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Between conception and 3, a child’s brain undergoes an impressive amount of change and development. At birth, it already has about all of the neurons it will ever have. It doubles in size in the first year, and by age three it has reached 80 % of its adult volume. Synapses are formed at a faster rate during these years than at any other time. In fact, the brain creates many more of them than it needs and at age two or three, the brain has up to twice as many synapses as it will have in adulthood. This excess of synapses produced by a child’s brain in the first three years makes the brain especially responsive to external input. During this period, the brain can “capture” experience more efficiently than it will be able to later, when the pruning of synapses is underway. The brain’s ability to shape itself – plasticity – lets humans adapt more readily and more quickly than we could if genes alone determining brain development. .
Good quality relationships and secure attachment enable a growing brain to become socially efficient, so providing a basis for future self-control and cognitive development. Much of the baby’s environment – from the baby’s point of view – consists of relationships with his or her parents or carers. The quality of this environment influences the development of the brain and social behaviours in ways that form a foundation for the child’s future experiences and his or her responses to them. Evidence suggests that the quality of the parent-child relationship flows from the way in which parents are looking after, caring for and responding to their young child. As children become 3 years old and older, the Effective Provision of Pre-School Education (EPPE) study demonstrates that those who experience a good early years home learning environment, a good quality pre-school and a more effective primary school are more likely to show improved cognitive and social outcomes compared with children who have two, one or none of these experiences
Heckman also points out particular characteristics of early years investment, not found with investments in later years. He points out that because early years interventions both promote economic efficiency and reduce lifetime inequality, so they provide policy makers with a rare ability to spend money in a way which delivers both social and economic benefits at the same time.
DAS aims to give new parents information and advice they can trust covering a wide range of issues related to staying healthy in pregnancy, preparing for birth and looking after their baby. By signing up to the service, parents-to-be and new parents will receive regular emails and text messages containing relevant and timely NHS approved advice as their pregnancy develops and as their child grows. The web link is below https://www.nhs.uk/InformationServiceForParents/pages/home.aspx By 2014/15 260,000 two year olds will be able to access free early education We need to ensure that we’re achieving the best outcomes for children: Support for childcare settings to drive quality improvement, particularly links to home learning environment; Links into children’s centres and health services so that children and families can access other services they need; Workforce development so that staff understand “the two-ness of twos”.
Center for the Developing Child, Harvard: Programs and policies that are designed to address domestic violence, substance abuse, and mental health problems in adults who have (or are expecting) children would have considerably stronger impacts if their focus also included the children’s developmental needs, beginning in the prenatal period.
Revised slideshow morning session for e circulation june 13th
Primary Prevention – cheaper than cure,better outcomes for children June 13th 2012 Supported by
Welcome from the ChairChristine Davies, CEO, Centre for Excellence and Outcomes, C4EO Supported by
Keynote speaker: EarlyIntervention agenda & context settingSarah Teather, Children’s Minister, Department for Education Supported by
Why BIG Lottery hasgiven it’s support to this agenda Dharmendra Kanani Director, England, BIG Lottery Supported by
A local governmentperspective on child abuse and neglectDavid Simmonds, Chairman LGAChildren and Young People Board Supported by
Better fences - fewer ambulances Robin MillarProgrammes Director, Centre for Social Justice Supported by
The importance of alocal area prevention strategy George Hosking CEO, WAVE Trust Supported by
The importance of a local area prevention strategy George Hosking, WAVE Trust Primary Prevention – cheaper than cure, better outcomes for children Central Hall, Westminster, 13th June 2012
The Barnet Graph of DoomWithout dramatic change, within 20 years the Council will beunable to provide any services except adult social care andchildren’s servicesIrrespective of savings planned under One Barnet TransformationStrategy, demographic change – more children, more elderly – willsoak up every available penny‘In 5-7 years … it starts to restrict our ability to do anything verymuch else. Over a 20-year period, unless there was really radicalcorrective action, adult social care and children’s services wouldneed to take up the totality of our existing budget.’ Nick Walkley, Barnet CEO
Current reality of budget cuts – 1Matt Dunkley, Director of Children’s Services, East Sussex 2011-12 budget: £20m cuts to Children’s Services – ‘We have done the best we can with the challenge we were set’ The challenge: deliver a heavy, frontloaded package of cuts Ringfenced schools budgets off limits. Child protection and looked-after children budgets insulated Cuts fell disproportionately on preventive services inc. early years’ ‘… not the way forward I would have ideally chosen.’
Current reality of budget cuts - 2Matt Dunkley (continued) East Sussex has put 600 more children (most under five years old)on child protection plans in the past two years (2011) Number of looked-after children has almost doubled to 560 Government’s Early Intervention grant cut, in effect, by 20%. Soaring demand, little sign that trigger factors such as parentalsubstance abuse is falling ‘The pace at which we had to do this … led to missed opportunityto do a smarter piece of work … to reshape those services.’
Fundamental choiceContinue on current path or create aParadigm shift: Invest in primary prevention
Continue on current path?Out of 12 million children under 16 in UK: Severely maltreated 1 to 1.6 million Physical neglect over 1 million Alcoholic in household 1 million Witnessing domestic violence ¾ million
Costs of continuing on current pathAnnual waste from adverse early years estimated at over £200 billion, nationallyIncludes cost of welfare benefits, crime, mental health, alcohol and drug abuse, violence, family breakdown, domestic violence, NEETS, prison service, looked after children, young offenders, special educationdoesn’t include...Lost tax revenue and costs of poor physical health
The future: doom or hope? What if, instead of doom and gloom, we could find a more up todate way to set policy, using the latest scientific knowledge? … which will produce far happier, healthier and more prosperouscommunities… Is there a safe and economically viable way to do this?
Implication for optimum investmentSource: Heckman, James J. (2008). "Schools, Skills and Synapses," Economic Inquiry, 46(3): 289-324.
Pattern of public spending on education in England & Wales over the life cycle, 2002/2003
A new paradigmNational and local strategies of primary prevention, rather thanreactionTransformation of the quality of parenting – through changedattitudes and better preparation for parentingRespect for children’s right not to be abused or neglectedUnderstanding and adoption of early years interventions that work
Lifelong skills created very earlyResearch of Nobel Prize Winner, James Heckman An open and persevering child learns more – early success fosters later success, advantages cumulate – young children more flexible and adaptable – much easier to prevent deficits from arising in early years than to remediate laterMannheim Study of Children at Risk (MARS) Individual differences in basic abilities increase between 3 monthsand 11 years
Lifelong skills created very earlyResearch of Nobel Prize Winner, James Heckman Achievement gaps between children primarily due to gaps in skills Hard and Soft skills very important for success in life – conscientiousness - perseverance – motivation - attention – emotional self-regulation - self-esteem – ability to defer gratification – sociability (ability to work with and cooperate with others) These crucial skills mostly created in early years, in the family Gaps in skills emerge early, before pre-school, and persist
Causes and consequences: Californian ACE StudyMajor investigation on links between childhood maltreatmentand later-life health and well-being17,000 Kaiser Permanente members at comprehensive physicalexaminations provided detailed information on their childhoodexperiences of physical and emotional abuse, including beingreared in households with domestic violence, drug and alcoholabuse.WHO now conducting its own international (including UK)ACE study
Californian ACE StudyHealth risks which increase with 4 ACEs (17% of popn): liver disease (x 2) lung disease (x 3) adult smoking, depression, serious job problems (x 3) intercourse by 15, absenteeism from work (x 4) alcoholism and alcohol abuse (x 6) intravenous drug use (x 11) suicide attempts (x 14)
Pathways to crime often set by age 3Dunedin study of all Violent offenceschildren born in 1972, Abused partnersto age 21 Number with 2+ criminal convictions 55% 47% 2.5x 18% 1x 9.5% At risk Normal At risk Normal At risk Normal
Key: understand infant brainWorks via neurons (brain cells) & synapses (connections)At birth: 10 trillion synapses - 200 trillion (or more) by age 3Emotional brain largely created by experience in first 18months; acutely vulnerable to traumaBrains of abused children significantly smaller, less developed
Understand the infant brain Alan Schore - 10-year immersion in thousands of scientific papers in neurobiology, psychology, infant development ‘The child’s first relationship, the one with the mother,acts as a template … permanently moulds the individual’s capacity to enter into all later emotional relationships’
Key factors: Attunement and EmpathyAttunement between mother and infant develops empathy.Lack of attunement means empathy does not develop.Low maternal responsiveness at 10-12 months predicted: – at 1.5 years: aggression, non-compliance, temper tantrums – at 2 years : lower compliance, attention getting, hitting – at 3 years : problems with other children – at 3.5 years: higher coercive behaviour – at 6 years : fighting, stealing Absence of empathy characteristic of violent criminals – worst psychopaths no emotion at all
Early years prevention saves money - 1 Expert opinion USA: Dr Bruce Perry James Heckman (Nobel Prize winning economist) RAND Research Institute / Karoly, Kilburn, and Cannon (2005) Felitti and Californian ACE studies Washington State Institute for Public Policy (WSIPP) Expert opinion UK: Government Office for Science London School of Economics Action for Children / New Economics Foundation Croydon Prevention Strategy WAVE Trust
Early years prevention saves money - 2 RAND Research Institute / Karoly, Kilburn, and Cannon Cost benefit analyses or meta-analyses of early years’ programmes showed payoffs per dollar invested from $1.80 to $17.07 Estimated net benefits from $1,400 to nearly $240,000 per child Chicago Child-Parent Center Program / Reynolds Benefits > $80,000 per child - $10.80 of benefits per $1 invested Children with four or more family risk factors yielded almost double the benefits of those with fewer ($12.8 vs. $7.2) Children from highest poverty neighbourhoods had returns more than four times higher than those from less disadvantaged areas
Early years prevention saves money - 3Federal Reserve Bank of Minneapolis/Rolnick & Grunewald Internal rates of return for early years programmes exceed returnsfrom both stock market and typical public policy investments [would also significantly exceed returns from many UK large-scalepublic investments, including high speed HS2 rail link]Washington State Institute for Public Policy (WSIPP) Rigorously conservative approach to programme evaluation – $1.75 per $1 for Parents as Teachers – $3.23 per $1 for Nurse Family Partnership – $7.00 per $1 for Parent Child Interaction Therapy – $10.32 per $1 for Level 4 Group Triple P
WAVE’s Core Recommendation Implement a committed primary prevention strategy for children from conception to age 3US Surgeon General: ‘Preventing an illness from occurring is inherently better than having to treat the illness after its onset. The classic public health definition of primary prevention refers to interventions which ward off the initial onset of a disorder’
Strategies of preventionNational strategies Infancy and Early Childhood in Sweden Every Opportunity for Every Child, Netherlands Scotland – new Preventive StrategyLocal strategies Croydon Prevention Strategy (joint local authority & PCT) Derry, Fermanagh and Tyrone Ballymun, Dublin
A National Strategy of PreventionApproach to Infancy and Early Childhood in Sweden 99% of pregnant women access maternity healthcare services, 99%of families use child healthcare services, avg. 20 contacts 98% of maternity services offer group parenting education to firsttime mothers, specialist support to teen mums, single mums Parent education c10% of midwives time; Parents invited to joinparent groups when child 1-2 months (61% attended 5+, Stockholm) 65% of midwives receive regular professional training on parentingeducation, 72% instructed by a psychologist
A National Strategy of PreventionApproach to Infancy and Early Childhood in Sweden 100% of hospitals have BFHI (baby-friendly) status (UK<10%) Long periods of paternal and maternal leave to support baby Breastfeeding: 98% of Swedish mums begin breastfeeding (79% UK) 72% breastfeeding at 6 months (22% UK) 15% exclusive breastfeeding at 6 months (less than 1% UK)
A National Strategy of Prevention SWEDEN UK % Live Births to teen mothers 1.6 7.1 Infant Mortality (per 1,000 live) 2.5 5.1 Smoking (% per day aged 15+) 16 25 Alcohol (litres per person p.a.) 7 11 Adult Obesity (% of population) 11 23 Smoking Related Deaths (per 100,000 popn) 196 245 Chronic Liver Disease Deaths, < 65 yrs (per 4 9 100,000) Cancer Deaths, < 65 yrs (per 100,000) 56 67 Circulatory Disease Deaths, Under 65 32 43
Infant Mental Health Strategy: Derry, Fermanagh and TyroneVision for the Infant Mental Health Strategy: WHSCT committed to supporting families to provide secureattachments children need to make best possible start in life Every child has a right to a supportive environment to create andsupport positive mental health and emotional wellbeing Investment in early years’ child development and positive infantmental health, contributing to lifelong health, social and economicoutcomes
Infant Mental Health Strategy: Derry, Fermanagh and TyroneWhole Child Approach: a holistic systems-based model of Early InterventionCollective Responsibility:• 1) Women and Children’s Services plays a primary delivery role• 2) Ante-natal and perinatal services a core universal service• 3) Every Directorate actively supporting delivery of the strategyQuality Service Standards:• All delivery based on timely access to services based on need• Evidence-based best practice and innovation at core of all services
Infant Mental Health Strategy: Derry, Fermanagh and TyroneSpecific Initiatives: Hidden Harm Action Plan for Northern Ireland and Think Child/Think Parent/Think Family project A universal perinatal mental health pathway Leading on Roots of Empathy Programme NI Regional Healthy Futures strategy principles: health visitorssupporting children & families during formative early years Leading on Family Nurse Partnership
Ballymun, Dublin: Ready, Steady, Grow Service aims: Improve positive pregnancy and birth experiences Strengthen adaptive protective systems in infancy and toddlerhood Increase confidence and competence of parents Promote healthy infant and child development Reduce childrearing problems
Ballymun, Dublin: Ready, Steady, Grow Initiatives: – Amplify range & increase uptake of ante natal support in collaboration with primary health care team, maternity services – Enhanced baby development clinic in partnership with Public Health Nurse team – Increased emphasis on infant social and emotional development – Direct support to families and onward referral as appropriate – Build capacity of statutory/community services to understand and respond to infant mental health need
Ballymun, Dublin: Ready, Steady, Grow Strand I - Preparing for Parenthood Focus on pregnancy and Infant Mental Health incl. systematic strategy for engaging expectant mothers and partners Support adaptation to pregnancy & relationship with unborn child Better meet ante natal needs of women and their families Increase capacity of ante natal care
Ballymun, Dublin: Ready, Steady, Grow Strand II - Parent-child Psychological Support Programme Promote strong parent-child relationships, parental wellbeing and adaptive systems in children Provide parents with information on child development Check baby’s progress and changing needs Empower parents to solve conflict
Ballymun, Dublin: Ready, Steady, Grow Strand III - Infant Mental Health Promotion Focus on promoting social & emotional development in children Build service capacity to respond to infant social and emotional need – capacity building for staff, families, programmes, systems – identify, treat, reduce mental health problems birth to 3 years – direct observation of children and care-giving environment – interventions designed to change behaviour
Early intervention programmes - 1Excellent Parenting programmes Nurse Family Partnership Roots of Empathy First Steps in Parenting Leksand Model, Sweden SKIP (Strategies for Kids, Information for Parents)
Early intervention programmes - 2 Fostering attunement, breast-feeding, secure attachmentAttunement Video Interactive GuidanceBreast-feeding Breastfeeding Initiative, BlackpoolSecure Attachment Circle of Security, Sunderland Infant ProgrammeReducing teen pregnancy Enfield
Report on recent study ofpolicies from conception to age 2 Sally Burlington Deputy Director, Sure Start and Early Intervention Division, Department for Education Supported by
Special Interest Group: Pregnancy to 2 Sally Burlington Department for Education 13 June 2012 Supported by
Conception to 2 is the most crucial phase of development The first 2 years of life are critical to a child’s development. How we treat 0-2 yr olds shapes their lives… and ultimately our society.• Period of fastest development – 80% of all brain volume development is complete by age 3; and is fundamentally affected by early relationships and interactions• Lays foundations for all later development Supported by
Poor support at this stage can have life- long impact on outcomes• Poor attachment in infancy is associated with behaviour problems later on (and the effect doesn’t reduce over time)• It can affect anyone: the effects are not less for higher socio-economic groups• Early childhood abuse and neglect affects physical and mental health and life-time outcomes; and the next generation Supported by
Key factors• Health in pregnancy (including maternal stress)• Maternal health and mental health post-birth• Quality of relationship (attachment) with main carer has impact on: – emotional wellbeing (and infant mental health); – capacity to form and maintain positive relationships with others; – brain development; – language development; and – the quality of the home learning environment. Supported by
Early childhood programmes have been shown to have substantial net benefits and social gains• … and net savings to the public purse particularly through better long term health and crime reduction• Cost-benefit analyses show a range of net benefits, up to 1000 x initial costs• James Heckman: highest returns for earliest interventions (0-3)• Best effects are delivered when long-term follow-up Supported by
But care is needed in interpreting this….• American evidence does not necessarily translate directly to the UK• In the UK we already have universal maternity and perinatal health provision: Healthy Child Programme, and Family Nurse Partnership• People tend to quote the most positive effects rather than the most likely• Most striking effects are for groups with a large number of risk factors Supported by
Nevertheless, some key conclusions:• Full implementation of the Healthy Child Programme (supported by 4200 new health visitors by 2015) will give us a world class service (more like Sweden than USA?)• Opportunity to “join up” services for infants and their families when responsibility for public health moves to local authorities from 2015• Implementation – what you do and how you do it – is key• Early findings from FNP evaluation are very positive (suggesting some of the success of American schemes can be replicated here): doubling of capacity is very welcome Supported by
Wider policy developments• 4,200 new health visitors• Doubling of Family Nurse Partnerships• Prof Cathy Nutbrown review of early years workforce• Free early education for disadvantaged 2 year olds• Digital Advice Service for parents just launched• New Early Years Foundation Stage: new focus on very young children; identifying prime areas of Communication and Language; Social and Emotional Development; Physical Development;• New requirement for all EY settings to undertake a progress check for 2 year olds, and to provide a report to parents. This will help to identify development needs – to be integrated with the healthy child review Supported by
Some lessons from evidence can be used to influence ongoing practice• “Spread the word” to all practitioners: understand what very early child development looks like, and importance of secure attachment: do people in childcare settings understand babies’ behaviour?• Publicise good sources of advice• Early years workforce: importance of a key worker; emotionally intelligent staff; effective supervision – role of reflective supervision Supported by
Other Implications• How to target? Stigma vs “deadweight”• Therefore make best use of universal provision, and stop people falling through the net by – Early identification and early help systems (HV, social work and strong multi-disciplinary approaches) – Effective information sharing between professionals – Sure Start Children’s Centres and outreach working effectively to identify and support the most vulnerable families very early in a child’s life – Staff in other EY settings (especially 2YO and earlier childcare) having a good understanding of child development and how to spot and tackle problems appropriately and quickly.• Continue to improve our understanding of what evidence based intensive support can be commissioned: who it works for; what it costs; timescales and management. Supported by
Resources• Pregnancy Book http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107 302• Birth to Five http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107 303• The NHS Choices website also provides a wealth of information relating to pregnancy, maternity and the early years, including an interactive Pregnancy Care Planner (based on ‘The Pregnancy Book’) and Birth to Five guide (based on the ‘Birth to Five’ book) and a range of videos on issues relating to pregnancy, babies and children. http://www.nhs.uk• Start4Life http://www.nhs.uk/start4life/Pages/healthy-pregnancy-baby-advice.aspx• Healthy Start http://www.healthystart.nhs.uk/• Information Service for Parents http://www.nhs.uk/InformationServiceForParents/pages/home.aspx• Age specific downloadable handouts: http://www.zerotothree.org/about-us/areas-of-expertise/free- parent-brochures-and-guides/ http://community.fpg.unc.edu/connect-modules/learners and http://community.fpg.unc.edu/connect- modules/5-step-learning-cycle for an explanation. Supported by
Lunchwith Social Investment Business models showcased Supported by