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