Since Gateway began in 2006, our tag line has been “Changing Lives, Changing Services”.
To change services, we have to play an influencing and sometimes challenging role, sharing evidence of the need for change. That’s why we have always seen it as part of our responsibility to gather views from service users, ensuring that what they say is heard by decision-makers and other people of influence.
And that’s why we’re delighted to announce that Gateway will be providing Birmingham and Solihull’s Maternity Voices Partnership.
A Maternity Voices Partnership (MVP) is a team of people who work together to review and contribute to the development of their Local Maternity System (LMS). Gateway will be bringing together regular panels of service users (people with experience of maternity services, and their families) and service delivery representatives (like commissioners, midwives and doctors) to ensure that a wide range of voices are heard.
Why Gateway? Well, having run the Pregnancy Outreach Workers Service (POWS) for over a decade, we’re ideally placed to deliver – if you’ll excuse the pun – the Maternity Voices work. We know that there is often a lack of awareness of services in the places where those services are needed the most, so we’re particularly keen to be part of a national programme that wants to build better relationships with hard-to-reach communities, and hear from as many service users, from as many different backgrounds, as possible.
Through POWS, we have already established strong connections within those communities that are known to have a poor take-up of services. We also have strong connections with midwives, Children’s Centres, Social Services, housing providers and other third sector organisations who work with pregnant women – particularly in areas of multiple deprivation. Gateway’s staff are often from these communities themselves, and are experienced in working with and encouraging people who don’t typically come forward.
Gateway’s role will be to form the MVP, finding the right people to be part of it, ensure the quarterly meetings cover topics that are of relevance to service users. Then, we’ll provide the Partnership’s feedback to the LMS Board.
We will soon be advertising for service users to get involved, we’ll be providing training to prepare them for the first meeting in July. If you have recent experience of Birmingham and Solihull’s maternity services, and you’re interested in finding out more, please contact our MVP Co-ordinator Sharon Bartlett at email@example.com.
This MVP will be part of the new Birmingham and Solihull United Maternity and Newborn Partnership (BUMP), which has been set up as a result of the National Maternity Review (Better Births). We’re very much looking forward to being part of project BUMP, giving as many people as possible a voice, and bringing the ambitions of the National Maternity Review to life.
(The photos on this page were all taken by, or of, our Pregnancy Outreach Workers.)
Last week, we ran the first session of training for our Peer Educators: young people who will be going into schools to talk about their experiences of parenthood.
We’re delivering this programme in the West Midlands in partnership with Straight Talking, a London charity that employs teenage mothers and young fathers to educate young people about early parenthood, healthy relationships, child sexual exploitation and sexting, enabling them to make responsible life choices.
Gateway was chosen to deliver the programme in the West Midlands because of our proven successes with services like the Pregnancy Outreach Workers Service (POWS). It’s thanks to networks and experience like this that we’ve been able to recruit young people to the programme very quickly and hit the ground running. You can hear from one of them, Emily, in the video below.
The point of Straight Talking’s Peer Educators scheme is not only to reduce the high rate of teenage pregnancy and child sexual exploitation in the UK, but to support teenage parents themselves to achieve economic wellbeing and quality of life. Because the work is paid, with full training, it offers really good work experience, building confidence and opening the door to potential longer term employment. We love this model of working – employing people with direct, personal knowledge of the issues their clients face, and helping people to help each other – and it fits perfectly with our values, aims and objectives.
Last week’s training was led by representatives from Straight Talking, together with two Peer Educators who have been working with Straight Talking in other areas of the country. It began with some sessions in the training rooms at Gateway, including how to manage a classroom – no easy task! – and how to get pupils talking. The experienced mentors helped the new recruits to learn how to set ground rules and lead ice-breaker activities that will help them to start conversations and debates with pupils.
The next day, the new Peer Educators got to see how it worked for real, as they shadowed their mentors and watched them lead some Straight Talking sessions at Grace Academy in Solihull. Gateway’s Programme Co-ordinator Caroline (pictured at the top of the page with three new recruits) said, “it was really interesting to see how engaged the pupils were and how much they seemed to enjoy learning from the Peer Educators. There were some good debates and the hands-on activities really got the pupils thinking – like deciding how they would prioritise if they were faced with having to budget for a young family. Each session ended with a young person telling their own story of becoming a teen parent, and each time it was really powerful. It clearly makes a big impression on the children.”
In the video below, Emily talks about why she wants to be a Peer Educator, and why going into schools to talk about being a teenage mum is helping her, too.
Ruben from Straight Talking said, “Working with Gateway is going to be important for Straight Talking, simply because they share the same ethos as us, which is working with people to try and get them back into employment, and working with teenage mothers to give them the best health and wellbeing. You can tell straight away with the people that Gateway brought in that it’s going to be a good working relationship.”
We’re really looking forward to finding more young people to become Peer Educators over the next few months. If you became a parent when you were a teenager, you’re still under 25 now, and you’d like to find out more, call Caroline on 0121 456 7820.
Shazia has been a POW since the start of the service in 2007. At the time, she wasn’t sure what she wanted to do – she’d done some teacher training but knew it wasn’t for her. However, as part of teacher training she’d met someone involved in the health sector, and felt immediately that she would be more suited to this sort of work.
Soon afterwards, she saw an advert for the new Pregnancy Outreach Workers Service and liked the idea of it. “I liked the fact that there would be no routine and I would be doing something different every day, and that I’d be in charge of my own caseloads. I always knew I wanted to help people and that’s exactly what I would be doing.”
Shazia puts her ability to engage with people down to her sense of humour. “I’ll make fun of myself if I have to. Helping clients to see the humour in situations breaks down barriers and brings people closer together.”
Shazia’s most memorable clients are those who have had issues with substance misuse. “When I started, my knowledge of drugs wasn’t great – I knew a bit about it but not much – but over the years I’ve learned a lot from my clients. Now, I understand the phrases people use, and the way users think.”
She continued, “the thing about addiction is: there’s no point in patronising someone or telling them they shouldn’t do what they’re doing. They know this already. They feel a terrible amount of guilt. They deserve to be treated nicely.”
She went on, “the pull of addiction is really, really strong. If the only people you know are dealers or addicts themselves, and they all have your number and know where you live, that’s a hard environment to get away from. Most of the addicts I’ve met started using in response to abuse or trauma from a young age – things they’ve never had any real support for – so the problems go very deep.”
Shaz recently bumped into someone she supported six years ago. As they chatted, the woman thanked her, saying, “you were the one who treated me like I mattered, and didn’t look down on me”.
Shazia says, “This person’s journey was special to me because I was the one who communicated with her the most, explaining what was happening and often being the person who had to give her bad news. She had a social worker, who was very good, but she didn’t trust her… So it was me who was her birthing partner, staying three nights in the hospital with her. And then it was me who explained to her that, because she hadn’t had four clean drug tests, it was unlikely her baby would be going home with her.”
When support ends, Shazia says it’s important to close cases properly by ending contact and making sure that clients are self-reliant. “It’s not fair on them if they continue to rely on me afterwards,” she says.
(Shazia went on maternity leave last month. When she returns next year, it will be to a new role within Birmingham’s new Early Years Health and Wellbeing service.)
Jacque came to Gateway at the very start of the POW Service in 2007. For her, it was the ideal job.
“I have a degree in Family Work and before I joined POWS I was working with families as an outreach worker and social therapist. Working one to one with families is ideal for me.
“I love helping people face to face, helping them to find balance and meeting their needs. Sometimes people just need someone to listen to them, and even just a fifteen minute chat can have a big impact. This kind of social support is vital.
“One of the great things about POWS is that we are from the communities we support, so we know what’s out there and can engage at a community level. The women we work with trust us, because there’s a mutual understanding. We can have a real heart-to-heart … it’s mom to mom.
“Over the years the POWs have supported thousands of women between us. The original remit for the service was to support ‘marginalised’ women – those who have experienced domestic abuse; women with mental health issues; families with no recourse to public funds – and over the years the needs have become more acute.
“The women we’re supporting now are more vulnerable than ever. They include refugees and people who have been hit really, really hard by the recession, so we are dealing with a lot of homelessness, and language barriers.
“Although on paper we do a lot of the same things that other support workers do, the difference is that we are more available; more accessible than most. We will come out to see people wherever they need us to, whether that’s at home, at a Children’s Centre or at the shops, and they can call us at any time.
“It’s our job to make sure baby is born healthy, and to reduce inequality. And the way we do that is to make sure mom has support from as early a stage as possible. If she’s smoking or drinking, or if she isn’t eating properly, perhaps because she doesn’t have the finances to support herself – then of course the child will be born into inequality.
“Some of the happiest times with POWS have been seeing people’s excitement at a new house, or seeing women breastfeed happily when they never thought they’d be able to.”
Jahanara has been with Gateway on and off for many years. Like many of our POWs, she originally joined as a Community Family support worker, but as a speaker of different Punjabi dialects, including Mirpuri, she’s also worked as a Gateway Interpreter.
As a POW, Jahanara works with a mix of women, but over the last couple of years has seen more and more women with mental health problems.
Recently she supported a client who has suffered severe depression and mental health issues after being raped. She had never told anyone about it – not even her husband – and it was only when she became pregnant with her husband that she finally started talking about what had happened.
“She’s in such poor health that she hasn’t really been able to look after herself,” says Jahanara. “But it’s my job to make sure that she will be able to look after her baby when it arrives. We have spent a long time talking and her husband now understands that he needs to really look after her at the moment.”
Sometimes it will take a while for women to admit they need help. On one visit to a new client, the pregnant woman told Jahanara everything was fine – but Jahanara noticed that her other children were going barefoot and wearing ill-fitting clothes. So, on the next visit, she took along some items from Gateway’s baby bank, including children’s clothes, baby clothes, toiletries and nappies. “She couldn’t believe it,” says Jahanara. “She said, ‘I only get £90 a week and it goes so quickly. You can’t believe how much you’ve helped me.’ It gave me peace in my heart.”
Often, women will have a number of support workers, but don’t feel like anyone is there to support them, themselves. “Sometimes women just need someone to make them smile, or to pop to the shops with them,” says Jahanara, “and provide a bit of moral support in everyday life. Most support workers are there for the child, but we are there for mum, giving her someone to rely on and a number to call in times of need.”
Sophia has been here since the start of the service in 2006. She says, “it’s completely changed in that time!
“Over the last decade – and the last couple of years especially – it’s gone from simple signposting and accompanying women to appointments, to supporting women with issues around safeguarding and substance misuse, and helping them through court reports and procedures.”
Sophia says she’s learned a lot as a POW, both on the job and from her colleagues. “We’re a good team,” she says. “It’s important for us to be able to offload onto each other, bounce ideas around, and support each other through difficult cases.”
Sophia explains how important it is for POWs to meet women as early as possible during their pregnancy. “POWS is a preventative service. Often, if we meet women in the first few weeks of pregnancy, we can start helping them to begin the routines and habits that will lead to a healthy pregnancy. We can sort out a lot of issues before they get to the point where the woman or her unborn child go into safeguarding.”
Sophia is keen to point out that POWS are there for mum, when everyone else is there to support the child, and that they can prevent safeguarding issues. “The whole reason POWS were brought in was to empower women. If we can support them to make their own healthy choices from the beginning, then we can prevent a lot of issues later on down the line. In many cases we can help to stop babies being removed and going into care.”
Many of Sophia’s clients are women with a number of complex issues. “One woman who always stays in my mind already had a teenage child, and she’d had another baby years ago who’d died. When I met her she was pregnant with her third child, but she was not in a good way at all – she was drinking heavily, smoking cannabis and more. She’d been referred to drug workers and social services, but she needed more help during her pregnancy so she came to us.
“I helped her to focus, really. By taking her out of her environment a bit, and helping her to make sure that her money went onto the things she would need for her baby rather than drugs, I supported her to start new, healthier routines.
“For many women, the only support network they have is an unhealthy one, so we can provide a different outlet – we’re there for her to talk to at the end of the phone, we can meet up with her at home or in the community, and we can support her with all the admin that having a baby brings – filling in forms, shopping for essentials and getting to appointments on time.”
Shaista’s been here for nine years so she’s a relative newbie!
“POWS used to work out of Children’s Centres, which was a bit isolating, so coming together to work out of the Gateway office a few years ago was the best thing. Being able to work as a team, sharing advice and supporting each other is important for us.
“I’ve worked across Birmingham, with all types of new mums, including teenagers and older mums, and in lots of different communities, from Washwood Heath to Handsworth.
“That’s what I love about the job: we’re out in the community, and anything can happen. But that’s also why POWS are good for pregnant women – because we can go to them.
“It’s all very well making an appointment for someone to visit a Children’s Centre, but it’s not always practical to expect a pregnant woman to travel, especially if they have other young children too. If they’re new to the area they may not be able to remember where to go, or how to get there on public transport, and if finances are an issue, then even bus fares can be prohibitive.
“We are also really accessible. We are there from early on in the pregnancy, because early intervention can be vital. The more that services are cut, the more vulnerable women need someone to help them prepare, and to navigate through what is often a very confusing and admin-heavy time.
“Clients have our phone number and they can call us any time. We can visit families in the evenings if necessary, and we can use our own transport to pick people up and take them to appointments. It’s this sort of flexibility that really sets us apart from other health professionals and helps us to build a more genuine, useful relationship with the women we work with. We’re not turning up in a suit with an official-looking badge, we’re just popping over to give them a bit of support.
“One of the things that has really helped us recently is the ability to use more modern technology in our roles. We all have tablets that we take to each appointment and that means we can help people to fill in forms, bid on council properties, and make appointments there and then. This can be really important for people who don’t have internet access at home, have limited phone credit, or find it hard to talk on the phone, perhaps due to language barriers.”
Over the next few months, the dedicated Pregnancy Outreach Workers Service (POWS) will be closing. POWS is to be consumed into Birmingham’s new Early Years Health and Wellbeing service, which is a partnership led by Birmingham Community Healthcare NHS Foundation Trust (BCHC), so our POWs will be transferring to new roles with BCHC’s partners Barnardo’s, Spurgeons Children’s Charity, St Paul’s Community Development Trust and Springfield Project.
But what about the gaps?
We’re pleased our POWs will be able to continue to make use of their extensive knowledge and specialist skills, and that Public Health has recognised that this group of vulnerable women exist and need support. But POWS will no longer be an identifiable service, and I’m worried this will leave gaps.
As yet, there is little information about how exactly mums and mums-to-be who are at risk will be looked after under the broader Early Years service.
Details of the new model of service often refer to “children and families,” but not to pregnant women specifically. Will pregnant women still receive dedicated support from an early stage of pregnancy? And when a child is taken into care, will the mother continue to receive direct, one-to-one support?
We have asked for reassurance, and have received some further comments from Commissioners, but the information is still sparse. In my opinion there is a potential for gaps here which could, over time, become problematic.
At the moment, POWS offers intervention from as soon as a woman knows she’s pregnant. Often, a POW will get involved at 14 or 16 weeks – sometimes as early as ten – and the earlier we get there, the more we can do. Once the POW receives the woman’s contact details, she’ll be in touch within 48 hours.
These early weeks, while the baby is in the initial stages of development, are always vital, but even more so when a woman has complex needs. Amongst many other things, POWs can help women stop drug use or smoking, ensure she’s eating (and eating the right things), identify suitable accommodation, and make sure she is engaging with midwifery services and attending appointments.
Commissioners have told us: “The health visitors within the new service will receive referrals from midwifery in line with need. Where the woman is vulnerable or has additional needs this will be before 26 weeks.”
The earliest time mentioned in the documentation we have seen is 20 weeks, more than halfway through pregnancy.
Dedicated time, responsiveness and intensity of support
The information we have about the new model talks about an initial visit, and then a second visit. We know this isn’t enough for women with complex needs. Much of a POWs’ work is unpredictable and can include a lot of one-to-one crisis management. For example: taking women to appointments, providing phone and text message support at any time, supporting homeless women to ring round the Housing department and hostels, helping women to remove themselves from domestic abuse and taking them to a safe place, and providing support during mental health crises, including out-of-hours chats and accompanying women to get support from the Community Psychiatric team.
When we raised this with Commissioners, we were told: “The new integrated service will be able to meet needs of the type you set out. There will be the integration with other services across the city ensuring that the service responds at the right time and in the right way, especially as you say in situations of homelessness and DV. The single cross service record will provide assurance on the services and level of engagement of an individual which will also assist the service in supporting women through their pregnancies.”
What we’re not clear about is who will be providing this support. We’re not clear if women will have the chance to build a one-to-one relationship with a support worker who can help her to navigate through services, provide a single point of contact with regular phonecalls/texts and visits, and provide moral support.
Women with a safeguarding need make up about 20% (80-90) of the women POWS support annually, with about 50 of these needing intensive support – between half a day and a day a week. Where a woman is facing the removal of her baby, the POW is often pivotal: ensuring mum understands what is being said, and being on hand to make sure she takes the necessary action in relation to the Child Protection Plan.
But, again, we’re not sure who will provide this support in the new model.
Commissioners told us: “The provision of support to enable parents to develop the skills they need to parent well and the provision of step down services for those who are in the social care system are important elements of the new model.
“Within the new model no specific timeframes have been set for support to this group, it is our expectation that support is provided in line with need. This flexibility will help to build upon the approach currently operated within the POWS service.
“The new model is health visitor led with the health visitors identifying and brokering support for children and families in line with need.”
But will it provide intensive support for mum? I would really like to be reassured that women will get the continuity, trust and flexibility that they need in these circumstances.
I feel like Commissioners have given us the opportunity to have our say. I’ve filled in impact assessment forms with input from the POWs, and when I’ve raised my concerns I’ve been invited to say where the gaps are.
But I’m just not convinced we’re being listened to or understood. Although I’ve received responses, they feel flimsy. I don’t feel they’ve been detailed enough to provide me with reassurance, and this leaves me worried.
I really hope the new service will prove me wrong.
Suad has been working as a Pregnancy Outreach Worker for over six years. Because of her language skills, she works mainly with people who are new arrivals to the country.
Suad (pictured) says, “the POWs’ strength comes from being able to work one-to-one with mum. Many of the women I work with come from a background where women don’t have many rights, so in a lot of cases it’s my job to educate and empower them. I help them understand that they have rights, and that they have a voice.”
One of the women Suad worked with is Fatima*.
Originally from Yemen, Fatima had grown up in a small farming village where the culture dictated that girls weren’t allowed to go to school. So she had never learned to read or write and, even though she spoke Arabic, she often found it difficult to make herself understood.
At around the age of 20, Fatima moved to the UK with her husband to live with him, his mother and his two sisters, and over the next six years, she had three children.
During her fourth pregnancy, Fatima’s midwife referred her to POWS and she was assigned to Suad.
“It was difficult to communicate at first,” says Suad, “but I worked out pretty quickly that Fatima had been systematically abused and isolated by her husband and his family. When she was with them, she had been beaten every day. She’d only just managed to leave them, after six years of abuse.”
Fatima’s husband’s family had made sure that she only ever left the house either alone without her children, or with a family member. But one day she found herself outside, alone and with two of her children. So instead of going to the shops, she went to her neighbour’s house for help.
The neighbour, a friend of Fatima’s own family, who understood the situation (and had in fact contacted police in the past, although Fatima had declined their help) immediately put her in a taxi to Fatima’s uncle’s house, and told the husband’s family she didn’t know where she’d gone.
Now, with no belongings and no benefits, living in her uncle’s house with a baby on the way, Fatima needed urgent help. She had a supportive midwife, but she hadn’t been able to fill in any forms or pass any security tests, because she couldn’t speak English, and couldn’t read or write, even in Arabic. She didn’t know how to access any services or even what kind of help she was entitled to.
Over the three months that Suad supported Fatima, she helped her to apply for the benefits she was entitled to, as well as finding baby clothes and equipment for her, putting her in touch with a family solicitor, and getting her onto the housing waiting list.
When Suad finished supporting Fatima, she was still living with her uncle and two of her children, but her story is far from over. Her remaining son is still living with her husband’s family and, sadly, doesn’t have contact with his mum.
Thanks to the midwife who referred Fatima to Suad, and the support services that Suad has been able to help Fatima to access, including a family solicitor, Fatima is continuing to build a new life and working towards bringing her own family back together.
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:
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.
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.
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.
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.
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 (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.