Category: Closing the Gap

Innovative services and provision that bridge the gap between statutory services and the users they are trying to reach

POWS: so much more than pregnancy outreach

When you hear “Pregnancy Outreach Work”, what do you think of? Breastfeeding education, perhaps? Blood pressure checks, or birth plans?

The truth is, the women we work with need much, much more than this. The risks our Pregnancy Outreach Workers Service (POWS) clients have include:

  • substance misuse
  • domestic abuse
  • safeguarding
  • mental ill health
  • housing and homelessness
  • issues linked to being a recent arrival to the UK
  • other issues linked to financial hardship

The Pregnancy Outreach Workers Service (POWS) provides crucial extra, early interventions needed to support women with these issues – often because no-one else can.

POWs are able to work with woman from a very early stage of pregnancy; often from as early as 10 weeks. Take away POWS, and the standard maternity pathway means no extra support until the Health Visitor gets involved at 26-28 weeks.

We can do this because of our close relationship with midwives, who alert us to women who would benefit from an early intervention. It means that we can start to tackle – and often resolve – issues as soon as possible, reducing risks that might otherwise have affected the unborn child.

As well as filling this gap, POWs work alongside many other services, including Housing Officers, Midwives, FNPs, Social Workers and the emergency services, to create a “wraparound” support service for families. And we do so in an efficient, cost-effective way.

Housing

More than two thirds of our clients have a housing risk. Around 47% are in temporary accommodation (eg living on a friend’s sofa, or in a B&B or hostel) and another 21% are in accommodation that, although more stable, is completely unsuitable for bringing up a baby (access issues, no power, problems with damp or rodents, etc).

POWS help women to access the support they need, including helping them to understand systems and processes, to access and fill in forms, to make homelessness and housing benefit applications, to bid on properties, and to furnish social letting properties (which are usually let without curtains, carpets or any furniture or white goods).

Importantly, POWS support also enables other services and agencies to do their jobs more efficiently. Having a POW on hand to offer social, emotional and practical support means that a Housing Officer, for example, can concentrate solely on their remit: finding a tenant suitable accommodation. POWS also save time for Housing Officers further down the line, because those who receive our support are more likely to understand how to sustain their tenancy. Together, we create a more efficient and less costly system.

Mental health

Nearly two-thirds (65%) of the women supported by POWS have a mental health need, but many would not have any support if it wasn’t for POWS.

All sorts of mental health problems, including “low level” depression and anxiety, can begin or escalate when a woman is pregnant or in her child’s first year. But with the right social support, many mental health risks can be reduced.

For women with a diagnosed mental health condition they’re struggling to control (medically “high risk”), POWS offer practical support, including help to manage medication and attend appointments. However, many of the women we see are medically “low risk”, with low reported wellbeing, or high levels of anxiety. Because they don’t meet the criteria of a clinically diagnosed mental health condition, they don’t qualify for extra support from other services. For these women, the one-to-one support a POW gives is vital, and has been proven to help.

We use the nationally-recognised DASS (Depression Anxiety and Stress Scales) to measure our impact and 50% of the women we worked with in the last year have seen an improvement in their DASS score as a result of support.

What’s more, a clinical study by researchers at the University of Birmingham, published last year, showed that the intervention of a POW was “beneficial in preventing postnatal depression in women with two or more social risk factors”.

Safeguarding

Most of the safeguarding advice for new mothers is based around the child. Of course, the safety of the child is paramount, but children aren’t the only people who need protection and support.

Collecting food and toiletries for our “baby bank”

So while social services and midwives are focusing on the child, our focus is on mum.

Just over a quarter of the women POWS support officially meet the threshold of “vulnerable adult”. Around a third of our clients have a child protection plan in place for the unborn baby. Often, we’re looking at a “double whammy”: a vulnerable adult with a protection plan in place for her unborn child.

If mum leads a chaotic lifestyle, with intermittent or no support from family or friends, then working on her own to build up the sorts of routines and networks that she will need as a parent – and that social workers and family courts will approve of – can be virtually impossible.

With a POW, however, there’s hope.

Not only will the POW work one-to-one with mum to come up with an action plan, helping her to tackle issues in a methodical way and providing her with important contacts, but she will also liaise with social workers and other services to ensure that they are aware of the changes being made.

In this way, mum is supported to be the best possible parent she can be, and mum and baby have a better chance of staying together.

This isn’t just a better outcome for mum and baby – it’s cost-efficient, too. The approximate cost of removing a child and caring for them in the foster system runs into tens of thousands of pounds.

Put simply: POWS solve issues and save money.

Chloe’s story

Chloe (not her real name) is a great example of the ways in which POWS can step in to break the cycle and stop someone slipping through the cracks. When we met Chloe, her two children had been taken into care and she had just found out she was pregnant again. She was deeply unhappy with her situation and desperate for things to change, but didn’t know where to start. Chloe has been brave enough to talk about what happened next.

Health Trainer group at the Signing Tree

Positive partnerships: strength in numbers!

Forming strong partnerships with other local organisations is a very important part of Gateway’s work.

By sharing resources we are able to provide a more cost-effective, joined-up service – both as an individual organisation and as a sector. In an environment where budgets are shrinking, effective partnerships mean less duplication of work, which saves vital resources. It also means less “pushing from pillar to post” for clients, easier access to services and one point of contact to help someone navigate through services.

People rarely have one issue they need support with, so all our services have always worked in partnership with other organisations, either formally or informally. Over the last couple of years, however, partnership work has become even more important to the Health Trainer service as they have started working with broader groups of people, reaching out to communities who might not otherwise be able to access the service.

Health Trainers at The Signing Tree

One partnership that we’ve set up relatively recently is with BID Services, a charity supporting people who are deaf, hard of hearing, visually impaired or have a dual sensory loss. BID Services runs a social enterprise called the Signing Tree, based at the Deaf Cultural Centre in Ladywood – and it’s here we now run a Health Trainer service with interpreters (one provided by Gateway, and the other by BID).

Gateway Health Trainer Richard, pictured, says, “I visit the Signing Tree once a month, where I set up a classroom together with two interpreters. If it wasn’t for them, the communication barrier would definitely be a sticking point – I don’t think many of the people I see at the Signing Tree would contact the Health Trainer service otherwise. The interpreters are brilliant – they actually get involved and help me to provide an informative yet fun session each month. We have 15 clients per session and it’s very popular – in fact last time, I had to turn four people away.”

Bhavana Jamin, Specialist Enablement Co-ordinator at BID, says, “This has been a positive experience for all the deaf people involved. The trainers make the pace of the sessions meet the clients’ needs and by this the clients became confident to participate and engage with the sessions. They gain access to information about their health and wellbeing that they may not be able to access from other areas, so they now have some knowledge of healthy food choices, and the information is presented visually.

“Word of mouth has been used to promote these sessions within the community and I now have a waiting list of people who would also like training in the future. So I look forward to working with Gateway again in the future.”

Strong partnerships allow us to do several things, especially when clients have more complex needs. They enable us to have an up-to-date knowledge of the issues that people in Birmingham are facing, so we can adapt the services we offer and respond to need as quickly and usefully as possible. It means more opportunity to help clients prioritise their needs, and to deal with issues in a way that suits the individual, by taking the services to them.

As well as the Signing Tree, we now also deliver services in partnership with a number of other organisations, including Jobcentres in South Birmingham, and Cerebral Palsy Midlands, based in Harborne.

If you would like to know more about working with Gateway, whether that’s to work with our Health Trainer service, or any other Gateway services, for example the Pregnancy Outreach Workers Service, do contact us – we’d be very pleased to hear from you.

Saving time for GPs and money for the NHS

Social prescribing” (sometimes called “care navigation” or “care co-ordination”) is a bit of a buzz topic at the moment. Although similar approaches have been used for many years, the financial squeeze on clinical services is greater than ever, leading to greater interest in alternative pathways.

Social prescribing refers to the idea of GPs and other primary care professionals referring people to a range of local, non-clinical services, and treating people in a more holistic way; looking at the “whole person” and taking into account social, economic and environmental factors.

But does it work? Our experience running the Pregnancy Outreach Workers Service, Health Trainers and Gateway Healthy Futures, tells us that the answer is a resounding “yes”… but that creating a successful service depends on a number of factors.

Saving time and money… building resilience

Gateway Healthy Futures Team
Gateway Healthy Futures, a pilot programme that finished at the end of September 2016, was designed specifically to reduce the number of unnecessary GP visits by providing patients with a non-clinical alternative. GPs referred patients who had presented with risks including social isolation, low reported wellbeing, ongoing mental health conditions, alcohol or substance misuse, and financial hardship, and the Healthy Futures Practice Navigators provided them with practical support, reassurance and a point of contact.

It’s an idea that we had been batting around for a couple of years before we had the opportunity to develop it. Eventually, it came to fruition thanks to My Healthcare, a consortium of GPs in South Birmingham. Gateway Healthy Futures was one of a series of projects funded by MyHealthcare with money provided by the Prime Minister’s Challenge Fund.

It’s now five months since the Gateway Healthy Futures service ended, but we’re pleased to see initial reports from its formal evaluation (which was carried out by international development consultancy Mott Macdonald) are very positive. It shows that Gateway Healthy Futures reduced the time people spent with their GP (when a social intervention was more appropriate), and that the people our Practice Navigators worked with significantly increased their self-reliance and self-care during and after the support.

“…GPs are happy with the service because it is reducing the burden of social needs patients on primary care.”

“Feedback from patients … indicates that self-resilience levels have increased due to the scheme. Anecdotally, there is evidence of behaviour change; the scheme has helped some patients to understand that the GP is not always the most appropriate source of support for helping with non-clinical issues.”

The Gateway Healthy Futures service was also found to be cost-effective.

“The use of non-clinical staff members instead of GPs is cheaper by around one third of the cost.”

“… had [Gateway] not intervened, patients would likely have been referred on to social services at a much greater additional cost; the care navigation service is estimated to represent a saving in this scenario of approximately £10 per hour.”

Lessons for the future

One element that was key to the success of Gateway Healthy Futures was being able to work with GPs who engaged with the service. Because we already had a relationship with MyHealthcare (via Health Trainers) and the GPs had been involved with Gateway Healthy Futures from the start, they had confidence that it would work. This benefited everyone involved – including the patients, who trusted their GP’s recommendation and were more likely to engage themselves.

And thanks to experience gained from our other services, in particular from over a decade of running the Pregnancy Outreach Workers Service, we were also able to employ and train the right kind of staff. Our Practice Navigators provided a flexible, understanding and open-minded service, providing “whole person” support.

Rather than falling into the trap of “doing what’s best” for patients, without really consulting with them on a deeper level, Gateway’s services generally let the patient lead the support. We believe that asking someone what their priorities are, believing them, and working with them to build self-confidence and resilience creates a programme of support that is more successful and more sustainable.

Gateway POWS: unique support for mum

When social services become involved to protect an unborn child, who is there for mum?

Gateway Pregnancy Outreach Workers Service (POWS) is a unique service in this respect. Because, while social services and midwives – quite rightly – are focusing on the child, our focus is on mum. As far as we know, we’re the only organisation that can provide this intensive level of support to women during and after pregnancy.

The women POWS work with are referred to the service for many reasons. Many have issues with unsuitable accommodation, financial difficulties, problems with substance misuse, or risky relationships. All are vulnerable. Some have had children removed from them in the past, which means that their current pregnancy will be under increased scrutiny, bringing added pressures to an already difficult situation.

While this scrutiny and focus on the unborn child is necessary, it can often leave mum feeling bereft and unsupported, with her original needs unmet. And if she leads a chaotic lifestyle, with intermittent or no support from family or friends, then working on her own to build up the sorts of routines and networks that a parent needs (and that social workers and family courts will approve of) can be virtually impossible.

This is where POWS support is invaluable. Not only does a POW work one-to-one with mum to come up with an action plan, helping her to tackle issues in a methodical way, but she will also liaise with social workers and other services to ensure that they are aware of the changes being made.

Gateway POW, Shazia, who supported Chloe*.
In the video below, you can hear from Chloe*, who tells us about the support her POW Shazia gave to her, and how it changed the outcome of her social services intervention.

Shazia says, “Chloe was proactive – she knew the dangers and wanted to change – but she needed emotional and practical support to actually get stuff done. I was able to be there for her throughout the pregnancy, not just at the end of the phone, but with practical advice – signposting her to other services, going with her to appointments, writing letters on her behalf and making sure social services knew she was making progress.”

Just having someone available to talk to is really important, so POWS work together to make sure all their clients get constant access to support. Shazia works part time, so she introduced Chloe to another POW she could contact, and made sure she had the number for the office too. If anything happened and Shazia wasn’t around, someone else would be.

Shazia continues, “There were times when Chloe doubted herself and times when she struggled to understand what she needed to do, but as time went on she started to believe in herself and that’s when she really started to make changes. She was keen to prove herself – even requesting things like additional drug tests – and just generally needing me to do things for her less and less. A nice example is when I rang her to remind her she needed to register the baby’s birth – and she’d already done it!”

As you’ll see from the video, Chloe is still making progress. She’s a lot happier now, and a lot more confident in herself. In fact, we found out this week that she has been given unsupervised access to her other two children on a regular basis.

Even when a mum doesn’t get the outcome she wishes for, and a child is removed, POWS are able to continue supporting her for up to eight weeks. However, it frustrates us that we can only work with her for such a short time. A mother is extremely vulnerable – and likely to fall into old patterns – during this period, so continued practical and emotional support and guidance is absolutely vital at this time.

Finally: the sort of support offered by POWS isn’t just something that would be “nice to have” for hundreds of families – it also saves a surprising amount of money. The approximate cost of taking a child into care for nine months runs into tens of thousands of pounds, but the approximate cost of the combined preventative services accessed by a vulnerable mum over nine months is less than a quarter of that.

*Name has been changed

Stocking up on emergency supplies

Every day, our outreach workers visit clients all over Birmingham who are in need. Could you help us to help them?

Two of our outreach services, Gateway Healthy Futures and the Pregnancy Outreach Workers Service (POWS), work with people who are in the most “at risk” categories – and each week our staff are seeing more people in dire need of basic essentials from our food and baby bank. Could you help us to stock up?

Who we are working with

The Gateway Healthy Futures service provides a one-stop-shop for people with a wide range of social needs. GPs can refer anyone that needs non-medical help, so that includes people who have issues around things like housing, alcohol, finances, benefits, social isolation, and much more. Our Practice Navigators provide reassurance and a point of contact for the people they work with, as well as vital practical support.

One of the people recently referred to us by her GP is Angie*, who’s in her 50s and lives in Kings Norton. One of our Practice Navigators, Lindsey, visited Angie on a Monday morning a few weeks ago – and it’s a good job she did, as you’ll hear in the video:

We don’t normally start asking for donations until we are planning our Christmas Hampers, but we’d like to be able to stock up on more emergency essentials, so that we can offer practical help to people like Angie all year round. (Of course, this will be as well as the help we give them to access all the support they’re entitled to, and signposting them to other agencies for support.)

How can you help?

To help us stock up, we’ve expanded our donations list to include things that our Gateway Healthy Futures clients might need, as well as our POWS clients. If you’re able to donate any of the below items, they would be gratefully accepted at our offices: Floor 5, Chamber of Commerce, 75 Harborne Road, B15 3DH. Alternatively give us a ring on 0121 456 7820 and we can arrange pickup. We’d also love it if you could share this list with your contacts.

Imperishable food (unopened):
Tins – beans, soup, custard, peas, beans, fish (tuna, mackerel, pilchards) etc.
Rice
Flour
Herbs and spices
Lentils
Pasta
Pasta sauces/jars of sauce
Biscuits
Some sweets and chocolate would be nice

Toiletries (unopened) for men and women:
Toilet rolls
Toothpaste/toothbrushes
Shampoo/soap/shower gel
Body lotion/moisturiser/hand cream

Other useful items for men and women:
Packs of underwear, socks (these need to be new)
Woolly hats, gloves, blankets (second hand is fine if clean and in good condition)
Slippers – with backs, not slip-on (these need to be new)

Pregnancy Outreach Workers Service (POWS)
POWS works with pregnant women who have a low medical risk and high social risk, dealing with issues including temporary accommodation, homelessness, substance misuse, domestic abuse, offending, newly arrived communities, poor mental health and safeguarding. So our donations list for POWS clients includes some extras that will be especially helpful to new mums and mums-to-be.

Toiletries (unopened) for POWS clients, including:
Sanitary towels – the larger “maxi pad” type is better for new mums
Newborn nappies
Baby wipes
Cotton wool
Baby bath wash
Baby lotion
Baby clothes – up to twelve months as we have little space to store them (second hand is fine if clean and in good condition)
Books and toys for mums who may also have older children (second hand is fine if clean and in good condition)

We’ve also updated our Amazon wishlist, where you can buy items and choose to have them sent directly to our office.

Thank you very much.

How have I helped you today?

We thought we’d have a bit of a change from our usual fortnightly blog post and rather than a story from one of our services focus on something a bit more pictorial, with photos and comments from people we’re currently working with.  Hearing what people think of us and what they’re achieving or the changes they’re making is really important.  It’s essential in terms of us making sure we’re providing what people need and getting the level of support right but at the same time the information is often encouraging and thought provoking.

To make gathering this type of information quick and easy our Outreach Staff all have the www.impactassessmentapp.com installed on their phones.  At the end of each appointment or visit they use the app to gather a few simple things; a comment in response to the question “How have I helped you today”, a satisfaction rating – done by using a sliding scale and if they’re willing a photo, a bit of audio or even video.  We think it’s really important to record the comment as it’s said, sometimes the Outreach Worker will pass the phone to the client so they can type in what they want to say themselves or if not it’s entered exactly as it is said so it remains in the client’s voice.

We thought we’d give you an insight by showing you just a little of who we’ve been working with and what we’ve been doing together over the past few weeks.

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Jenny (right), her baby daughter and Collette, Pregnancy Outreach Worker

“I am happier than I have been in a long time.  I love my new flat and have been along to the Children’s Centre where there are lots of groups going on which I’m going to go to.”

 

daibetes-group-2
Ken, who’s reached week 9 of our Pre Diabetes Programme

“I now have smaller portions, more fruit, more veg and I exercise more.  All the talk about healthy options has been noted! “

 

 

 

 

june-hf
June, a recent referral into the Healthy Futures Service

“By telling me all the things that are available if I need them you’ve helped me realise there are still things available for me to do.”

 

 

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Mohammed, Pre Diabetes Programme

“I’ve gained knowledge about food but I’ve also made friends.”                    

 

 

 

xiaoli-pow
Xiaoli, client of the Pregnancy Outreach Worker Service

“We’ve talked about my birth plan and the things to expect when I deliver.  I feel I understand a bit more about labour now.”

 

 

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Jody (left) and her Pregnancy Outreach Worker, Sarah

“We’ve looked at properties together and we’ve also filled in the Sure Start Grant form.” 

 

 

 

 

Paul one of our Health Futures
Paul who was referred to our Healthy Futures service by his GP.

“You’ve referred me to a couple of activities I can go to this week. I’m looking forward to going to them, it gets me out of the house, I’m sick of looking at the four walls.” 

 

 

margaret-hf
Margaret who was also referred to our Healthy Futures Service by her GP

 

“You’ve helped me fill in the PIP application and given me a bit more confidence.”       

 

From the information we’ve collected via the app we also know that over the past six months we have provided one to one support to 1424 people and as we gather some basic demographic information we know various things like age and work status.  We can see that we’re working with a wide range of people which is important.

In terms of age the largest single group are those aged 50-64 with 420 people falling into this group but then in total 1045 were of working age,  321 people were over 65 and at the other end of the scale 43 were aged 18 or younger.

In terms of work 439 were in either full time or part time employment and 648 were unemployed,  then 45 were in full time education and 292 were retired.

Satisfaction – we talked about this at the start and how at the end of each appointment or visit we ask people to rate their satisfaction or happiness by indicating where they feel they are on a sliding scale, which is out of 100.  70% is the average score, so that’s like 7 out of 10, but what we can see is that 57% is the average people are scoring at the start of their support but by the end it’s increased to 77%.  This shows that satisfaction increases significantly as time goes on, but then that stands to reason as when people start to see or feel the effect of what they’re doing then their belief and confidence grows in us and the changes we’re making together.

Clinical study shows that POWS improve maternal mental health

We talk about “evidence-based” services a lot, but for social interventions such as our Pregnancy Outreach Workers Service (POWS) it can be difficult to find proof that the service is successful without resorting to anecdotes and self-reported data.

mum-and-baby

However, a group of researchers at the University of Birmingham, funded by CLAHRC (Collaboration for Leadership in Applied Research and Care) West Midlands, have recently published their findings from a clinical study into the POW service – and we’re very pleased to note that it shows clear statistical evidence of benefit to the women we support, particularly with regards to their mental health.

The study

The research took the form of a Randomised Controlled Trial (RCT) – the most academically rigorous way of determining whether a cause-effect relation exists between treatment and outcome.

It looked at 1324 women, some of whom received standard maternity care and some of whom were supported by POWS, and compared outcomes such as antenatal attendance, postnatal depression and mother-to-infant bonding.

The findings

The study found that mother-to-infant bonding is better when mum has the support of a POW.

It also found that, for women who have two or more social risk factors, the intervention of a Pregnancy Outreach Worker was beneficial in preventing postnatal depression.

The study adds, “this finding is important for women and their families given the known effect of maternal depression on longer term childhood outcomes”. It concludes:

This trial provides evidence that a lay support service targeted to women with two or more social risk factors improves aspects of maternal psychological health relative to controls; such improvements are likely to be of lasting impact due to the known effect of maternal depression and poor attachment on longer term childhood outcomes.

This, together with the relatively low costs of the service, means that consideration should be given by policymakers to introduction of a lay support service.

When the trial was being carried out, we worked with a much wider group of women than we do now. The research showed that our interventions have the biggest impact on women with two more more social risk factors – and it is this group that we now work with exclusively.

Our POWs work hard to offer early help to women who are at risk; to make sure that baby arrives safely, and to support mum to be the best parent she possibly can. This study is incredibly helpful in validating the work our brilliant POWs do, and we’re delighted to see it published.

You can read the full study on the BMJ Open website here.

Gaps in service leave women in danger

Mind the gapAt Gateway we often find ourselves “filling in the gaps” – in funding and in service. And on Thursday last week we were faced with a very stark reminder of this.

Julie (not her real name) was referred to the Gateway Pregnancy Outreach Workers Service (POWS) by her midwife, and assigned to Denise. They met for the first time on Thursday, at the house Julie shares with her partner.

Within minutes of meeting, Julie told Denise that she felt unsafe in the house, especially now that she was pregnant. She explained that her partner was extremely controlling and regularly violent. Although the police had been involved already, she’d denied the abuse when questioned in front of him because she was frightened. She told Denise, “right now, he’s asleep upstairs. If I leave him, I need to do it now.”

In a situation like this, the plan is always the same, and POWS know it by heart: get the woman to a place of safety, give her an opportunity to talk, and find her somewhere to stay.

Denise immediately called a colleague to pick them both up and let her manager know what was happening. While they were making their way to the Gateway offices so that they could talk openly, her manager was calling the relevant agencies to find Julie some accommodation.

However, it soon became clear that all was not going to go to plan.

Not pregnant enough

Denise and her manager Michelle made nearly 30 phonecalls on Thursday and not a single agency was able to accommodate her. Julie fell outside the criteria for every organisation.

None of the places of refuge, charities and other organisations – and yes, we tried them all – could take her because she is an overstayer (she had originally come to the UK on a short term visa, and hadn’t returned at the due time).

Apparently the fact that she is here illegally – despite having lived in the UK for many years and having a National Insurance number and NHS number – overrides the potential danger to her life.

Birmingham MASH (Multi Agency Safeguarding Hub) can help pregnant women, even those with immigration issues… but only from 20 weeks. At 15 weeks, Julie is not yet pregnant enough.

We are absolutely not looking for blame here; we are looking for solutions. Each organisation has to have boundaries, and for good reason, but… where is someone like Julie supposed to go?

By late afternoon things were looking desperate, so Denise took Julie to the police station (although of course this met with some resistance from Julie). After waiting to be seen for an hour, Julie told them everything; how she was trafficked here in the first place, why she can’t return to her home country, and the history of violence with her partner. But, again, it came down to “this is an immigration issue”.

We asked again, where is she supposed to go?

The police suggested many of the places we had already tried and eventually persuaded the Salvation Army, who had already refused her a place, to give Julie a bed for that night. But it was for one night only, and she would have to leave by 9am on Friday. They also suggested we go to the Neighbourhood Office first thing the next day.

In the morning Denise picked Julie up from the hostel. Together with a council officer at the Neighbourhood Office, Denise, Julie and Michelle spent another frustrating day speaking to agencies – many of which they’d already tried – and coming up against the same barriers. Referrals would go so far, only to be refused due to Julie’s immigration status and the fact she has no recourse to public funds.

By the time the office closed, Julie had had enough. She was tired.

That evening, she went home to her partner.

What’s the answer?

We don’t know what else we could have done for Julie, but her situation is by no means unique. It’s so frustrating to see someone in need and not be able to help them.

We are still supporting her, of course; we’re helping her to find out if she has grounds for citizenship and helping her to put together all the paperwork and information she needs to “become legal”. In five weeks’ time she will be able to re-apply to MASH for housing because she will be 20 weeks pregnant – and we will help her through that process too. We are giving her food and toiletries and ensuring she has access to her midwife, despite what is now an even more dangerous situation at home.

But we can’t make sure she’s safe, and that is incredibly, horribly frustrating.

Health Trainers go above and beyond

When you hear the term Health Trainer, you might think of the work they do to support people to diet and get down to the gym.

Health Trainers Josh and WayneBut a Health Trainer’s work isn’t all about healthy eating and exercise. Health Trainers, like all of our services, support the whole person.

We know that people who are in debt or worrying about their housing are less likely to stop smoking or to start eating well. Once someone feels like their life is on a more even keel, however, they are more likely to become physically healthier.

So, for us, it’s important that Health Trainers look at all the issues that their clients face and support them with any changes they want to make. This might mean signposting someone to another agency for help with substance misuse, finances, domestic abuse or housing; or it might mean giving them the opportunity to find – and the confidence to join – community groups or classes.

Health Trainers, like all Gateway’s staff, are trained extensively to equip clients with the latest information on, for example, changes to the benefits system and other social issues that could affect them.

They’re also experts in behavioural change, and the principles of behaviour change apply across the board – so seeing a Health Trainer, and learning how to recognise patterns of unhelpful behaviour, can have a positive impact on all areas of a person’s life.

And, of course, being part of Gateway means that Health Trainers have access to a huge knowledge base and network. So although they can’t be experts in everything, they are experts in finding someone who is!

In some cases Health Trainers get involved with organising groups, classes and events themselves. Just this week we received a letter from Pauline at the Long Term Conditions group that we help to run:

“…we would not have been able to continue with the group meetings without Gateway’s help. All the members of our small committee have long term health conditions and, as each year passes, we depend more and more on Gateway to expertly manage our budget, make all the arrangements for our speakers, catering and venue, arrange transport for those who need it and generally and enthusiastically make tea, answer questions, assist the less able with their lunch and much more………and all with a smile. They also help us to complete the CCG forms and signpost us to services that can help with specific problems…..as well as encouraging those who are able to go to the meetings that enable us to contribute our opinions (and needs) on health and social services matters.”

Wellbeing Advisor Scheme

One way in which we are currently building on the work that Health Trainers do, and evolving the service, is via a new Wellbeing Advisor scheme.

This is a pilot we set up with a group of nine Northfield Practices within Cross City CCG who form the Northfield Alliance.

All the practices have a Health Trainer assigned to them, so they’re already familiar with the service, but one practice and GP in particular, Dr Peter Arora from Jiggins Lane Surgery, wanted a service that also met the needs of patients who were presenting with an increasing range of social issues, including debt, caring responsibilities, housing problems and social isolation.

So we met with Dr Arora and our Health Trainer Commissioner, Elaine George, to agree how we might be able to support clients, and what sort of referral pathway would work best.

Now, GPs and other practice staff at Northfield Alliance practices directly refer to Health Trainers as before, but the referral form lists any additional social issues and Gateway effectively takes responsibility for that client and any interaction or engagement they have with other agencies.

walkingOur main partner in the scheme is Citizens Advice Bureau (CAB) and in agreeing to be referred to the scheme, patients agree to a referral to both Health Trainers and CAB. Obviously for some people, their social issue takes precedence and in those cases we refer them to CAB initially, but then follow up at a later date to establish if they are at the point at which they’d like to work with a Health Trainer for lifestyle support.

While CAB are the main partner, Health Trainers also direct people to other agencies, such as our own Befriending Service, and of course through setting up group activities themselves such as EXTEND classes, Long Term Conditions groups, and walking groups.

Being able to support the whole person, and provide behaviour change tools to influence all aspects of their life, from health, to wellbeing via finance and housing means, we believe, more sustainable results for that person, less pressure on services such as GP, Social Services, DWP etc and a happier, healthier population.

Sharing our knowledge with the Child Poverty Commission

Did you know that Birmingham has a Child Poverty Commission? The cross-partner Commission, which includes the Council, the University of Birmingham and The Children’s Society, was set up in March last year to look at ways of reducing child poverty and making sure children are not disadvantaged by their background.

It’s early days for this group, though, and the first stage is for them to get the fullest picture of the extent of the issue. So we’re very pleased that they’ve asked us to get involved and share our knowledge.

At its launch, the Council’s press release about the Commission said:

“As well as asking professionals to give evidence, the commission wants to listen to the everyday experiences of children and families living in poverty and understand poverty from their perspective and bring to life the stories of children and families behind the hard statistics.”

We were asked by the City Council to get involved as they recognise that our Pregnancy Outreach Workers Service (POWS) works with some of the most in-need families in the city. The Commission is keen to see case studies and information compiled via our Impact Assessment App, but they’re also really keen to hear some experiences first hand, so they’ll be visiting us in a few weeks’ time to meet some of the families we work with and hear how life is for them.

POWs’ experiences of Child Poverty

mother-babyPOWs support some of the most vulnerable women and families in the city, and they come face to face with child poverty on a daily basis. The issue is immense… and it’s growing.

Some of the women we work with don’t yet have a child so, in these cases, “child poverty” includes the strong potential for the baby to be born into poverty.

More than 75% of the women we support record “Financial Hardship” as a current issue when they are assessed. This means they have unmanaged debt, rent arrears, or a low income and, in many cases, all three. For many of the women we visit, we also record that their living accommodation is unsuitable. This could mean overcrowded, in need of repair, or unsafe, and of course we have to take into account the imminent arrival of a baby. The main barrier the women have to changing this is financial hardship.

Since the POW service changed last April to working with the most vulnerable women only, we’ve seen demand for food parcels and hardship payments double. We are also seeing a growing number of women who are underweight or suffering from dietary deficiencies. This issue becomes a real danger during pregnancy, both to mother and child.

Although we do what we can, there’s a limit. Frequently, despite the hard work of our POWs, we’re not able to make things all that much better. To be honest, we often feel a bit helpless. So we’re very pleased to be able to talk about our experiences to the Commission and, hopefully, help to make a difference.

Celina’s Story

Celina* came to the UK from the Caribbean because she had been suffering domestic abuse from her partner (she has actually suffered a miscarriage in the past as a result of the abuse). Legally she should have returned to her home country by now, but her partner has been threatening her family and she is understandably frightened to return.

Celina’s had a lot of complications and medical issues during and since the birth, but her baby is doing OK. Like most of the women POWS support, Celina has dire financial hardship, and because she is now an overstayer, she doesn’t have any access to funds at all. She cannot claim any financial support and wouldn’t be allowed to work even if she could. She has told us she is worried for her own survival.

Just before Christmas, Celina’s Pregnancy Outreach Worker Jacque took Celina a Christmas hamper which included a few essentials – food, baby items and toiletries – as well as a couple of treats for mum and baby. You can hear Celina’s reaction in the video below.

*name has been changed