Revised slideshow morning session for e circulation june 13th

Supported by

Primary Prevention – cheaper than cure, better outcomes for

childrenJune 13th 2012

Supported by

Supported by

Welcome from the Chair

Christine Davies, CEO, Centre for Excellence and Outcomes,

C4EO

Supported by

Keynote speaker: Early Intervention agenda &

context setting

Sarah Teather, Children’s Minister, Department for Education

Supported by

Why BIG Lottery has given it’s support to

this agendaDharmendra Kanani

Director, England, BIG Lottery

Supported by

A local government perspective on child abuse and neglect

David Simmonds, Chairman LGA Children and Young People Board

Supported by

Better fences - fewer ambulances

Robin MillarProgrammes Director, Centre for Social

Justice

Supported by

The importance of a local area prevention

strategy

George HoskingCEO, WAVE Trust

The importance of a local area prevention The importance of a local area prevention strategystrategy

The importance of a local area prevention The importance of a local area prevention strategystrategy

George Hosking, WAVE TrustGeorge Hosking, WAVE Trust

Primary Prevention – Primary Prevention –

cheaper than cure, better outcomes for children cheaper than cure, better outcomes for children

Central Hall, Westminster, 13Central Hall, Westminster, 13thth June 2012 June 2012

Without dramatic change, within 20 years the Council will be Without dramatic change, within 20 years the Council will be unable to provide any services except adult social care and unable to provide any services except adult social care and children’s services children’s services

Irrespective of savings planned under One Barnet Transformation Irrespective of savings planned under One Barnet Transformation Strategy, demographic change – more children, more elderly – will Strategy, demographic change – more children, more elderly – will soak up every available pennysoak up every available penny

‘‘In 5-7 years … it starts to restrict our ability to do anything very In 5-7 years … it starts to restrict our ability to do anything very much else. Over a 20-year period, much else. Over a 20-year period, unless there was really radical unless there was really radical corrective actioncorrective action, adult social care and children’s services would , adult social care and children’s services would need to take up the totality of our existing budget.’ need to take up the totality of our existing budget.’

Nick Walkley, Barnet CEONick Walkley, Barnet CEO

The Barnet Graph of DoomThe Barnet Graph of Doom

The Barnet Graph of DoomThe Barnet Graph of Doom

Current reality of budget cuts – 1Current reality of budget cuts – 1

Matt Dunkley, Director of Children’s Services, East Sussex Matt Dunkley, Director of Children’s Services, East Sussex 2011-12 budget: £20m cuts to Children’s Services2011-12 budget: £20m cuts to Children’s Services

– ‘‘We have done the best we can with the challenge we were set’We have done the best we can with the challenge we were set’

The challenge: deliver a heavy, frontloaded package of cutsThe challenge: deliver a heavy, frontloaded package of cuts

Ringfenced schools budgets off limits. Child protection and looked-Ringfenced schools budgets off limits. Child protection and looked-after children budgets insulatedafter children budgets insulated

Cuts fell disproportionately on preventive services inc. early years’Cuts fell disproportionately on preventive services inc. early years’

‘… ‘… not the way forward I would have ideally chosen.’not the way forward I would have ideally chosen.’

Current reality of budget cuts - 2Current reality of budget cuts - 2

Matt Dunkley (continued)Matt Dunkley (continued) East Sussex has put 600 more children (most under five years old) East Sussex has put 600 more children (most under five years old) on child protection plans in the past two years (2011)on child protection plans in the past two years (2011)

Number of looked-after children has almost doubled to 560Number of looked-after children has almost doubled to 560

Government’s Early Intervention grant cut, in effect, by 20%.Government’s Early Intervention grant cut, in effect, by 20%.

Soaring demand, little sign that trigger factors such as parental Soaring demand, little sign that trigger factors such as parental substance abuse is fallingsubstance abuse is falling

‘‘The pace at which we had to do this … led to missed opportunity The pace at which we had to do this … led to missed opportunity to do a smarter piece of work … to reshape those services.to do a smarter piece of work … to reshape those services.’’

Continue on current pathContinue on current path

or create aor create a

Paradigm shift: Invest in primary preventionParadigm shift: Invest in primary prevention

Fundamental choiceFundamental choice

Continue on current path?Continue on current path?

Out of 12 million children under 16 in UK:Out of 12 million children under 16 in UK:

Severely maltreated 1 to 1.6 millionSeverely maltreated 1 to 1.6 million

Physical neglect over 1 millionPhysical neglect over 1 million

Alcoholic in household 1 millionAlcoholic in household 1 million

Witnessing domestic violence ¾ millionWitnessing domestic violence ¾ million

Costs of continuing on current pathCosts of continuing on current pathCosts of continuing on current pathCosts of continuing on current path

Annual waste from adverse early years estimated at over £200 Annual waste from adverse early years estimated at over £200 billion, nationallybillion, nationally

Includes cost of welfare benefits, crime, mental health, alcohol and drug Includes cost of welfare benefits, crime, mental health, alcohol and drug abuse, violence, family breakdown, domestic violence, NEETS, abuse, violence, family breakdown, domestic violence, NEETS, prison service, looked after children, young offenders, special prison service, looked after children, young offenders, special educationeducation

doesn’t include...doesn’t include...

Lost tax revenue and costs of poor physical healthLost tax revenue and costs of poor physical health

The future: doom or hope?The future: doom or hope?

What if, instead of doom and gloom, we could find a more up to What if, instead of doom and gloom, we could find a more up to date way to set policy, using the latest scientific knowledge?date way to set policy, using the latest scientific knowledge?

… … which will produce far happier, healthier and more prosperous which will produce far happier, healthier and more prosperous communities…communities…

Is there a safe and economically viable way to do this?Is there a safe and economically viable way to do this?

Implication for optimum investmentImplication for optimum investment

Source: Heckman, James J. (2008). "Schools, Skills and Synapses," Economic Inquiry, 46(3): 289-324.Source: Heckman, James J. (2008). "Schools, Skills and Synapses," Economic Inquiry, 46(3): 289-324.

Pattern of public spending on education in England Pattern of public spending on education in England & Wales over the life cycle, 2002/2003& Wales over the life cycle, 2002/2003

National and local strategies of primary prevention, rather than National and local strategies of primary prevention, rather than reactionreaction

Transformation of the quality of parenting – through changed Transformation of the quality of parenting – through changed attitudes and better preparation for parentingattitudes and better preparation for parenting

Respect for children’s right not to be abused or neglectedRespect for children’s right not to be abused or neglected

Understanding and adoption of early years interventions that workUnderstanding and adoption of early years interventions that work

A new paradigmA new paradigm

Lifelong skills created very earlyLifelong skills created very early

Research of Nobel Prize Winner, James HeckmanResearch of Nobel Prize Winner, James Heckman

An open and persevering child learns moreAn open and persevering child learns more

– early success fosters later success, advantages cumulateearly success fosters later success, advantages cumulate

– young children more flexible and adaptableyoung children more flexible and adaptable

– much easier to prevent deficits from arising in early years than much easier to prevent deficits from arising in early years than to remediate laterto remediate later

Mannheim Study of Children at Risk (MARS)Mannheim Study of Children at Risk (MARS)

Individual differences Individual differences in basic abilitiesin basic abilities increase between 3 months increase between 3 months and 11 yearsand 11 years

Lifelong skills created very earlyLifelong skills created very early

Research of Nobel Prize Winner, James HeckmanResearch of Nobel Prize Winner, James Heckman

Achievement gaps between children primarily due to gaps in skillsAchievement gaps between children primarily due to gaps in skills

Hard Hard andand Soft skills very important for success in life Soft skills very important for success in life – conscientiousnessconscientiousness - perseverance- perseverance– motivationmotivation - attention- attention– emotional self-regulationemotional self-regulation - self-esteem- self-esteem– ability to defer gratificationability to defer gratification– sociability (ability to work with and cooperate with others)sociability (ability to work with and cooperate with others)

These crucial skills mostly created in early years, in the familyThese crucial skills mostly created in early years, in the family

Gaps in skills emerge early, before pre-school, and persistGaps in skills emerge early, before pre-school, and persist

Causes and consequences: Causes and consequences: Californian ACE StudyCalifornian ACE Study

Causes and consequences: Causes and consequences: Californian ACE StudyCalifornian ACE Study

Major investigation on links between childhood maltreatment Major investigation on links between childhood maltreatment and later-life health and well-beingand later-life health and well-being

17,000 Kaiser Permanente members at comprehensive physical 17,000 Kaiser Permanente members at comprehensive physical examinations provided detailed information on their childhood examinations provided detailed information on their childhood experiences of physical and emotional abuse, including being experiences of physical and emotional abuse, including being reared in households with domestic violence, drug and alcohol reared in households with domestic violence, drug and alcohol abuse. abuse.

WHO now conducting its own international (including UK) WHO now conducting its own international (including UK) ACE studyACE study

Californian ACE StudyCalifornian ACE StudyCalifornian ACE StudyCalifornian ACE Study

Health risks which increase with 4 ACEs (17% of popn):Health risks which increase with 4 ACEs (17% of popn):

liver disease (x 2)liver disease (x 2) lung disease (x 3)lung disease (x 3) adult smoking, depression, serious job problems (x 3)adult smoking, depression, serious job problems (x 3) intercourse by 15, absenteeism from work (x 4)intercourse by 15, absenteeism from work (x 4) alcoholism and alcohol abuse (x 6)alcoholism and alcohol abuse (x 6) intravenous drug use (x 11)intravenous drug use (x 11) suicide attempts (x 14)suicide attempts (x 14)

Pathways to violence by age 3Pathways to violence by age 3Pathways to violence by age 3Pathways to violence by age 3

Pathways to crime often set by age 3Pathways to crime often set by age 3Dunedin study of allchildren born in 1972, to age 21

Pathways to crime often set by age 3Pathways to crime often set by age 3Dunedin study of allchildren born in 1972, to age 21

Number with 2+Number with 2+

criminal convictionscriminal convictions

2.5x2.5x

1x1x

At riskAt risk NormalNormal

Violent offencesViolent offences

55%55%

18%18%


Abused partnersAbused partners

47%47%

9.5%9.5%


Key: understand infant brainKey: understand infant brainKey: understand infant brainKey: understand infant brain

Works via neurons (brain cells) & synapses (connections)Works via neurons (brain cells) & synapses (connections)

At birth: 10 trillion synapses - 200 trillion (or more) by age 3At birth: 10 trillion synapses - 200 trillion (or more) by age 3

EmotionalEmotional brain largely created by experience in first 18 brain largely created by experience in first 18 months; acutely vulnerable to traumamonths; acutely vulnerable to trauma

Brains of abused children significantly smaller, less developedBrains of abused children significantly smaller, less developed

Understand the infant brainUnderstand the infant brain

Understand the infant brainUnderstand the infant brainUnderstand the infant brainUnderstand the infant brain

Alan Schore - 10-year immersion in thousands of scientific Alan Schore - 10-year immersion in thousands of scientific papers in neurobiology, psychology, infant developmentpapers in neurobiology, psychology, infant development

‘‘The child’s first relationship, the one with the mother,The child’s first relationship, the one with the mother,

acts as a template … permanently moulds the individual’s capacityacts as a template … permanently moulds the individual’s capacity

to enter into all later emotional relationships’to enter into all later emotional relationships’

Key factors: Key factors: AttunementAttunement and Empathy and EmpathyKey factors: Key factors: AttunementAttunement and Empathy and Empathy

Attunement between mother and infant develops empathy.Attunement between mother and infant develops empathy.

Lack of attunement means empathy does not develop.Lack of attunement means empathy does not develop.

Low maternal responsiveness at 10-12 months predicted:Low maternal responsiveness at 10-12 months predicted:

– at 1.5 years: aggression, non-compliance, temper tantrumsat 1.5 years: aggression, non-compliance, temper tantrums– at 2 years : lower compliance, attention getting, hittingat 2 years : lower compliance, attention getting, hitting– at 3 years : problems with other childrenat 3 years : problems with other children– at 3.5 years: higher coercive behaviourat 3.5 years: higher coercive behaviour– at 6 years : fighting, stealingat 6 years : fighting, stealing

Absence of empathy characteristic of violent criminalsAbsence of empathy characteristic of violent criminals

– – worst psychopaths no emotion at allworst psychopaths no emotion at all

Primary Prevention does workPrimary Prevention does work

Successful Primary PreventionSuccessful Primary Prevention

Successful Primary PreventionSuccessful Primary Prevention

Need for Primary PreventionNeed for Primary Prevention

??

Early years prevention saves money - 1Early years prevention saves money - 1

Expert opinion USA:Expert opinion USA: Dr Bruce PerryDr Bruce Perry James Heckman (Nobel Prize winning economist)James Heckman (Nobel Prize winning economist) RAND Research Institute / Karoly, Kilburn, and Cannon (2005) RAND Research Institute / Karoly, Kilburn, and Cannon (2005) Felitti and Californian ACE studiesFelitti and Californian ACE studies Washington State Institute for Public Policy (WSIPP)Washington State Institute for Public Policy (WSIPP)

Expert opinion UK:Expert opinion UK: Government Office for ScienceGovernment Office for Science London School of EconomicsLondon School of Economics Action for Children / New Economics FoundationAction for Children / New Economics Foundation Croydon Prevention StrategyCroydon Prevention Strategy WAVE TrustWAVE Trust


RAND Research Institute / Karoly, Kilburn, and CannonRAND Research Institute / Karoly, Kilburn, and Cannon Cost benefit analyses or meta-analyses of early years’ programmes Cost benefit analyses or meta-analyses of early years’ programmes

showed payoffs per dollar invested from $1.80 to $17.07showed payoffs per dollar invested from $1.80 to $17.07 Estimated net benefits from $1,400 to nearly $240,000 per childEstimated net benefits from $1,400 to nearly $240,000 per child

Chicago Child-Parent Center Program / ReynoldsChicago Child-Parent Center Program / Reynolds Benefits > $80,000 per child - $10.80 of benefits per $1 invested Benefits > $80,000 per child - $10.80 of benefits per $1 invested Children with four or more family risk factors yielded almost Children with four or more family risk factors yielded almost

double the benefits of those with fewer ($12.8 vs. $7.2)double the benefits of those with fewer ($12.8 vs. $7.2) Children from highest poverty neighbourhoods had returns more Children from highest poverty neighbourhoods had returns more

than four times higher than those from less disadvantaged areasthan four times higher than those from less disadvantaged areas


Federal Reserve Bank of Minneapolis/Rolnick & GrunewaldFederal Reserve Bank of Minneapolis/Rolnick & GrunewaldInternal rates of return for early years programmes exceed returns from Internal rates of return for early years programmes exceed returns from both stock market and typical public policy investmentsboth stock market and typical public policy investments

[would also significantly exceed returns from many UK large-scale [would also significantly exceed returns from many UK large-scale public investments, including high speed HS2 rail link]public investments, including high speed HS2 rail link]

Washington State Institute for Public Policy (WSIPP)Washington State Institute for Public Policy (WSIPP)Rigorously conservative approach to programme evaluationRigorously conservative approach to programme evaluation

– $1.75 per $1 for Parents as Teachers$1.75 per $1 for Parents as Teachers– $3.23 per $1 for Nurse Family Partnership $3.23 per $1 for Nurse Family Partnership – $7.00 per $1 for Parent Child Interaction Therapy $7.00 per $1 for Parent Child Interaction Therapy – $10.32 per $1 for Level 4 Group Triple P$10.32 per $1 for Level 4 Group Triple P

WAVE’s Core RecommendationWAVE’s Core Recommendation

Implement a committed Implement a committed primary preventionprimary prevention strategy strategy for children from conception to age 3for children from conception to age 3

US Surgeon General:US Surgeon General: ‘‘Preventing an illness from occurring is inherently better Preventing an illness from occurring is inherently better

than having to treat the illness after its onset. The classic than having to treat the illness after its onset. The classic public health definition of public health definition of primary preventionprimary prevention refers to refers to interventions which ward off the initial onset of a interventions which ward off the initial onset of a disorder’disorder’

National strategiesNational strategies Infancy and Early Childhood in SwedenInfancy and Early Childhood in Sweden Every Opportunity for Every Child, NetherlandsEvery Opportunity for Every Child, Netherlands Scotland – new Preventive StrategyScotland – new Preventive Strategy

Local strategiesLocal strategies Croydon Prevention Strategy (joint local authority & PCT)Croydon Prevention Strategy (joint local authority & PCT) Derry, Fermanagh and TyroneDerry, Fermanagh and Tyrone Ballymun, DublinBallymun, Dublin

Strategies of preventionStrategies of prevention

A National Strategy of PreventionA National Strategy of Prevention

Approach to Infancy and Early Childhood in SwedenApproach to Infancy and Early Childhood in Sweden

99% of pregnant women access maternity healthcare services, 99% of 99% of pregnant women access maternity healthcare services, 99% of families use child healthcare services, avg. 20 contacts families use child healthcare services, avg. 20 contacts

98% of maternity services offer group parenting education to first 98% of maternity services offer group parenting education to first time mothers, specialist support to teen mums, single mumstime mothers, specialist support to teen mums, single mums

Parent education c10% of midwives time; Parents invited to join Parent education c10% of midwives time; Parents invited to join parent groups when child 1-2 months parent groups when child 1-2 months (61% attended 5+, Stockholm)(61% attended 5+, Stockholm)

65% of midwives receive regular professional training on parenting 65% of midwives receive regular professional training on parenting education, 72% instructed by a psychologisteducation, 72% instructed by a psychologist


Approach to Infancy and Early Childhood in SwedenApproach to Infancy and Early Childhood in Sweden

100% of hospitals have BFHI (baby-friendly) status (UK<10%)100% of hospitals have BFHI (baby-friendly) status (UK<10%)

Long periods of paternal and maternal leave to support babyLong periods of paternal and maternal leave to support baby

Breastfeeding:Breastfeeding: 98% of Swedish mums begin breastfeeding (79% UK)98% of Swedish mums begin breastfeeding (79% UK) 72% breastfeeding at 6 months (22% UK)72% breastfeeding at 6 months (22% UK) 15% exclusive breastfeeding at 6 months (less than 1% UK)15% exclusive breastfeeding at 6 months (less than 1% UK)

SWEDENSWEDEN UKUK

% Live Births to teen mothers% Live Births to teen mothers 1.61.6 7.17.1

Infant MortalityInfant Mortality (per 1,000 live)(per 1,000 live) 2.52.5 5.15.1

Smoking Smoking (% per day aged 15+)(% per day aged 15+) 1616 2525

Alcohol Alcohol (litres per person p.a.)(litres per person p.a.) 77 1111

Adult ObesityAdult Obesity (% of population)(% of population) 1111 2323

Smoking Related DeathsSmoking Related Deaths (per 100,000 popn)(per 100,000 popn) 196196 245245

Chronic Liver Disease Deaths,Chronic Liver Disease Deaths, < 65 yrs (per < 65 yrs (per 100,000)100,000)

44 99

Cancer Deaths,Cancer Deaths, < 65 yrs (per 100,000)< 65 yrs (per 100,000) 5656 6767

Circulatory Disease Deaths,Circulatory Disease Deaths, Under 65Under 65 3232 4343


Vision for the Infant Mental Health Strategy:Vision for the Infant Mental Health Strategy:

WHSCT committed to supporting families to provide secure WHSCT committed to supporting families to provide secure attachments children need to make best possible start in lifeattachments children need to make best possible start in life

Every child has a right to a supportive environment to create and Every child has a right to a supportive environment to create and support positive mental health and emotional wellbeingsupport positive mental health and emotional wellbeing

Investment in early years’ child development and positive infant Investment in early years’ child development and positive infant mental health, contributing to lifelong health, social and economic mental health, contributing to lifelong health, social and economic outcomesoutcomes

Infant Mental Health Strategy:Infant Mental Health Strategy:Derry, Fermanagh and TyroneDerry, Fermanagh and TyroneInfant Mental Health Strategy:Infant Mental Health Strategy:Derry, Fermanagh and TyroneDerry, Fermanagh and Tyrone

Whole Child Approach: Whole Child Approach: a holistic systems-based model of Early a holistic systems-based model of Early InterventionIntervention

Collective Responsibility: Collective Responsibility: 1) Women and Children’s Services plays a primary delivery role 1) Women and Children’s Services plays a primary delivery role 2) Ante-natal and perinatal services a core universal service 2) Ante-natal and perinatal services a core universal service 3) Every Directorate actively supporting delivery of the strategy3) Every Directorate actively supporting delivery of the strategy

Quality Service Standards:Quality Service Standards: All delivery based on timely access to services based on needAll delivery based on timely access to services based on need Evidence-based best practice and innovation at core of all servicesEvidence-based best practice and innovation at core of all services


Specific Initiatives:Specific Initiatives:Hidden Harm Action Plan for Northern Ireland and Think Child Hidden Harm Action Plan for Northern Ireland and Think Child /Think Parent/Think Family project/Think Parent/Think Family project

A universal perinatal mental health pathwayA universal perinatal mental health pathway

Leading on Roots of Empathy ProgrammeLeading on Roots of Empathy Programme

NI Regional Healthy Futures strategy principles: health visitors NI Regional Healthy Futures strategy principles: health visitors supporting children & families during formative early yearssupporting children & families during formative early years

Leading on Family Nurse Partnership Leading on Family Nurse Partnership


Service aims:Service aims:

Improve positive pregnancy and birth experiencesImprove positive pregnancy and birth experiences

Strengthen adaptive protective systems in infancy and toddlerhoodStrengthen adaptive protective systems in infancy and toddlerhood

Increase confidence and competence of parentsIncrease confidence and competence of parents

Promote healthy infant and child development Promote healthy infant and child development

Reduce childrearing problemsReduce childrearing problems

Ballymun, Dublin: Ready, Steady, GrowBallymun, Dublin: Ready, Steady, GrowBallymun, Dublin: Ready, Steady, GrowBallymun, Dublin: Ready, Steady, Grow

Initiatives:Initiatives:

– Amplify range & increase uptake of ante natal support in Amplify range & increase uptake of ante natal support in collaboration with primary health care team, maternity servicescollaboration with primary health care team, maternity services

– Enhanced baby development clinic in partnership with Public Enhanced baby development clinic in partnership with Public Health Nurse teamHealth Nurse team

– Increased emphasis on infant social and emotional developmentIncreased emphasis on infant social and emotional development

– Direct support to families and onward referral as appropriateDirect support to families and onward referral as appropriate

– Build capacity of statutory/community services to understand Build capacity of statutory/community services to understand and respond to infant mental health needand respond to infant mental health need


Strand I - Strand I - Preparing for ParenthoodPreparing for Parenthood

Focus on pregnancy and Focus on pregnancy and Infant Mental Health incl. systematic Infant Mental Health incl. systematic strategy for engaging expectant mothers and partnersstrategy for engaging expectant mothers and partners

Support adaptation to pregnancy & relationship with unborn childSupport adaptation to pregnancy & relationship with unborn child

Better meet ante natal needs of women and their familiesBetter meet ante natal needs of women and their families

Increase capacity of ante natal careIncrease capacity of ante natal care


Strand II - Strand II - Parent-child Psychological Support ProgrammeParent-child Psychological Support Programme

Promote strong parent-child relationships, parental wellbeing and Promote strong parent-child relationships, parental wellbeing and adaptive systems in childrenadaptive systems in children

Provide parents with information on child developmentProvide parents with information on child development

Check baby’s progress and changing needsCheck baby’s progress and changing needs

Empower parents to solve conflict Empower parents to solve conflict


Strand III - Strand III - Infant Mental Health PromotionInfant Mental Health Promotion

Focus on promoting social & emotional development in childrenFocus on promoting social & emotional development in children

Build service capacity to respond to infant social and emotional Build service capacity to respond to infant social and emotional needneed

– capacity building for staff, families, programmes, systemscapacity building for staff, families, programmes, systems

– identify, treat, reduce mental health problems birth to 3 yearsidentify, treat, reduce mental health problems birth to 3 years

– direct observation of children and care-giving environmentdirect observation of children and care-giving environment

– interventions designed to change behaviourinterventions designed to change behaviour


Excellent Parenting programmesExcellent Parenting programmes

Nurse Family PartnershipNurse Family Partnership

Roots of EmpathyRoots of Empathy

First Steps in ParentingFirst Steps in Parenting

Leksand Model, SwedenLeksand Model, Sweden

SKIP (Strategies for Kids, Information for Parents)SKIP (Strategies for Kids, Information for Parents)

Early intervention programmes - 1Early intervention programmes - 1

Fostering attunement, breast-feeding, secure attachmentFostering attunement, breast-feeding, secure attachment

AttunementAttunement Video Interactive GuidanceVideo Interactive Guidance

Breast-feedingBreast-feeding Breastfeeding Initiative, BlackpoolBreastfeeding Initiative, Blackpool

Secure AttachmentSecure Attachment Circle of Security, Sunderland Infant ProgrammeCircle of Security, Sunderland Infant Programme

Reducing teen pregnancyReducing teen pregnancy EnfieldEnfield

Early intervention programmes - 2Early intervention programmes - 2

..

..

Supported by

Report on recent study of policies from conception

to age 2

Sally BurlingtonDeputy Director, Sure Start and Early Intervention Division, Department for

Education

Supported by

Special Interest Group: Pregnancy to 2

Sally BurlingtonDepartment for Education

13 June 2012

Supported by

Conception to 2 is the most crucial phase of development

• Period of fastest development – 80% of all brain volume development is complete

by age 3; and is fundamentally affected by early relationships and interactions

• Lays foundations for all later development

The first 2 years of life are critical to a child’s development.How we treat 0-2 yr olds shapes their lives… and ultimately our society.

Supported by

Poor support at this stage can have life-long impact on outcomes

• Poor attachment in infancy is associated with behaviour problems later on (and the effect doesn’t reduce over time)

• It can affect anyone: the effects are not less for higher socio-economic groups

• Early childhood abuse and neglect affects physical and mental health and life-time outcomes; and the next generation

Supported by

Key factors

• Health in pregnancy (including maternal stress)• Maternal health and mental health post-birth• Quality of relationship (attachment) with main carer

has impact on:– emotional wellbeing (and infant mental health); – capacity to form and maintain positive relationships with

others;– brain development;– language development; and– the quality of the home learning environment.

Supported by

Early childhood programmes have been shown to have substantial net benefits and social

gains• … and net savings to the public purse

particularly through better long term health and crime reduction

• Cost-benefit analyses show a range of net benefits, up to 1000 x initial costs

• James Heckman: highest returns for earliest interventions (0-3)

• Best effects are delivered when long-term follow-up

Supported by

But care is needed in interpreting this….

• American evidence does not necessarily translate directly to the UK

• In the UK we already have universal maternity and perinatal health provision: Healthy Child Programme, and Family Nurse Partnership

• People tend to quote the most positive effects rather than the most likely

• Most striking effects are for groups with a large number of risk factors

Supported by

Nevertheless, some key conclusions:

• Full implementation of the Healthy Child Programme (supported by 4200 new health visitors by 2015) will give us a world class service (more like Sweden than USA?)

• Opportunity to “join up” services for infants and their families when responsibility for public health moves to local authorities from 2015

• Implementation – what you do and how you do it – is key• Early findings from FNP evaluation are very positive

(suggesting some of the success of American schemes can be replicated here): doubling of capacity is very welcome

Supported by

Wider policy developments

• 4,200 new health visitors• Doubling of Family Nurse Partnerships• Prof Cathy Nutbrown review of early years workforce• Free early education for disadvantaged 2 year olds• Digital Advice Service for parents just launched• New Early Years Foundation Stage: new focus on very young

children; identifying prime areas of Communication and Language; Social and Emotional Development; Physical Development;

• New requirement for all EY settings to undertake a progress check for 2 year olds, and to provide a report to parents. This will help to identify development needs – to be integrated with the healthy child review

Supported by

Some lessons from evidence can be used to influence ongoing practice

• “Spread the word” to all practitioners: understand what very early child development looks like, and importance of secure attachment: do people in childcare settings understand babies’ behaviour?

• Publicise good sources of advice • Early years workforce: importance of a key worker;

emotionally intelligent staff; effective supervision – role of reflective supervision

Supported by

Other Implications• How to target? Stigma vs “deadweight”

• Therefore make best use of universal provision, and stop people falling through the net by– Early identification and early help systems (HV, social work and strong

multi-disciplinary approaches)– Effective information sharing between professionals– Sure Start Children’s Centres and outreach working effectively to

identify and support the most vulnerable families very early in a child’s life

– Staff in other EY settings (especially 2YO and earlier childcare) having a good understanding of child development and how to spot and tackle problems appropriately and quickly.

• Continue to improve our understanding of what evidence based intensive support can be commissioned: who it works for; what it costs; timescales and management.

Supported by

Resources

• Pregnancy Book http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107302

• Birth to Five http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107303

• The NHS Choices website also provides a wealth of information relating to pregnancy, maternity and the early years, including an interactive Pregnancy Care Planner (based on ‘The Pregnancy Book’) and Birth to Five guide (based on the ‘Birth to Five’ book) and a range of videos on issues relating to pregnancy, babies and children. http://www.nhs.uk

• Start4Life http://www.nhs.uk/start4life/Pages/healthy-pregnancy-baby-advice.aspx

• Healthy Start http://www.healthystart.nhs.uk/

• Information Service for Parents http://www.nhs.uk/InformationServiceForParents/pages/home.aspx

• Age specific downloadable handouts: http://www.zerotothree.org/about-us/areas-of-expertise/free-parent-brochures-and-guides/

http://community.fpg.unc.edu/connect-modules/learners and http://community.fpg.unc.edu/connect-modules/5-step-learning-cycle for an explanation.

Supported by

Lunchwith Social Investment Business

models showcased

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Revised slideshow morning session for e circulation june 13th