Sir Harry Burns talks about building assets for children’s mental health

 This is a video of a talk given by Sir Harry Burns, (Chief Medical Officer for Scotland) at the launch of Scotland’s new mental health indicators. It is 30 minutes long, but in it he gives an excellent account of the ‘assets model’ of creating good health. Quite radical and thought provoking.


A Collective Responsibility

The following is the conclusion of a comprehensive review of research about breastfeeding and why there is such a difference between socio economic groups in Scotland conducted by the Glasgow centre for population health

There is considerable evidence and policy support for breastfeeding as the best source of nutrition in the first six months of life. However, the socio-cultural and demographic contexts of the mother are more important determinants of breastfeeding practice than theoretical knowledge of the benefits of breastfeeding.

In a breastfeeding culture, all strands of society would consider breastfeeding as a human right and make it the ‘norm’ rather than the exception. The mother plays a central role and should be supported in her ‘duty’ to make the child’s ‘right’ possible but it is not her responsibility solely, as the choice of infant feeding is located within multiple contexts and influenced by inter-related factors. Maternal health in particular is pivotal since the ‘issues with the mother’ become the ‘issues with the child’. Protecting maternal health invariably protects child health and by extension, the future.

A breastfeeding culture makes it a collective responsibility – addressed in multifaceted approaches – to create an environment where the ‘best for the infant becomes the best for the rest of us’.

I really like the sentiment of the above because it puts responsibility with the community supporting a women rather than the individual. I think this responibility becomes clearer when you understand that the majority of women from all background do initiate breast feeding – over 70%.

Based on the Infant Feeding Survey conducted in 2010, the estimated breastfeeding initiation rate in Scotland was 74%. This was a significant increase from rates reported in 2000 (55%) and compared favourably with initiation rates in England (82%), Wales (71%), and Northern Ireland (64%). However, this rate was still less than the rates reported in other European countries.

However, only 36% were still breast fed by 10 days. So its everybody responsibility to make sure that its as easy as possible to maintain that decision, and for communities where initiation rates are low – its everyone’s responsibility to turn that around. This supports needs to be evident from all sectors of society – if it is just health professionals then there is a danger women feel badgered to breast feed rather than supported.

What can we do :-

  • make sure your local shops, cafes, schools, hospitals, health centres and public building are welcoming of women who are breastfeeding by getting them to sign up to a breast feeding friendly award
  • if you are teacher look at how you can use the new breast feeding in the curriculum resource like that recently piloted by Whitecraig Primary school
  • make sure your workplace has a policy in place to support women who are breast feeding
  • if you have positive experience of breast feeding talk about it and offer advice and support to new mums
  • become a peer supporter or develop a peer support system for women who have made the decision to breast feed
  • if you work in primary care or a a midwife make sure you are up-to-date on how to offer practical support to women with breastfeeding and know where to direct women who are experiencing problems
  • If you are a person with responsibility in public service make sure that your organisation understands that breast feeding is a community responsibility and not just an individual choice.
  • Since its election time – ask the people you intend to vote for what they will do to make sure the community is taking responsibility for supporting breast feeding mums

Any other suggestions welcome

Finally breast feeding is not just a nice thing to do it makes a difference for children and reduces costs

Results from the UK Millennium Cohort Study (MCS) of 15,890 infants found a 53% decrease in the rate of hospital admissions for diarrhoea and 27% for respiratory tract infections in infants exclusively breastfed for six months.

Longitudinal studies of breastfeeding and intelligence in later life (in Denmark and the Philippines) suggest a strong association between breastfeeding and performance in intelligence tests in adulthood. Findings from these studies, comparing breastfed and non breastfed infants, showed that longer breastfeeding duration of up to nine months influenced intelligence even after adjustment for socioeconomic and possible family effect


Want to know about the difficulties faced by some people in eating healthily?  Then read the attached report on Food Practices among Mothers of Young Children by Dr Jeni Harden, Dr Adele Dickson, Ms Naomi Mason

Food practices among mothers of young children – a preliminary report

This report sought to develop an understanding of food practices in socio-economically disadvantaged families.  There is a complex interplay between social constraints and individual lives which shapes food practices in the home.  This study identified multiple, interlinking social factors which shape parents’ food practices and so which shape young children’s eating behaviour.  At a societal level, effective policy and practice should therefore seek to address the wider contexts within which food practices are experienced by those living near to or below the poverty line.  It is recognised that this is both a very long term goal and one that has proved challenging for successive governments therefore more focussed recommendations can also be offered from the main findings.

Parents have knowledge of healthy eating practices, but are restricted by their financial and social circumstances

All the mothers in the study had a sound knowledge of what food they ‘should’ be providing for their children.  The limitations to practising this ideal were both financial and social.  To address the issue of cost and time, more advice on preparing quick meals on a budget could be offered.

Children are not the passive recipients of food

The mothers described ways in which children, from a very young age, were are able to influence and sometimes dictate what food they were eating.  Policy relating to healthy eating needs to recognise the role that children play, both in terms of children’s rights within the family, but also as part of the challenges faced by parents.  More support around parenting strategies in relation to food may prove useful to parents.  This could be addressed in the context of pre-school provision, working with both parents and children together.

Food practices are transmitted through generations

Most of the mothers described the ways in which their own childhood experiences with food had shaped their own practices as parents.  However this awareness of the links to their own past, did not seem to alert them to the potential difficulties in maintaining a ‘do as I say not as I do’ practice in relation to food.  Advice and services could be targeted to parents on the issue of their own diet in relation to the longer term implications for themselves and for their children.

The significance of age

There were little differences found in the study between the younger mums and the older mums.  Most of the issues were shared across both groups and the age of the mother did not appear to be significant in shaping food practices.

Delivering on Early Years

A conference at the National Museum of Scotland on the 7th March organised by Holyrood saw a range of speakers from across theUK and panel discussions on a wide range of topics of interest to professionals with an interest on improving and promoting early years care.

Human Connections

The day was ably chaired by Tam Baillie, Scotland’s Commissioner for Children and Young People and was started off with a look at human interconnections and the connected baby with a moving and heartfelt presentation by Dr. Suzanne Zeedyck who used and promoted her new video “The Connected Baby” (

This was followed by illustrative case studies on the importance of attachment from Paul Gilroy of Crossreach (Paul Gilroy Crossreach) and on working with communities by Mary Glasgow of Barnardos Scotland (Mary Glasgow Barnardos)

The Policy Context

The second part of the morning focused on the wider policy context and was kicked off by Councillor Isabel Hutton, COSLA Spokesperson for Education, Children and Young People.  Cllr Hutton emphasised the importance and centrality of the early years acrossScotlandin order to make a long term positive difference toScotland’s future.  This was followed by an interesting panel discussion and Q&A session with a range of participants form Health, Education, Local Government and the Third Sector.

Funding Opportunities and Challenges

The afternoon began with a session focused on funding with input form and a panel discussion with representatives from the Scottish Community Foundation, Inspiring Scotland and the Big Lottery Fund.  Much useful information was shared on the mechanisms, procedures, priorities and thinking behind some of the more substantial grant funders inScotland.

Making it Happen in Nottingham

Katy Ball Nottingham

The final session of the day looked at howNottinghamhas succeeded in rebranding itself as an earlyInterventionCitywith a full and interesting presentation from Katy Ball the Head of Early Intervention and Market Development with Nottingham City Council.  She illustrated how Nottingham had turned around a series of negative aspects of a city with high levels of deprivation and associated problems to one where an Ofsted Inspection recently said that Nottingham has…”an extensive and outstanding range of early intervention services, making a marked shift with vulnerable children and families”.  This was achieved with an extensive basket of early intervention programmes starting from:

  • universal services offered to all (Healthy Child Programme);
  • moving on up to proportionate universal services offered widely but pushed towards certain groups (Baby Massage);
  • then on to targeted work with specific groups (Family Nurse Partnership);
  • and on finally up to highly specialised programmes working with high end/high cost groups to reduce costs and intergenerational impact (Family Intervention Project)

Making it Happen in Nottingham in Northumberland

Jane Casson Northumberland

Katy was followed by a very inspirational speaker, Jane Casson MBE, a Locality manger for Sure Start Northumberland.  She detailed how a range of rather unexpected partnerships developed across her patch with shared services and often co-location of services such as:

  • Sure Start family centres
  • Ambulance Service
  • Community Transport
  • Environment Agency
  • GP Support Services
  • Midwifery Services
  • Probation Services
  • Local Community Charities

This wide range of close partnership working and facilities sharing has led to very significant cost savings as well as a range of concert positive outcomes for individuals, families and communities including:

  • Reduction in smoking.
  • Reduction in 0-3 admitted to A&E.
  • Safety information available for all families.
  • Training in health and safety and basic first aid available to all families.
  • Reduction in house fires.
  • Reduction in casualty / fatality figures.
  • Home Fire Safety message to hard to reach groups.
  • Address the community safety agenda.

John Boyce / Ann Hume

Public Health Practitioner / Manager

East Lothian Community Health Partnership / Olivebank Children & Families Centre, Musselburgh

Smoke Free legislation – good for Scotland’s babies

A study conducted in Glasgow has linked a reduction in  the number of premature and low birth weight babies with the ban on smoking in public places introduced into Scotland in 2006.

These findings suggest that the introduction of national, comprehensive smoke-free legislation in Scotland was associated with significant reductions in preterm delivery and babies being born small for gestational age. These findings are plausible and add to the growing evidence of the wide-ranging health benefits of smoke-free legislation, and support the adoption of such legislation in other countries that have yet to implement smoking bans.

There are lots of reasons why babies are born premature or with low birth weight but smoking has long been known as a key preventable reason for this. Given how important a predictor low birth weight is for future health this is a result really worth celebrating – but not with a cigar !



Booking early!

The NHS has a new target to get pregnant women to book early for antenatal care – it is now one of the NHS Scotland performance measures, which means that NHS managers have to report to government on how well this is being achieved.

At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation by March 2015 so as to ensure improvements in breast feeding rates and other important health behaviours

The hope is that if women can be persuaded to book as early as possible in their pregnancy then there is more likelihood that they will get the support and advice they need in the period of foetal development that is the most sensitive. However this is not something that can be done by maternity services alone as was pointed out in the refreshed Framework for Maternity Servces last year

We know that improving access to antenatal care is insufficient; it needs to be accompanied by a focus on continuous, effective,  assessment of health and social need in order to identify any prevention and early intervention actions needed before babies are born and in the early days of their lives. We know that to do this effectively, maternity care staff need to work in partnership with each other and with women and their families, using health asset or strengths based approaches

Women, their partners and families need to be able to access a range of support and advice, not just medical information, but also information on child development, nutrition, as well as social and psychological support where needed. The NhS is often known as the cradle to grave service – but in reality it is the conception to grave service – and for future health outcomes those first few months post conception are a key time for services to support both parents and the future child.


Suffering in Silence

 Some of the parents who spoke about the ‘things that mattered to them’ at the Healthy Happy Bairn’s conference outlined the impact depression following birth can have on women and their families. So a new report on the impact of postnatal depression with case studies and practical suggestions as to how families can be helped through better and more aware services is timely.

In Britain today, we are letting families down by not preparing them for the possibility of postnatal depression and not acting quickly or appropriately when it occurs – as a result we are stacking up problems for the future and causing needless misery for thousands. We believe that the recommendations in this report have the potential to give new strength to families at a crucial stage in their lives with long term, positive consequences. Failure to deliver this change means more unnecessary suffering and the spiralling costs of the consequences. We cannot afford to do nothing.


Healthy Happy Bairns Conference 7th Feb

Over 170 people from parents to politicians attended the Healthy Happy Bairns conference on 7th Feb at the Quayside in Musselburgh.

There was a lot of positive energy, and emotion, throughout the day which was very well chaired by local parent and former health minister Susan Deacon.

The day started with Councillor Roger Knox welcoming Aileen Campbell the Scottish Government’s early years minister.

Aileen outlined the government and her personal support for the early years agenda and emphasised the importance of early years in the early intervention and prevention agenda which is so important to modernising public services in Scotland.  healthy happy bairns conference ministers speech

As her speech came to an end children from Wallyford and Whitecraig surprised the participants by standing up to sing – ‘Lean on Me’. By the end of the first verse participants were further surprised when the adult members of the Wallyford and Whitecraig ‘Singstars’ stood to join the children singing. By the end of the song the whole conference was on its feet singing and clapping to the rhythm of the song. The young musicians from Musselburgh Grammar who had been hidden behind the conference screen emerged with music teacher Jo Halliday  – too much applause. The ‘flash mob’ singing was fun, but also hopefully made the point that engaging children and parents is key to the mission of Support from the Start and that means we have to think and act imaginatively.

The words of the song  ‘Lean on me’ were echoed in some of the themes that parents who had agreed to speak at the conference brought to the fore. Inga, Michele and two Tracey’s  gave often very personal and emotionally powerfull statements about what had been important to them when they had needed support. Each story was very differnt but I think some of the common themes included:-

– Any parent can need support no matter their circumstances

– Asking for support is not always an easy thing to do and professionals can make this much easier when they listen

– People who need support want to be treated as individual human beings not as a problem, whether that’s defined by medical  diagnosis or social / psychological assessment

– Support has to be accessible in terms of time and place and flexible people orientated services are most valued by parents

 – If we want healthy, happy bairns we have to have healthy, happy parents

 The parents were followed by Don Ledingham, chair of the Support from the Start planning board and Director of Education and Children’s Services for East Lothian Council on the theme of Creating a space for change. He has posted the contents of his presentation on his learning log

Dr Rosemary Geddes gave a presentation in the early development intrument which is being piloted in East Lothian. EDI_SuppFrStart7Feb2012

John Boyce East Lothian Public Health Practitioner & Ann Hume. Manager of Olivebank Child & Family centre in Musselburgh gave a presentation on the evaluation process and findings for Support from the Start. Healthy Happy Bairns evaluation

Over a lunch there was a market place featuring posters of work taken forward by the service champions in East and Midlothia. Pdfs of the poster can be accessed here

HHB Posters 1-5 Final

HHB Posters 6-10 Final

HHB Posters 11-15 Final

HHB Posters 16-22 Final

In the afternoon after a welcome from Jane Hopton assistant general manager for East Lothian Community Health partnership there were three presentations that aimed to set the scene for the afternoon workshops

Karen Grieve, National Programme manager for Equally Well gave a presentation entitled ‘Transforming services an assets based approach’ which outline the ethos and theoretical framework developed through the Equally Well process in Scotland. healthy happy bairns KG slot

Graham Mackenzie Consultant in Public Health for NHS Lothian looked at information resources on childrens health and well being that are available at a community level. Graham MacKenzie

The final presentation / speech was from Ronnie Hill, Head of Children’s services for East Lothian Council in which he set out the vision for the second phase of Support from the Start Ronnies Powerpoint- 07.02.12   Healthy Happy Bairns Conference- The Vision 7.02.12

The workshops were key to the hoped for outcomes for the day there were nine in total one for each school cluster in East Lothian one for participants from the Midlothian test site, one for people with an East Lothian wide role and one for people with a pan Lothan / national role. A seperate post will cover the output from the workshops.

The day ended with reflections from Susan Deacon

Video Interaction Guidance

The service champions that have been such a crucial part of Support from the Start have had regular shared learning time, in which they exchanged ideas, proposals and problems. From the outset the champions were looking for ways for services to be more positively focused on very young children – prebirth – three, recogising the cricitcal importance of these years to childrens development.

Janice Macleod, (School nurse team leader) in particular has been indefatigable in her pursuit of the importance of attachement theory for the practise of frontline staff. She now chairs a multi agency working group which is leading on the development of training and practise development that will support staff to incorporate attachment theory into practise. Janice initiated a range of contacts – local, national and international in her pursuit of the goal of incorporating attachment theory into practise. Very productive relationships have been developed with East Lothian Councils Educational Psychology team, academics from a range of universities, researchers and practioners from a range of agencies and national agencies. In particular Janice established a working relationship with Penny Rackett an educational psychologist from North Suffolk who is particular proponent of the use of video interaction guidance (VIG) as a tool to improve attachment in the very early years.

VIG is a well established method in Psychology. It is also a Scottish invention being based on the work of Colwyn Trevarthen a  Scottsih psychological researcher and I believe an East Lothian resident. It is a method or technique that requires carefully trained practitioners with excellent communication and interpersonal skills, who need access to detailed supervision. However, there  is a simplicity to the method that is appealing – basically it helps parents / carers to see the positve aspects of their communication with very young children and by so doing helping them to build on the strenghts that they do have. An excellent website give a full description of what VIG is and how it is used in various settings and age groups.

The website describes VIG as follows:

Video interaction guidance is an intervention through which a “guider” aims to enhance communication within relationships . It works by engaging clients actively in a process of change towards realizing their own hopes for a better future in their relationships with others who are important to them. Guiders are themselves guided by the values and beliefs around respect and empowerment.   These include a belief that people in troubled situations do want to change, a respect for what clients are managing to achieve in their current difficulties, and a conviction that the power and responsibility for change resides within clients and their situations

This link gives a short but detailed descriptin of the evidence base for VIG an how it works