Promising practice details

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C4EO theme: Early Intervention

Naomi House - a Mother and Baby residential drug treatment home, Bristol

Themes this local practice example relates to:

  • Families, Parents and Carers
  • General resources
  • Local area early intervention strategies

Priorities this local practice example relates to:

  • Improving children’s and young people’s achievement, behavioural and emotional outcomes through effective support and intervention with mothers, fathers and carers of 7-19 year olds

Basic details

Organisation submitting example

One25 Ltd

Local authority/local area:

Bristol

 

The context and rationale

Background details to your example

What was our idea?
Naomi House closed at the end of February 2012.

One25 has 15 years experience of supporting women trapped in a lifestyle of drug abuse and street sex work. In recent years the approach of harm minimisation has led to the widespread use of methadone as a heroin substitute. This approach has in turn led to an improvement in women’s general health. They are not as malnourished as in the past and their menstrual cycle is more regular, resulting in an increase in pregnancy coupled with problematic drug use.

One25 offers intensive support to female street sex workers. Due to their chaotic lifestyles and the fact that they feel stigmatised, the women rarely access appointments with health professionals therefore pregnancies can go unreported until late into the pregnancy. The women are often picked up late by maternity services, which reduces the women’s chances of being able to keep their babies. Those women who do manage to keep their babies are very often ‘set up to fail’ by statutory services as there is not enough intensive provision and support to enable the women to overcome the barriers to successfully raising their children in the community.

The One25 case work team work intensively with pregnant women but the reality we were experiencing was that the majority of women were not able to remain with their children. This was heartbreaking to see especially as many of the women expressed a strong desire to remain with their babies and to make steps to improve their lives. Sadly, for many, this was not possible due to the lack of mother and baby residential treatment homes. This resulted in the women returning to a life of street sex work and drug abuse and burying their pain until the next pregnancy and so the cycle would continue.

We were aware of an acute shortage of supported housing for mothers with addictions.
We were aware of only three other mother and child units in England and Wales working with women who are substance dependent. The cost of these units is high and the waiting lists long, but the support they provide enables some mothers to acquire the essential parenting and life skills needed to care for their children. The alternative is that women are placed in unsuitable and unsafe accommodation that is unhelpful to their lifestyle. This contributes to reasons for relapse, which in turn lead to childcare issues with the Children and Young People's Service (CYPS). Naomi House would provide the opportunity for the mother to address her substance misuse whilst being supported in learning parenting and life skills. The project equips families with the tools to work and stay together with a drug and alcohol free lifestyle. Women would receive therapeutic treatment individually and in a group to address their underlying issues of drug abuse and sex work.

A Case Study:

Hayley is a pregnant 35 year old lady. Her childhood was spent in care and she has had no positive parenting or role models whatsoever. She has 4 children, all of whom are already in care. Due to Hayley’s history with Social Services, they will automatically be involved with her new baby. The baby, when he is born, will go straight into withdrawing and Hayley will be allowed to stay with him during this 5-10 day process. He will then go straight into foster care while court proceedings begin and Hayley will return to her hostel accommodation.

One of the primary issues is her lack of stable accommodation. The hostel is not dry (substance use is permitted) and is therefore a very vulnerable place for Hayley to be living as she attempts to make lifestyle changes. There is a lack of appropriate services for her to access. In Bristol, you have to be 25 or under to go to the mother and baby units therefore disqualifying her from this specialised support which she so desperately needs.


What were we trying to achieve?
Naomi House set out to break the generational cycles of abuse and parent/child separation by offering a safe environment where mums could live with their babies whilst addressing the dual problem of their substance misuse and the gaps in their knowledge and experience of adequate parenting.

The key objectives were to:
• Work with specialist services to protect and improve the wellbeing of children where maternal addiction has been a problem;
• Promote family attachment, parenting skills and child development;
• Help mothers deal with issues underlying their addiction;
• Help mothers develop personal/life skills for independent living;
• Provide positive move-on with appropriate support in order to maintain progress.

What evidence and knowledge did we draw on?
The Home Office document ‘Paying the Price: a consultation paper on prostitution’ (July, 2004) opened up a national debate on developing “a clear and coherent strategy if we are to impact on the safety and health of individuals and communities”. It was acknowledged in the paper that prostitution is a complex area. The paper highlighted the need for pathways out of prostitution which include protection and support. One25, along with a number of other agencies working with the client group, had identified a gap in provision in Bristol of accommodation for pregnant women, and women with babies, who have drug/alcohol dependency and who are involved in, or vulnerable to, selling sex.

Dr Nikki Jeal conducted a health needs assessment on 71 female sex workers in a one-month period in July 2000. The findings, entitled: A health needs assessment of street-based prostitutes: cross sectional survey, Nikki Jeal and Chris Salisbury, have been published in the Journal of Public Health, Vol. 26(2), p.151-157, 2004. These findings show that almost two thirds (65%) of the 71 women had children. Of the 43 women with children aged 16 years or less, only 21% had one or more of their children living with them. Of the 80 children aged 16 years or less, nearly two thirds (62%) were living with family members; 11% were in care or fostered, and 10% had been adopted. Of the women who had children, those who had been in care as a child were significantly less likely to have their own children living at home with them compared with women who had not been in care.

We had noted that two thirds of the women we had worked with had given birth to children and 79% of these mothers had experienced the anguish of having them removed. When women became pregnant, they were usually placed in unsuitable accommodation which often led to relapse and the removal of their babies. It would appear that the system set the women up for failure. The women were not given adequate help and support to become the parents they desired to be. Families were being torn apart before they had been given a chance to succeed.

The project was inspired by extensive research highlighting the benefits of parenting training in residential substance abuse treatment (Baker and Carson 1999, Camp and Finkelstein 1997, Barnard 2007, Etherington 2008). Pregnancy was cited in a 2004 Home Office report as being a main factor for change for this group. During a beneficiary consultation in 2004, they clearly emphasised their need for this project.

The project has also been linked with a number of strategies, e.g. Bristol County Council’s Children and Young People’s Plan 2006-9. It has gained support from agencies including CYPS, Bristol maternity drugs services, Bristol Specialist Drugs and Alcohol Services, Bristol Drugs Project, Drugs and Homeless Initiative, local nurseries and MPs, who have recognised the gap in provision and have pledged support in order to maximise the specialist expertise.

 

The practice

Further details about the practice

What did we do?
The founder of One25 had a vision to open a mother and baby residential home as far back as 2001. During a consultation with the women of One25, conducted in 2004, our user group clearly highlighted their need for supported accommodation for pregnant women and their babies. When asked what would help them to stop selling sex on the streets, this was identified as one of the main factors. This response was also given when asked what, in their opinion, was the most important thing the Home Office could do.

Due to the chaotic lifestyles and multiple needs of this client group, Social Services have often found it necessary to remove babies from their mothers and place them in care. This highlighted a gap in the provision of services available to pregnant or new mothers who are also homeless, chaotic drug-users and sex working. As a result, discussions have took place over a two year period between drug workers, CYPS, One25, Bristol City Council and housing providers.

Four years later in 2005, the first steering group was formed to turn the vision into reality and fundraising began. By 2007, we were ready to recruit a Naomi House development coordinator to develop the project and continue to raise funds. At this stage a business plan was drawn up and in August 2008 we recruited the Naomi House manager. This is when the work really started with tasks such as:

• Secure the accommodation;
• Refurbish the accommodation;
• Writing policies and procedures;
• Purchase furniture and equipment;
• Install CCTV;
• Ensure adequate security – locks on internal doors etc.;
• Landscape the garden;
• Purchase drug testing equipment;
• Develop links with external services/agencies;
• Assess potential residents;
• Recruit the staff team;
• Come up with new and innovative ways to secure further funding for a project which was still a concept. One idea for this was to set up arrangements for a baby shower (in the style of a wedding list – but with Mothercare). This fundraising initiative provided Naomi House with most of the required start up equipment.

In January 2009, Naomi House was ready to open. At this stage we had running costs for one year.

The project houses and supports one of the most marginalized and least catered for groups in substance misuse and homelessness. Female sex workers are acknowledged to be one of the hardest to reach groups, and are often unable to fit into generic services in housing and support. The project meets this need and increases the amount of supported accommodation for pregnant women and women with babies who have substance misuse and who have been involved in the sex industry across the country significantly. The project works with other agencies to maximise the level of expertise and specialist work and support needed.

Initially it was thought that Naomi House would be a safe house for mums and their babies but what quickly became evident was that due to the complexity of the women’s needs and the high levels of CYPS involvement in their lives we would need to provide more than just a safe house if CYPS were to be convinced of the suitability of Naomi House as an alternative to removal of the baby at birth. At this early stage we became aware that we needed to develop a residential drug treatment home for mothers and their babies. Naomi House would be about abstinence, not maintenance, through: actively helping women come off prescribed drugs by working in partnership with Bristol Specialist Drugs Service; helping women look at underlying issues and traumas; helping women gain life and parenting skills; breaking the generational cycle of drug abuse, trauma, abuse, poor parenting, and institutionalised care.

Who was involved?
The steering group was led by the founder of One25 and the members consisted of health professionals, social workers and experienced One25 staff. Advice and guidance was sought from drug services, child and adult social care services, health services, police, mother and baby residential homes and drug treatment units.

The first staff team consisted of a manager, deputy manager, three key workers and one support worker. A childcare worker was recruited in February 2009. A team of bank workers for occasional work were recruited and we began to build a register of reliable and appropriate volunteers. Links were formed with local services and agencies, for example health centres, GPs and health visitors, mother and baby groups, and churches.
A large team of volunteers, staff and supporters were involved in the refurbishment of Naomi House. This saved us the cost of paying decorators, gardeners, etc.

Naomi House gained the support of a number of agencies working in the field including Children and Young People's Services, local maternity services, Bristol Drugs Project, Bristol Specialist Drugs and Alcohol Services, Bristol City Council, South Gloucestershire Council, Safer Bristol Partnership, and local services for general health, counselling, education, parenting, etc.


What were the intended measureable outcomes?

In year 1, we expected the following outcomes:

At least 4 mothers and their babies/toddlers will have been intensively supported by Naomi House.
Our client group has complex needs and it was decided to start small and to create a home rather than a hostel environment.

After 21 months, 12 mothers and 11 babies/toddlers have benefitted from the service.
This has been achieved through a programme of therapeutic and educational activities including weekly individual therapy and group drama therapy for emotional literacy and interpersonal skills, art therapy, relapse prevention and auricular acupuncture, keywork budgeting and debt workshops, family exercise, parenting training, individual key work sessions, care planning, and access to local community resources.

All babies/toddlers will have had their basic needs met and been kept safe.

After 21 months, 11 babies/toddlers have had their basic needs met and been kept safe.
This has been achieved by providing parenting classes, a fully equipped and staffed crèche facility, a qualified and experienced childcare worker, 2 key workers, 2 support workers, a deputy manager, a manager and suitable volunteers. Naomi House is staffed 24 hours providing a safe, warm and nurturing environment. Provision is made for an out of hours ‘on call’ service.

All babies/toddlers will be meeting their developmental milestones unless they have specific health needs which do not make this possible.

After 21 months, 11 babies/toddlers achieved the above.
This has been achieved by providing weekly parenting classes which have looked at a range of topics including feeding, diet, play, sleep, behaviour management, safety and routines. The parenting classes are planned with an objective and outcome and each topic may stretch over several weeks. The parenting classes consist of a mixture of discussion, role play and practical tasks. For example the women have discussed, written and implemented healthy diet plans, prepared weaning foods and meals for older babies, toddlers and adults. They have also designed and created story bags and books, carried out risk assessments on their own rooms and shared rooms within Naomi House and discussed, written and implemented their own individual routines for themselves and their babies. The women have also looked at providing appropriate stimulation for their babies, different types of play (e.g. messy play, treasure baskets) and looked at the purpose of play. The women have also taken part in groups looking at language development and the importance of talking to babies and singing with them. The women have also had the opportunity to learn some ‘Baby Signing’. Four of the women completed a First Aid Training Course in August.

In addition to group parenting sessions the women also have a weekly individual parenting session. The topics for the sessions are varied and individual to each woman and her baby and are raised either by the woman, through concerns identified on the Baby Care Plan, which is completed jointly by the mother and the Childcare Worker, or as the result of observations made by Naomi House Staff.

We also encourage the women to attend Mother and Baby Groups such as Rhyme Time at the local library and to attend a local Sure Start Centre. We have developed good links with Sure Start, where the women can access help, advice, support and develop further parenting skills when they move on from Naomi House.

All babies/toddlers will have improved maternal attachment as a result of their time at Naomi House. There is lots of evidence to show that children are more likely to thrive when they have a secure attachment to their mother.

After 21 months, 11 babies/toddlers achieved this.
Evidence suggests (British Journal of General Practice, Nov. 2007, 1:57(544), 920-922) that a secure attachment with a main carer is important to a child’s development as it allows children the ‘secure base’ necessary to explore, learn and relate, and the wellbeing, motivation, and opportunity to do so. It is important for safety, stress regulation, adaptability, and resilience.

Within the therapeutic environment of Naomi House and within the over arching child protection guidelines in place, the mothers are solely responsible for the care of their babies whilst they are at Naomi House apart from when the children are being cared for in the Naomi House Crèche. The crèche is held during the Therapeutic Group Times. The women therefore, carry out all the day-to-day tasks involved in caring for babies and toddlers, these include feeding, changing, bathing and comforting their child in addition to talking to them using eye contact and playing with them.

Naomi House encourages and supports activities which promote attachment such as breast feeding and baby massage.

Some of the newborn babies who have lived at Naomi House have experienced withdrawal symptoms from drugs such as opiates, which they have been exposed to whilst in the womb. These babies have had periods where they have cried a lot, sometimes incessantly. These babies have required a special approach to being cared for by their mother’s during times when they have been experiencing withdrawal. These approaches have involved the need to avoid over stimulating the baby and being swaddled and cuddled by their mothers for long periods.

Good attachment between mothers and their babies has been evident at Naomi House in a variety of ways. For example, when a baby is crying they are comforted and will quieten more quickly when comforted by their mother rather than by crèche staff and a distressed toddler will only seek comfort from their mother and not other adults in Naomi House. Additionally, when the women collect their babies from the crèche the babies are happy and excited to see their mothers and will put out their arms to their mothers.

All mothers will have accessed addiction, health, therapeutic and parenting services and will be developing their skills for independent living with their child.

After 21 months, all 12 mothers have regularly attended drama therapy groups, facilitated on Fridays to support the residents’ emotions before the weekend. This provides a safe, therapeutic and expressive group that focuses on building the women’s confidence, positivity, interpersonal skills, personal resources and emotional literacy. This form of therapy allows difficult personal problems to be expressed and safely contained within a supportive, creative group.

After 21 months, 12 women benefit from regular attendance at individual therapy. Each resident attends one session of 50 minutes per week. The general therapeutic aims for each woman are: increased outcomes in emotional literacy; self-esteem and confidence; improved insight into their drug abuse and motivation to cope using healthier coping strategies; development of their sense of access to community resources and a positive social network; development of their sense of themselves as a good enough mother; and therapeutic exploration of past history and trauma using interventions from the Therapeutic Spiral Model For Treating Trauma with Psychodrama.

These outcomes are evidenced through client self-evaluation and in the therapeutic material they produce, therapist notes kept in their confidential file and from the way that the women present within the residential unit. A working agreement contract is drawn up with each resident. This also establishes individual therapeutic aims at the assessment stage, which form part of the self-evaluation.

Relapse Prevention materials and modules are delivered within a consistent therapeutic structure that also enables women to express/voice their feelings and any ambivalence they are experiencing.
Core elements include:
• Decisional balance about pros and consequences of drug use;
• Stages of change and motivations;
• Warning signs of relapse and managing these;
• Consequences and empathy, particularly regarding the child's perspective;
• Benefits of sobriety;
• Auricular acupuncture.

Qualitative evidence is collected on the resident’s case notes, which records their attendance and any concerns or positive developments. A log of all the outlines of the relapse prevention groups is recorded.

Over a period of 21 months, 12 women receive ‘Psychosocial & therapeutic support with understanding relationships’ in Wednesday groups, which are delivered as part of a rolling programme that focuses on the following topics, relevant to their needs:

'The social networks': 8 session series.
'Relationship to self’: 10 session series.
'Sexual health and contraception’: 5 session series.

Elements of programme that are in development:

'Nutrition and eating well': 4 session series.
'Abusive relationships': 4 session series.
‘Risks for children associated with parental substance dependence and sex work’: 4 session series.
‘Training and employability support’: The positive move-on plan includes linking the residents up with community provision that supports them to enroll in part time training programmes once they are settled in the area. Further Education and Training is brought up, during their stay at NH, as a goal for once they are in the community- with a view to up skilling once their child starts school.

Three mothers will have maintained abstinence from illegal drugs and two from alcohol (any use of alcohol/illegal drugs will necessitate move-on from Naomi House and ongoing work in the community to stabilise them and safely reunite them with their child).

After 21 months, six women have completed a full detoxification from all drugs and/or alcohol.

This has been achieved through working closely with the specialist drug services (mostly BSDAS), who provide ongoing key work support and a reduction plan for residents whilst they are still on heroin substitutes such as methadone. For those with crack as a primary drug of choice there is no substitute drug, which involves staff working closely with the resident to manage their behaviours, emotions and cravings. One resident has completed a final detox through the local specialist hospital unit (Acer Unit) on a two week residential programme. This involved her baby being accommodated in foster care for the two week period.

Our in-house therapeutic programme also supports residents to address drug and alcohol misuse, the cycle of addiction and relapse prevention with the aim of strengthening resolve and equipping residents with the tools to sustain a life free from addiction and therefore a realistic chance at achieving this. The work is complex and underlying factors for addiction (such as childhood trauma and abuse) start to emerge when clean from illicit drugs/alcohol. These issues start to be addressed, although this has to be done in a highly sensitive manner at this stage of recovery from addiction.

Two mothers will have detoxed from all prescribed heroin substitutes e.g. methadone.

See above.

All residents (both mothers and babies/toddlers) will have care plans covering housing needs, health, self-esteem, etc. to equip them for life in the wider community.

After 21 months, 12 mothers and 11 babies achieved this. Every six weeks each resident completes a care plan together with their keyworker. Each care plan covers the following areas; physical health, substance misuse, emotional well being, relationships, life skills, spiritual health and move-on planning. Each woman scores their progress according to these sections and sets themselves SMART (Specific, Measurable, Attainable, Realistic and Time-bound) goals to be achieved within this six week time frame. Our care plans are very much working documents which are used as the basis for weekly keywork sessions to provide focus, clarity and motivation. Please see graphs below which highlight the self reported progress of three residents at Naomi House over a six month period.

GRAPHS TO ILLUSTRATE SELF-ASSESSED PROGRESS AT NAOMI HOUSE

SJ

JF

JB


Four mothers and their babies will have engaged with parenting support groups at Naomi House and/or in the wider community.

See above

Three mothers and their babies will have fostered positive relationships with extended family members (not all family members are appropriate, therefore this cannot be promised in every case).
Relationships with family members can often become strained as part of the consequences of extended drug misuse. Wherever possible, Naomi House encourages reparation of key relationships. We recognise that on leaving Naomi House, residents and their babies will benefit from as many safe and positive support systems as possible. In some cases, family members (grand-parents) have been involved in the care of babies/toddlers prior to entry to Naomi House and also would like to continue building relationships with their children and grandchildren. We work closely with CYPS to build positive relationships with those family members that are deemed appropriate. This may involve phone conversations, supervised visits, or attendance at case conferences.

All mothers will have given feedback on the services that they have received, attended residents meetings, inputted and shaped the ongoing services and activities provided by Naomi House.

 

Evidence and evaluation - making a difference to children, young people and families

Evidencing your practice has made a difference to children, young people and families

The result of our actions has been that 12 women and 11 babies have lived at Naomi House and benefitted from the intensive support and development skills to enable them to raise their children in a safe and loving environment. 12 women over a period of 21 months have attended drama therapy groups and individual sessions that support them to explore, integrate and learn to contain their emotions, within supportive therapeutic structures. This means that the mothers will be better equipped at containing their emotions and moods relating to past trauma, when around their young babies. They have also been supported to therapeutically explore and share their feelings and contain them appropriately, so they will be less likely to relapse.

Three women have positively moved on with their babies into the community. All these women and their babies are living in accommodation in the community. According to where they have relocated, Naomi House provided an initial move-on support package specific to their needs whereby they could access relevant support services, e.g. named drug services and support workers, Sure Start, housing officers, counselling services, community activity groups. Two of these women have moved close to key members of their families and are continuing to build on these relationships.

Four of the women are continuing to live at Naomi House and developing skills to enable them to live more productive lives. All four women attend regular drama therapy groups that support their interpersonal skills and facilitate their ability to share/ express their emotions safely and appropriately and receive support from the group. These women are learning relaxation techniques and self-soothing techniques to overcome their experiences of abuse and trauma. Relapse prevention strategies are reviewed on a weekly basis to equip them with the skills to overcome any cravings.

Six women have completed a full detox from all drugs and/or alcohol. All of the babies have consistently met all of their developmental targets. This is monitored through physical developmental checks carried out by the health visitor and ongoing observation by the childcare worker. Any concerns are recorded in their care plan and followed up by the child care worker with health professionals.

Naomi House addresses addictions, enables parenting and supports exiting from street sex work. As outlined in section 2, ‘Relapse prevention’ materials and modules are delivered within a consistent therapeutic structure that also enables women to express/voice their feelings and any ambivalence they are experiencing. Qualitative evidence is collected on the resident’s case notes, which records their attendance and any concerns or positive developments. A log of all the outlines of the relapse prevention groups is recorded. Over a period of 21 months, 12 women receive relapse prevention. This number of women also attend ‘Psychosocial & therapeutic support with understanding relationships’ in regular Wednesday groups, which are delivered as part of a rolling programme. The topics are relevant to the needs of women who have sex worked to facilitate their chronic dependence on substances such as heroin and crack cocaine. Women complete an initial self-assessment and an evaluation form which records their learning and personal insights about the topics. Qualitative evidence is collected on the resident’s case notes, which records their attendance and any concerns or positive developments.

Parenting has been enabled by providing weekly parenting classes which have looked at a range of topics including feeding, diet, play, sleep, behaviour management, safety and routines. The parenting classes are planned with an objective and outcome and each topic may stretch over several weeks. The parenting classes consist of a mixture of discussion, role play and practical tasks. Qualitative evidence is collected on the resident’s case notes, which records their attendance and any concerns or positive developments.

We have devised a database that enables us to record statistics, e.g. the appointments women and babies attend, such as groups, one-to-ones, doctor, dentist or hospital appointments). We also have password protected computer database case notes, individual confidential files, self-and peer-assessment and care plans for both mother and child. Care plans are reviewed and updated on a regular basis and progress is monitored through this process. It is operated through a self and keyworker scoring system whereby discussion can be had on perceived progress.

Some quotes from women who have benefitted from Naomi House:

“I took the step for myself because I want to be free to be me, free to walk down the street with my head held high, free to play with my son, take him to the park, for a swim, free to give myself and him the love we both so deserve. It wasn’t an easy choice to come into Naomi House, but the best one I’ve made in years.”

“The best thing about Naomi House is being able to keep my baby. I love her more than anything in the world. Last Christmas I wouldn’t have dreamed I’d be here, caring for my baby and learning new things. I’m in control now and making life better for both of us.”

“Naomi House is a great place to learn to love my life and be free.”

“My baby got taken into care. I felt like I had let him and all my kids and family down; my heart and soul were in pieces. But I’ve been given a wonderful chance - a gift - to have a life, my son, and a future with all my children. Now I’m on the path to recovery and have been given a chance to stay clean. Now my family aren’t waiting for that call to say it’s the END. No more misery, just the beginning. Amen. Thank God for another day clean.”

“Naomi House is good for [baby daughter’s name] because she’s got her mummy. If it wasn’t for Naomi House she would have been taken into care.”

“Naomi House was the only way to keep us together. I fought for this place because it meant we could be together straight away.”

“My daughter enjoys the baby massage, it makes her all relaxed. She loves being with Jan [childcare worker] in the crèche and playing with all the other babies.”

“It’s really good for my child to have other people to interact with, having other people to be good examples than parents.”

“I think it’s a brilliant place. It’s been really hard in the past when I’ve had other kids taken away to stay clean. Here I’m together with my baby and it gives me more reason to stay clean.”

“Naomi House is brilliant. It’s given me the chance to prove to people that I can do it.”

“I want to be a mum. It’s so supportive. There should be more places like this helping vulnerable people.”

“I wouldn’t have been able to get clean out in the community. Here I’m getting my baby back. It’s hard but she’s worth it.”

“The best thing about Naomi House is being with my child and being off drugs.”


In April 2010, we were awarded the GlaxoSmithKline IMPACT Award. Chairman of The King’s Fund who administer the awards said about One25:

““One25 works with an extremely vulnerable group of women and makes lasting improvements to their lives. It has recently opened a new residential facility for women who have exited sex-work and their babies to enable them to care for their children. It changes people’s lives and the dedication of its staff and volunteers is impressive.”


Other funder feedback:
“The A B Charitable Trust has continued to fund Naomi House for a number of years with confidence. The project steps in to stop the generational cycle of abuse and addiction and has made a lasting difference to families in Bristol.”

Director of The A B Charitable Trust - May 2010

Social services, drug services and health services are all closely involved with Naomi House. We work in a multidisciplinary way with relevant services. Agencies now have a real solution in Bristol to the problem of pregnancy and drug addiction among street sex workers. Referrals have come in from out-of-county as Naomi House is unique and the only one of its kind in the country.

Local networks have been established with GPs, health visitors, mother and baby groups, etc.
One woman’s story highlights how One25’s links with the police, maternity services and social services resulted in placement in Naomi House which in turn changed her whole life.

One woman’s story
“Susie” is a 32 year old woman with 3 kids who have been removed from her care. She was selling sex on the streets for years and heavily using crack and heroin – because of this she was allowed very little contact with her family. She says “my life was such a mess. I was smoking crack and heroin and working the streets. I hated all of it. I wanted a real life – a normal life.” Last year Susie got pregnant again and knew she needed to turn her life around in order to be a loving, stable mother for her baby. However, when she was 6 months pregnant she was raped. She came in to One25’s drop-in heavily traumatised and in need of our support. Our therapeutic caseworker helped Susie to report the crime, go to maternity services and receive specialist trauma support.

The next day she was given a place at Naomi House where she and her baby daughter have since flourished, even to the extent that she was confident enough to testify against her attacker last summer and find justice. She recently wrote “My life has changed so much since I have been here. I’m so happy. Me and my baby girl are doing so well. I’m seeing my oldest daughter again. I have been clean from drugs for nine months. Now I know I’m worth so much more. Now I’m a much better mother to my children…Thanks to Naomi House me and my baby daughter are together – and thanks to me of course, for being strong.” Thanks to the support of Naomi House, this family have now moved out into the community together with a bright future ahead of them.

A testimonial from the Coordinator for Bristol Maternity Drug Service also shows the interagency work happening with Naomi House and other agencies:

During the time Naomi House has been up and running, the majority of the referrals have come from our service (Bristol Maternity Drug Service). The communication has been good and mutually supportive between the services and we have been able to contribute in terms of experience and knowledge, as well as learn a lot from the Naomi House team. Naomi House has taken a very professional approach by managing to remain compassionate, while at the same maintaining clear boundaries.

The outcomes are very impressive and I don’t believe this would have been achieved without this level of support and therapeutic input. For example we have referred a few woman who have been using crack and heroin heavily throughout the pregnancy, have then managed to stabilise their drug use on Acer Unit and then been transferred to Naomi House on discharge. Some of these women have been admitted to Naomi House on large doses of methadone but within a few months have become drug free. Without Naomi House these women would not have had the chance to care for their babies due to the child protection concerns, let alone address their drug use and associated behaviour.

Naomi House has proven its value over the last 21 months. We provide a value for money and cost effective service. Current funding requirements for Naomi House = £240,149 per annum: £715.63 per adult and £474.07 per child per week.

The cost of parent and baby carer foster placement alone would be in £693 (financial guidance for foster carers updated 2010). A private foster care placement would cost substantially more than this.

One25 has secured the funding for Naomi House to date through trusts, grants, and individual giving. This is not sustainable in the long term.

We have applied for CQC registration and we are further developing our therapeutic treatment programme in order to meet approved and recognized standards.
Early in 2011 we plan to launch as a charging service and we expect adult and child services to fund the beds for mothers and babies.

We are putting together a charging structure in order to cover 75% of the existing costs of running Naomi House.

We are currently exploring the options available to expand the service to become an 8-10 bed home with more scope to cater for women at varying stages on the journey to independent living. This would enable us to be even more cost effective and to recover 100% of the costs. We also plan to build some reserves in order to build on the provision of move on accommodation and move on support.

The estimated cost of housing 10 women (costed at 70% occupancy) would be £554.50 per adult per week and £312.34 per child per week. We increased the staffing costs based on the recruitment of more admin support, a third keyworker, a second counsellor/therapist, a childcare assistant and more bank staff and night workers. All other costs were increased proportionally according to the number of residents. The difference in weekly costs between 4 women residing in a 4 bed unit and estimated costs of 7 women residing in a ten bed unit is £322.86 per week per woman and baby.

 

Sustaining and replicating your practice

Helping others to replicate your practice

In January 2010, after our first year of opening, we carried out our own in-house review of the service. This is a very honest account of where we were up to at that time and highlights the ‘ups’ and ‘downs’ and the lessons learned during our first year. In addition to this, a research study has been completed by Natasha Mulvihill for the Centre for Gender and Violence Research, University of Bristol: ‘An exploration of the issues for policy and for practice raised by ‘Naomi House’, a service supporting women with a history of working in street prostitution and drug addiction to keep their new babies’ (September, 2010)

At the end of year one, we reviewed our mission and method of implementing our mission. We considered where we fitted in the treatment/safe house spectrum. Initially it was thought that Naomi House would be a safe house for mums and their babies but what quickly became evident was that due to the complexity of the women’s needs and the high levels of CYPS involvement in their lives we would need to provide more than just a safe house if CYPS were to be convinced of the suitability of Naomi House as an alternative to removal of the baby at birth. Although this was a challenge for us, we recognized it in the early stages of development and we were able to adapt our plans to accommodate offering a therapeutic treatment programme. The therapeutic programme is still growing from strength to strength. We are improving and developing the programme to meet recognized national standards.
We are clear therefore that Naomi House is a therapeutic treatment home where we are able to offer a good level of in-house opportunity for women to address their addiction and the underlying causes.

We have restructured the staff team in order to provide the best care and support possible in the most cost effective way. We have considered staff morale and issues relating to stress and tiredness. Staffing the house for 24 hours and 7 days per week has been a challenge, but we now have a staff structure which works and is also cost effective.

There have been many challenges and barriers during the planning stages and first 21 months in operation. However, these are to be expected with any new venture, so it has been an opportunity to learn from our experiences and incorporate certain elements and procedures to ensure best practice, e.g.
• In order to alleviate unnecessary stress on the manager and deputy manager, we now have a team of well-qualified volunteers (comprising retired and experienced social workers who are well-respected in the field) who assist with the on-call rota.
• Following a difficult out-of-county referral (mainly due to lack of information from referring agency and lack of solid links for Naomi House with the receiving authority in those early stages), we have refined our procedures for out-of-county referrals; we are well-established now and have built good working relationships with both Bristol and South Gloucester CYPS, with clear referral pathways.
• We have also developed good working relationships with the two local maternity hospitals and we work very closely with the specialist midwives who focus specifically on mothers with addictions who can often have added complications and vulnerabilities during pregnancies. This has proved invaluable in avoiding misunderstandings, e.g. on two occasions, women were sent home from hospital by the delivery suite staff after assessment. This resulted on both occasions in babies being born at Naomi House as on their return. The women went almost immediately into active labour with no time to return to the hospital. We now have an agreement that all Naomi House women will not be sent home once admitted. Both babies were absolutely fine and the emergency services were called to assist but it highlighted the specific nature of the work that we do and the vulnerabilities, as stated, of this service user group.

This line of work is unique and specialist in nature. We have worked hard to gain the respect that we have over the months and now receive regular referrals from Bristol specialist drug and alcohol services (BSDAS) and the social work team at the maternity hospital, amongst others. We are mindful of the importance of working in partnership with CYPS in order to gain the best outcomes for mother and baby, whatever that might be. We have learned that one of the key things of importance in this work is to ensure that at all times we have clear and concise communications with all the professionals that we work with. We have achieved this through some of the learning we have been through and sheer hard work at building the links.

One of the challenges has been to enable women to move towards abstinence and begin the in depth therapeutic work within what at times appears to be a maintenance culture within the drug agencies. Initially, we faced many challenges. including negotiating the lease and the pressure of preparing for the opening date. Our first out-of-city referral challenged us. We experienced staffing and rota issues as we were managing a 24/7 rota and there were issues around a lack of space resulting in us changing our plans to become a 4 bed unit rather than a 5 bed unit. We were aware that we were pioneering something new and generating everything from scratch. There were particular challenges regarding the nationally recognised chaos of the street sex working scene and the levels of violence that the women experience. There were initial challenges of multi-disciplinary working and building the links; keeping the money coming in; lone working at the weekends; developing therapeutic programmes amongst everything else.

Over a million children in the UK are affected by their parent’s addictions. These children are highly likely to get caught up in a cycle of deprivation, abuse and addiction unless someone steps in. There is a lot of evidence which shows that children are more likely to thrive when they have a secure attachment to their mother; Naomi House keeps families together in a safe and nurturing environment and provides intensive support to enable them to give their child a better start in life.


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