Early years support

Children’s Centres provide a variety of services, including child and family health services, childcare, integrated early education, parenting and wider family support. This incorporates advice on employment and training for parents, through links with Jobcentre Plus. A breakdown of the use of these services by Children’s Centre area, measured by the number of children aged 0-4 attending each centre is provided in Table 7 (Figure 1 in the Introduction contains a map of these boundaries).

Table 7: Number of children aged 0-4 years attending Children’s Centres by area

  A B C D E F
2011/12 2,329 3,200 2,173 2,471 1,608 2,517
2012/13 2,275 3,590 2,380 2,486 1,605 2,460
2013/14 2,434 3,601 2,354 2,343 2,043 2,348

Source: Hackney Learning Trust

Teenage pregnancy

Support for teenage mothers is delivered through the FNP programme (see Box 3 below). Home visits are delivered by trained nurses on a weekly, fortnightly or monthly basis, with each visit lasting between one and one-and-a-half hours. Within a trusting and supportive relationship between the family nurse and the family, themes such as attachment, relationships and psychological preparation for parenthood are explored. Behaviour change methods are used to assist families to adopt healthier lifestyles for both themselves and their babies, provide good care for their children, and plan their future. Once the child has reached two years old, the family is transferred to health visiting services to complete the remainder of the Healthy Child Programme.

This type of support has been shown to improve outcomes for mothers and their children in the short, medium and long term.

Box 3: Outline of the FNP programme

Family nurse partnership (FNP) – this programme offers targeted ongoing intensive support to first time teenage mothers and their babies (and fathers or other family members if mothers would like them to take part). It was developed by the University of Colorado over 30 years ago and was established in England in 2007 as part of the then government’s ‘Reaching out: think family’ plan on social exclusion.

Eligibility criteria are as follows:

  • first time mother aged 19 or under at conception
  • living in London Borough of Hackney
  • enrolled before 28th week of pregnancy.

In 2014/15, the FNP programme in Hackney received 75 referrals and, of these, 41 clients were enrolled (42 in total when including transfers). While provision is available for the City, there have been no referrals so far.

For those who decline the offer of joining the FNP programme, or who are beyond 28 weeks of pregnancy when identified, Public Health midwives will support them throughout pregnancy until they are transferred to the health visiting service.

Maternal smoking

A joint NHS-local authority initiative is underway in Hackney to implement NICE guidance on smoking in pregnancy, in particular establishing carbon monoxide (CO) testing to validate smoking status in all pregnant people. 3 This includes provision of CO monitors to the local FNP programme to ensure universal testing of pregnant teenagers. Validating smoking status in this way provides an opportunity for clinicians to give advice to pregnant smokers and make referrals to a stop smoking service.

All Hackney health visitors are required to be trained up to Level 1 in smoking cessation education (also known as ‘very brief advice’) and can be trained up to Level 2 (delivering intensive one-to-one stop smoking advice to clients who would like to stop smoking for 15-30 minutes per week for up to six weeks).

Pregnant people who want support to quit smoking can access a specialised pregnancy stop smoking clinic at the Homerton, as part of Hackney stop smoking services. There is no specialist pregnancy stop smoking support in the City of London.

Maternal weight

The Homerton offers advice, information and support for pregnant people with a high BMI, including the ‘Wednesday Club Clinic’ for those with a BMI of 40 or greater (very obese) to meet with a multidisciplinary team to discuss labour and delivery choices. 4

Maternal mental health

Relevant services in Hackney and the City of London are provided by the perinatal mental health team. The team provides care to those who have moderate to severe mental health difficulties in pregnancy or within one year of delivery. These problems can be pre-existing or arise during the perinatal period. Inpatient treatment is provided in a specialist unit at the Homerton.

In 2014/15, there were 120 perinatal mental health clients resident in Hackney and the City, which is 3.5% of the number of births to residents during this period (3,464 births in total). These data exclude mothers with mild mental health problems who are either managed in primary care or not receiving any formal support (no data are available to estimate the numbers involved).

Maternal and infant nutrition

The ‘Breastfeeding Welcome’ scheme launched in Hackney in 2015 and aims to encourage and support breastfeeding in the borough’s public, private and voluntary sector spaces. The scheme aims to raise awareness of the benefits of long term breastfeeding and empower people to feel comfortable breastfeeding outside of the home.

There are nine breastfeeding groups in Hackney that provide specialist advice and support on breastfeeding, which are advertised to parents by midwives and health visitors. These groups are run by the Public Health midwives and Breastfeeding Network Support,C and most are held in Children’s Centres. A survey about breastfeeding support in Hackney, completed by mothers attending breastfeeding groups in quarter two (Q2) of 2014/15, found that midwives were the most common source of support (23% of respondents), closely followed by partners/husbands (34%), with only 11% of respondents reporting that they received support from their health visitor.

One potential cause of feeding problems is ‘tongue tie’, where the frenulum of the tongueD extends along the underside of the tongue. Tongue tie may cause difficulties in breastfeeding and occasionally may cause difficulties in bottle feeding. A tongue tie service is available in Hackney and the City through which babies can be referred to the infant feeding specialist midwife at the Homerton, who can confirm whether tongue tie is present and decide whether to perform a simple outpatient procedure to divide the tongue tie.

Notes

  1. https://www.breastfeedingnetwork.org.uk/hackney/
  2. A frenulum is a small fold of tissue that restricts the motion of a mobile organ in the body; a frenulum is found extending from the floor of the mouth to the midline of the underside of the tongue.
  3. https://www.breastfeedingnetwork.org.uk/hackney/
  4. A frenulum is a small fold of tissue that restricts the motion of a mobile organ in the body; a frenulum is found extending from the floor of the mouth to the midline of the underside of the tongue.

References

  1. J. B. Austin, S. Selvaraj, D. Godden and G. Russell, “Deprivation, smoking, and quality of life in asthma,” Archives of Disease in Childhood, vol. 90, no. 3, pp. 253-257, 2004
  2. M. Burr, C. Verrall and B. Kaur, “Social deprivation and asthma,” Respiratory Medicine, vol. 91, no. 10, pp. 603-608, 1997
  3. J. B. Austin, S. Selvaraj, D. Godden and G. Russell, “Deprivation, smoking, and quality of life in asthma,” Archives of Disease in Childhood, vol. 90, no. 3, pp. 253-257, 2004
  4. M. Burr, C. Verrall and B. Kaur, “Social deprivation and asthma,” Respiratory Medicine, vol. 91, no. 10, pp. 603-608, 1997