The First Steps Programme


This section provides information including the aim, delivery and results to date of the First Steps Programme (FSP), which was developed to improve support for families as early as possible living in the regeneration areas in South Lanarkshire.

FSP secured three years funding (2008-2011) from the Fairer Scotland Fund to improve support for families as early as possible. On this page you will find information on:


Aim

The aim of FSP was to ensure the best possible start in life for vulnerable first time mothers and their babies living in the regeneration areas in South Lanarkshire.


Outcomes

The expected key outcomes are:

  • reduction in alcohol use
  • healthier eating
  • positive preparation for birth and post natal period
  • reduction in smoking
  • maximised financial security
  • improved mental health and well being
  • increase in breastfeeding rate in first time mothers
  • increase in the number of women undertaking physical activity
  • children have appropriate healthcare support
  • improved nutrition for children
  • positive household environment
  • improved oral health in children.

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Planning

In February 2008, a group of representatives from NHS Lanarkshire, various council departments, NHS teams and the voluntary sector was set up to develop an early years health improvement programme that would intervene at an early stage with South Lanarkshire’s most vulnerable families.

The steering group used local and national research findings, local data and the emerging Single Outcome Agreement (SOA) and Government policies to help identify programme outcomes and target groups and target geographical areas.

To ensure that the new service developed was informed by potential clients, Community Links, a voluntary sector community engagement organisation was commissioned to undertake research work with vulnerable mums, mums to be and their families.

The findings from this research influenced the design of the emerging service. Consultation also took place with Social Work, Early Years Education and Public Health staff, ensuring an inclusive approach and future buy in at the delivery stage.

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Delivery

Key aspects of FSP include:

  • Only vulnerable first time mothers and their babies living in the 15% most deprived datazones in South Lanarkshire who have low or no income can be referred onto FSP
  • FSP is a quality, targeted, intensive, flexible service which offers support to midwifery and public health staff and the families they work with
  • Referral agents were limited to only public health nurses and midwifes from NHS to ensure that the programme focused on early intervention, not crisis intervention
  • The service is additional to existing support and provides continuity between the antenatal and post natal period until the baby is age three. The amount of contact time depends on the needs of the family
  • FSP is delivered mainly in the home and focuses on both the child and the parents to provide useful advice and practical help. FSP is needs led and each client has an individually tailored programme
  • In most cases the First Step Workers (FSW) visit the clients on a weekly basis and sessions last around 2 hours
  • Examples of activities carried out within the home include cookery, play, establishing routines and home safety, etc
  • Examples of activities outside the home include walking, shopping, swimming, supporting clients to attend other services/groups, for example, Bookbug sessions in local libraries, toddler groups and baby massage.

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Workforce Developments

The FSP is managed by a designated Programme Manager. A team of seven First Steps Workers (FSW) and a health promotion assistant were recruited to deliver the FSP.

The FSW's all have child care or health care knowledge acquired through SVQ/HNC level education or equivalent experience and come from various backgrounds, ensuring a mix of skills and experience across the team. A training and development programme was designed and the delivery to all FSP staff is ongoing.

The FSP hosts regular awareness-raising sessions with referral staff to keep them informed of developments, help them understand where they fit, encourage accountability across partners and provide them a forum whereby issues can be discussed and fed back into the planning process.

Development days for FSW are held on a regular basis, allowing feedback from the frontline to be carefully considered and developed into key components of the programme.

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Evaluation

A key part of the FSP is monitoring client progress and a number of tools have been designed to support this. The FSWs conduct assessments with their clients on a regular basis to allow their progress to be recorded and measured.

From these assessments, along with discussions with the referrer and the client, a client action plan is developed. The FSWs were involved in the development of these tools helping to empower the workers and ensure ownership of these tools and increase the likelihood of them being used.

An evaluation framework, in line with the South Lanarkshire Single Outcome Agreement, has been designed to monitor and review the programmes performance and measure the impact of the programme on the families involved in relation to agreed outcomes and indicators.

An external evaluation of the programme is a crucial part of the FSP. The aim is to identify the lessons that can be learnt to enhance it during funding and rolling it out and/or mainstreaming it beyond funding.

The evaluation will:

  • identify the impact of the programme on children and mothers, public health teams, midwifery teams and other partners
  • assess how the programme is achieving its intended outcomes, what factors are contributing to the achievements and what may be hindering achievements
  • identify the factors that encourage mothers to engage with First Steps.

Based on the evidence gathered, recommendations will be made on adjustments to the programme at each stage. This will include adjustments to the process and management as well as the activities.

For a copy of the evaluation report please contact Shirley Mitchell on Shirley.Mitchell@lanarkshire.scot.nhs.uk

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Results to date

The programme launched in April 2009 and the early indications are looking very positive:

  • Many of the workers now have full caseloads and in some areas there is a waiting list demonstrating the high levels of demand for the service
  • most women have engaged with the service with enthusiasm and have in most cases shown commitment to work towards a number of goals
  • Of the 285 women engaged to date, the project has already supported many to achieve agreed goals, and 68 have completed their programme (As of March 2011)
  • Examples of achievement from those who have completed the programme include: 2 women have gone on to do childcare courses at a local college and have secured nursery places for their children to allow them to do so
  • Many current clients have reported positive improvements in their lives including improved confidence to engage with existing services, increased healthy eating, moving into new tenancies and setting up home, returning to pre-existing hobbies, stopping smoking and attending ante/post natal appointments with NHS staff.

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Reviewed 29 July 2014

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