Agenda item

Jenny Lingrell, Joint Assistant Director of Commissioning, Performance and Inclusion, and Lindsey Knight, Pause Practice Lead, presented an update on Rotherham Pause Practice which had become operational in July 2018.  This report followed on from a previous scoping report submitted to Improving Lives Select Commission in October 2017, which prompted the decision to proceed with the project.

The Pause model kept the women at the centre and enabled them to address a number of complex and intersecting needs.  As of March 2019, the team were working with a cohort of 24 women and of these 16 were fully engaged with the Pause Practice had which meant that the women agreed to use an effective form of long-term reversible contraception, which gave the gave them the chance to pause and take control over their lives with the aim of preventing repeated pregnancy. The 24 women in the cohort  had had 78 children removed between them, an average of 3.3 children removed per woman.

Pause Rotherham had been extremely effective at identifying and engaging women on the programme achieving 87% appointment attendance last quarter.  The women identified what areas they would like to focus on with the highest priority being relationship with children.  It had been successful in supporting women to engage in the court process and complete Life Story work

During the last quarter Pause Rotherham had:-

-          supported 8 women with their housing needs including supporting 3 to access new properties and working in partnership with Housing colleagues to avoid an eviction

-          supported 3 women to access a GP surgery, one to go to hospital for an operation, 4 to access Mental Health Services and 3 to access support from the Sexual Health Clinic

The Pause Rotherham Board had been established and included a broad multi-agency representation including a Councillor.  It had also undertaken joint work with the National Team including the Practice Lead being elected to sit on the Pause National Practice Board to help shape and drive forward practice nationally.

However, whilst the evidence suggested that Pause Rotherham was implementing the model successfully and partners were supportive, it was necessary to start work to explore if Rotherham wanted to sustain the practice and how it would be funded.  The final figures in April 2018 showed 270 women who were eligible for Pause equating to 720 children who had been removed.

A Pause Success Event was to be held in July 2019 to celebrate the first year of the practice.  It was hoped by that time further plans would be in place to address the sustainability of the project including the Practice Lead submitting a sustainability report and meeting with all agencies involved to look at the overall cost benefit analysis.  Work was taking place with the South Yorkshire Police looking at cost savings related to crime and domestic abuse within the cohort.

Over the course of the next 6 months the women would continue to work on their goals and benefit from the 1:1 sessions with their practitioner.  The women would move into the transition work in October 2019 where they would be supported with their plans moving forward once having completed the 18 month programme.

Discussion ensued with the following issues raised/clarified:-

-          The national Pause Team was helping Rotherham to build a profile of the money the project was saving other service areas.  The challenge encountered in Rotherham was not unique.  It was quite easy to attribute costs to Children’s Service where there was the cost avoidance of removing children that might be born in the future but also the cost avoidance for other services i.e. missed appointments, responding to anti-social behaviour and crime, eviction.  The work of Pause supported all those areas of work.  The aim was to build the evidence base and the awareness thereof to potentially create a sustainable funding model that was not reliant on the funding stream from one Directorate

-          Although predominantly a service for women, it recognised that there were a number of women who, although may not be in healthy relationships, wanted to remain in them.  Part of the work included their male partners to support them to understand healthy relationships

-          The National Pause Team was currently looking at what a Pause offer could look like to men as it was recognised that they too had experienced loss when children were removed

-          Pause nationally was continuing to undertake work on its longitudinal  studies and the success rate of the interventions.  Pause practices were now being expanded throughout the country, moving into Scotland and Northern Ireland.  Research had been undertaken by Lancaster University previously which had looked at the impact of the recurrent care proceedings on women.

It was asked if more current research was underway on the success of the Pause intervention to inform the evaluation prior to a decision being taken to allocated more funding. This would be raised with the Chief Executive of Pause National who sat on Rotherham’s Strategic Board

-          There were a small number of women who were currently working with Pause who had much more chaotic lifestyles with substance misuse, unstable housing needs, difficulties with partners, mental health issues etc..  Part of the model was intensive and consistent outreach work adapting to different needs.

-          Following on from the scoping exercise where 270 women had been identified, prioritised using a model based on the research conducted at Lancaster University.  The research highlighted particular categories that identified women who were at higher risk of having babies e.g. age of the woman when she had her first child, succession/age of the children, whether the children had been adopted, whether the women was a victim of CSE, whether she was a care leaver as well as her age in terms of child bearing years.  All 270 had been considered using that criteria to identify those thought to be the highest risk women of recurrent pregnancies.  The project was working with 13 out of the top 20 who were classed as the highest risk.  There were still a number of women that were eligible for Pause.  The Team Co-ordinator was taking referrals on a regular basis from Social Workers or other agencies who were identifying more women. The Pause model specified it worked with only 24 women to ensure that the intervention was deliverable

-          The remaining 246 women not supported by Pause would be supported by existing services such as Drug and Alcohol Services, Mental Health, Rotherham Hospital and the Community and Voluntary Sector

-          The project worked closely with the Sexual Health Service in an attempt to strengthen pathways for the women to access those appointments, who may otherwise struggle to manage these commitments   

-          Pause worked very closely with Housing colleagues who were very supportive of the work of the project and were a member of the Strategic Board.  Consideration would be given to the possible progression of women within the project to Housing First when work had stopped with the current cohort.  There was a Housing representative on the Strategic Board

-          Now the first cohort of Pause women were established to prove the efficacy of the project, it was now the focus of the Strategy Group to build a sustainable model and meet with colleagues across the partnership and see where the project had helped reduce demand on other parts of the Service and not just CYPS

-          The Pause National Team database was used to record all the activity that took place which enabled a quarterly report to be submitted.  This also enabled benchmarking against other areas

-          Approximately 15 women had not wanted to take up the Pause offer.  Their refusal had been respected as it was a voluntary service

The Select Commission wished the message to be conveyed to “Bluebell” that she was an inspiration after Members had heard her case study.

Resolved:-  (1)  That the progress of the Rotherham Pause Practice and the impact on the women on the caseload be noted.

(2)  That a further update be submitted on partner contributions.

(3)  That further details be submitted regarding the longitudinal impact of the Pause project.

(4)  That exploration take place of whether the women who had completed the Pause project could progress to the support of Housing First.