
The rationale
Despite not having received Family Hubs and Start for Life programme funding, Royal Borough of Kensington and Chelsea (RBKC) and Westminster City Council wanted to strengthen the delivery of their Start for Life Offer through increased integration and formalisation of services. Although an integrated bi-borough approach was already well established, “a natural next step” was to focus on the integration of specific services. In particular, the joint team noted the need to develop an integrated framework to connect the different levels of perinatal mental health support (from universal to specialist) and improve the early identification of families with mental health needs. Additionally, the team identified a need to implement an integrated crisis infant feeding offer, particularly following feedback from voluntary and community sector (VCS) partners who were seeing an increase in families requesting infant formula or baby food from food banks. The team in RBKC and Westminster City Council decided to focus on the co-production of two new frameworks to address perinatal mental health and infant feeding.
The intervention
Feedback from the perinatal mental health steering group suggested that there is a need within RBKC and Westminster to “take away some of the taboo around mental health and infant mental health”. Universal services can play a vital role in reducing some of the taboo that parents feel about accessing support. Health visitors hold a unique position in building relationships with families, assessing their needs, offering support and guiding families to appropriate services.
Health visitors offer emotional wellbeing visits (parents can contact their health visitor to request extra support) where parents have the opportunity to talk about how they are feeling and how they are adjusting to having a new baby. These visits allow health visitors to provide wellbeing support to parents and identify additional support needs if appropriate, such as support groups for those with mild to moderate difficulties. Health visitors can also make referrals into specialist services where appropriate. RBKC and Westminster wanted to leverage this key role and so facilitated collaboration between perinatal mental health teams and health visiting teams to embed a greater focus on mental health and wellbeing into the wider integrated service. The health visiting team also work closely with outreach teams to target priority groups that are less likely to engage in services.
For the infant feeding pathway, a working group comprised of public health, the Infant Feeding Lead from the health visiting team and VCS partners met for six months to co-produce a crisis infant feeding pathway. In addition, VCS partners were supported through training to deliver consistent key messages agreed across the pathway, learn about the WHO International Code of Marketing of Breastmilk Substitutes (the Code), encourage breast feeding and ensure safe bottle feeding.
Implementation Steps
1. Develop an offer through co-production and collaboration
To formalise the developing crisis infant feeding pathway, leaders from RBKC and Westminster City Council brought together stakeholders in regular meetings as a working group. This group worked together to create the pathway and training materials. Similarly, a perinatal mental health steering group was established to provide oversight for the pathway and a sub-group to develop the training offer.
2. Develop key principles that directed the Early Years and Family Services
In relation to developing an integrated perinatal mental health pathway, a workshop was convened bringing together all stakeholders. It agreed four shared principles for the work. These included:
- Consideration of the needs of the whole family;
- A team-around-the-family approach used to communicate better with the family under one plan and one lead professional;
- A relational approach, focusing on building trust and empowerment rather than ‘doing to’;
- Working with the whole family context to create sustainable change rather than seeing issues in silos.
These principles underpinned the integrated pathway.
3. Leverage staff that engage with families across multiple services
The team recognised that universal services play a vital role in raising awareness of services, assessing and identifying needs in families. As health visitors regularly engage with families, RBKC and Westminster wanted to leverage these relationships to support more families in accessing the services they need. Working collaboratively with teams in Family Hubs, new identification and referral processes were developed by the working groups. These are now embedded into the health visiting process so that families requiring perinatal mental health or infant feeding support are identified earlier and referred to the appropriate services.
4. Leverage Family Hubs to enable integration
Family Hubs serve as critical infrastructure for integrating services and have supported seamless collaboration. Geographically integrating services has improved service accessibility and enabled families to access a broad spectrum of support.
5. Develop an integrated digital platform to increase awareness of services
Throughout RBKC and Westminster, it was recognised that information on family services was not well-coordinated and that more consistent messaging was necessary. To address this, the Family Information Services page on both Local Authorities’ websites were updated to become “one-stop shops” for information on local Family Hubs and Start for Life offers. The team are developing a digital platform that will bring information on available services together in one place.
6. Utilise data to identify baseline needs within communities
The team then focused their specialist resources within these areas. For example, the team analysed breastfeeding data across both boroughs to understand where there were areas of low uptake and high drop off rates at the 6-8 week mark. The team also used public health supplied data to gain an understanding of the effectiveness of their services.
The impact of the intervention
Impact on staff and the wider system
There is now an integrated perinatal mental health pathway and a crisis infant feeding pathway, both of which are underpinned by training for all professionals, including social workers. This has enabled a more effective, collaborative and holistic approach to joint working, enabling the team in RBKC and Westminster to draw upon expertise and resources to support the development and implementation of initiatives for a wider group of practitioners. Integrated working was described as an enriching experience for staff members, who felt empowered to tackle challenges head-on; “you see people’s faces light up when they talk about initiatives which involve finding a solution”. Additionally, staff members felt more assured that if they identified additional needs for families, others across the wider team could help support them.
Impact on families
Interventions related to the perinatal mental health and crisis infant feeding pathways now have a broader reach. Services are more joined up with a streamlined referral process for families. Families are less likely to fall through gaps between services or be left waiting for a referral without support. The Family Hubs team can explain the available support to families and how to access it, meaning that the families’ experience of engaging with services is more personalised. The team can also equip families with the resources to identify their own needs. Feedback from service providers highlighted that Family Hubs are seeing increased footfall due to better awareness of the services available within communities
Lessons learnt
The team indicated that with funding, they would have consulted with more families to incorporate their views into developing the digital platform. Additionally, they would have commissioned specialists to expedite the platform’s development. The team felt that if the digital platform had been implemented sooner, it would have helped them achieve their goals more quickly.
Top tips for implementation
- Share data between services to create a shared understanding of the local Start for Life offer and support integration.
- Co-production and effective working relationships are crucial to building solid service integration foundations.
- Robust governance and strategic buy-in are essential. The team in RBKC and Westminster City Council highlighted that staff members often change. However, with robust governance and strategic buy-in, interventions will continue to be supported until new staff members are brought in.
This case study has been produced by the Start for Life Unit within the Department of Health and Social Care, in partnership with RSM, Royal Borough of Kensington and Chelsea and Westminster City Council. By sharing promising examples of delivery, we hope to facilitate connections between LAs across the country and support local delivery of Start for Life services. For further information please contact familyhubs.startforlife@dhsc.gov.uk.
For any questions regarding the case study or the pathway documents, please contact Lau Prieto lprieto@westminster.gov.uk
The data included in these case studies is self-reported by Local Authorities and has not been quality assured by the Department of Health and Social Care. The views expressed are those of the authors and not necessarily those of the Department.
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