Evidence to Lancashire Fairness Commission Dr Ann Hoskins Director Children Young People and Families UKs u15s mortality is now amongst the worst in Europe 2 Since 1980 UK child mortality rate has moved from one of the best in 11 European countries to the worst ID: 489888
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Starting WellEvidence to Lancashire Fairness Commission
Dr Ann Hoskins
Director Children, Young People and FamiliesSlide2
UK’s u15s mortality is now amongst the worst in Europe
2
Since 1980 UK child mortality rate has moved from one of the best in 11 European countries to the worst.Slide3
Overview of issues to be covered
Laying the foundations for good parenting including a healthy pregnancy
Early
years development that supports children from 0-5 and their families build their skills and resilience so that they are ready for schoolSupport to teenagers and adolescents to build life skills and personal resilience to prepare them for the transition to adult life 3Slide4
Giving Every Child the Best Start in Life is crucial to reducing Health Inequalities across the life
c
ourse
Ensure high quality maternity services, parenting programmes, childcare and early years education to meet need across the social gradientEnsuring that parents have access to support during pregnancy is particularly importantAn integrated policy framework is needed for early child development to include policies relating to the prenatal period and infancy, leading to the planning and commissioning of maternity, infant and early years family support services as part of a wider multi-agency approach to commissioning children and family services4Slide5
5
Children, Young People and Families: Life course approach
Marmot 2010, Fair Society, Healthy Lives: The Marmot ReviewSlide6
6
The evidence base shows we can make a difference through early intervention and public health approaches
(
http://www.dwp.gov.uk/docs/early-intervention-next-steps.pdf
and www.earlyinterventionfoundation.org.ukThere are economic and social arguments for investing in childhood. The Family Nurse Partnership estimated savings five times greater than the cost of the programme in the form of reduced welfare and criminal justice expenditures; higher tax revenues and improved physical and mental health
(Department for Children, Schools and Families (2007)
Cost–Benefit Analysis of Interventions with Parents.
Research Report DCSF-RW008)..
Marmot showed that of c. 700,000 children born in 2010, if policies could be implemented to eradicate health inequalities, then each child could expect to live two years longer.
(http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review)
Child poverty has short, medium and long term consequences for individuals, families, neighbourhoods, society and the economy. These consequences relate to health, education, employment, behaviour, finance, relationships and subjective well-being
(http://www.jrf.org.uk/system/files/2301-child-poverty-costs.pdf.).
Why Children and Young People
are a PrioritySlide7
7
Inequality in early cognitive development of children in the 1970 British Cohort Study, at ages 22 months to 10 years
Environment matters for short, medium and long term outcomesSlide8
Blackburn with Darwen
Adverse Childhood Experiences:
Increased
risk of having health behaviours/conditions in adulthood for individuals who experienced four or more ACESTIs: risk is increased 30-foldHeroin or Crack user: risk is increased 10-foldPrison or cells: risk is increased 9-fold Hit someone last 12 months: risk is increased 8-fold
Morbidly Obese : risk is increased 7-fold Been hit in last 12 month: risk is increased 5-fold Pregnant or got someone accidently pregnant under 18: risk is increased 4-fold
Regular heavy drinker: risk is increased
4-fold
Liver
or digestive
disease:
risk is increased
2-fold
Adverse
childhood
experience;retrospective
study to determine their impact on adult health behaviours and health outcomes in a UK population. Bellis
M,Lowey H, Leckenby N, Hughes K, Harrison D Journal of PH, advance access 013/04/14
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Environment matters for short, medium and long term outcomesSlide9
Early yearsSlide10
Key factors for poor development outcomes
Parental depression
*
Parental illness or disabilitySmoking in pregnancy*Parent at risk of alcoholismDomestic violenceFinancial stress*Teenage mother, smoking in pregnancy and parental depression frequently occur together* Associated with worst outcomes – cognitive emotional, conduct, hyperactivity, peer & pro-social Analysis of MCS, Sabates & Dex, 2013
Parental
worklessness
Teenage mother
Parental lack of basic skills, which limits daily activities
Household overcrowding
10Slide11
The Scientific Base
Protective factors
Breast feeding and nutrition
Bernardo LH, Rajiv B, Jose Cm, Cesar GV (2007) Evidence on the long-term effects of breastfeeding. Systematic reviews and meta-analysis, Geneva, WHOImmunization NICE (2009) reducing the differences in the uptake of immunizations (including targeted vaccines) among children and young people under 19 , NICE PH guidance 21 London : NICEParenting and parent–child relationship Gardner FEM (1987) Positive interaction between mothers and children with conduct problems: is there training for harmony as well as fighting? Journal of Abnormal Child 15, 283- 93 Psychology Relationship between parents Coleman L, Glenn F (2009) When couples part, Understanding the consequences for adults and children London: One plus One 11Slide12
Opportunities for LAs with transfer commissioning 0-5 yearsHealthy Child Programme
Commissioning HCP 0-5
Opportunities
Joining up commissioning in local authorities for children’s public health, early years and wider family services Involving HWB to promote aligned/joint commissioning between LA, CCGs (which commission NHS children services) for services around the child and familyStreamlining universal access to Healthy Child Programme with early intervention and targeted interventions/programmes for families needing more helpJoining up 0 – 5 Healthy Child Programme with 5 – 19 Healthy Child Programme (which is already commissioned by LAs) Better integration of services at point of delivery with improved access and experienceImproved outcomes for children families and communities and reduced inequalitiesSlide13
Progressive universalism
13
Universal
Core universal
offer
Universal partnership plus
Universal plus
e.g. Interagency work to support children in need
Child protection & safeguarding
Additional parenting support
e.g. sleep, feeding, behaviourSlide14
Universal
Health and development reviews
Screening and physical exam. Immunisations Promotion of health and wellbeing, e.g.: smoking, diet and physical activity, breastfeeding and healthy weaning, keeping safe, prevention of sudden infant death, maintaining infant health, dental health Promotion of sensitive parenting and child development Involvement of fathers Mental health needs assessed Preparation and support with transition to parenthood and family relationshipsSignposting to information and servicesUniversal plusEmotional and psychological problems addressed
Promotion and extra support with breastfeeding Support with behaviour change (smoking, diet, keeping safe, SIDS, dental health) Parenting support programmes, including assessment and promotion of parent– baby interaction
Promoting child development, including language
Additional support and monitoring for infants with health or developmental problems
Common Assessment Framework completed
Higher risk
High-intensity-based
intervention
Intensive
structured home visiting programmes by skilled practitioners
Referral
for specialist input
Action
to safeguard the child
Contribution
to care package led by specialist
service
Common
Assessment Framework completed
SAFEGUARDING
Healthy Child Programme (HCP):
best start for all children and extra help where neededSlide15
Maternity and Early years: targeted interventions
Targeted interventions by HV e.g. postnatal depression
Working
with the Troubled Families Programme to develop a health offer and improve integration with health servicesFamily Nurse Partnership quality assurance of FNP unitWorking with partners to promote early intervention including the Early Intervention Foundation / Big Lottery 15Slide16
694,241new
opportunities available
last
year in the England
(ONS 2012)To prevent early adversities stopping our children developing their full potential
Every child ready to learnSlide17
AdolescenceSlide18
Adolescence – periods of change
Adolescence and early adulthood represent a transition period marked by many pressures and challenges . . .
Physical and emotional changes . . .
Changing social relationships and growing academic and professional expectationsEuroHealthNet, Making the Link: Youth and Health Equity 18Slide19
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There are more than 11.5 million aged 10-24 in England
The rate of developmental change during adolescence is second only to infancy
Good health allows young people to make the most of their teenage years – education and socialisationMany poor health outcomes for adults originate when we are young, for example smoking, mental health, obesity and violenceWhy focus on adolescence?Slide20
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Behaviour across Adolescence
Source: Hawkins & Monahan 2009 Slide21
Research from the CMO’s report
All cause mortality for 10-19 year olds is now higher than for other periods of childhood except for
newborns
– main cause is InjuryFive of the ten riskiest factors for the total burden of disease in adults are initiated or shaped in adolescenceAdolescents have higher use of health services than other child categories above the age of 3There appears to be a window of vulnerability to risky behaviours between 14-17 years 21Slide22
Adolescent health and wellbeing framework
A high level document to inform local strategies that will draw on what works and what matters
Working in collaboration with schools, FE and Local Authorities
Central to our work to support local improvements – identifying what works from the evidence base, supporting evidence into practiceStrengthening the public health workforceWider than just ‘public health’ trained workforce – youth services, children’s centres, VCS etc
PHE next steps
22Slide23
Foundations in adolescence and young adulthood
Our framework will be promoting:
Using the 10-24 years life course period in line with CMO and WHO
Raising importance of relationships, especially with parents/carers as well as peersBuilding life skills alongside raising awareness of key issues, such as sexual health, drugs and alcohol, positive mental health – and the importance of schools, colleges and other settingsBuilding resilience – risk taking is an important part of development, how can young people be supported to make safe decisionsRole of integrated or connected services – minimise the complexity of accessing services and maximise how they overlap
Challenges and opportunities for achieving public health outcomes for children and young people
23Slide24
How can we make a difference?
Use knowledge about
risk
and what builds resiliencePromote evidence and learning from practice about what works Combine targeted help for those most at risk with universal interventions
Take a life course and place-based approach –early years, schools, families, and communities
Work in
partnership,
taking a coordinated
and collaborative approach
, recognising strengths of different partners and using resources
effectively
Listen and act on what children, young people
and parents/carers
tell us
Challenges and opportunities for achieving public health outcomes for children and young people
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