KEY CHANGE WORKSHOPEarly Intervention in Maternity Services

Early Years Collaborative: Learning Session 4

WORKSHOP OBJECTIVES• Build a common understanding of the operational definition

of this key change area.• Present emerging learning in this key change area, including

both evidence base and new learning that will advance our knowledge in this area.

• Introduce concept and opportunity of a “Pioneer Site”• Discuss current or potential work within your CPP in this

area and generate themes across CPPs.• Brainstorm change ideas to bring for discussion with your

CPP colleagues during the end of day CPP Planning Session.• Have fun!

SOME IMPORTANT NOTES• All feedback will be gathered after the session

by the Early Years Collaborative team and made available on the Extranet.

• Our discussions today are about learning, not about performance, so sharing your challenges and failures can be just as important as sharing your wins and successes.

MEETING NORMS REFRESH• Suspend judgment as best you can.• Respect one another.• Seek to understand rather than persuade.• Invite and honour diverse opinions.• Speak what has personal heart and meaning.• Go for honesty without going on and on and

on.

Our Key Change Area: Early Intervention in Maternity Services…

1. Early Access to Antenatal Care

2. Promotion of a healthy pregnancy

3. Supporting the development of positive attachment relationships

4. Smoking cessation

5. Coordination of support and transfers between services

1. Early Access to Antenatal care

What do we mean?

At least 80% of pregnant women in each SIMD quantile will have booked for antenatal care by the 12th Week of gestation by March 2015 to ensure improvements in breastfeeding rates and other important health behaviours (Scottish Government heat target)

What is ‘the booking’?• A comprehensive assessment of a pregnant woman’s health needs including social and lifestyle behavioural risks

• Allocates women to a ‘pathway’ of care based on risks identified – red, amber or green

• Mental health history, drug and alcohol use, smoking

• ‘Gateway’ to other services – Family Nurse Partnership, smoking cessation, dietary support

http://www.healthcareimprovementscotland.org/our_work/reproductive,_maternal_child/woman_held_maternity_record/swhmr_maternity_record.aspx

But what’s in it for the woman? Why book early?

• Referral for early scan (11-13 weeks) – screening for Down’s Syndrome and other abnormalities

• Midwife can sign forms confirming stage of pregnancy for employer / benefits / housing

• Midwife can refer if woman wanting additional support – and can be faster if known to be pregnant – mental health, dietician, physiotherapist

• Healthy Start vitamins …

But last time….• Maternity services likely to be different from earlier experiences:

• Current focus in maternity services on improving continuity of carer

• The ‘nuchal fold’ scan (early Down’s screening) recent development

• More focus on smoking cessation support

• Growing levels of support and coordination for women with additional needs – specialist perinatal mental health midwives, substance misuse midwives…

• Changes to antenatal education resources

2. Promoting a healthy pregnancy • Everyone’s role:

• Importance of regular antenatal appointments: baby’s growth and wellbeing, support behavioural change, assess maternal condition and identify problems early (diabetes, raised blood pressure)

• Do we all know the recommendations for pregnancy for physical activity? Diet? Alcohol?

• Important role of antenatal education: increasing focus on parenting, not just labour

• Joint working: invite midwives to talk to social care professionals and staff about pregnancy and current public health recommendations

• Invite midwives to come to other local groups: mums groups, any groups/drop ins with young adults

• Give maternity services feedback about what you hear from your clients about services: problems with access, gaps in care, suggest/ provide premises for drop ins

The role of other services before 12 weeks…

• If you become aware that someone is pregnant, encourage them to call the midwife

• Have local information about booking available to all workers – telephone numbers

• Tell women about the ‘Ready Steady Baby’ mobile app:

•http://www.readysteadybaby.org.uk/

• Emphasise the risks of binge drinking and alcohol:

•http://www.knowledge.scot.nhs.uk/home/learning-and-cpd/learning-spaces/fasd.aspx

3. Supporting attachment• Encourage women to talk to their baby

• Ask women about the baby’s preferences /patterns when they are in utero

• Encouraging use of slings

• Getting the home ready

• Identifying and reducing stress and distress – talking therapies, group support

• Consider talking about the ‘baby’ rather than the ‘bump’

• Midwives: skin to skin, screening for antenatal and postnatal mental health, support breastfeeding

4. Smoking Cessation• Are we all clear about the risks of smoking in pregnancy: ‘Just’ a small baby?

• Increased rates:

• Premature birth, small for gestational age (symmetrical – brain development may be affected)

• Stillbirth: smoking >10 day doubles the risk, from 1 in 200 to 1 in 100

• Smoking and Cot death:

• 1-10 a day during pregnancy 4x risk

• >20 a day during pregnancy >8x risk

• Both parents smoking postnatally 6 x risk

5. Coordination of Services and Communication

• Developing a common language

• Developing common assessment tools and handover materials

• Sharing information – regular meetings about families of concern

• Develop joint visiting / co-location of drop ins

• Presence of social care services at antenatal clinics

Education available to support youVisit the Ready Steady Baby Website/download the app:

•http://www.readysteadybaby.org.uk/

•Dip into the Health Scotland resources:

•http://www.maternal-and-early-years.org.uk/topic/pregnancy

•Brief interventions e learning modules, diet and nutrition, smoking and alcohol

• E toolkit on antenatal access: http://www.healthscotland.com/documents/22566.aspx

• Use the NES Knowledge Network e learning resources on Fetal alcohol harm, cot death:

•http://www.knowledge.scot.nhs.uk/home/learning-and-cpd/learning-spaces/fasd.aspx

BECOMING A “PIONEER SITE” IN THIS AREA• A Pioneer Site is an area (specific geographical

location, nursery, clinic, school, community centre etc.) that has:1. The local will and interest to work on this important issue with

their community.2. Leadership support to be the CPP’s Pioneer Site for this issue. 3. Adequate resourcing to do the work required for testing in this

area.4. Some existing work in this area.5. Willingness to share their data and learning with the

Collaborative, warts and all!

CURRENT WORK IN THIS TOPIC AREA • STEP ONE: With your table, reflect on what

you are doing within your CPP, or could do in this area:– Who are individuals and/or teams currently

working on in this area? What are they doing? Be as specific as possible.

– Be sure to generate as many ideas as you can and write each idea on a post-it note.

CURRENT WORK IN THIS TOPIC AREA

• STEP TWO: Reflect on your ideas and identify emerging themes from your table.– Write the 3-5 largest themes on post-it

notes and bring to the front of the room.– Facilitators will review all table themes to

find the top 5 themes from the room.

REPORT OUT

• What surprised you in your discussions?• Are there any immediate ideas you want

to take back to your home team given what you discussed?

THEMES FROM THE ROOM• PLEASE INSERT HERE (DURING SESSION):

– Top 5 emerging themes based upon facilitator themes from tables.

THEMES FROM THE ROOM

• With your table, review top 5 themes from the room on wall posters:– Discuss with your table where your specific

idea post-it notes might be placed within each of the 5 themes.

– Designate 1-2 people to place specific post-its on poster paper.

FINAL REFLECTIONS

• What are 5 change ideas you could work with in your community you can bring to your CPP planning meeting?

PARTING THOUGHTS

• We need Pioneer Sites!• Remember, a Pioneer Site has the will and

interest, the leadership support, some existing work in this area, resources (people) to adequately do the work, and a willingness to share their data and progress.

Do you think your CPP could be a Pioneer Site? Express interest with one of your facilitators and the EYC team will follow up to explore

this opportunity with you.

THANKS FOR A GREAT SESSION!