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

‘Music and Me’

 ‘Music and Me’, a resource for Nursery staff, is the product of a process that began almost eighteen months ago in Preston Lodge High School. There, as part of a wider conference about ‘Learning, Emotions and Well Being’, Dave Trouton, a talented musician and composer, led a workshop presentation about using music to help develop emotional literacy in a teenage group. At about this time, too, the scoping of an ‘outcome pathway’ for readiness to learn in young children was being developed as part of the planning for ‘Support from the Start’. This process recognised that there was scope for further development of the role of music and rhythm to support language development in the early years. Sheila Laing, HT of Campie Primary School, and Education Department service champion for ‘Support from the Start’, then developed a proposal to pilot work in this area in a nursery setting and, if possible, develop a resource that could be used by all nursery staff, irrespective of their own perceived musical ability.

Many months later, a successful pilot of ‘Music and Me’ has been completed in the nursery classes of Wallyford and Whitecraig Primary Schools, and a second stage pilot in Campie and St. Martin’s nursery classes will start soon. Two key outcomes for ‘Support from the Start’ – improving readiness to learn (aspects such as active listening, concentration, turn taking), and improving emotional well being (for example developing self expression and emotional literacy) are addressed in the resource, as well as skills such as carrying out instructions, turn-taking and co-operation and collaboration. CPD in how to use the resource will be offered to nursery staff in all East Lothian primary schools early next session, alongside a roll-out to all primary schools. The resource has tried to address, among other things, real concerns on the part of the nursery children. Anxietyabout using the dinner hall, queuing, making choices, etc., when they moved up to P1 has been addressed through pupil involvement in a ‘Sound Story’ within the resource, and ‘Grandad Turnip’s Story’ helps children to discuss not only why it’s ok to feel sad sometimes, but also the importance of telling someone about it.

 

Discussion and active listening play a big part in the lessons. Feedback from the initial pilot has been very positive, not just from staff. ‘Is the music man coming back in?’ asked one pre-school pupil, just a few weeks ago.

Final word must go to Pat Holden, Principal Teacher of Primary Music Specialists, who, while delighted to have been involved in the production of this very practical resource that can be accessed by all nursery staff without requiring any specific musical skills, adds that he sincerely hopes ‘that this is aresource that will be well used and not just sit on a table in the music corner!’

Written by Mary Howie

The following link has a short vdeo of a Music & Me seesion with a voiceover commentary by at Pat Holden

https://docs.google.com/leaf?id=0BxkVZo58FAzFZTM3NTQyYjEtNjVmNi00YTg1LTg3ZjgtMDFhZGU1NTVkZjdl&hl=en_GB&authkey=CMzstYEO

Joining the Dots …

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

 AN INDEPENDENT REPORT BY PROFESSOR SUSAN DEACON

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

  www.scotland.gov.uk/Resource/Doc/343337/0114216.pdf

??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:-

Passionate

Punchy,

Positive

Provoking

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

 Regards

Steven Wray

‘These are the things that matter to me…’

 

A group of parents who use voluntary sector services for families of early years children were supported to make a short film about what made a difference for them and their children. The film was made at Stepping Forward a Sure Start centre in Penicuik.

The idea for the video came from conversations that Susan Deacon had with groups of parents in Mid & East Lothian as part of her evidence gathering for her report to the Education Minister.  A previous post  ‘Conversations with Susan’ described the content and impact of the discussion she had with parents. Parents were supported by the Media Co-op to make the video. Many thanks to Shelley for uploading the video to YouTube (I still haven’t mastered that)

We will use the video as part of Support from the Start  ‘civic conversation’ about health and the early years. Its first public viewing will be to East Lothian councillors.

Baby Extra

Baby Extra is an antenatal intervention developed in Holland aimed at enhancing attachment postnatally.

The intervention is time limited, non stigmatising, low cost, builds on existing practise and research and appears to be very successful. Penny Rackett, educational psychologist, gave a very interesting presentation about the programme and described the design and early stages of a pilot in Suffolk aimed at replicating the intervention in a British context.

I couldnt help thinking that if this quality of intervention had a market in the same way as some drug therapies do then investors would be falling over themselves to get the rights to develop and test it further. Instead its left to an intrepid front line professional to lead the way on top of an already busy workload with minimal resource. If there any readers of this blog with capital to invest in a social intervention that has the potential to make a difference then this might be your baby.

Baby Extra

Poster SRIP Baby Extra 2009

Can we support parents ante-natally to improve attachment post birth?

Penny Rackett educational psychologist from Norfolk was invited to talk about her research into interventions before birth that are designed to enhance attachment once the child is born.

Penny gave a presentation to a wide range of practitioners and managers at a twilight  seminar on Thursday 3rd February and the next day met with the members of  a  Support from the Start working group looking at a range of  initiatives and training needs around utilising recent research and development on attachment theory. 

The first presentation below reviews current research on what works in attachment theory and practise. The second presentation reviews research on assessment of attachment behaviours ante-natally.

East Lothian presentation 1

Assessment

Fathers

Dadswork the East Lothian charity dedicated to supporting the needs of  Dads as parents has been involved in the development of a national organisation of ‘Fathers’ organisations

Organisations and individual can sign up at this link  www.fathersnetwork.org.uk/index.php?home

The role of Dads  has been receiving a higher profile lately.

I am part way through reading Carol Craig’s book ‘The tears that made the Clyde’,  which makes a powerful case for how Scottish male culture impacts on health and social outcomes in Scotland. She argues that this macho male culture  developed partly as a result of men abandoning family life because of desperately poor housing and overcrowding during the industrialisation of Scotland. She goes on to argue that many of the social ills which have proved so resistant to change in Scotland are fed and nurtured by that culture.

 Similar arguments abut male culture and the need to change it are made by supporters of the white ribbon campaign in relation to Domestic Violence –  that it is a problem all men need to own if it is going to change.

At a presentation I attended this morning on ‘attachment theory & practise’ by an Educational Psychologist and researcher –  Penny Rackett,  the importance of dads in supporting children to have secure attachments in early life was stressed. She reported on studies which showed that Dads who felt that their contribution to rearing children had been valued were also the dads that were most attuned to the communication of their babies / children. So involving Dads is important.

Although most children still live in a home with two adults, it seems from statistics that increasing numbers of  Scottish women are raising children without the involvement of a ‘live in father’.  It also seems that lone parenting is a more prevalent experience for Scottish women than other European women. Why is that happening and what does it say about Scottish men and their attitudes to family life? Are men not coping with the kind of  stress involved in raising children and choosing to escape from it. Do men feel that they don’t have any real role in raising children now that their traditional role of breadwinner has faded? What is the role of a father in Scottish culture?

Big questions – and ones that  need to be part of a national discussion and debate. Perhaps what Dadswork have helped to start will be the start of a discussion between fathers of what it means to be a father in 21st century Scotland and how that role can be supported and valued.

Changing culture is very difficult – and I am sure can only start when lots of people ask the similiar question and talk to each other about the implications of those questions.

I am a father – its a role for which I had no preperation  beyond my own experience of parenting. Prior to becoming a parent I don’t think I ever discuseed what a dad is meant to do with anybody. For our first child I did attend the ante natal classes that were on offer, but like many men felt like a spare part. It may well have changed now but twenty years ago it was all about the mechanics of birth – lots of heavy breathing and discussion of pain control options.

I don’t recall my father ever talking to me about what it meant to be a dad. However, I have no doubt that his parenting style has heavily influenced me (for good and bad) because I occasionally catch myself saying things that make me think, ‘God I sound like my old man’.  In writing this I have asked myself the question – Do I know how to talk to my own sons about what it means to be a father? The answer is probably no,  at least not in any coherent way.  Having asked the question I am going to think about it – because I have a sense that Dads are important and that men ought to value  and celebrate the role of father.  In fact I am going to do more than think about it I am going to talk about it, with my wife! Well,  perhaps I will try talking to some of my male friends who are fathers. They may well think I have lost the plot but it will make a change from fishing and shooting. And who knows if enough Dads in Scotland talk to each other about what it means to be a Dad and how you can be good enough at it, maybe the next generation of Dads will have a better steer than the last.

Steven Wray

‘Are We Securely Attached’

Early Years Conference ‘Are We Securely Attached’

March 17th  2011 Queen Margaret University, Edinburgh

 The Early Years and Childcare Team are once again organising an Early Years Conference which aims to raise awareness of the critical importance of Early Years development in improving children’s life chances

 Speakers at the conference are:

Robin Balbernie is currently Consultant Child and Adolescent Psychotherapist in Gloucestershire CAMHS. He works with the Children’s Centres in Cheltenham, Gloucester and the Forest of Dean as lead of the Secure Start team, providing an infant mental health service. He has a special interest in early interventions, originally arising from his work with adopted children, and is on the Committee of the Association of Infant Mental Health (UK) and is also a member of the Young Minds’ Policy and Strategy Advisory Group.”

 Suzanne Zeedyk is currently Senior Lecturer in Developmental Psychology at Dundee University. Suzanne’s work focuses on parent-infant relationships. She works closely with organisations such as the Scottish Violence Reduction Unit, HomeStart, Kids Taskforce and a number of city councils. Her key aim is to increase awareness of the extent to which, when making decisions about the care we give to children. We are also making decisions about the kind of society we wish to build.

 The day will be facilitated by Susan Deacon who was MSP for Edinburgh East and Musselburgh from 1999 to 2007 and Scotland’s first cabinet minister for Health and Community Care.  She holds a range of advisor and non executive roles with organisations in the private, public and third sectors.  She has been a consistent advocate for the importance of children’s early years.

 Who should attend?  Anyone working with young children and their families, or who has responsibility for strategic planning for Early Years services

 The Programme and Booking Form are available from Pauline Evans 01620 827141

pevans@eastlothian.gov.uk or  from this link below –

https://www.edubuzz.org/earlyyears/2011/01/13/56/

The wheels of change?

“A health asset is any factor or resource which enhances the ability of individuals, communities and populations to maintain and sustain health and well-being”.  These assets can operate at the level of the individual, family or community as protective and promoting factors to buffer against life’s stresses.”  Anthony Morgan, 2009

At national conferences that I have been able to attend over the last six months there has been a consistent theme of working with an assets approach rather than a deficit approach. Often these two approaches or models can be talked about as polar opposites, with the asset approach being all good and the deficit approach being all bad. That clearly isn’t the case – another word for deficit is need; and services identifying and targeting specific need can be very important in making a difference to people.

However, it feels to me that the thinking around the asset approach has a lot to offer public service, which has arguably been overly focused on responding to need / deficit with the unintended consequence of dependency and dis-empowerment. I think the key thing that the proponents of an assets based approach are trying to establish is that the control over who, and how,  needs are defined is sometimes even more important than the actual interventions that services provide. (There is a lot in this that will be familiar to people who have argued for community development approaches to health inequality over the last decade)

In my experience the deficit model is part of the accepted culture in statutory services, it is the way things are done. Yet where problems are complex with multiple interacting causes the predominant deficit model is probably the wrong tool for the job.   Such thinking  is challenging.  In particular many service planners and managers have become very attached to ‘action plans’ and it can seem like heresy to suggest that developing tables of neatly ordered actions  may not always be the best place to start with a complex problem like health inequality.  (For avoidance of doubt, I think planning in this traditional sense is an essential skill. As a Prince2 practitioner I like nothing more than being able to get all the ducks in a row and make a project flow from conception to completion) Compared to the orderly world of service planning working with an assets approach might seem ‘unplanned’, even ‘chaotic’;  it needs individuals to take responsibility for a common or agreed vision, to make connections with others and ultimately to  ‘get on with it’. 

Jenny Campbell (of Lifetimes Work) gave me a useful way to think about different approaches to achieving change, based on the humble wheel. Firstly she described a model with a central hub in the wheel. The hub is  where planning is done and decisions are made. Spokes radiate from the hub and transmit the power of the centre to where services are delivered. This model is very efficient and supports measurement of change – good for directing resources for example in managing waiting lists or developing  new service provision.   

The second approach is a model in which the focus is very much on the rim of the wheel, where services are delivered and used. Its strength is generated by making connections across the interior of the wheel. In this model the centre plays a much less active, but probably no less significant role, and change is generated by practitioners and service users making connections with each other directly not necessarily mediated through the centre. 

To me in terms of an asset based approach to tackling health inequality the second model makes sense – the strengths or assets are there in a community, its a matter of connecting them up creatively rather than through bureaucratic planning forums. (How many of you are aware of or involved in such forums that tie themselves in knots trying to connect everything whilst at the same time maintaining direction and control from the centre.) Key to an assets approach is a common vision – that all the partners are signed up to. It seems to me that the job of the centre in an assets approach is to constantly explain that vision so that the people on the rim of the wheel can develop the connections that are needed to do the job. The centre need to be in constant communication with the assets that are creating positive change and find ways of supporting, celebrating and disseminating it.

Dr Harry Burns has been a key proponent of an assets based approach, and I believe his work on ‘salutogenenesis’ gives a theoretical undderpinning for why such an approach could be successful in creating good health. As Chief Medical Officer for Scotland he produces an annual report on key public health issues and challenges. The latest report is entitled: Time for Change and he outlines his thinking about the creation of good health in Scotland and how an ‘assets approach’ can help with this. He illustrates what is meant by an Assets approach with the story of a community in Cornwall. I have reproduced it here because it is such a startling story of success.

Extract taken from the Chief medical officers annual report

Health in Scotland 2009 – time for change.

Beacon and Old Hill

When one thinks of Cornwall, one usually has a mental image of beautiful countryside, thatched  cottages and afternoon teas. Yet, in the mid 1990s, Cornwall housed one of the most deprived council estates in Britain. Penwerris, the electoral ward comprising the Beacon and old Hill estates which had a population of 6000, had, according to a University of Bristol report, the largest percentage in Cornwall of children in households with no wage earners, the second highest number of children living with lone parents. Unemployment rates on the estates were 30% above the national average, child protection registrations were high, postnatal depression afflicted a significant number of mothers, domestic violence was common and violent crime, drug dealing and intimidation were commonplace. By 1985, quality of life in the area was plummeting. “It had the reputation of being a ‘no go area’ for the police, crime and vandalism were spiralling out of control, and the community had become more or less completely dissociated from the statutory agencies.” (Durie et al) Two local health visitors, Hazel Stuteley and Philip Trenoweth are credited with beginning the regeneration of the area after a particularly disturbing series of events.

 In the Health Visitors’ own words:

“The flashpoint came simultaneously for us both, literally in Rebecca’s case, when she witnessed the family car ignite following the planting of an incendiary device. She was 11 years old then and although physically unhurt, she was deeply traumatised by this. Already in mourning for her friends’ pet rabbit and tortoise, which had recently been butchered by thugs from the estate, this was the final straw. As family Health Visitor for the past 5 years, I was a regular visitor to her home. Her Mum was a frequent victim of domestic violence and severely post-natally depressed. My caseload had many similar families with multiple health and social problems. Seeing Rebecca and her family’s deep distress, I vowed then and there that change must happen if this community was to survive. I had been watching it spiral out of control for long enough.”

 Thereafter, the two health visitors embarked on a series of meetings in which they tried to engage statutory agencies with members of the community. Of note was the fact that many individuals they thought would want to be involved in turning the area around refused to become involved and many of the public meetings held to encourage dialogue were described as ‘stormy’. What is apparent from the descriptions of the process is that the people were listened to. The residents identified the problems they were most concerned about and statutory agencies engaged with the community in designing a response. Residents became co producers of solutions rather that passive recipients of actions others had determined would be good for them.

 This was a critical part of the process. People learned that expressing their concerns was not a waste of time. They learned their opinions had value and that they mattered to others. Social networks developed and problems became shared. Importantly, solutions emerged from these interactions between people who had previously been alienated from each other.

 “The most significant aspect of the regeneration process on the Beacon and Old Hill estate was that, from the outset, there was no initial funding, no hierarchy, no targets, no business plan, only a shared vision of what the community wanted to be, rather than an obsession with what it had to do. Thus, the regeneration process was not a result of a predetermined plan. Rather, the process emerged as a consequence of the interactions between the members of the community, and between the community and its environment, namely the statutory agencies, the police, the council, and so forth. As the community evolved, so also the agencies and professional bodies co-evolved with the community.” (Durie et al)

 The story of Beacon and Old Hill is one of a few individuals being motivated by the failure of conventional approaches to a problem to try something different. In listening rather than lecturing, they heard the members of the community outline solutions to their difficulties. Finally, they were confident enough to allow solutions to emerge organically rather than through a conventional project planning approach which relies on the outcome being predetermined. In effect, leadership in this case did not involve taking a community in a predetermined direction, but rather involved helping individuals discover their own direction by awakening within themselves the capacity to take control of their lives. They had used an asset model rather than focussing on the deficiencies in the lives of the community

End of extract

The following is a quotation from the report on Beacon and Old Hill cited in Dr Burns report which defines the level of impact that was achieved in the community:

 “By 2000, the overall crime rate had dropped by 50%. Affordable central heating and external cladding had been installed in over 60% of the properties which significantly impacted on childhood asthma rates and schooldays lost. Child Protection Registrations had dropped by 42%. Post-natal depression was down by 70%. Breast feeding rates increased by 30% The educational attainment of 10-11 year old boys – i.e., level 4, key stage 2 – was up by 100%. The number of unwanted teenage pregnancies had been significantly reduced to the extent that in 2002 there were no unwanted teenage pregnancies.  And the unemployment rate was down 71% amongst both males and females.” (Durie et al)

The full report can be accessed here and is well worth a read  Community_regeneration_and_complexity

 If Support from the Start has been successful at all in generating change – its because it has built on the strengths of the people who deliver support to children and families that need it – whether they are community members, unpaid volunteers, voluntary sector staff, NHS staff or local authority staff. The key assets for early years health are the parents of the 0-8 year olds and the  staff and volunteers who support them -all Support from the Start has done is identified champions amongst them and given them space to come up with ideas.  Credit has to be given to senior managers and politicians who have said okay here is the vision  – we want to more effectively address health in targeted communities by  focusing on the early years of life, here is the space and some resources to do it –  you have permission to get on with it,  just keep us informed about what you are doing. ( Sometimes less is more and my failure as lead officer to produce an ‘action plan’ for  Support from the Start  – may well be my greatest contribution)