11 november 2011 midwives- making a difference. joyce leggate belinda morgan family health project...
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11 November 2011
Midwives- making a difference
NE Fife
Glenrothes
Kirkcaldy Levenmouth
West Fife
Dunfermline
© Ordnance Survey Crown Copyright - © 2000 ACTIVE Solutions Europe Ltd
Midwives- making a difference
Joyce Leggate
Belinda Morgan
Family Health Project
NHS Fife
Aim of the project
Through intensive midwifery support from booking until 28 days postnatal to address inequalities in health care that is available to Fife residents. There are distinctive inequalities between
health care available in affluent areas compared with disadvantaged areas,
including pregnancy outcomes of vulnerable and excluded mothers.
Rationale
– The rationale for the family health project is based on the premise that health inequalities are set in the very earliest years of a child's life, even before birth. A number of factors can impact on a child’s health for example, nutrition, stress and health harming behaviours of mothers.
– The period between 0 and 3 years is a critical window for shaping life chances and is a key area of focus in the Scottish Government's Early Years Framework.
– Early intervention approach to reducing health inequalities, and so is particularly aligned with the Early Years Framework.
Why pre-birth?
• Windows of opportunity• 95% of the structure of the brain and its
development is complete by 3 years of age.• Change is easy and quick in the early years and
has profound and lasting effects• Change is possible later but slower and harder.• Children “make the best” of the experiences they
meet
Outcomes of early neglect & maltreatment
• Poor cognitive development
• Poor sensory integration
• Lack of self-regulation
• Lack of empathy
• Persistent belief about self and the world
• Reduced capacity to make good relationships
Optimum learning opportunity
Public perception of Fife
Reality for many Fife residents
Family Health ProjectPrinciple Objectives
• Improve maternal & child health outcomes in the most economically deprived areas of Fife
• Improve parenting
• Strengthen parent & child bonding
• Improve breast feeding rates
• Reduce maternal smoking
• Increase multi-agency support
The Family Health Team(Lynne missing)
Why midwives?
• Midwives are the first point of contact under KCND
• Comprehensive medical and social history taken using SWHMR
• Acceptable to client group especially first time mothers and those with looked after children
Why midwives?
• Scottish health policy demonstrates a clear commitment to early childhood development by identification of high risk children and families.
• Although initial investments are great, the returns over the long term can be much greater.
Process
• Needs assessed and agreed
• One to one visits from named midwife
• Parenting needs identified and support from nursery nurses given
• Involvement with groups in family centres
• Integration with local services beyond pregnancy
Extended team
Housing Officer
Consultant Obstetrician
Social Worker
Mother &
baby
Health Visitor
Family support worker
Family members Educationservices
GeneralPractitioner
Family HealthNursery Nurse
Family Health midwife
Communitymidwife
Psychiatric nurse
Mellow parentingprogrammeQuit 4 Life
midwives
Reasons for referral
11%
40%
16%
8%
3%
14%
0%
3%5%
Learning Difficulty D
Lack of Support S
Postcode P
YMI
Drug liasion
Mental health issues
Domestic Abuse
Previous SWinvolvement
Reasons for referralHousing Status
6%
60%1%
33% Homeless/hostel
Rented
Home ow ner
Living w ith parents
Outcomes
• Breast feeding rates -14%• Average birth weight -3242g• Delivery of parenthood education -89%• Maternal smoking -29 % • 10% referred to Quit 4 Life midwife• Mellow bumps, mellow babies and mellow
parenting groups accessed • Teen mother groups established• 35% involved in child protection process
Challenges
• Midwifery colleague resistance
• Nursery nurse boundaries –letting go!
• Sharing information – more always wanted!
• Health visitor resistance initially
• Lack of appropriate resources
• Continued funding in current fiscal climate
What we did NOT expect!
• Teenagers well supported by family and school• Child protection impact on workload• Involvement in groups in family centre• Number of referrals due to learning disability• Inappropriate referrals• Referrals from community midwives escalated• Support from social services• Genie is out of the lamp!
SOME MOTHERS AND BABIES ENJOYING ART & CRAFTS AND HEALTHY
EXERCISE
More fun and play
Joyce Leggate
BSc, PG cert. Addictions, RGN, SCM
Clinical Midwifery Manager
Forth Park Hospital
Kirkcaldy KY2 5RA