Pause Dorset equality impact assessment

Aims of the policy or strategy

The aim of the Pause Dorset programme is to give women who have experienced, or are at risk of, recurrent care proceedings an opportunity and support to ‘pause’ and take control over their lives, to improve their wellbeing, resilience and stability. This helps them set in place strong foundations on which they can build a more positive future for themselves.

The service will contribute to a reduction in future numbers of children brought into care and the disruption of trans-generational cycles of poor outcomes experienced by some of the most vulnerable families in our community.

Women who experience repeat removals often vulnerable with complex needs which are not currently being addressed. They may experience trauma and grief associated with the removal of their children, they may suffer from domestic abuse, mental health illnesses or substance misuse and they may have built up a mistrust towards children’s social care services, resulting in poor engagement with existing support services.

The criteria for any Pause programme (nationally) is women aged 18-44 who are at risk of further pregnancy and subsequent removal and have had 2 or more children removed within the last 5 years.

Intended Outcomes:

Short term

reach and engage eligible women in the programme with a commitment to a pause in pregnancy including starting a method of contraception of their choice
development of pathways to better facilitate access for this cohort to services including contraception and mental health
positive changes to the relationships between birth mothers and existing children
building of relationships and trust between the women and their Pause “practitioner”

Medium term

positive changes in women’s sense of self (general wellbeing, self-esteem and support network) and ability to self-advocate
women have improved stability and use of entitlements, support and services (including primary care), including use of planned care instead of crisis care
increased accessibility to services and support
systems better support those who experience recurrent removals
increased understanding towards those who have/are at risk of experiencing repeat removals

Long term

reduction in the number of children who experience care
existing children develop a better sense of identity
existing and future children go on to have better outcomes
improved outcomes for the cohort of women at risk of repeat removals (including health and wellbeing, housing, financial, social, self-efficacy outcomes)
reduced pregnancies where children are subsequently taken into care
feeling empowered with improved emotional resilience
cost avoidance due to a reduction in repeat removals, reduced risk of children being born with health and related needs (i.e. where born to a mother with addiction), and a general shift by women in their use of health and other services from unplanned to planned use
public money is saved

Background to the proposal

Dorset Council is seeking to reduce the number of children brought into care in Dorset.

In Dorset, women are usually well supported during the process of having their child removed from their care, however, once court proceedings have been completed and the child has been removed, the scoping has identified a gap in a multi-agency approach for post-care proceedings which focuses responds collegiately to the needs of mothers/parents nor intervenes to break the cycle. Therefore, there is a cohort of women, who experience repeat removals of children into care.

The Dorset Council “Best Start in Life”, part of the Children, Young People & Families plan 2021-23 and Strengthening Services plans for 2021-22, prioritises the development and implementation of a multi-agency approach of intensive support to women who have had multiple children removed from their care.

Public Health Dorset, on behalf of the Dorset Strategic Alliance, has worked with colleagues from across the system to explore ways of delivering a holistic programme for vulnerable women, and their partners (where appropriate), who have experienced, or at risk of, repeat removals of children from their care.

The Council is commissioning a provider to deliver the licenced Pause Programme model (which will be called “Pause Dorset”) in Dorset, to offer long-term intensive support to an eligible cohort of women experiencing, or at risk of experiencing, recurrent care proceedings.

Pause is a national trauma-informed voluntary programme for women who have experienced, or are at risk of experiencing, repeat removals of children from their care which works to break this cycle of removals. The programme is underpinned by the “Pause: Creating Space for Change” model.

Intelligence and Communication

Data, information, evidence and research used and how it has influenced the decision-making process

review of commissioning for similar programmes in other Local Authority areas in England
evaluations (DfE; 2017 and 2020) of the Pause post-care proceedings support service
local scoping data (Pause, July 2021) which identified the eligible cohort and informed the local demographics and need
local Children in Care data (Dorset HealthCare, July 2021)
fact finding and discussion with local system partners to understand their experience of working with this cohort

This data told us that

the results of the Pause scoping exercise identified 51 women in Dorset who have had two or more children removed in the last three years or women with one child removed who may go on to have another child.
of these women, 161 children had been removed from their care.
in addition, the scoping exercise identified 71 women who have had one child removed – it is likely that a number of these women are at risk of further removals.
in July 2021 Dorset Council had 446 children in care and 465 care leavers. In addition to children in care from the resident population, over 196 children from other local authorities were placed in Dorset.
an offer of long-term intensive support has not previously been available through existing universal, early help or specialist services. Therefore, there are no dedicated services in place to support women to break the cycle of repeat removals of children into care.
there is a case for change given the number of women in the Dorset Council area who would be eligible to receive support within the Pause model criteria
there needs to be a system-wide offer for these women through which support for their complex needs, often including physical and mental health, can be easily accessed
a holistic, trauma-informed programme of support empowers women to protect themselves against further pregnancies whilst taking the time to address their own needs
prevention of pregnancy in this cohort of women will mean less children are taken into Local Authority Care and reduce the number of Care Proceedings which follow
the effectiveness of this programme requires established referral pathways to be in place to enable these women to access a contraception method of their choice

Engagement or consultation that has taken place as part of this EqIA

we have worked with multi-agency partners from across the system to undertake view-seeking into their experiences of working with women who have had children removed into care and those who have worked with women who have complex needs (i.e. domestic violence, drugs and alcohol and mental health)
the national Pause model has been informed by a network of practices with experience of working with this cohort of women
during mobilisation an engagement plan will be agreed to seek the views of local women

Feedback and communication

Feedback to those consulted during the mobilisation phase will be included in the engagement plan and information shared accordingly, There is a multi-agency Pause Dorset project board which will ensure any feedback from stakeholders will be fed back to the system

Assessment

Impacts of the policy or strategy

impacts table
Impact on who or what?	Effect	Details
Age	Neutral	The local Pause scoping found that, as of June 2021, the ages of the women in the cohort eligible to receive the Pause programme, ranged from 20 to 43 years old. The mean average age was 31 years old. The number of women aged 30 and under was 23 (45%). The age of the women when they gave birth to their first child ranged from 15 to 33. The average age at first birth was 21 years old. Based on data from the scoping report for the age of women when they had their first child removed, 53% (27 women) had become mothers before they turned 20, including two women aged 15 years. A study by Lancaster University found that the risk of having a child removed into care increases to one in three if the mother was very young at the time of the first birth or first removal. Any women who are 17 years and under would usually be known to Children in Care teams. The Pause Dorset programme will use updated scoping data to identify the eligible cohort during mobilisation of the service. A prioritisation exercise will take place to identify those women who have the most complex needs and are at the highest risk of further repeat removals of children into care. It is likely that women towards the higher end of the age range will be at lower risk of giving birth to more children, so Pause Dorset may end up working with younger women. However, each case will be assessed individually.
Age bracket affected	n/a	Women aged 18-44 years are eligible for the Pause programme. This age bracket is considered “child bearing age” by Pause. The service does not cover females under 18 years of age which could potentially leave this group without support to reduce the risk of pregnancies and removal of children; however this wouldn’t be considered a negative impact on this younger cohort.
Disability: (including physical, mental, sensory and progressive conditions)	Neutral	The intensive-support element of the Pause programme affords the Pause practitioner the opportunity to work longer-term with these women to ensure they get the maximum benefit from the programme.
Specific group affected	n/a	All women who can become pregnant will be eligible for the Pause Dorset programme if they meet the criteria of having 2 or more children removed permanently in the past 5 years. Women with disabilities, both physical and learning, need to be able to access the service and benefit from the support provided
Gender Reassignment & Gender Identity	Neutral	Pause works with women who have or are at risk of their child(ren) being removed and works to break the cycle of pregnancies leading to repeat removals. In the case of male to female (MTF) gender reassignment, pregnancy would not be a risk factor, so the service would not benefit those individuals. In the case of female to male (FTM) reassignment, the risk of pregnancy is still a factor if the individual has not undergone gender reassignment surgery which would impact their fertility or ability to become pregnant. Individuals with FTM reassignment therefore need to be able to access the service. Pause has worked with individuals who have been exploring their gender identity (FTM) and would continue to support them whilst they still meet programme eligibility criteria and are at risk for further pregnancies that could lead to a removal of the child. Care will be taken to safeguard these individuals from any transphobic behaviours and language - both from professionals and other women accessing the programme- and practice teams will be led by the person on their preferred pronouns and name. Advocacy and training will be provided for supporting these individuals
Pregnancy and maternity	Positive	Pause works with women when they are not pregnant and do not have children in their care. The only pre-requisite for a woman to work with Pause will be that they commit to taking a pause in pregnancy by using a contraception method of their choice. This pause from pregnancy occurs whilst woman is engaged with the 18-month Pause programme, to take a break from the destructive cycle of repeat removals. Women who do not wish to use contraception are, therefore, excluded from the programme, unless there is a medical reason for them to not use contraception. Following transition from the Pause programme, the aim is that women will have made sufficient changes to be able to build on their capacity to successfully parent should they become pregnant again in the future.
Race and Ethnicity	Neutral	Research by Lancaster University showed that 16% of births to this group of women led to SCBU stays, compared with 8% for the general population. Women of all races will be able to access the service (where the Pause eligibility criteria is met). However, there may be lower engagement and uptake from women from ethnic minorities and those who do not speak English. Women who do not speak English would be offered support with an interpreter and any relevant documentation would be translated. Since late 2020, the Pause national team has been researching the impact of race on the women who work with the Pause programme and those who are eligible, including barriers to support. They are committed to becoming an anti-racist organisation, as detailed in their statement of intent - https://www.pause.org.uk/about-us/our-people/our-commitment-to-anti-racism/
Religion or belief	Neutral	Women with all religions and beliefs will be able to access the service (where the Pause eligibility criteria is met). If a woman is unable to use contraception (one of the programme pre-requisites) due to religious beliefs, the woman and her Pause Practitioner will work alongside the local sexual health service to explore suitable alternatives to enable the woman to have a break from pregnancy and fully engage in the Pause programme. Pause Dorset will use discretionary measures to look at women on a case by case basis
Sexual orientation:	Neutral	Pause works with women regardless of sexual orientation. The programme provides the opportunity to challenge stereotypes around domestic violence and other inter-relationship harms or disfunction.
Sex (consider both men and women):	Neutral	Pause Dorset will work with primarily with women and will include their partners where appropriate, recognising the role they play in achieving the women’s defined outcomes. Other services which also address the needs of men will be considered outside this programme.
Marriage or civil partnership	Neutral	Marriage or civil partnerships are not anticipated to have an impact on the access to, or ability to benefit from the programme. The local Pause scoping found that, as of June 2021, 84% of the women in the eligible cohort had experienced domestic abuse irrespective of marital status. The impact of this programme may lead to an increase in dissolution of marriages or civil partnerships where the woman is unsafe. The woman’s marital status is likely to have an impact through court proceedings where parental responsibilities are a factor
Carers	Positive	Women engaged in the Pause programme will receive support to improve their self-care and family responsibilities. There may be a positive impact on any young carers who remain in the family home
Rural isolation	Positive	The rurality and accessibility of the Dorset Council area has been recognised in the development of the Pause Dorset programme. It is considered a key barrier to address through service delivery to ensure those living in rural isolation or those who are unable to travel are not disproportionately disadvantaged. Harder to reach communities include gypsies and travellers and those not permanently housed living in temporary accommodation. Each woman is given “Women’s Resource” funding which can be used to reduce barriers to access and public transport costs
Single parent families	Positive	Women who are isolated will have access to a Pause practitioner who will be able to provide support and improve their connectivity.
Social & economic deprivation:	Neutral	The Pause programme has an allocation per woman known as the “women’s resource” which is intended to provide financial support as required to achieve the woman’s goals. The programme supports women to address their finances and to learn how to budget to avoid poverty.
Armed Forces communities:	Neutral	The Pause programme will work with the eligible cohort irrespective of their military connection, arrangements, or communities.

Key to effects or impacts

Positive - the proposal eliminates discrimination, advances equality of opportunity and/or fosters good relations with protected groups.

Negative - protected characteristic group(s) could be disadvantaged or discriminated against

Neutral - no change/ no assessed significant impact of protected characteristic groups

Negative - protected characteristic group(s) could be disadvantaged or discriminated against

Action plan

Issue	Action to be taken	Responsible officer	date to be completed by
Pregnancy & maternity	We will ensure the tender questionnaire and evaluation criteria seek to cover the points identified in the EQIA. We would expect the successful provider to submit an EQIA as part of their mobilisation and subsequent contract monitoring will hold providers to account on these issues	Jo Wilson (Public Health Dorset) Jen Spencer (Public Health Dorset) Tom Smith (Dorset Council Procurement)	1 May 2022 (commissioning/tender) 1 October 2022 (provider mobilisation plan)
Carers		Jo Wilson (Public Health Dorset) Jen Spencer (Public Health Dorset) Tom Smith (Dorset Council Procurement)	1 May 2022 (commissioning/tender) 1 October 2022 (provider mobilisation plan)
Rural isolation		Jo Wilson (Public Health Dorset) Jen Spencer (Public Health Dorset) Tom Smith (Dorset Council Procurement)	1 May 2022 (commissioning/tender) 1 October 2022 (provider mobilisation plan)
Single parent families		Jo Wilson (Public Health Dorset) Jen Spencer (Public Health Dorset) Tom Smith (Dorset Council Procurement)	1 May 2022 (commissioning/tender) 1 October 2022 (provider mobilisation plan)

People who have agreed the EQIA

Name Jen Spencer

Date 19 January 2022

Equality Lead Bridget Downton

Date 26 January 2022

Equality and Diversity Action Group Chair Bridget Downton