Agenda item

The Board received a presentation from Anna Smith, CEO of One 25 and Ann James, Director of Children and Families on the Pause Bristol programme.

Ann James explained that the programme formed part of Bristol City Council’s One City Approach to work with women and help them with their recovery from bad childhood experiences and to help in reducing the need for demand in criminal health, justice and housing demand.

Anna Smith explained that Pause 25 helped women involved in street sex work.

The presentation made the following points:

·       Women who had two or more children permanently taken into care were at the heart of the One25 service which had been operating since 2017. It had been established to address the problems caused by a repeated cycle of children being removed from parents

·       65,000 women were involved in care proceedings with 1 in 5 returning to family court order concerning the child. Many were out of care themselves and their babies were born into care. Many had also experienced neglect and physical and sexual abuse in their past

·       The purpose of Pause was to identify those women who were frequently disengaged from all other services and to intervene to help provide them with goals and to break the cycle of birth and removal

·       The team consisted of 5 people, including 3 practitioners with a caseload of 7 to 8 each that was kept deliberately low to ensure intensive work could be carried out. The other two members of staff consisted of a lead and co-ordinator

·       The first cohort of women in Brsitolbeing supported included 100% who had suffered domestic abuse, 91% with mental health problems and 65% with problems caused by alcohol and drugs addiction

·       Details were provided of different elements of situations faced by women using this service. In Bristol there were particularly complex problems facing women of drugs and homelessness. Many did not realise they were supposed to stop their child support benefit and were getting into debt. They might have low self-esteem, not have a GP and lead very chaotic lives either on the streets or in inappropriate housing. They might also be in a controlling and abusive relationship

·       Details were provided of women who had  completed the programme and obtained more secure housing. Outcomes included an improvement in dealing with issues caused by past loss, trauma and self esteem

·       There had been two cohorts of women completed. Details of the results of Cohort Number One were provided with Cohort Number Two currently being evaluated. A third cohort was about to start

·       As part of the process, women agreed to accept long term contraception.

·       An analysis of Cohort One showed that 91% of women had mental health diagnoses with just under half receiving a further assessment by the NHS, 30 had received statements given to the Police concerning violence or abuse, there was a 50 per cent reduction in A and E visits, 9 had face to face contact with children, 14 had been helped to leave abusive partners and 10 had been helped to secure a tenancy with 4 being street homeless

·       An assessment had shown that in the first few months 40% of women would have liked support but it was not necessary and at the end 20% more felt this – also 17% felt they didn’t need to use the service any further. A baseline of life satisfaction of 3.8 had increased to 6.5, whilst an assessment of worthiness had increased from 4.4 to 6.7 which was a huge success given that many of the women involved frequently expressed suicidal thoughts

·       A slide showing a number of quotes from women were shown – one which was particularly notable was from a woman who said that now she felt confident about getting on a bus which was hugely difficult for her before

·       The success of the service is if the women no longer require this service, don’t become pregnant until they want to and deal with their problems of drug use

·       The Board was then shown a video of a case study involving a woman being able to cope with looking after her children following intervention from Pause

·       The most important part of the work of Pause was helping women take control of their lives

·       The current cohort (Cohort 3) ends in November 2021. This was a rolling programme requiring three year corporate and Bristol City Council funding.

At the end of the presentation, Board Members made the following comments:

·       It was hoped that the Health and Well Being Board could engage as required in the work of Pause

·       Thanks to Ann James and Anna Smith for a very moving film and personal stories.

·       The Health and Well Being Board does not hold a budget so is not in a position to discuss funding.

·       However, one option might be to facilitate partners to examine possible options for funding. It was noted that there had been dialogues with a number of family law firms about this

·       Some Local Authorities provided Pause programmes as a cost avoidance measure. A case could be made for change in each of the organising bodies involved

·       A contribution of £100,000 had been provided by Public Health but a strategic approach  is required to look at the wider picture.

·       It was good to see local outcomes from the programme

·       Janet Rowse indicated that discussions with Healthier Together and Children’s Services could take place concerning possible options for funding for the One25 Programme.

ACTION: Janet Rowse (Sirona Care and Health) and Jacqui Jensen (Director of Children’s services, Bristol City Council) to have discussions concerning this, together with Healthier Together.