Tag: health inequality

Are We Getting it Right ?

Getting through my ‘to read file’ – this time going back to the fascinating parliamentary review by the finance committee of early years interventions

http://www.scottish.parliament.uk/s3/committees/finance/reports-11/fir11-01.htm

The committee members had quite a challenge to absorb the depth of information / evidence provided verbally and in writing to the committee. Reviewing some of the evidence offered to the committee really make you ask the question – Are we getting it right for children in Scotland. Scandinavian countries have been in the news a lot for the wrong reasons in the last few weeks – but their investment in children clearly pays off in improved outcomes. For example

Sweden’s strong focus on prevention starts at the very beginning of life with emphasis on breastfeeding (98% of Swedish mothers begin breast-feeding and 72% have maintained this at 6 months vs 79% and 22% in the UK). In addition long periods of maternity and parental leave support attention to the needs of the child in its earlier months. 100% of hospitals have BFHI (baby-friendly) status (compared with less than 10% in the UK) and early parent training is provided for a high proportion of the population.

What Works in Early Years Education, a review of approaches to Early Years Education across the globe, cites two international comparisons of academic performance in English schools, in one case with Slovenia, in the other case with Switzerland. Though the Slovenian children started school two years later, within 9 months they had caught up on English mathematics attainment. The Swiss children started school a year later than those in England, yet the Swiss one year younger than English children performed better in maths. A study which addressed why this was the case identified the variable academic ability of children in the English reception class.

However, one report given to the committee as evidnece stood out for me because it chimed so strongly with the ethos of Support from the Start – It is a report from an organsation called the Wave Trust which has produced a comprehensive review of international evidence on violence reduction. It gives the following six success factors  in improving social & health outcomes.

1. Those who prioritise investment in the earliest years secure the best outcomes

2. The quality of parenting/care is the key to a successful society

3. There could be a major dividend from focused commitment to ensure children arrive at school ‘school ready’

4. The impact of poor early care can be alleviated by the right experience during school years

5. Galvanising the community is the secret of success

6. Innovative approaches to social care can provide significant benefits at minimum cost

We know that many of Scotland’s closest neighbours are so much better at improving outcomes for its citizens, and this reports emphasises that, but it also give a clue about what can be done to change it. The success factors / key messages they outline are relatively simple but they need to be applied systematically and need relentless leadership in pursuing them. They also need Scotlands citizens to be engaged and demanding better services for children.

Steven Wray

 

Start Active – Stay Active

Having spent the last two weeks blissfully on holiday – I returned to the usual full in-box. Amongst everything else I have made a new ‘to read’ file of all the recent reports and reviews that have been sent to do with early years health and well being. Will post up links to some of these reports as I read through them.

The first was highlighted to me by Laura Hamilton senior health promotion specialist for physical activity – Start Active Stay Active It is a joint report by the UK’s four chief medical officers outlining the benefits of physical activity. Luckliy I had had a very physically active holiday so I was feeling quite virtuous as I dipped in and out of the report (as had my 11 year old daughter who is at home nursing a blister after a trip up Ben Lawers yesterday).

I note that the guidlines for physical activity for children have changed and that they have been given a specific early years slant for the first time. The headline summary is below but there are some very useful short guidance documents for different age stages  on the Depatment of health website. The guidlines on the DOH website splits the under 5 age group into walking and not walking – which seems to be very helpful.

EARLY YEARS (under 5s)
1. Physical activity should be encouraged from birth, particularly through floor-based play and water-based activities in safe environments.
2. Children of pre-school age who are capable of walking unaided should be physically active daily for at least 180 minutes (3 hours), spread throughout the day.
3.  All under 5s should minimise the amount of time spent being sedentary (being restrained or sitting) for extended periods (except time spent sleeping).

CHILDREN AND YOUNG PEOPLE (5–18 years)
1.  All children and young people should engage in moderate to vigorous intensity physical activity for at least 60 minutes and up to several hours every day.
2. Vigorous intensity activities, including those that strengthen muscle and bone, should be incorporated at least three days a week.
3.  All children and young people should minimise the amount of time spent being sedentary (sitting) for extended periods.

The executive sumary of the report notes that the evidence for the impact of physical activity on health and well being is conclusive, but is evidence enough to change policy on transport – fast food outlets – urban planning – school timetables etc etc.

In conclusion, we know enough now to act on physical activity. The evidence for action is compelling, and we have reached a unique UK-wide consensus on the amount and type of physical activity that is needed to benefit health.

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.

 

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.

Champions development fund

Service & Community champions are a key part of Support from the Start, they are people with an interest in health, equality and the early years from across a wide range of services.

Champions have access to shared learning (action learning) and a small peer reviewed development fund. Many exciting project have been taken forward by the champions using this fund – but this by no means represents the total of initiatives that champions have taken forward only those for which they have used development funds. A link to a monitoring rport for the fund over the financial year 2010 – 2011 is below –

Summary 2010 2011 (4)

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: http://atvb.ahajournals.org/cgi/content/short/17/8/1490

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 (e.g.by 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

News

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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Events 

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 events@childreninscotland.org.uk.

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].

Early years conference

Attended the East Lothian Early Years team annual conference in mid March and it was a truly inspirational event. It was chaired by Susan Deacon national early years champion and had two excellent speakers – Robin Balbernie and Suzanne Zeedyk. The early years team have now posted Robin Balbernies presentation on their edubuzz blog, if you couldn’t make the conference or just want to review the wealth of material that was in the presentation it well worth the time it takes.

[issuu viewmode=presentation layout=http%3A%2F%2Fskin.issuu.com%2Fv%2Fcolor%2Flayout.xml backgroundcolor=ffffff showflipbtn=true documentid=110412163933-5ef9b6327b3e442eadf148f1d69bc128 docname=poverty_and_stress_on_relationships username=dgilmour loadinginfotext=The%20Impact%20of%20Poverty%20on%20Infant%20Mental%20Health showhtmllink=true tag=earlyyears width=420 height=315 unit=px]
Hopefully, the early years team will also be able to post Suzanne’s presentation – which had a number of video clips of very early baby parent interaction – but Suzanne was such a powerful and charismatic presenter I think you really needed to be there to get the full force of it.

Interventions for Promoting Early Child Development for Health- an Environmental Scan

Dr Rosemary Geddes from the Scottish Collaboration for Public Health Research and policy has completed an ‘Environmental Scan’ of interventions aimed at promoting cognitive and social development in early years children.  Rosemary has previously given presentations to the planning board for Support from the Start and was one of the speakers at a 1/2 day session on readiness for learning (see earlier posts).

I have to admit I wasn’t familiar with the term ‘environmental scan’.  It turns out that it is management speak for getting a very smart person like Dr Geddes to rapidly but systematically review evidence for what works in a policy area at the same time as making an assessment of what is actually being delivered. 

The definition given in the report  is

Environmental scan – In management terms, an environmental scan is the internal communication of external information about issues that may potentially influence an organisation’s decision-making process. Our environmental scan refers to the process of rapidly scoping the literature for evidence of what works, reviewing the current policy landscape and interviewing key informants to determine which programmes are currently being delivered.

The document is a weighty read at 169 pages, but gives a very clear review of the research in this area, including brief overviews of different programmes that met the criteria to be included in the scan, and the range of Government policy and strategy that has bearing on children’s early development .

Interventions for Promoting Early Child Development for Health

‘The Foundation Years’

Frank Field MP was commissioned by the British Prime Minister in June 2010 to provide an independent review on poverty and life chances by the end of  the year. The aim of the review is to: 

• generate a broader debate about the nature and extent of poverty in the UK;

• examine the case for reforms to poverty measures, in particular for the inclusion of non financial elements;

• explore how a child’s home environment affects their chances of being ready to take full advantage of their schooling; and

• recommend potential action by government and other institutions to reduce poverty and enhance life chances for the least advantaged, consistent with the Government’s fiscal strategy.

His report is now available and although it is a UK government document it is well worth a read you can download it here TheFoundationYears1 The following is a quotation from the introduction on the findings of the review

We have found overwhelming evidence that children’s life chances are most heavily predicated on their development in the first five years of life. It is family background, parental education, good parenting and the opportunities for learning and development in those crucial years that together matter more to children than money, in  determining whether their potential is realised in adult life. The things that matter most are a healthy pregnancy; good maternal mental health; secure bonding with the child; love and responsiveness of parents along with clear boundaries, as well as opportunities for a child’s cognitive, language and social and emotional development. Good services matter too: health services, Children’s Centres and high quality childcare.  (Page 7 The Foundation Years 2010)

Can’t disagree with that – but this is not just another report weighing the evidence on the importance of early years. In chapter four he describes a very practical vision for ‘Building Foundations Years Services’  the principles of which which I think many practitioners in Scotland would find very positive.

Perhaps one of the key things for me in this report is that he puts parents at the centre of his thinking – not in a patronising way – but making it clear that improving outcomes for children cannot be achieved by services alone.

What parents do is the most important factor in children’s development.  Services need to be better at engaging parents and building on their strengths. More opportunities to learn parenting skills should be provided, including through the school curriculum.