Greater Manchester Baby on Board A Whole-system Approach to Building Great Foundations through Perinatal and Parent Infant Mental Health

Transcription

1 Greater Manchester Baby on Board A Whole-system Approach to Building Great Foundations through Perinatal and Parent Infant Mental Health Wednesday 7 March 2018

2 Workshops (refreshments available) Workshop 3 Women and Babies on Edge of Care Willows Suite

3 Welcome! to book a place snt-tr.infantparentservice@nhs.net

4 Stockport Infant Parent Service The Infant Parent Service is a conception to age five service which looks at early intervention to promote healthy positive relationships between parents, carers, infants and young children. The service is accessible to young children and their families presenting with a wide range of social and emotional difficulties. These difficulties can sometimes interfere significantly with the development of the fundamental building blocks necessary for nursery and school readiness and for securing optimal life chances in later life. Early intervention from the Infant Parent Service using collaborative methods has shown good outcomes for the mental health of both parents and young children.

5 Families on the edge of care? Parents who have had previous children removed, parenting subsequent children. Vulnerable mother fathers and babies, babies who come into the world on a child protection plan. Children's whose environments impede their development. Where there are safeguarding concerns. Young children who have been in care returning home.

6 Families in adversity Families with multiple complexity. Adverse circumstances. Domestic violence. Mental Health difficulties. Adverse Childhood Experiences.

7 Brinnington Family Pilot The Infant Parent Service was part of a research study looking at children from 18 months and then tracking them over 18 months. Children were screened using Ages and Stages, Parent Questionnaire looking at general development and social and emotional development. Offering interventions (for those children whose development not on track)

8 Brinnington Babies Four babies tracked (from early infancy). Environment trumps everything Graham Music. Orchids and Dandelions Dobbs 2009

9 Ghost In The Nursery Ghosts in the Nursery Selma Fraiberg. Transmission of trans-generational trauma - how things persist.

10 Angels In The Nursery Angels in the Nursery Alicia Lieberman. Early benevolent experiences with parents can protect against even overwhelming trauma.

11 Safeguarding Arena Safeguarding - Development

12 Collaborative Working Multi Agency Multi-professional Working. Concentric Circles of Containment. Chasing and capturing engagement.

13 Hope and Development Holding on to Hope. Development of long term relationships and continuous support across the early years. Creating a emotionally healthy social environment.

14 All Rights Reserved 2018 Design by:

15 STRENGTHENING FAMILIES PROGRAMME Salford City Council Tim Littlemore - Head of Integrated Social Work and Prevention Elly Siddall - Parenting Practitioner Ashley Martin Family Support Worker

16 What is Strengthening Families? Strengthening Families is an intensive specialist programme for pregnant women who are pre 23 weeks gestation and are at risk of their unborn child being removed from their care as these are parents who have already had children removed. The programme aims to reduce the number of children going into care and prevent mothers from getting into the cycle of repeat removals. Intensive support is offered through the Strengthening Families Practitioners, the programme has a dedicated Parenting Practitioner and 3 Family Support Workers. Depending on need this support can be a programme of bespoke 1:1 sessions or group work. Parents are offered a variety of courses to attend both before and after their baby is born. These include the Health in Pregnancy and Parenting (HIPP) course and Webster Stratton Incredible Years Programmes. Strengthening Families allows vulnerable families to be indentified and receive the earliest possible help, ensuring babies have healthier outcomes and are safeguarded pre and post birth. The programme provides support for first five years of the child s life OR adult support for a two year period following the removal of a baby.

17 Strengthening Families is a direct response by Salford City Council to the growing number of women repeatedly losing their children to the care system due to a range of issues such as domestic abuse, poor parenting, crime and drug and alcohol abuse.

18 Referrals in to Strengthening Families All parents referred in to Strengthening Families must have had a previous child removed from their care. Other risk factors commonly presented are: Risk Factors % Domestic Abuse Substance Misuse Family Factors inc. Extended Family Mental Health 7.77 Chaotic Lifestyle 4.37 Adult with Learning Difficulty 3.88 Adult previously LAC 3.40

19 HIPP Programme Content Parenting Health Relationships Lifestyle Education Engagement with services Benefits to Parents engaging with the course: Promotes bonding and attachment process during pregnancy Educates parents on the impact of parental lifestyle choices on babies and children s development, health and welfare Provides parents with support to lead a healthy lifestyle Educates parents on the most up to date guidance on caring for babies Reinforces parental responsibility before birth of the baby Reflection on past parental experiences to identify where things have gone wrong Helps parents provide evidence of consistent engagement with services through pregnancy Aids understanding of the Pre-Birth Assessment process and how best to approach this Contraceptive advice and support and encouragement to access this following babies birth

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21 STRENGTHENING FAMILIES The story so far for our Strengthening Families Parents and Children We are tracking 87 children born to a cohort of 78 mothers who are currently part of the Strengthening Families Programme At the time of being referred to us, these 78 mothers had had 112 children removed from their care At birth, 97% of Strengthening Families babies are made subject to a child protection plan. It is common for PLO to be initiated The diagram below evidences where these 87 babies currently sit on Salford's threshold of need. Universal (80%) CIN (5%) CP (10%) LAC (5%)

22 5 year support plan - Parent & Baby An allocated Family Support Worker, offering support and advice regarding issues such as housing, relationships, parental lifestyle, education, employment, money management and child development Referrals on to specialist services e.g. SIDASS, Achieve 1-1 bespoke parenting work Access to Evidence Based Parenting Programmes e.g. Baby Incredible Years Priority access to Children s Centre activities e.g. baby massage, first foods course Additional child health and development input from a Health Visitor (above and beyond the universal offer) Ongoing encouragement and support in accessing contraception The level of support varies as families move across the thresholds and is tailored to meet families individual needs.

23 2 year support plan Adult only Emotional support provided during court process, final contacts etc. Support with the LAC process and in writing letters for letter box contact Support and advice on a range of issues e.g. Housing, benefits, money management, education, employment and relationships Encouragement and practical support to access long term contraceptive methods Referral in to specialist adult services e.g. Mental Health and Achieve Recovery Historically, parents have felt deserted following the removal of a child. Strengthening Families aims to maintain a working relationship with the adult to prevent the cycle of repeat pregnancies and potentially harmful behaviours. We aim to enable the parent to invest in themselves in the hope there may be better outcomes in their future!

24 Questions & Comments

25 Workshops (refreshments available) Workshop 3 Delivering High Quality Specialist Perinatal Care Willows Suite

26 Delivering High Quality Specialist Perinatal Care The Specialist Perinatal CMHT for GM Progress update/group Activity workshop Dr Sarah Jones. Consultant Perinatal Psychiatrist Carla Mobear. Operational Manager-Perinatal Service Jane Arands. Service Manager/Project Lead

27 Introduction Perinatal Mental Health Servies A Background - Dr Sarah Jones Recap - Operational Implementation/ GM wide Coverage plans - Jane Arands How do we Develop/Achieve One Perinatal Pathway across GM - Group discussion - Carla Mobear Questions?

28 Perinatal Mental Health Services: A Background Dr Sarah Jones Consultant Perinatal Psychiatrist Greater Manchester Mental Health NHS Foundation Trust

29 Outline Background: Why do we need Community Perinatal Services? Key Developments in Perinatal Mental Health nationally National Climate: 5-year forward Key Developments Locally

30 Background Why Do We Need Community Perinatal Services? 1. Perinatal Mental Illnesses are Common 2. Perinatal Mental Illnesses are Serious 3. Perinatal Mental Illness are Treatable

31 1. Perinatal Mental Illness is Common

32 2. Perinatal Mental Illness is Serious

33 3. Perinatal Mental Illness is Treatable

34 Perinatal Mental Health is a Public Health Issue

35 Why Do We Need Specialist Services? Specialist skills to manage and nurse mentally ill women whilst enabling them to meet the emotional and physical needs of their infants Specialist understanding of the impact of mental illness on the parent-infant relationship and development of the infant Specialist knowledge of the risks and benefits of medication In depth understanding of changes associated with childbirth In depth understanding of the organisation of maternity services Responsive to specific timeframes of perinatal period Liaison with maternity services and Children s Social Services Specialist in-patient units (MBUs) Critical number of patients required to maintain specialist knowledge and skills Lower thresholds in specialist services vs. CMHTs

36 NHS Five Year Forward View 1. The implementation plan includes the objective that there will be increased specialist mental health support in all areas by 2020 to Commitment to Perinatal Mental Health Services 265 million over 5 years ( ) for: more inpatient provision, Perinatal CMHT and the PNM Networks 3. Four new MBUs commissioned: - Kent and Medway NHS and Social Care Partnership Trust - Devon NHS Partnership Trust - Lancashire Care NHS Foundation Trust - Norfolk and Suffolk NHS Foundation Trust 4. Wave 1 funding complete and Wave 2 funding deadline: Friday 9 th March

37 Key Developments Locally Devolution in Manchester Greater Manchester excluded from applying for Centralised/Wave Funding No Specialist Community Perinatal Services in GM - Mother and Baby Unit - Obstetric Liaison Clinics at St Mary s Hospital and Wythenshawe Hospital - Perinatal Outpatient Clinic (Psychiatric-led only) covering GM-wide

38 Overview of Key Events A recap of the timeline of Perinatal Developments in GM GM given the national allocation 5YFV as part of the 2016/17 settlement. Ongoing work has been taking place with the Perinatal SCN and clinical and commissioning representatives to develop the 3 Perinatal Services for GM July 2017 Strategic clinical network submitted a GM Bid to GM Health and Social Care partnership GMMH will develop and deliver the Perinatal CMHT across GM IAPT and Early Attachment Services will develop plans to build capacity August 2017 GMMH developed an internal business case with Clinical leads. The Strategic Clinical Network submitted a GM business case which includes the GMMH business case. Sep 2017 GMMH held meetings with GMCA Research Team. Perinatal CMHT FBC reviewed 13 th October MH Implementation oversight sub panel. GMMH business case will go to GMMH Implementation meeting 3 rd November

39 Key Developments Locally November 2017 GM business case accepted for implementation Joint Commissioning Board agreed for funding post 2021 to go into CCG baseline

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41 Specialist Perinatal CMHT Mobilisation Rapid and effective mobilisation is a key issue. From the 30,000 target to the GM share of this total, the proportion of the region s share of the population (5.6%). In other words GM will be expected to deliver 5.6% of the target which is about 1,800 additional women accessing Specialist Perinatal CMHT by GMMH Mobilisation Team in place from November with clinical leadership, operational partnership and corporate services support

42 Perinatal CMHT Operating Model Team Base, Coverage and Locations (based on births and GMMH bases) Perinatal CMHT Clusters and Perinatal CMHT locations Base CCG coverage Mobilisation Date Cluster 1 MBU S Manchester, C Manchester, Stockport Trafford Cluster 2 Bolton Wigan, Bolton, Salford, Bury February 2018 May 2018 Cluster 3 North Manchester N Manchester, Rochdale, Oldham, Tameside TBC

43 Perinatal CMHT Clusters and Birth Rates Cluster Two 13,431 Cluster Three 11,923 Cluster One 11,533

44 GM Birthrates ANNUAL LIVE BIRTHS IN 2014 (data from the Office for National Statistics) Total birth rate in England 664,339 Greater Manchester (Met County) 36,644 Bolton 3,788 Bury 2,356 Manchester 8,051 Oldham 3,336 Rochdale 2,894 Salford 3,558 Stockport 3,378 Tameside 2,874 Trafford 2,828 Wigan 3,581

45 Specialist Perinatal CMHT- Operational Implementation The Specialist CMHT is aligned to the MBU at Laureate House as One Team in a Hub and Spoke model Manchester Network will be Operationally responsible for supporting the Perinatal Services. Senior leads for the service are establishing relationships and clinical/operational links with stakeholders to plan integrated working arrangements

46 Recruitment to date. Good News! Recruitment commenced in November and despite the workforce challenges facing organisations, interest in the posts have been positive and 16 staff have been recruited so far! There are 20 posts To date there are 7 new starters. Other staff commencing over the next month or so The Specialist CMHT will work across Cluster One building up caseloads and working with midwifery, MBU and Adult Mental Health Services

47 The Clinical Model to date- Cluster One Specialist Perinatal Community work has been taking place since January with Consultant Psychiatrist supporting obstetric liaison clinics at MRI and Psychiatric Outpatient clinic at Laureate House. The Specialist team will respond in office hours (via the Perinatal CMHT) to urgent assessments, preconception advice, carry a caseload of patients. Out of office hours will be no change (The MBU will support the referral process/ Urgent Care pathway for ongoing assessment to the CMHT) Cluster One will be covered by Sarah Jones, Consultant Psychiatrist (until recruitment of substantive consultant) Work with maternity services, PIMH, IAPT and Adult Mental Health services making links and aiming for true integration Plans for Cluster Two and Cluster Three bases underway

48 Working into Cluster Two- May onwards From May 2018 Dr Ipse Mukharjee will commence in Cluster Two The CMHT workers will commence in Cluster 2 in line with the additional staffing The Specialist team will respond in office hours (via the Perinatal CMHT) to urgent assessments, preconception advice. Out of office hours will be no change (The MBU will support the referral process to the CMHT) Operational leads for the service are establishing clinical/operational links with stakeholders to plan governance arrangements/isa s

49 The Full Care Perinatal CMHT Pathway. By 2021

50 Group Activity How do we develop/achieve one perinatal pathway? Discuss how we develop and achieve the perinatal pathway across GM? Making sure we breakdown organisational boundaries? What opportunities are there for innovation? What do you see are the challenges ahead? How do we overcome those challenges? How can the three perinatal teams support each other to integrate?

51 Thank you Any questions