15-24years old were screened for chlamydia; 7.2% tested positive. Termination services have been re-commissioned resulting in consultation and treatment services delivered in / adjacent to Buckinghamshire Collaborative working between Maternity services and Connexions in supporting young parents has resulted in Buckinghamshire identifying 79% of the DfE estimate of young mothers compared with the national average of 64%. The Guidance for education, support and reintegration for pregnant students and young parents was first published 2006 and updated in 2012. Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 4
Children s Centres have worked in partnership with maternity, health visiting, youth services and Connexions to offer 8 Young Parents Groups across the county The Family Nurse Partnership (FNP) began recruiting pregnant teenagers for their intensive 2 year support programme from November 2012. 3. Recommendatio ns In order for progress to continue the following recommendations need to be taken into consideration: 1. Sex and Relationships Education in schools /academies is at risk as PSHE/ SRE is not statutory as education institutions become more autonomous the opportunity co-ordinated approach to delivery of SRE is difficult to achieve (see 5.1.1). All partners need to be aware and support school /academies to deliver evidence based, age appropriate sex and relationships education. 2. Public Health will be transferring to the Local Authority in April 2013 providing an opportunity to reflect upon progress with the Teenage Pregnancy agenda to date and to consider the way forward. This review has cited many areas in which Public Health are currently involved with commissioning of services around contraception and sexual health. It may be appropriate for some Local Authority responsibilities around prevention of teenage conceptions and STIs to be taken on by Public Health colleagues to avoid duplication of effort and aid communication for colleagues who will need to seek information from a single service within the Local Authority. 3. The Sexual Health website has been one of the most effective and efficient innovations related to teenage pregnancy and related issues over recent years as evidenced by the number of visits during 2011/2012 (see 7.1.2). It is user friendly holds an enormous amount of information and is simple to administer however it does require a dedicated individual to do this. The website needs to continue in its present easy to access format and not be hidden within a parent website when Public Health transfers to BCC. Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 5
4. Health Zones in education and community settings have increased the availability of confidential services to young people and are an important preventative service. The post of Health Zone Co-ordinator has ceased. There needs to be careful consideration around continuing this role as without central co-ordination and support Health Zones may falter. 5. Support for young parents is part of the remit of Children s Centres. There needs to be a co-ordinated approach across all providers so that young parents across the county receive an equitable service. 4. Background In 1998 the Social Exclusion Unit (SEU) was asked by the Prime Minister, Tony Blair, to study the causes of teenage pregnancy and to develop a strategy to reduce the high rates of teenage pregnancy and parenthood in England. The Social Exclusion Report on Te enage Pregnancy in England was published in June 1999. The report stated that the UK had the highest rate of teenage pregnancies in Western Europe. The national Teenage Pregnancy Strategy was launched as a result of the Social Exclusion Report s findings. The strategy had four main components: 1. National media awareness campaign 2. Joined up action co-ordinated nationally and locally across all relevant statutory and voluntary agencies 3. Better prevention through improving sex and relationships education (SRE) and sexual health services 4. Support for teenage parents to reduce their long term risk of social exclusion by increasing the proportion returning to Education, Employment or Training (EET) Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 6
All 148 top tier Local Authorities (LA) were required to develop Teenage Pregnancy Strategies to reduce teenage conceptions and to support teenage parents. Local strategies were led by a Teenage Pregnancy Co-ordinator. Local Teenage Pregnancy Partnership Boards were set up. Teenage Pregnancy strategies were performance managed by Regional Teenage Pregnancy Co-ordinators and supported by the Government s cross departmental Teenage Pregnancy Unit (TPU). Funding was provided initially through a dedicated Teenage Pregnancy Grant to every LA which has since been absorbed into general funding as part of the Early Intervention Grant. All local Teenage Pregnancy Strategies had two main aims: To reduce to under 18 conception rate by between 1 40-60% from the 1998 baseline by 2010 To reduce the risk of long term social exclusion for teenage parents and their children by increasing to 60% the participation of 16-19year old mothers in to education, employment and training (EET) by 2010. The Teenage Pregnancy Independent Advisory Group (TPIAG), a non departmental body, was set up in 2000 for a fixed term of 10 years to advise the Government on the Teenage Pregnancy Strategy and to monitor its implementation. The Teenage Pregnancy IAG final report was published in December 2010. The current Coalition Government formed in 2010 discontinued Local Authority teenage pregnancy targets. However, teenage pregnancy has remained an area of policy interest. The under 18 teenage conception rate is one of the three sexual health indicators in the Public Health Outcomes Framework (2013 2016) as one of the national measures of progress on child poverty. Teenage Pregnancy is also expected to be one of the three national indicators, along with late HIV diagnosis and Chlamydia screening, in the new Department of Health Sexual Health Plan due to be published in the autumn of 2012. Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 7
Thus there is a continued focus on preventing teenage conceptions as well as the social impact of parenting upon teenage mothers and their children. After the release of the 2010 under 18 conception rates in February 2012 Sarah Teather, Minister of State for Children and Families and Paul Burstow, Minister of State for Care Services issued a joint statement. They said This Government remains committed to reducing rates of teenage pregnancy still further and improving outcomes for young parents and their children. This is central to our aim to reduce inter-generational poverty and inequalities. 5. Why Teenage Pregnancy Matters The rationale for tackling teenage pregnancy and supporting teenage parents are well documented and referred to in Teenage Pregnancy: Accelerating the Strategy to 2010. The health and wider inequalities issues include: Babies born to teenage mothers have a 60% higher infant mortality rate than those born to older mothers Children of teenage mothers have a 63% increased risk of being born into poverty and are more likely to have accidents and behavioural problems Teenage mothers are 3 times more likely to smoke during their pregnancies Teenage mothers are 50% less likely to breast feed than older mothers Teenage mothers are 3 times more likely to have post natal depression and have a higher risk of poor mental health for 3 years after the birth than older mothers 15% of all young people not in education, employment or training (NEET) are pregnant teenagers or teenage mothers Teenage mo thers are more likely to have no qualifications at age 30 1 45% in Buckinghamshire Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 8
Children born to teenage mothers do less well at school and disengage early from learning and sometimes well before they have finished compulsory education. Daughters of teenage mothers are twice as likely as daughters born to older mothers to become teenage mothers themselves. Similar disadvantages affect young fathers. Rates of chlamydia are highest in women aged 16-19yrs and men aged 20-24yrs Efforts to improve outcomes for young parents will, in turn, reduce the chances that their children will become teenage parents themselves and therefore less likely to experience some of the factors associated with teenage pregnancy. Supporting teenage mothers to access and use contraception effectively after the birth of their first child will also help prevent subsequent unplanned pregnancies. Programmes to prevent teenage pregnancy and support teenage mothers and young fathers are part of a long-term effort to narrow social and health inequalities and tackle child poverty. Tackling the risk factors for teenage pregnancy can have an impact on a range of other local priorities included in: 1. The Buckinghamshire Children and Young People s Plan 2011-2014 priorities: Closing the Gap Transitions Early Intervention and Secondary Prevention Family Focus Children and Young People s involvement in decision making 2. Investing in our Children s Future Prevention and Early Intervention Strategy 2012-2015 3. Buckinghamshire Sexual Health and HIV Strategy 2009-2014 4. Buckinghamshire Child Poverty Strategy 2011-2014 5. Buckinghamshire Families First programme Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 9
6. Teenage Conceptions in Buckinghamshire Annual data for teenage pregnancy is published by the Office for National Statistics (ONS) fourteen months in arrears; therefore the conception rates for 2010 (the Teenage Pregnancy Strategy target year) were published in February 2012. The England and Wales under 18 conception rate for 2010 was the lowest since 1969 at 35.5 conceptions per thousand young women aged 15 17. Teenage pregnancy rates have been consistently lower in Buckinghamshire compared with most other areas nationally. During 2010 there were 195 conceptions (births and abortions) to women under the age of 18 years resident in the county, compared with 234 conceptions in 2009. The rate of conceptions was 20.2 per 1000 young women aged between 15-17yrs (under 18s) becoming pregnant in 2010 compared with a rate of 24.2 per 1000 in 2009. (See Appendix 1) This was the lowest rate in Buckinghamshire since the Teenage Pregnancy Strategy baseline year of 1998. The Buckinghamshire 45% reduction of the under 18 conception rate target was not met. However it did reduce by 18.5% from 1998 to 2010 the lowest reduction achieved in the ten year teenage pregnancy strategy period. A research report published by BPAS in 2010 Young People in London Abortion and Repeat Abortion stated that there is an acceptance of early motherhood associated with social deprivation. Teenagers who have aspirations are more likely to terminate than continue with their pregnancies. This seems to be the case locally as the proportion of teenage conceptions leading to abortion has been consistently higher in Buckinghamshire (59.5% in 2010) than for the South East (51.8%) and in England (50.3%). The percentage of abortions to maternities in the more affluent southern area of the county, are higher that other parts of Buckinghamshire and nationally Chiltern District Council area 66% from 1998-2009 and South Bucks 71%.(See Appendix 1). The majority of teenage pregnancies leading to delivery in Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 10
Buckinghamshire occur in the urban areas of Aylesbury and High Wycombe where there are also areas of higher deprivation. This is of concern as there is evidence which shows that children born to teenage mothers are more likely to experience a range of negative outcomes in later life (see Section 5) and are more likely, in time, to become teenage parents themselves thus perpetuating the disadvantage that young parenthood brings from one generation to the next. 7. The Buckinghamshire Teenage Pregnancy Strategy Teenage Pregnancy in Buckinghamshire was addressed through two strands. Prevention of conceptions and sexually transmitted infections (STIs) in young people Support for teenage parents including prevention of subsequent pregnancies and supporting young mothers into Employment Education and Training (EET) 7.1 Prevention of teenage conceptions and sexually transmitted infections The publication of Teenage Pregn ancy: Accelerating the Strategy to 2010 in 2006 identified that comprehensive education about relationships and sex (SRE), combined with easy access to effective contraception were key initiatives which had an impact on reducing under 18 conceptions and sexually transmitted infections. 7.1.1 Sexual Health Education Sex and relationships education (SRE), is the process of acquiring information and forming attitudes and beliefs about sex, sexual identity, relationships and intimacy. SRE enables young people to develop skills so that they make informed choices about their behaviour, and feel confident and competent about acting on those choices. It also helps to protect them against abuse and exploitation. SRE aims to Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 11
reduce the risks of potentially negative outcomes from sexual behaviour, such as unwanted or unintended pregnancies and sexually transmitted infections including HIV. It also aims to contribute to young people s positive experience of their sexuality by enhancing the quality of their relationships and their ability to make informed decisions over their lifetime. All those who are involved with children and young people need to have the skills and confidence to address sexual health issues when they arise. In Buckinghamshire this has been addressed through staff training, information for parents / carers and development of tools and support for those who deliver sexual health education to children and young people. Sexual Health Awareness Training for staff (Sex Matters Tier 1) A one day Sexual Health Awareness course, Sex Matters Tier One, is commissioned by BCC Children & Young People s Services and delivered by Brook to staff from Buckinghamshire statutory and voluntary services who work with children and young people since 2003. 2012 Update: Over 1500 staff (140 per year) staff from statutory and voluntary children and young people s services have been trained since 2003 with consistently positive course evaluations. Sex Matters Tier 1 participants are asked about the impact of the training on their practice 6-18 months after the course was delivered they said: It has helped me deliver a more sensitive and knowledgeable service to vulnerable children. Has helped me a lot regarding young people as I have discussed and given appropriate information. The young people that I work with are better able to make their choices. The course has given me confidence in engaging young people in health. the subject of sexual The training has made me more confident when having discussions about sexual health. It has also reminded me of the pressure's young people face growing up. Given me a fresh insight into how teens view their sexuality and the degrees of sexual activity in this age range. Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 12
Sex and Relationships Education (SRE) in schools A SRE Consultant was appointed in 2004 as a member of the Buckinghamshire Healthy Schools Team. The role included supporting schools in delivering age appropriate SRE from primary education through to Year 13 thus enabling children and young people to make informed choices around personal relationships and sexual health The SRE Consultant was also responsible for training practitioners in the PSHE Certificate which focussed upon knowledge and skills to deliver Substance Misuse and SRE in schools and other settings. Eighty seven staff, including teachers, community nurses and other professionals, involved in PSHE education delivery, had formal training most leading to national accreditation from 2004 to 2011. Most staff were encouraged to undertake the sex & relationships (SRE) module, as predominantly funded via The Teenage Pregnancy Strategy. 2012 Update: Central funding for the Healthy Schools programme ceased at the end of March 2011. The coalition government s policy is that Healthy Schools will continue but now schools led. As a result the Buckinghamshire Healthy Schools Team was disbanded in 2011 with loss of the role of the SRE specialist to support school / academies with SRE. Schools /academies have devolved budgets with little free support from School Improvement Services. SRE support is delivered through traded services and has to compete with statutory curriculum subjects. SRE and Parents /Carers An information leaflet Worth Talking About- Talking to children about relationships and sex was developed and distributed in 2011. The Speakeasy parenting course developed by the fpa is offered through Buckinghamshire Parenting Support Team. It aims to: Increase parents' confidence and communication skills with their children Foster a positive and open approach to discussions of sex, sexuality and sexual health and Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 13
Increase factual knowledge around sex and sexual health. RU Ready? Buckinghamshire staff in CaSH, Youth Services and other agencies which are involved with providing information and support to young people use the principles of RU Ready? These are designed to support young people around delaying first sex and ensuring that sexual activities are consensual. Health Zones - Young People s Health Drop-Ins From 2004 Young People s Health Drop-ins later known as Health Zones began to deliver services in schools, and community settings. This service has been built upon the Check out service provided by voluntary youth services at the Youth Enquiry Service (YES) in High Wycombe and Way-In at Chesham. The first school based Health Drop-In was set up at Beaconsfield High School for Girls in January 2004. A Health Zone Co-ordinator was appointed on a fixed term contract to 2012 to provide support for setting up and delivery of Health Zones across the county. Health Zones are delivered in a confidential environment, they provide general information and support on health related issues which may range from eating disorders, bereavement, chronic health conditions etc. and personal relationship /sexual health issues. Condoms are provided through the C Card scheme, pregnancy tests and chlamydia screening is also offered at all Health Zones. School / academy based Health Zones are delivered by practitioners who are not members of school /academy staff thus ensuring that students receive an independent and confidential service. The service is supported by the Health Zone Co-ordinator and delivered by a multiagency team of 2-3 practitioners who work in partnership to staff the Health Zones. Community Public Health Nurses (SCPHN), known as School Nurses, usually lead the school /academy multiagency Health Zone teams which include youth workers, Connexions and substance misuse workers. Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 14
Young people have been appointed as Health Zone Ambassadors and are involved in setting up and promoting the service to their peers. 2012 Update There are 6 Health Zones in Buckinghamshire schools / academies at: Beaconsfield High School, Wye Valley School, Princes Risborough Upper School, John Colet School - Wendover, The Grange School - Aylesbury, and Aylesbury Vale Academy There are 6 Health Zones in community settings at: Buckingham Youth Centre, Youth Space Aylesbury, The Roundhouse Wycombe, Youth Space- Wycombe, and The Crypt- Marlow, The Youth Bus Health Zone on the Road visits targeted locations offering the service in areas where young people have difficulties in accessing statutory services 7.1.2 Contraceptive and Sexual Health Services (CaSH) Public Health, NHS Buckinghamshire and Oxfordshire Cluster have produced the NHS Buckinghamshire Sexual Health and HIV Strategy 2009-2014 which was developed with all local sexual health providers and commissioners the strategy includes key priorities and an implementation plan. Public Health has worked in partnership with the Local Authority and other stakeholders to commission and develop a range of Contraceptive and Sexual Health (CaSH) services which contribute to the reduction of teenage conceptions and sexually transmitted infections. The services commissioned by Public Health include: a) Level Three Sexual Health and Contraceptive Services Public Health commissions three Level 3 Specialist Genitourinary Medicine (GUM), HIV and Contraceptive and Sexual Health (CaSH) services which are delivered by Buckinghamshire Healthcare NHS Trust through the Brookside Centre (CaSH) Services, Aylesbury and the SHAW (GUM) Clinic, High Wycombe. These services are well established and are available for all the population including young people. Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 15
b) Long Acting Reversible Contraception (LARC) All methods of contraception are offered at Level 3 services including Long Acting Reversible Contraception (LARC). This method of contraception is reliable and often attractive to young people as once the device, an implant or intrauterine contraceptive devise (IUCD), is inserted and checked there is no need for repeat appointments. Public Health also secured funds to set up a programme of LARC training for GP practices and an enhanced scheme to increase the availability of the method across the county. c) National Chlamydia Screening Programme The National Chlamydia Screening Programme (NCSP) was launched in 2003 as a result of evidence that young people aged 16-24 years were at high risk of contracting the bacterium. There has been close partnership working between the local CSP since the beginning of the screening programme in Buckinghamshire in 2007. The scope of the programme has developed so that young people aged under 25 years are offered a chlamydia test, and treatment if the test is positive, through CaSH services, GP practices, and some pharmacies. 2012 Update 10,747 young people aged 15 to 25 years in Buckinghamshire were screened for chlamydia (this was 18.8% of the eligible population against a 35% target) 7.25% of those tested were positive d) Young People s CaSH services Prior to 2000 weekly dedicated young people s CASH services called Check-out had been established at Brookside Clinic in Aylesbury, the GUM service (now the SHAW clinic) in High Wycombe and by Brook in Buckingham. Condoms were also distributed through the two voluntary youth service Check-out venues at Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 16
YES in Wycombe and Way-In, Chesham. General Family Planning clinics were also held at Aylesbury Brookside, Wycombe Hospital and Chalfont Hospital. However young people in the rest of county were unable to access CaSH services local to where they lived or attended schools and colleges. 2012 update A weekly Young People s CaSH Clinic in a Box hosted by YES, High Wycombe, and staffed by Brookside contraceptive nurses began in December 2008 A new young people s CASH service provided by Brook was set up in Burnham in 2010, this was in addition to the service already provided by Brook in Buckingham and will be taken forward by the THT (see below). A new contract for an integrated contraception and STI screening service provided by the Terrence Higgins Trust (THT) began in April 2012. One of the key target groups is young people. The service will provide outreach in a range of community settings building on services provided in Further and Higher Education venues and youth and community settings Sex and Relationship training for Further and Higher Education services staff will be offered so that they are better equipped to deal with their student s relationships and sexual health issues. e) C Card Condom Distribution Scheme The Buckinghamshire C Card distribution scheme was launched in November 2008 and is managed by the Brookside CaSH services. Sex Matters Tier 2 training has been developed for staff who offer condoms and pregnancy tests to clients. The scheme is delivered through statutory and voluntary service providers across the county these include Health Zones (see above) youth services, Connexions and substance misuse services. 2012 Update: Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 17
60 staff were trained to deliver the C Card condom distribution scheme during 2011/2012 1445 young people were issued with C Cards during 2011/2012 Approximately 20,292 condoms were distributed during 2011/2012 f) Pharmacy Emergency Hormonal Contraception ( EHC) scheme The Buckinghamshire scheme to train pharmacists to issue Levonelle EHC to young women aged 18 years and under who had unprotected intercourse within 72 hrs began in 2005. 2012 Update: 38 pharmacists currently participate in the scheme 552 young women were seen in 2011/2012 Participating pharmacists also offer chlamydia screening to young women who request EHC g) Buckinghamshire s Sexual Health website Bucking hamshire s Sexual Health website www.sexualhealthbucks.nhs.uk went live in May 2009 and provides one portal for information on all contraception and sexual health services (CaSH) in Buckinghamshire with appropriate links to national websites. 2012 Update: The Buckinghamshire Sexual Health website received 9,571 visits from 6906 people during 2011/2012 h) Termination (Abortion) Services Public health is the lead commissioner for the termination service across Bucks, Milton Keynes and Oxfordshire. This will be transferred over to Clinical Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 18
Commissioning Groups for 2013/14. An important aspect to this service is the link with local contraceptive services to avoid repeat terminations. Prior to the current contract Buckinghamshire had to travel outside the county for termination services, this was particularly difficult for teenagers. 2012 Update Abortion services are now more accessible for Buckinghamshire residents with clinics in Luton, Buckinghamshire, Milton Keynes and Oxford. Abortion Services in Buckinghamshire i) Sexual Assault Service The NHS has also commissioned the Sexual Assault Referral Centre (SARC) at Upton Hospital and Bletchley Police Station. This will be transferred over to the NHS Commissioning Board from 1 April 2013. 7.1.3 Vulnerable Young People - Young People in Care Young people in care are considered to be particular risk of unprotected sex and teenage pregnancy. A Personal Relationships and Sexual Health Policy for Children in Care was written and published on the Buckinghamshire Local Safeguarding Board website. Sexual Exploitation Some young people are vulnerable to being groomed for sexual exploitation. Buckinghamshire Children & Young People s Service has commissioned Barnardo s to deliver RU Safe? A Young People s Sexual Exploitation and Missing Service which supports those who have returned to home /care from going missing by providing information on keeping safe and supporting those who have been sexually exploited. Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 19
7.2 Support for Teenage Parents 7.2.1 Teenage Pregnancy Liaison Midwife The Teenage Pregnancy Liaison Midwife was appointed in June 2005. This role was created to provide additional support for teenage families to provide the best outcomes for mothers during their pregnancy and for their babies. The midwife built up close multi-agency working relationships, of note has been that with the Connexions service. In April 2007 Multi-Agency working to support pregnant teenagers: a midwifery guide to partnership working with Connexions and other agencies was published. This document included 2 anonymised case studies supplied by the Teenage Pregnancy Liaison Midwife and the Connexions team which demonstrated the clear pathway for teenage parents across Buckinghamshire that had been set up and the benefits of this close working relationship on the teenage mothers in Bucks. This formed the basis of the current multi-agency working. 7.2.2 Connexions Specialist Teen Parent Personal Advisers (TP PA) Buckinghamshire Children & Young People s Service commissions the Connexion service. A Connexions Teen Parent Personal Adviser was appointed in 2005 the role has proved invaluable with excellent partnership working established between the Connexions Teen Parent Personal Advisers and the Teenage Pregnancy Liaison midwife who was also appointed in 2005 (see above). Connexions TP PAs also work in partnership with Children s Centres and Youth Services to deliver Young Parent s Suppor t Group programmes. The res ult off partnership working is that is that most young parents in Buckinghamshire are known to the Connexions service and to BCC: 2012 Update DfE estimate of teenage mothers under 20 for 2011/2012 = 193 No. of teenage mothers under 20 known to BCC was 153 = 79% known to BCC (The South East average of known teenage parents is 66% and the National average is 64%) Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 20
7.2.3 Guidance for Schools, Academies and Colleges to Support Pregnant Students and Young Parents The Guidance for Schools, Academies and Colleges to Support Pregnant Students and Young Parents was first published in 2006 and was updated in 2012. School age young parents are monitored by the Exclusions and Reintegration Team. BCC guidance is published to all schools, academies and pupil referral units on the education, support and reintegration of pregnant pupils and school age parents. 7.2.4 Care to Learn The Care to Learn Grant was launched in 2003/2004 which provides financial support for teenage parents aged up to 20 years old who want to continue in, or return to learning. It helps with the cost of their childcare and travel. 7.2.5 Young Parent s Groups The first Buckinghamshire Young Parent s Group Babysteps was hosted by the Healthy Living Centre in Aylesbury in 2006. The young mothers who attended named the group and requested further groups so Step 2 It an accredited course was developed and delivered at the Healthy Living Centre in November 2007. This was a result of partnership working between The Healthy Living Centre, Connexions, Health Visitors, Adult Learning, Youth Services and Sound Studio. The model of young parents groups has been adopted by Children s Centres across the county with Baby Steps and Tiny Toes groups attracting young parents in urban and rural areas. 2012 Update Children s Centres in Buckinghamshire have developed the Young Parents Group model and continue to work with Connexions, the Youth Service and Health Visitors. Young Parents Groups were held at 8 Children s Centres across the county during 2011/2012. Young Parents Groups Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 21
The funding for education for Young Parents has been devolved to accredited learning providers. Aylesbury College took over this role during 2011/ 2012 and delivered the programme to young parent learners 7.2.6. Family Nurse Partnership (FNP) Buckinghamshire Family Nurse Partnership began recruiting clients in November 2012. The evidence based FNP is an intensive home visiting preventative programme offered to young women aged 19 years and under having their first baby. The FNP programme begins in pregnancy and continues until the child is two years old. This early intervention offers young parents and their children: Improved pregnancy outcomes Improved child health & development Reduced abuse & neglect Improved maternal life course development e.g. improved self sufficiency Investment in the programme and families will have individual, family, community and financial benefits Conclusion All the achievements of the Buckinghamshire Teenage Pregnancy Strategy have been the result of committed and co-operative partnership working across a wide range of statutory and voluntary services. This has provided a sound base on which to build further developments to reduce the incidence of young people who contract sexually transmitted infections, to reduce the number of teenage conceptions and to provide co-ordinated support for teenage parents and their children. Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 22
Appendix 1 Conception Rates by Area of Usual Residence Under 18 Conception Rates - Buckinghamshire Rates of conception are calculated from data of live birth, stillbirths and legal abortion. Rates are based on per 1000 females 15-17 yrs old Data is released from the Office of National Statistics (ONS) 14 months in arrears in February of each year Buckinghamshire's Teenage Conception target is 45% decrease from 1998 baseline by 2010 Numbers 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 England 41,089 39,247 38,699 38,439 39,350 39,553 39,545 39,683 39,003 40,298 38,750 35,966 32,552 South East 5,384 5,058 5,085 5,022 5,033 4,932 5,086 5,316 5,191 5,205 5,224 4726 4384 Bucks 223 232 239 212 207 199 204 218 209 236 240 234 195 Rates 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 England 47 45.3 43.9 42.3 42.6 42.1 41.5 41.1 40.4 41.7 40.4 38.2 35.4 South East 37.7 36.2 36.1 34.8 34.4 33.1 33.5 34.2 32.9 32.8 32.9 30.1 28.3 Bucks 24.8 26.3 27.1 23.4 22.6 21.5 21.9 22.7 21.3 23.9 24.4 24.2 20.2 %leading to abortion 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 England 42.4 43.5 44.8 46.1 45.8 46.1 46 46.8 48.9 50.5 49.7 49.1 50.3 South East 45 46 47.3 49.1 47.4 48.3 48.7 50.3 51.2 52.7 51 50 51.8 Bucks 52 53 54.5 61 62.3 57.3 64.7 59.6 63.6 61.6 60.8 60.7 59.5 Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 23
Teenage Conception Rates 1998-2010 50 45 40 35 30 25 England South East Bucks 20 15 10 5 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 24
% of Teenage Conceptions leading to abortion 1998-2010 Rates are based on per 1000 females 15-17 yrs old 70 60 50 40 30 England South East Bucks 20 10 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 25
Under 18 conceptions data for LAD1 and LAD2 (all LAs including county districts) 1998-2010 N.B. Rates are per 1000 female population aged 15-17. 2010 data are provisional Sources: Office for National Statistics and DfE 1998-00 2001-03 % leading to abortion Number Rate 2004-06 % leading to abortion Number Rate 2005-07 % leading to abortion Number Rate 2006-08 % leading to abortion Number Rate 2007-09 % leading to abortion Number Rate 2008-10 % change in rate % leading % leading to to Area of usual residence Number Rate abortion Number Rate abortion 98/00-08/10 Buckinghamshire 694 26.1 53 619 22.5 60 631 21.9 63 664 22.7 62 686 23.3 62 711 24.3 61 669 23-11.9% Aylesbury Vale 245 27.1 53 227 22.9 56 236 24.1 61 233 23.6 61 237 23.9 59 250 25.4 56 231 23.4-13.7% Chiltern 92 18.4 60 79 16 70 69 12.9 68 90 16.6 67 108 19.9 67 122 22.5 68 114 21.1 14.7% South Bucks 67 21.6 61 75 22.5 68 87 24 77 92 25 75 93 24.6 76 91 23.8 74 93 24.2 12.0% Wycombe 290 30.6 50 238 25.3 58 239 23.9 57 249 24.2 56 248 24 58 248 24.3 58 231 23.1-24.5% Review of Teenage Pregnancy in Buckinghamshire 2012 FINAL Lynda Ayres 26