So how can Gateway’s Pregnancy Outreach Workers Service help people to break this cycle?
Admitting that you need help is a really positive step, but you have to be prepared to work towards the life you want, too. So our POWs are trained not just to give practical advice, but to help women take control of their own lives in order to move forward.
Saira’s story
Saira was referred to the POW service by her midwife. She and her husband were living in a flat above a shop after having to move out of a shared house. But the flat was full of mice and cockroaches and its only access was via slippery fire escape steps.
Saira was clearly suffering from depression and low self esteem. In a recording made by her POW, Maria, it’s clear she didn’t believe she had any control over her situation. She says: “I’m pregnant; I have no family support. I don’t know what’s going to happen right now. It’s dangerous living here, but what can I do?” In a quiet voice, she asks, “Is there anyone out there who can help me?”
During Maria’s first visit, she explained to the couple how they would need to work together to sort things out. “I took them aside separately and said ‘we all need to work at this, and you will need a lot of patience, because it’s going to take time’,” Maria says. “No-one has a magic wand.”
Like many clients, Saira says she liked Maria because she felt that she wasn’t judging her. Maria’s help was practical and without prejudice.
“On the first visit, I phoned around and we started to apply for the various things that they were entitled to and needed to sort out,” Maria says. “For example, Saira had put off applying for income support because she thought it would affect her partner’s finances, so we worked that out, and got him to apply for working tax credit.”
But, as they unravelled some of the financial issues, Maria was also working towards raising Saira’s self-esteem.
For example, Saira was so self-conscious that she didn’t want to go to antenatal classes. She said she felt fat and didn’t want people to see her. Maria’s approach was to try and make her feel better about her body image in other ways. “I asked her to send me photos of herself on the days that I didn’t visit her – just for my benefit, so I could she she was OK,” she explains. “In the first few photos she sent, she’s looking down at the floor, but after a few weeks she’s smiling and looking into the camera. She’s starting to feel better about herself; she doesn’t mind the idea so much.”
They talked about the future. “I asked her to think about what she wants to achieve in life,” says Maria. “It’s something that many women forget to think about when so much else is going on. She told me lots of things, but I helped her to see that what it boils down to is taking more control. So we talked about that. I got her to realise that she is already very powerful – after all, she had carried a baby! – and we discussed how she must make sure to retain that feeling of power when she deals with everyday situations.”
Since Maria’s first visit, which was almost six months ago, Saira’s depression has started to lift. Now that they have split the practical issues into more manageable chunks, she is finding the confidence to ask for help with the things she needs. She asked a friend to help with the deposit on a better home – something she hadn’t wanted to do before. She’s making phonecalls herself. She takes her baby out and about to clubs and support groups and is even talking about going back to work.
“She doesn’t wait for permission as much as she used to,” Maria says; “she speaks out a bit more. And she’s gone from feeling tired, exhausted – and even threatened, worrying that her baby will be taken away – to realising that she is a good mom.”
In this audio clip, you can hear how Saira’s language has changed from where she was at the start. Rather than hoping that someone will step in, she talks about specific issues and sounds far more active. There’s still a lot to sort out, but she’s in control and – with support – she’s prepared to work for it.
listen to ‘Gateway Family Services: Saira’ on Audioboo
We’re pleased to announce that we have a date for the 2013 Gateway Fun Run!
It’s a 5km course (that’s just over three miles) and everybody’s welcome, whatever your ability. You don’t even have to be able to run the course – you can walk it if you like.
Following the success of last year’s run, when around 70 people took part, we decided to make it an annual event. There were runners, walkers and even mums with buggies! Most people were linked to Gateway in some way – lots were current or past clients of our Health Trainer or Lighten Up services – but some were people who had just seen the adverts and turned up on the day.
The Gateway Fun Run is part of our ongoing work to provide a variety of easy and accessible ways to get active. This is just one option but this gives people the opportunity to do something as a group knowing they’ll draw support from each other.
Last year, Joan was the oldest participant at 80. Following a serious illness, she’d been working with one of our Health Trainers – and increasing her walking was something they’d been doing together. So they suggested she come along and take part, which she did as part of her recuperation. Joan said: “the best thing about today has been walking in company and, of course, the sense of achievement at the end”.
Charlene also took part. She came along with her slimming group, many of whom had signed up through the Lighten Up weight management scheme. She too had health issues, so decided to walk – but was delighted with herself for completing and said: “Coming here today has given me the boost to get out there and do more walking”.
Watch Charlene’s video:www.youtube.com/watch?v=n0Cdvsa1wcU
If you’re looking for a way to get more active and you want some motivation, a fun run is a great thing to aim for.
As NHS Choices explains :
Running is free, you can do it anywhere, and it burns more calories than any other mainstream exercise. Regular running and walking can reduce your risk of chronic illnesses, such as heart disease, type 2 diabetes and stroke. It can also boost your mood and keep your weight under control.
If you’re interested in taking part in the Gateway fun run, give us a call on 0121 456 7821 or email maxine.brown@gatewayfs.org to register your interest.
We’ll then be able to tell you about the group training we have planned as a warm-up to the July run. We’ll be offering a weekly walking group and a running group to cover different abilities, to help you get into training. We’ll also put your name down for a goody bag!
Ideally, we hope that people who take part in the fun run will get a taste for it and perhaps think about joining the weekly Cannon Hill Parkrun . Around 200 people complete the Parkrun every week – why not you?
Yesterday saw the final session of our 20 minute walking group , based at Shenley Green Surgery. As previously mentioned, the idea for this group was to provide some gentle group exercise for those who, for a range of reasons, can’t manage to join a regular walking group.
After a two week delay due to the bad weather, our intrepid group took a stroll up to Ley Hill Park in the sunshine yesterday.
Overall ,
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Keiran drew lessons from the previous walking group he’s organised to develop and promote this programme – and to get as many people as possible to complete it. “I promoted this as a course with a completion date, to give the walkers an aim and encourage them to attend all the sessions,” he explains. “This was reinforced with mid-way incentives – we gave the attendees pedometers and, at the end, each participant received a small prize for completing the course.”
Although he had planned many aspects of the programme, Keiran still had to adapt his approach slightly as they went along. “In the first session, I found it harder than I’d anticipated to cater for slower and faster walkers – even after only 20 minutes, it’s surprising how much a walking group can separate,” he said.
“So we arranged for two Gateway volunteers to get involved in the planning of the next five sessions and to help co-lead the walks. This meant we could focus on individual needs more, allowing walkers to increase their capacity and make the most of their time.” Of course, it also allows the volunteers to gain some valuable experience in event planning and leadership.
Each of the sessions kicked off with a short health awareness talk before the walking began. Various things were covered, like diet advice and safe ways of exercising.
The future of the assisted gentle exercise programme is bright. Most walkers have said they’d like the group to continue and some have already arranged to meet next week. Keiran’s arranging some further volunteer support for them, so that – ideally – this group can continue to meet up fortnightly from the surgery. In the meantime, he’s working on starting up the next walking group, with new participants to start in six weeks time.
“Overall, I’m very happy with our success,” Keiran says. “I’m really looking forward to the next one!”
Most people who use the Health Trainer service want to lose weight – but their stories are very different. That’s why the support we offer has to be different for every person.
One of the ways we make sure that we tailor our services to each person is by gathering information on our new Impact Assessment App. Rather than writing up a report after an appointment, the App allows us to record the client directly, during the visit, in their words. It records text, video, audio and images.
And the App allows us to record their journey from beginning to end. After a few appointments, we can sit down with a client and look back with them to see how far they’ve come.
So here are a few examples of the variety of help that the Health Trainers give – in the words of their clients.
Thomas
Eighteen year old Thomas came into the service in late Nov 2012 with a BMI of 50.
Four months later he said:
This is my 5th appointment with my health trainer today. So far I have lost 2 stone 10 pounds. I feel really good about my weight loss; as a young man I was embarrassed about my weight, and I’m not now. I wished I had met my health trainer last year. How I’ve lost the weight is by eating breakfast and lunch and an evening meal every day, and eating fruit and vegetables. The correct amount is crucial. I am looking forward to meeting people now, I go shopping, and I’m enjoying life more. Thank you for everything. You have been great.
Aston
Aston, aged 52, was referred by his GP at Karis Medical Centre at the beginning of March. He needed support with healthy eating as he eats very little during the day but then eats a lot in the evening, which is bad for him as a diabetic. One of the first things Joy his health trainer asked him to do was keep a food diary for a couple of weeks.
Completing the food diaries has helped me to see where I can start to make changes. I’ve decided to make a start with eating breakfast and looking at the menu options you gave me.
Nyachin
Nyachin is a 17 year old student who lives in Edgbaston. She wanted to lose weight so she would feel more confident and be able to wear trendy clothes. She began working with her Health Trainer just before Christmas. She’s now just had her fourth appointment and says:
Your advice has helped to keep me motivated and to think about what I am eating. You have given me more information and support to help me continue with the changes I have been making.
Her happiness score has increased from 65% to 100% in three months.
Derek
Fifty eight year old Derek was referred into the service in October 2012. At the time, he said:
Over the years my weight has kept going up and up. I was buying larger tops, now I’m wearing size XXL. I’m at my heaviest ever at 29 stone. Wayne [the Health Trainer] is advising me on healthy eating, portion sizes and doing moderate exercise. I feel really crap at the moment – Wayne you’ve got your work cut out as I’m hard to motivate!
In March 2013 he said,
I’m a driving instructor with major weight problems; my car seat was pushed that far back no one could sit in the back. After six months of being with my health trainer I feel so much better. My car seat has moved forward and my pupils are asking me my secret to losing weight! My health trainer has changed my life. I’ve still a long way to go but I’m doing it. I’ve lost weight before but put it all back on, and more besides. I now eat three meals, have fruit every day, drink water and eat no rubbish. Cakes, crisps, McDonalds have all gone! I have lost four stone so far.
Rhiannon
When 35 year old Rhiannon from Ladywood started working with her Health Trainer in January, she said:
I’ve tried many times to lose weight, so I’m really glad you can support me because I know I can’t do it on my own.
Two months on, she said:
I’ve lost over 2 stones with your help and I’m really happy. You made me feel good about the two stone I have lost so far – and to concentrate on this and not the 2lbs I’ve gained.
Clare
Clare, from Longbridge, is 25 and came into the Health Trainer service with her husband.
In February, Clare said:
I have no confidence at all.
Three months later, her Health Trainer took this video:
However they always have an eye on when their support will end – and much of what they do is to prepare the woman for this. Ideally she will be on a more stable footing and well able to be independent. For some women the journey is longer so there will still need to be a support network in place that adequately meets her needs. The aim to to ensure there is a seamless transition and that she doesn’t get lost in the system.
Michelle POW Programme Manager explains; “Ideally handover is something that is thought about before baby comes along. We like to ensure that every woman has at least one professional to turn to, should they need them. Frequently the handover is to a Family Support Worker so what we’ll try and do is arrange a visit to the local Children’s Centre while mum is still pregnant. Not only do they get to meet their Family Support Worker and begin to establish a relationship but they see what’s on offer and what they can tap into, so classes, groups etc.”
Michelle continues: “Sometimes mums-to-be, particularly those pregnant with their first baby, may worry about where to get support if they should need it once the POW is no longer around. This shows them that it’s there. It’s one less thing to worry about. It also means that they get familiar with the facilities before baby comes along, which is always a busy time, and it won’t all be new to them.”
Natasha’s coming to the end of her support from Rachael, her POW. She’s made real progress and it’s hoped that in a few months she’ll be ready to apply for her own house so she and her baby can live independently. For now, though, Rachael feels Natasha still needs some extra help – which is why she’s introducing her to what her local Children’s Centre can offer – and Natasha’s already applied to do their Positive Parenting course.
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Some of the women we support are going to need more help than others. In many cases the POW has been able to solve the problems the woman was referred to us with, but in some complex cases this isn’t possible. In this situation it’s about working in partnership with other professionals and ensuring that everyone knows the part they have to play.
Miriam, one of our POWs, has concerns about one of the women she’s supporting: “She had her baby six weeks ago but due to some recent changes both she and I feel she needs some specialist help. So I’m going to initiate a CAF (Common Assessment Framework). I’m just filling out the paperwork to get things underway because my aim is to make sure the initial meeting happens before my support ends. I’d like to see who’ll be responsible for doing what and make sure someone takes over the role I’ve been doing which has been sort of co-ordinating things”
Michelle adds: “It depends on the woman. We take a lead from her and how well she’s coping. What is set is that handover must happen. There are things we do as part of it that are standard, like making sure mum knows how to register the birth, that she’s getting the benefits she’s entitled to and that immunisations are booked in, but what support remains is a unique thing; it’s tailored to the individual.”
Of course we, as professionals, know what the risks are for smokers – but sometimes clients just don’t want to make it a priority. Or perhaps the client tells us they do want to address it, but it’s one of a long list of things. It’s quite a skill to support clients in tackling a whole range of issues AND keep smoking cessation on the agenda.
So how do we do it? We tend to find the holistic approach is beneficial for all of our clients. Rather than adding “stop smoking” to a person’s already long “to do” list, we help them to deal with all of the issues they have in a logical order. By helping someone to begin making positive changes in other areas of their life, we often find that they decide to tackle smoking as part of a new routine.
Health Trainer Susan says, “persuading someone to get out of a routine is difficult; it’s scary for them. But once the changes start happening, we see a knock-on effect.”
Sean, another Health Trainer, agrees. “If someone starts exercising, for example, we’ll often find that other positive lifestyle changes come from that, even without much further intervention. They start eating more healthily. They’ll gain confidence. Giving up smoking is one of the things that we continue to talk about as part of that chain reaction.”
Our Health Trainers frequently find that those people who don’t choose smoking as their first priority can be convinced to come back to it. What happens is that they first need to see they can make big changes to their life. So, for example, someone who’s been supported to lose weight sees for themselves what they can achieve with a bit of encouragement. Then, they can decide to tackle something else – maybe something that they felt was out of reach, like smoking.
The Health Trainer is key to this as they’ve already been there in the background helping and supporting them, so they’re trusted to do the same thing again.
For the Pregnancy Outreach Workers, the balancing act can be particularly difficult. Of course, time is of the essence, as the earlier in the pregnancy the woman can stop smoking, the better. However when a woman has a range of issues, some often complex, there can be a lot to tackle in a short time. Team this with the fact that pregnancy is already an emotional and vulnerable time, and women can feel a bit bombarded with do’s and don’ts. We know from experience that this is when behaviour change is far less likely to happen, so it’s vital to deal with the issues with consideration.
“We have to make sure to assess a client’s whole environment before tackling things like smoking,” says POW Sophia. “It’s important to get to know the client and build up a relationship with them – to really understand the bigger picture – before we can suggest it. There are usually lots of other problems that need to be dealt with and giving up smoking is often the last thing they want to do.
“For many clients, smoking is the only link they have to ‘life before baby’ and they see it as a stress relief – a way out. So if we’re going to persuade them to give that up, we have to pick our moment very carefully. It’s tricky, but we always find a way.”
Also, though, the volunteers themselves are benefiting – as, not only does volunteering make you feel good, it’s now proven to improve your health! A recently-published study has found that people who volunteer enjoy healthier hearts. That’s right - doing good is good for you!
Making a difference – the story so far…
So how does the volunteers programme work?
Clients are referred from other departments within Gateway – POWs, Health Trainers and Lighten Up – and via other routes, like partner organisations or GPs. Then Chelsea Gaffey, the administrator for EAST (Employment Access, Skills and Training), carefully matches volunteers with clients based on practical considerations like where they live and their availability, as well as interests and relevant experience.
“Some people are volunteering as part of their university course and using it as their placement, so if they have other skills to offer we try to take these into account too,” says Chelsea. “Some clients have specific needs, so we look for volunteers that might have dealt with similar issues previously.”
“We’re really happy with how it’s going so far,” Chelsea continues. “Our first group of volunteers are settling in really well – and we’re preparing to interview the next batch in the coming week.”
Practical and emotional support
Eleven volunteers already have at least one client of their own and are supporting them in all sorts of ways.
Lorraine has been attending slimming classes with a client who didn’t feel confident going on her own. As well as providing some moral support she’s also helped her to start managing her finances a bit better. Just having someone who’s available to help with a little practical and emotional support can be a big boost.
Tareena helped her client to find alternative housing, as the conditions he was living in were very poor and he was being threatened by his neighbours. Together, they’ve visited Shelter, who found him a new place to live. Now he’s very happy – his new accommodation is warm and clean and he’s able to cook his own meals. This client has many health issues and, without support from people like Tareena, he might not have been able to set the wheels in motion to get the support he needed.
One of our partners is the Thomas Pocklington Trust , who specialises in providing housing and support for people with sight loss. Social isolation and lack of interaction can be major problems for people with sight loss, so our befrienders have again been able to help. Volunteers Lorraine, Hannah, and Stephen have all supported people with visual impairment over the last few weeks. The help they’ve been able to give has been varied; accompanying their clients to the shops or to medical appointments, going for walks and even helping with IT problems.
There are still a few places available, so if you’re thinking that you’d like to give this type of volunteering a try, why not get in touch ?
Gateway’s volunteers programme is funded by the Big Lottery Fund.
That’s 85%, compared to an average of 65% in the wider community*.
In December alone there were 17 births and 16 of the women initiated breastfeeding – a whopping 93%.
Increasing the rate of breastfeeding is something that’s important at both a national and local level, so we’re delighted to be doing our bit to reach the city’s targets.
Most clients want to breastfeed – they know it’s the natural thing to do and the benefits it brings – but sometimes they need just that extra bit of help. That’s why all of our POWs are trained in breastfeeding support as part of Unicef’s Baby Friendly Initiative .
Before the baby arrives, POWs give their clients lots of information, including leaflets and DVDs from the World Health Organisation and Unicef. Often, POWs will watch the DVD with the client so that they can explain or interpret it, talk about it and answer questions. We also run group sessions where POWs can demonstrate different breastfeeding techniques using dolls.
Sophia and Khadijah run a session at Springfield Children’s Centre. “It’s a six week course, where we show the DVD and give out handouts, as well as giving demonstrations of things like how to help baby latch on,” says Sophia. “We answer questions and discuss worries so that the mums are as prepared as possible. Then, for up to eight weeks postnatally, we visit mum and baby to give some extra support when they need it most.”
In this video of a typical breastfeeding group session run by the POWs, Colette uses a doll to show some different techniques for breastfeeding:
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Another POW, Jacqui, says, “At the time of the birth, breastfeeding support is vital. We find that if the mother doesn’t get enough help and encouragement straight away, in the hospital, she’s more likely to start bottle feeding. That’s where POWs can really make a difference.”
Jahanara’s client had her baby on Sunday. “I was her birthing partner,” she explains. “Before the baby was born, the mum had told me that she wanted to breastfeed; this is her second child and she’d already told me how difficult she found it when she bottle fed her first baby. So I knew it’s what she wanted – but, after giving birth, she was so tired, she just didn’t want to do it. She wanted to give the baby a bottle. So I gently reminded her of everything she’d talked about before, and encouraged her to try again. Now she’s very happy to be breastfeeding.”
*published average breastfeeding rates for 2012 in the wards we cover. Source: Birmingham Public Health Health Inequalities Action Plan 2012 .
