NHS Ayrshire and Arran has developed an award-winning maternity team to support vulnerable families who need specialist help.
An initiative in NHS Ayrshire and Arran to support vulnerable families has brought about a 34% decrease in the number of child protection orders issued at birth between 2011-12 and 2012-13. This is in spite of a 59% rise in unborn babies being on the child protection register.
The figures, from the findings of our local audit of child protection activity in North Ayrshire, belie the valuable work undertaken by the vulnerable families maternity team. As well as helping pregnant and postnatal women with complex social needs by providing consistency of approach and continuity of care and carer, the framework surrounding the individuals has improved.
For example, multi-agency working is better and there is now a robust risk assessment to identify needs and ensure that unborn babies are protected. The service also works more effectively with fathers and families to ensure they are involved in the delivery of care for their partners and unborn infants. There is a more immediate response for families experiencing difficulties to help reduce the number in crisis too.
Communication between the wider multi-agency team has improved as well, with the information being shared now of a consistently high standard. This has strengthened evidence to support decisions for infants to remain with their family or to be removed at birth.
In 2011, before the team began, there were 48 community midwives across Ayrshire responsible for the provision of care for varying numbers of vulnerable women in their caseloads. Some midwives were unsure of up-to-date child protection referral and assessment procedures and there were issues in relation to continuity of carer, making it difficult for multi-agency staff to know who to contact. The sharing of information was sub-optimal, resulting in poorer engagement and outcomes.
The change came about as a result of several national policies in Scotland over the past five years, such as Getting it right for every child (The Scottish Government, 2012), which put maternity services at the forefront of protecting children against harm. It provided the impetus to strengthen the provision of community midwifery to vulnerable pregnant women with the aim of increasing engagement with families at higher risk of poor outcomes. The aim was to provide a preventative and strengths-based approach to care.
One of the main challenges was to deliver a change within existing resources. An audit of the workload/workforce was undertaken, followed by a re-organisation of staff to release one whole-time equivalent (WTE) midwifery post to start the pilot in North Ayrshire. After this proved a success with all agencies, a further two WTE posts were released from the existing workforce and funding was given for a 0.9 WTE MCA post to support the midwifery team.
The criteria for referral to the team includes: current or previous social work involvement, previous history of child abuse or neglect, either parent involved with addiction services or the criminal justice service, perinatal mental health, domestic abuse and other complex social problems.
The effective service continues to evolve and a parenting support group for vulnerable families has been set up recently too.
Mary Garven and Elaine Moore
Midwives, NHS Ayrshire and Arran