Parenting and health inequality

Attended a 1/2 day conference held by the Growing Up in Scotland team earlier this week. The session was led off by the new early years minister Angela Constance and one phrase in her speech caught my attention in particular.

As parents its what we do, not who we are, that is most important.

By which I think she meant that parents who are facing adversity in the form of poverty or poor health can do as good a job as parents who aren’t facing the same adversity. I think we all know that to be true, or at least we want it to be true.

However, it is also true that many parents do become overwhelmed by the adversity they face in bringing up children. Talking to some head teachers in the last week or so has highlighted this for me. In the run up to the summer holidays many parents and children face the summer holidays not with a sense of joy and opportunity, but with with a sense of foreboding -‘how am I going to cope without the structure that school and nursery provides’. For many children this fear is expressed in terms of their behaviour in school, and for the child protection system I suspect it is reflected in the number of Initial Referral Discussions that take place in the run up to the summer holidays. ( I would guess that the economic climate is making the summer holiday period even harder for some parents this year?)

Services are responding with partnership approaches to supporting families over the summer period. In Midlothian Equally well champions are using their development fund to support a project called ‘Play in the Park’ which has been developed in the Woodburn community over a number of years, and will extend it to the neighbouring community in Mayfield, they are also exploring ways of further supporting transition from nursery to P1.  In East Lothian champions are currently discussing whether to support for  a second year a Summer transition programme supporting parents of children who are moving from nursery to P1 who need some additional support

Talking about parenting skills always makes me a bit twitchy, partly because even if nobody is else is making judgements about me as a parent I cant’ help making judgement about myself. For the same reason I have never felt completely comfortable with parenting courses / programmes which are the focus of many parenting strategies. More fundamentally than doubts about my own performance I also wonder whether parenting programmes over emphasise the individual parent behaviours rather than the wider family and community support that is fundamental to good parenting. It is easier to be consistent with rules, be positive and affirmative and to have a good attachment or connection with your child / children if you feel supported as a parent and can access a network of practical and emotional resources. Angela Constance also spoke about the development of a national parenting strategy for Scotland which was a manifesto commitment for the SNP. I for one hope that it is as strategy for family support as much as a strategy for developing parenting skills.

The GUS team have made a particular study of parenting skills and their relationship with health and a presentation on the findings is linked here There is also an audio file of the presentation from Dr Alison Parkes on the GUS website. The slides are quite complex so the audio file is well worth listening to.


Financial literacy in the early years

Veronica Campanile – East Lothian’s indefatigable community planning policy officer alerted me to the following resource developed by the Scottish Book Trust & partners- they are lovely as well as useful tools

On The Money

Change the way you think about money with this collection of stories from four of Scotland’s top children’s authors. They look at all sorts of things to do with money in fun and useful ways. The stories are guaranteed to make you laugh and think, and look at money as you never have before.

There is also a brand new website dedicated to On The Money, the folowing is from the website.

On the Money is a new book of four stories by Theresa Breslin, Jonathan Meres, Nicola Morgan and Alison Prince, exploring issues of financial responsibility for children.
On the Money combines numeracy with literacy in an innovative way that hasn’t previously been implemented in Scotland. The project goes beyond knowledge and skills and the focus of many existing resources for financial education, to encourage crucial attitudes, values and dispositions relevant to responsible and enterprising financial

On the Money is a free resource that will be distributed to schools throughout Scotland. Standard Life, Learning and Teaching Scotland and Scottish Book Trust
have worked in partnership to produce a book of stories for primary school children to help them become financially informed and aware and to aid their growth into financially capable adults. The aim of the project is to develop the financial capability of primary school pupils as part of their general education. This will give pupils an opportunity to engage with key financial concepts, and to do this in a very creative and enjoyable way. Together we have developed a package of four stories, initially for primary school children, which incorporate issues to do with:

Financial responsibility (such as entrepreneurship and money management, exploration of moral dilemmas to do with money and awareness of  financial systems)
Advice for teachers on how to use the stories to explore the issues with pupils, including dealing with sensitive issues in classes where children come from very different economic and cultural backgrounds
An inclusive DVD resource that includes a British Sign Language video for the Deaf, audio tracks in English and Gaelic, and a presentation of the story illustrations as an aid to teachers who choose to read the stories aloud in the classroom
A website which includes PDFs of each of the stories and of the complete book, a PDF of the support materials, downloadable audio files of each story in English and Gaelic and downloadable British Sign Language versions of
each story.

Here is the link to the web page

Growing Up in Scotland

The latest findings of a study shining a spotlight on the realities of life as a child in Scotland were published this week.

Launched in 2005, the Growing Up in Scotland study (GUS) gathers the experiences of 14,000 children and their families including attitudes towards children’s services, parenting, childcare, healthcare and education.

This round of reports is the  fifth set in a longitudinal study which explores a range of issues experienced by children in the first five years of their lives. The reports cover a range of issues including parenting and child health, cognitive development, service use and support, and the impact of significant events.

The findings include:

· During the first five years of their lives, around one in ten children in Scotland experience their parents separating, with the incidence being highest in the first two years after the child’s birth. Separation increased the likelihood of mothers experiencing poor mental health and low income, both known drivers of child outcomes.

· The gap in cognitive abilities between children from more and less advantaged social backgrounds found at age 3 persists at age 5. The largest differences in ability are between children whose parents have higher and lower educational qualifications. Factors such as a rich home learning environment had a positive influence on the improvement of cognitive ability in the pre-school period.

· Mothers living in disadvantaged circumstances are more reluctant to engage with services aimed at supporting parents with young children and are less likely to make use of such services. Informal support by family and friends was used equally by those with different levels of service use.

· Child health and health behaviours are less favourable in families experiencing adversity. However, good parenting was found to have a positive impact on child health. This suggests that parenting support could go some way in reducing health inequalities.

In the reports one quote caught my eye in particular :

The positive impact of infant-maternal attachment on improvement in relative language ability was specific to children whose parents have lower qualifications. This implies that the overall negative effect on cognitive development associated with a lack of parental qualifications can be limited somewhat by improving early infant-maternal attachment.

This point jumped out at me because many of the other findings in the report were rather depressing in that they confirmed the picture of inequality without pointing at means of breaking the cycle of inequalities. We know that attachment can be improved and that their are interventions some of them relatively simple that can improve attachment behaviours between babies and significant adults even before the babies are born. Similarly the report highlights the benefits of positive parenting behaviours, and the need for good informal networks that parents can access when the going gets tough all things that we can make it easier for individual parents to achieve or access with good services and open caring communities.

‘Healthy Happy Bairns’

The output from a year long evaluation study led by the Queen Margaret Univerity ChangexChange team is linked below.


 The evaluation found that Support from the Start has created significant outcomes for children and their families. Children had new-found confidence, improved social relationships, were better equipped to cope with change, were more ready for school, and benefited from a more structured and more settled day and family life.  Parents involved improved their relationships with their children, were more able to avoid significant mental health issues, were less stressed and more able to cope with life events, had increased personal confidence, and were able to find support from extended social networks.

 We are confident that ‘Healthy Happy Bairns’ will be a source of ideas and inspiration for a range of professionals and organisations seeking to make a difference to health inequalities in the early years.  We would recommend that practitioners, managers and leaders take the learning and use it to make the changes required to create a positive impact in the early years experience of all children, so that they can secure a stable, healthy and happy future.


What have we been doing & where have we been?

The link below will take you to a document that attempts to describe what has been happening as a result of the Equally Well test site in East Lothian and the rationale behind that activity. It is a report to the National Programme for Equally Well on the two years in which the test site has been in operation.

The report is not an evaluation of Support from the Start,  it simply seeks to tell the story of what we have been doing and why.

I will, however,  shortly be able to post the outcome of an evaluation of Support from the Start in East Lothian, which was taken forward by a Queen Margaret University. The evaluation was delivered using an innovative approach that develops a local partnership linked to academic support to make sure that evaluation is both relevant and rigorous. Two East Lothian practitioners – John Boyce and Ann Hume – were seconded part time to the university to work with a ‘firefly’ team led by Professor Kirsty Forsyth. They carried out a number of focus groups with parents that had been involved in  champion led developments and initiatives, as well as completing a survey of champions. The output from the evaluation includes a resource for practitioners and planners who might want to use some of the approach and ideas that have been used in the test site. The resource is called healthy, Happy Bairns from a comment made by one  of the parents involved in the focus groups. Watch this space

Test site report to Scottish government National Programme for Equally Well

Chief Medical Officer meets East Lothian Children’s Services staff

As part of our agenda of looking at how we can improve outcomes for our most vulnerable children, Children’s Services staff in East Lothian council asked Dr Burns to speak to us about the role of Attachment in Early years and the impact it has on health and outcomes in later life.

 It was very inspiring talk. Many of us in Children’s Services are very aware of how important attachment is. The key messages and learning for us were:

 ·         The physiological consequences of poor attachment in relation to brain development and good physical health in adulthood.

 ·         As service providers we need to be aware of the danger of making people passive recipients of services rather than being actively engaged.

           This increases their sense of hopelessness and being out of control   

 A summary of the talk follows below helpfully provided by Vivien McVie (Policy and Planning Officer) Children’s Services. Dr Burns presentation is linked at the bottom of the post

 Hopelessness and Life expectancy:

Studies have compared life expectancy in Liverpool, Manchester and Glasgow: there is 60 % excess morbidity in Glasgow – predominantly in four areas: drug-related, alcohol-related, suicide, violence

Susan Everson did a study of men in 1997 which found a connection between increased risks of dying from heart disease (x4) and hopelessness. The reason for this was that the group of men who felt hopeless had laid down more fat in the carotid artery than the others. Thickening of the carotid artery causes blockages in the artery and leads to stroke and death.  For a brief summary of the study see:

What causes the fat to be deposited in the artery?

Hopelessness is stressful. Stress produces cortisol – used for fight or flight reactions. Cortisol causes abdominal fat to be mobilised for use as energy (for use in fight or flight) so when it breaks away, it can end up lining your arteries if it does not get used up ( running).

Hopelessness may not be acutely stressful but causes ongoing stress – people have been observed to have consistently higher levels of cortisol over the long-term.   Only a slight rise can produce damage over the long-term.

 A study on re resilience

 A study of Jews surviving concentration camps (Aaron Antonovsky) found that while 70 % had the expected poor consequences for health and mental wellbeing, there were 30% who had survived the experience very well. Before their experience in the camps started, these resilient 30% had already developed a sense of coherence in their view of the world, which they had experienced as structured, predictable and explicable, and also had the inner resources to deal with what came next.   They felt they could meet things head on and try to purposefully deal with what happened each day – i.e. a sense of self-efficacy, even in such circumstances:

“a  feeling that … these demands are seen as challenges, worthy of investment and engagement.”

 Causes / Consequences of stress:

 People need to experience the world as understandable, manageable and meaningful, or they will experience chronic stress. Tests in Canada showed that the longer a child remained in residential care (“orphanages”) the higher their levels of cortisol were at the end of each day. Tests of adults have shown a link between lack of control in their working lives and higher cortisol levels.

Dr Burns observed in his own working life as a surgeon that people who are manual workers do not heal as fast from wounds, i.e. not the usual 10 days but 12 days to recover from abdominal surgery.  This is because these people are not as much in control of their working environment as their bosses and so experience more stress. Another consequence of the resultant higher levels of cortisol is an inflammatory response, slowing down healing and this inflammatory response also leads to heart attack and stroke.

The inflammatory response from stress is compounded if you smoke, and are overweight – if you have all three it is x8 worse.

Inflammation in the arteries causes clots to happen, arteries get ruptured  – heart attack follows.

 Attachment : Causes/ consequences of stress in children:

 Inconsistency in parenting is the most stressful for children (more than consistently abusive/neglectful parenting).

Brains of children who have disordered attachment are affected in three parts with a fourth under discovery:

1)     The part of the brain that deals with judgment and decision-making is affected

2)    Short-term/working memory is affected

3)    Aggression, fear and anxiety are all heightened

When fight or flight dominates, there is no room left for learning or any other type of executive functioning.

Domestic abuse can be experienced in utero and it blocks development of certain parts of the baby’s brain because the baby is stressed and is producing higher levels of cortisol – this affects the genes and so they can pass these defective genes on to their own child. 

 Further consequences – self-control is inhibited so this affects likelihood of committing crime, getting involved in drug-abuse, earning a steady income. Reaction times are slightly dulled so road traffic accidents are more likely.

 Supplied byVivien McVie  April 2011

Dr Burns presentation

Harry Burns Presentation 8 March 2011

NHS Scotland Maternal and Early Years Newsletter: April 2011

Some very useful links to current strategy documents and events in the following newsletter. My attention was drawn to the self assessmetn for how well schools promote mental well being produced by HMIE and NHS Scotland, and the follow up the Scottish Governments study on the financial impact of early years intervention towards the bottom of the news letter


Consulting on the common core of skills, knowledge and understanding and values that should be common to everyone working with children  

This consultation describes areas of skills and knowledge, rather than levels, and is therefore appropriate for anyone in any role (including volunteers). The consultation goes onto ask for ideas and commitments around implementation of the common core once agreed.

Consultation responses are invited from any individual or group, and we would be grateful if you could promote this hyperlink across your own networks.

Visit the Scottish Government website to read the document [283Kb] and download a respondent information form [27Kb].

The closing date for responses is 15 June 2011.

Immunisation Scotland – protection for everyone

The Immunisation Scotland website has now been up and running for one year. Immunisation Scotland is a ‘one-stop-shop’ site providing information about all the current immunisation programmes in Scotland, the vaccines available and the diseases they protect against.

The target audience for the site is the general public, but NHS Health Scotland is also keen to raise awareness with health professionals who have contact with parents and carers as a way of promoting the site with the public.

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NHS Health Scotland, Healthcare Improvement Scotland and NHS Education Scotland are running a series of road shows in June to launch to new Scottish antenatal parent education pack.

All maternity services aim to provide women and their partners and families with a comprehensive programme of education for childbirth and parenthood.

The Scottish antenatal parent education pack has been created to prepare professionals to deliver consistent parent education, which respects and reflects the individual needs of pregnant women and their partners. It includes a national syllabus, a resource pack and a training element.

These road shows will offer you a chance to:

  • find out about how the new pack fits with current early years policy and direction
  • learn more about the three elements of the pack
  • explore how the pack could support antenatal education in your area though practical workshops which explore elements of the pack.

 The road shows will be taking place on:

  • Thursday 2 June 2011: 10 am –  4 pm Glasgow
  • Monday 6 June 2011: 10 am –  4 pm Dundee
  • Tuesday 14 June 2011: 10 am –  4 pm Inverness

Download a booking form to register for this event [48Kb].

Children in Europe conference: Improving services for 0-3s

06 June 2011
New Lanark World Heritage Village in Lanark

This special conference, part of an international programme of events, will look at how we can extend early years services to meet the needs of 0-3s and their families.

For more information and booking please contact Megan Rodgers on 0131 222 2446, or email

Principles for effective action: Promoting children and young people’s social and emotional wellbeing in education establishments.

This is a self-assessment tool for strategic partners involved in supporting staff to deliver health and wellbeing within Curriculum for Excellence.

These tools highlight the links between recent evidence-informed recommendations on promoting children and young people’s social and emotional wellbeing, Curriculum for Excellence Health and Wellbeing Outcomes and Scottish Government policy.

Download the primary school resource [1.8Mb].

Download the secondary school resource [375Kb].

Child poverty strategy for Scotland

This strategy sets out how we will focus on and give greater momentum to efforts to tackle child poverty. The main aims of this strategy are:

  • to maximise household resources
  • to improve children’s wellbeing and life chances.

There is significant overlap between these aims. In particular, measures to reduce income poverty and improve material wellbeing of families will have positive impacts on children’s outcomes.

While the actions set out in the strategy are mainly set in the short and medium term, it is important to recognise that this is a long term approach.

Download the strategy [452Kb].

Action for sick children (Scotland) community specialist play pilot: end of project report

Action for Sick Children (Scotland) has concluded a two year pilot project in NHS Forth Valley which provided hospital play specialist support in the community or at home, to children and young people attending tertiary centres for treatment. The pilot project was evaluated independently by MSc students from the University of Stirling. 

Download the evaluation report [986Kb].

A pathway of care for vulnerable families (0-3 years)

The pathway of care provides a suite of documents to support service delivery to vulnerable children and families (0-3 years). These have been developed as one of the national actions out of the Early Years Framework: 2008 [548Kb] ‘to develop integrated care pathways for antenatal, maternity and postnatal care’.

This guidance is aimed at managers, to support critical reflection on existing pathways of support for families who can be considered vulnerable. It promotes the use of the Getting It Right For Every Child (GIRFEC) National Practice Model as the tool to aid assessment, and takes you through the core universal journey that all children and families are entitled to.

Download the pathway of care [2.5 Mb].

The financial impact of early years interventions in Scotland – part two  

A research report prepared by the Scottish Government, following up the economic modelling report published in November 2010 [75Kb]. The package identifies a range of interventions across a broad spectrum of need.  These are considered to be an appropriate and realistic way of improving outcomes for children in Scotland, whilst lowering demand for future public services.

Part two of the economic modelling work has been developed to provide further support to local partners in Scotland’s councils, NHS Boards and elsewhere to decide on how best to set their budgets to support local children, families and communities. A copy of the report is available on the Scottish Government website.

Download part two [197Kb].

Joining the Dots …

 Joining the Dots – A better start for Scotland’s children


?Susan Deacon’s report to the Scottish Government is now available online at :-

??Just finished reading the report.

In reflecting on how I might introduce the report, and my reaction to it,  for this post; I decided that I could draw on the learning of the amazing authors in P2P at Sanderson’s Wynd.  The children (who have published an e-book on Amazon) have been finding interesting words, including ‘wow’ words, as part of their literacy work.  Here are my wow words for Susan’s report:-





but definitely not  pallid

Sanderson’s Wynd and Whitecraig Primary have pride of place on the front cover of the report with their great outdoor activity and learning photo’s


Steven Wray

Parentline Scotland

ParentLine Scotland is the free and anonymous helpline that offers support, advice and signposting by phone and by email, to any adult worried about a child no matter how big or small the issue. In addition to our locally delivered services, as a national helpline we work closely with your children’s services, helping them to act upon genuine child protection concerns.

How does increasing awareness of ParentLine Scotland help you?

ParentLine Scotland is a free additional resource that your staff can offer to parents and carers, and more people using the helpline frees up valuable time for delivering services to children and their families.

The helpline provides time and space for adults to talk about their concerns and to get a little bit of extra support, while the email service allows concerned adults to write about what is happening at a time that suits them. Your staff can feel confident that they are providing an additional complimentary service.

Since its launch in 1999, ParentLine Scotland has received over 108,000 calls covering a very wide range of issues including child protection concerns, postnatal depression, behaviour and discipline, family relationships and bullying to name but a few. All child protection calls are carefully screened and if appropriate the caller will be supported to report on to duty social work teams and where necessary, will be reported by ParentLine Scotland staff. The helpline was recently extended to provide a confidential email response service to give support to people who find it easier to write things down than pick up the phone.

Solihull Training opportunity – The First Five Years

Solihull Approach Foundation Course: ‘The First 5 years’ two-day training

 The Solihull Approach is an integrated psychodynamic and behavioural approach for professionals working with children (0-5) and families who are affected by emotional and behavioural difficulties. It is a highly practical way of working with families within a robust theoretical structure. It has a major contribution to make to the ways in which practitioners in health, education, social work and the voluntary sector can work with families to ensure that children have a good emotional start in life.  The Solihull Approach will help you to address emotional problems in a different way, giving you greater confidence in your own skills and practice.

 The Solihull Approach has been identified as an effective model for working with parents and young children and is part of East Lothian’s Parenting Strategy. 

 It is suitable for: Health Visitors, social workers, nursery nurses, community development workers, midwives, paediatricians, learning disability nurses, children’s nurses, speech therapists, family support workers, behaviour support teachers. 

  Two day training:  9.30am – 4.30pm May 3rd and May 17th.

Participants must attend both days to complete the training. The two training days are separated by a fortnight to allow professionals to use the model in their practice and feedback their experiences on Day 2.

 Venue: Training Department, Administration Building, Edenhall Hospital, Musselburgh

 If you wish to attend the training please contact (