Bugs, Boats and Obesity

Busy BugsThe East Lothian Physical Activity & Health Partnership hosted a meeting on promoting physical activity in the early years on 2nd March. The positive effects of moderate physical activity on all aspects of health and well being in all age groups are clear from research.

The meeting was led off with an informal presentation by Caroline from the Active School team who spoke about her work rolling out the Busy Bugs programme in East Lothian, as well as other programmes such as Basic Moves and Kickstart.

“Busy Bugs/Top Tots helps to introduce and sustain play and physical activity as part of a daily routine for children aged two to three-and-a-half years. The programme provides new ways to keep children active at nursery and at home, through play, movement to music, basic moves and games, with a focus on enjoyment and fun! The course covers programme planning, content and management, lesson plans, resources and the evaluation and review process. It is ideal for parents, nursery, playgroup workers and anyone else working with this pre-five age group.”

The Active School Teams approach is to train people – staff and community members – to deliver these programmes, and then to provide backup and support for these staff. They have found that support is needed especially until the trainees get some experience of delivering the programmes for children under their belts. Busy Bugs has been particularly popular with nursery staff, both local authority and private sector. A gap, discussed at the meeting, has been links to communities. A positive outcome from the meeting was a connection being made with the community development service that may help with this. There is also a need to develop a train the trainers package to help disseminate Busy Bugs and other programmes further than is possible within the resources of the Active Schools team. The teams vision is that this programme becomes a part of mainstream early years provision with back up and quality assurance provided by themselves. Hence, the Active schools team would train the trainers for school, nurseries and community settings who would then train staff to deliver the programmes in the different settings.

The meeting also heard about dance initiatives for this age group, and the provision of outdoor play in the form of play parks and outdoor areas of nurseries and infant schools.  It was clear that a lot of high quality work is going on in East Lothian to promote physical activity for this age group.

The issue of obesogenic environments was also touched upon as an explanation of why children (and adults) seem to be becoming more overweight despite such excellent work taking place in schools and nurseries. Basically an obesogenic environment is one in which it is easy to access lots of calorie dense food, and difficult to burn off those calories in physical activity. Such an environment makes it very easy to  gain weight particularly if you are genetically disposed.  In terms of weight gain it can be said that ‘Genes load the gun, but the environment pulls the trigger’.

Are East Lothian communities obesogenic – and if so are we asking all the dedicated staff who provide programmes like Busy Bugs to bail out a leaky boat?

Whats on?

Here are some Support from the Start related activities planned for the next few months

February 19th

Induction session for the staff members that have been nominated as service champions. Another session will follow for those that can’t make that date or are still to be nominated.

March 2nd

The East Lothian Physical Activity Partnership – will be asking the question – Early years & physical activity, what are we doing and can we do it better?

Venue: Early Years Centre Sanderson Wynd  9.30am – 11am

Contact Helen Bruce for further information hbruce@eastlothian.gov.uk

March 16th

Support from the Start – A conference on health inequality in East Lothian for parents/ carers and service providers

Venue: Brunton Hall, Musselburgh 9.30am – 4pm

Guest Speakers – Harry Burns, Chief medical officer for Scotland & Andrew Lyon of the International Futures Foundation

To book a place contact swray@eastlothian.gov.uk

March 24th

Bump to Bairn

An Informal and fun session for parents and children. Drop in and meet a range of services and professionals who support parents to be and parents of pre fives, and a range of other services for healthy living 

Venue: Loch Centre Tranent 12.30 – 2.30pm

For more information contact ginnie.moreton@nhslothian.scot.nhs.uk

April 1st

Inaugural meeting of the East Lothian Active Outdoor’s Network

Guest Speaker Juliet Robertson  ‘Active Outdoors in Early years Settings’

Venue: To be confirmed 2pm- 4pm

To book a place or for more information contact swray@eastlothian.gov.uk

 

Supporting The Best Possible Start For Children In Scotland

NSS Seminar Tuesday 3rd March 2009

In this my first trial post…

Can I draw your attention to a forthcoming National Services Scotland (NSS) seminar entitled ‘NSS – Supporting The Best Possible Start For Children In Scotland’, to be held on Tuesday 3rd March 2009 at the Teacher Building, St Enoch’s Square Glasgow. The seminar runs from 10am to 3.45pm.

The seminar will feature:

Presentations

Presenter

Recent developments in pregnancy / new born screening policy

Dr Ros Skinner

Child health inequalities

Dr Jim Chalmers

Child vaccination / immunisation schedule update

Dr Claire Cameron

 

 

Workshops

Facilitator

The Care of Critically ill Children in Remote and Rural Areas

Dr Andrew McIntyre

Audit of High Dependency Care for Children & Young People in Scotland:  Supporting Scotland‘s Healthcare Planning

Ms Julie Adams

Implications of recently published SGHD report on Early years, early intervention

TBC

Clinical quality and outcome indicators for children’s specialist services

Clare Clark & Alastair Philp

To register for a place, simply complete the registration form on the following link http://www.isdscotland.org/isd/5887.html and click the send button.

Completed forms should be returned no later than Tuesday 24th February.

Please feel free to pass these details on to any colleagues who may be interested in attending. Further seminars will be organised during 2009/2010, details of which will be circulated later in the year.

If you have any queries or require any further information, please contact Bill Dunn in the ISD Customer Relations Group on 0131 275 6234 or by e-mail at bill.dunn@isd.csa.scot.nhs.uk

 

 

 

 

 

 

 

Logic Modelling

In preparing for battle I have always found that plans are useless, but planning is indispensable.
–  Dwight D. Eisenhower

Having spent a good bit of time in the last few weeks working on logic modelsrelated to health outcomes I can agree with this sentiment. I have never been good at absorbing information that is presented in boxes.  For people like me at least the product of the logic modelling process is not very useful as a communication tool about the plan that it describes, particularly if I haven’t been involved in developing it.  However, the process of developing the logic model really does help with thinking through the linkages between Outcomes ( the impacts we want), the Outputs (the tasks we perform) and Inputs (what we invest) in a complex and dynamic environments such as health and well being.

Logic Modelling is never going to be a favourite task for me, but at least I can understand why it is necessary.

I am still an edubuzz novice and havent mastered the art of inserting images but hopefully clicking below will reveal a draft logic model for  Support from the Start

 equally-well-logic-model

Starting a conversation

‘Support from the Start’ aims to improve health in areas of East Lothian that have the poorest health outcomes by focusing on early years and parenting. Engaging service providers and members of the community is key to its success. 

But what does ‘enagement’actually mean and how can it be achieved?

Communties scotland has developed standards for community engagement, and the guidelines for the standards gives the following definition :-

 

 Developing and sustaining a working relationship between one or more public body and one or more community group, to help them both to understand and act on the needs or issues that the community experiences

So in this case community engagement means :

Developing and sustaining a working relationship betweent council, health and voluntary sector services that provide or support services to parents and children between 0 and eight, and the communities of Tranent, Wallyford, Whitecraig, Prestonpans and Musselburgh East to help them both understand and act on the issue of health inequality.

How can this ‘working relationship’ be developed and sustained?

In my experience good working relationships are like good conversations created from a mutual interest, and a mutual acceptance that the other person has something valid and important to offer / say. Crucially both sides need to demonstrate that they are listening to maintain the interest and involvement of the other partner.

At a national conference on Equally Well I heard a speaker from the International Futures forum talk about a ‘civic conversation’ as method of community engagement. The idea of a ‘civic conversaton’  was first put forward by philospher Anthony Grayling and has since been developed as a methodology for  trying to find out what people and services thought was important for the future of Glasgow, and to develop an understanding between services and community about the desired future.

 If we have health as part of the ethos of the city, then what policies and actions ought we develop to make this apparent and explicit. A civic conversation explores aspirations and possibilities for worthwhile action to ensure that both Glasgow and Glaswegians flourish. The basic premise underlying the civic conversation is that the way a community talks to itself, how it forms its values, beliefs and policies ultimately influences how it behaves. 

On the 16th March Scotland’s Chief Medical Officer is coming to a conference in East Lothian to help us start a ‘civic conversation’ about health inequality. He will  tell us why acting on health inequality is so important to East Lothian’s and Scotland’s future, and why the early years of life are crucial to improving health and preventing illness. Having intiated this ‘civic conversation’ we will need to be able to develop and sustain it, and the afternoon session of the conference will look at how we can take this conversation into the target communities. However, the end of the conference will not be the end of the conversation only the end of its beginning. We hope the community members and service providers that attend will go away with ideas about how to continue a ‘civic conversation’, and that the result of the many conversations that take place will be brought together in the following year at an event that will focus on developing and deepeing the conversation by showing how services and communities have listened to each other on the issue of health inequality.

Supporting research and evaluation

 

Learning is intended as one of the key tools for ‘Support from the Start’. The following describes how we will be supporting the learning process around ‘Support from the Start’.

We start from the premise that tackling health inequality is not something that is completely understood – there are no off the peg solutions.

However, we will not be ignoring what is already known, and part of the learning process will be disseminating information about what has been shown to work in the rest of Scotland and internationally. The Health & Early Years Learning Network will have a key role to play in this work. This network will be chaired by Ann Hume, East Lothian Council’s Early Years and Childcare Officer, and will promote and organise events and training session for ‘Support form the Start’. The first of these will be on the 16th March, and we are delighted to announce that the Guest Speaker will be Harry Burns, Scotland’s Chief Medical Officer. More information on this event will be the subject of another post – however you can reserve a place by emailing your contact details to: healthyliving@eastlothian.gov.uk

To support services and communities that want to undertake evaluation and research in relation to ‘Support from the Start’, we are establishing a Research and Evaluation group which will be chaired by Queen Margaret University. This group will bring together people and organisations with expertise to act as an information and support for ‘Support form the Start’ research and evaluation activity. Anybody that has a research idea connected to the health of children in the early years will be able to submit it to this group and receive feedback on how they might be able to turn into a practical research / evaluation proposal. The group will also be tasked with maintaining an overview of research and evaluation taking place in respect of ‘Support from the Start’, and liaising with national groups and resources for research.  

Another way learning will be supported is through ‘Action Learning Sets’. The Set members will be those individuals that have been identified as champions for ‘Support from the Start’. The Sets will allow the champions to meet on a regular basis and discuss problems and issues associated with tackling health inequality in their service areas.

Finally, this blog aspires to be a place where people can not only learn about East Lothian’s Equally Well Test Site, but also debate issues in relation to tackling inequalities in health.

Happy New Year

Steven Wray

Service Champions

A key feature of ‘Support from the Start’ – East Lothian’s Equally Well test site are Service Champions.

A service champion is an individual who has been identified as someone who can lead on the learning needed to address health inequalities within their service area.  This doesn’t mean that they are the only person within that service who carries the responsibility for health inequality – tackling health inequality is all of our responsibility. The role of the service champion is to bring the experience and knowledge of their service area to the work of Support from the Start, and to bring what they learn from Support from the Start to their service areas.

Service Champions will have a key role in linking across service boundaries and in making sure that health inequality is high on the agenda for services within East Lothian.

The expectations of a Service champion are :-

  • Communicating the vision and values of ‘Support from the Start’ within their service area
  • Bringing the experience and knowledge of their service area to a multi agency ‘action learning set’. 
  • Supporting services to identify training & information needs related to ‘Support from the Start’
  • Contributing as appropriate to this online learning log.
  • Be willing to participate, as appropriate, in the dissemination of the East Lothian Test Site experience to other authorities and agencies within Scotland.

Service Champions will be drawn from a range of services from both the statutory and voluntary sector. Senior managers have been asked to identify the right people for this role, and this process is currently underway . The names and contact details of Service Champions will be posted shortly.

Rationale For Support for the Start

brain-pic 

This picture was part of a presentation given by the Chief Medical officer Harry Burns at a conference on Equally Well. The pictures shows what happens to brain development in cases of extreme neglect. Neglect so extreme to cause such marked under development of a child’s brain is thankfully very rare but the picture does demonstrate that brain development is closely related to the environment a child finds itself in.
 
Dr Burns presentation described the determinants of early brain development with the following bullet points:- 
  • At birth, development shifts from genetic to environmental influences
  • There are 100 billion neurons but they are not part of functional networks
  • First few years are spent forming permanent neural networks -‘Neurons that fire together wire together’
  • Social interaction determines brain development

He went on to discuss attachment theory giving the following quote:

  “Infants develop the attachment behaviours that optimally enhance their survival in their own characteristic environments.”

Crittenden, 2000

 He described the development of attachment as ‘Serve & return’ meaning that the infant will respond to positive rewarding stimuli by developing an attachment which strengthens with each return. However, if the return is absent, negative or chaotic this will set up responses in the child that help it to cope with this environment but which will probably prove maladaptive in the longer term. He illustrated this with reference to a study called the Dunedin cohort which was 1000 children recruited in late 1972/3.  At age 3, “at risk” children were identified on the basis of chaotic circumstances, emotional behaviour, negativity and poor attentiveness

As adults, those “at risk” were more likely to : –

  • be unemployed
  • have criminal convictions (especially for violence)
  • been pregnant as a teenager
  • have a substance abuse problem
  • exhibit signs of insulin resistance and metabolic syndrome

The above means that the template for health can be set at a very young age, and though it is possible to change problems created by difficulties in the early years of life, a poor start can make it hard to catch up. This is the rationale for focusing on preventing health inequalities by focusing on the early years of life and support for parents. 

You can view the full presentation on the social circumstances of health at this link

Support from the Start

Scotland’s public health minister Shona Robinson chaired a ministerial taskforce to look at how Scotland can challenge the kind of inequality that leads to significantly different health outcomes for different parts of our community. The taskforce published a report called ‘Equally Well’ which amongst a number of recommendations called for the setting up of ‘test sites’ to lead on the learning that is needed to address the issue of health inequality. East Lothian has been selected as one of eight test sites in Scotland with a focus on early years and parenting. We have called the test site in East Lothian ‘Support from the Start’ to reflect the aim of ensuring that communities and services are doing all that is possible to address the health needs of the youngest members of our community in the areas where we know that health outcomes are poorest.

Support from the Start is not a short term project but rather a focus within all mainstream services on health inequality in the early years of life. Governance for the programme will be provided by a steering Board consisting of Councillor Roger Knox (Depute Provost & Health Spokesman); Councillor Ruth Currie (Cabinet Member for Joint Future & Community Care & Youth Champion); Sue Ross (Director of Community Services & Chair of Joint Health Improvement Project Board); Don Ledingham (Acting Director of Education & Children’s Services & Chair of Children’s Services Chief Officers Group); Gerry Power (General Manager East Lothian Community Health Partnership)  This group will provide strategic leadership and ensure that all relevant planning groups are involved in developing Support from the Start.

Four broad outcome areas for mainstream services in relation to health inequality have been identified:-

  • Community Engagement with key health issues in the early years,
  • Improving Support for Parents & Carers,
  • Improving Support for Families,
  • Creating Child Friendly Environments

We know that there is already lots of good practise in these areas but ‘Support from the Start’ will be asking service providers to review what they are are already doing with the following questions in mind : –

  • How do we get our communities, parents and children involved in key health improvement challenges for the early years of life? e.g. increasing the number of breastfeeding mothers, reducing passive smoking in the home environment, increasing physical activity levels of children in the early years, improving diet and dental hygiene
  • Do East Lothian services make it easy for parents to be ‘good enough’, and can parents access the right support, early enough when they are finding it hard to cope?
  • How do we target support for children and families that are at risk of poor health, and is it effective?
  • Does the physical space of our communities contribute to creating good health in the early years and support parents in raising healthy children safely

 Key to ensuring success in this endeavour will be engagement, leadership and learning. A process has started to identify individuals from across a range of services who can act as ‘champions’ for ‘Support from the Start’. These champions will be tasked with creating a learning environment in their service areas on the issues of health and social justice related to tackling health inequality in the early years. The champions will be contributors to this blog.

My hope for this web log is that it will be a space in which discussion and reflection on the complex task of reducing health inequalities in East Lothian can be supported and encouraged.

All views and opinions welcome.

Steven Wray

Health Improvement Development Officer