Plymouth: Enhancing services and upskilling workforce for continuity of care in PIR and PMH Services

In 2019, Plymouth consulted with children and families across the city to understand their perspectives on babies’, children’s and young people’s services. The consultation found that families had to navigate a complex system to access support. Furthermore, vulnerable families were sometimes distressed when they interacted with too many practitioners who they did not have an existing relationship with, reiterating their story multiple times. This consultation resulted in the implementation of A Bright Future Plan (2021-2026) which serves as a local shared vision to support babies, children, young people and families across Plymouth. The plan was written with the support of Family Hub partners. The shared ambition is for the babies and children of Plymouth to have the best opportunities as they grow up, and sets out specific strategies for the Family Hubs to achieve this, including:

• Families tell their story once and are fully involved in their plans to support strength-focussed change
• Families receive needs-based support from services for however long they need to embed resilience
• Limiting unnecessary “pass around” of families between services, and making the transition smooth where it is necessary; and
• Supplement needs-based offer with an early prevention approach to relationship and development issues.

Within parent-infant relationship and perinatal mental health services, the team wanted to ensure that families with complex needs do not end up with huge teams around them, but have only those practitioners which they need available to them. The team set out to smooth the transition between different levels of support (universal, targeted and specialist) for families, by building a “scaffold around the practitioners” who have an existing relationship with families.

A relational approach to service delivery underpins the work in Plymouth. Family Hubs and Start for Life programme funding has been focused on training and upskilling staff members who are well placed to form ongoing relationships with families. Since 2021, Plymouth have implemented a number of interventions:

• Upskilling staff members delivering universal services to identify families requiring more targeted and specialist support. Often the same staff member will deliver more targeted support and if required, refer the family into specialist services or consult with specialist services. This training has been opened up to colleagues from other services (including health visiting and Safe Families), to enhance co-delivery and improve relationships across the pathway.
• Six perinatal mental health champions were trained to enhance service-wide support. The team now participate in multi-agency triage meetings.
• Ten professionals were funded to take part in Building Babies Brains training. They then disseminated the learning regarding attachment and brain development across the city.
• Three team members attended Video Interactive Guidance training, facilitating parents to reflect on interactions with their children.
• Twenty plus practitioners completed Triple P Baby training, with five more courses planned.
• A NHS Talking Therapies team was implemented for the whole city. NHS England funding supported the recruitment of one trainee supervisor and four trainee practitioners. There are a further four practitioners co-located in Family Hubs currently. The NHS Talking Therapies Family Hub team manager received mental health supervision training to oversee 0-5 NHS Talking Therapies practitioners across the city (focusing specifically on the 0-2 period).
• Family Hubs and Start for Life programme funding has also enabled Plymouth to invest in the training of peer support workers who can support families referred into services. Since January 2024, two perinatal mental health peer support groups have taken place.

Parents and carers feedback demonstrates the positive impact that recent improvements to Plymouth’s parent-infant relationships and perinatal mental health offer have had on families, children and babies:

VIG feedback:

• “I feel confident that I can meet my child’s needs, and I am aware of the special moments that were already there no matter how small they are”
• “It has shown me how much I love my child”

Circle of Security feedback:

• “This course has helped me re-evaluate my own circle of security so that I have knowledge and skills to step back and focus on my child’s circle of security, so that I can understand why they are upset or what they are trying to communicate with me”

Baby massage feedback:

•  “No judgement zone. Friendly and supportive. A place to learn and share. Accommodating to my child as well as my baby”

Recently, the team in Plymouth demonstrated how their flexible relationship-based approach had a positive impact on vulnerable families when a World War two bomb was discovered in the city. Family Hubs provided safety when families were evacuated from their homes and staff supported the wellbeing of those families. “The feedback we have had locally is that children were helped to feel like it was a bit of a holiday rather than a drama”.

Enhancing services and upskilling also led to a range of impacts on staff. Staff have reported:

• Enhanced abilities to identify personal training needs due to a clearer understanding of their role in service delivery;
• Increased knowledge about the importance of parent-infant relationships and perinatal mental health;
• Feeling more confident in supporting families overall; and
• Embedding training into practice through peer meetings, discussions on the approach’s effectiveness and sharing best practices.

Plymouth have recently adopted a Human Learning Systems approach which recognises the need to understand the uniqueness of individuals and that there is no one single fix for families. The team highlighted that, with hindsight, they would have implemented this approach from the outset by embedding it into their delivery plan.

This case study has been produced by the Start for Life Unit within the Department of Health and Social Care, in partnership with RSM and Plymouth 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

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.