PHT June 2011_Jan 10 - UK Faculty of Public Health

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SPECIAL FEATURE: EARLY INTERVENTION Scotland aims for the best possible start Parenting programmes make long-term sense EVERY pound spent on parenting programmes to prevent conduct disorder in young children saves the taxpayer £8 over a child's lifetime. And this economic impact of early intervention is over and above the positive effects on the child’s wellbeing. Mental ill health is the largest single cause of disability in the UK, accounting for almost 23% of the overall burden of disease compared to about 16% each for cancer and cardiovascular disease. Most mental health conditions first affect people early in life, with 50% of cases occurring by age 14. Most current public spending on mental health is focused on crisis intervention and expensive longer-term care and support rather than on prevention and early intervention. Yet there is compelling evidence that good quality public mental health interventions dramatically cut costs and significantly improve lives. Behavioural or conduct problems which emerge early in childhood are very likely to persist into later life. The one in 20 young children whose problems merit a clinical diagnosis of conduct disorder face a lifetime of disadvantage, including high levels of ill health, offending and poverty. Yet early onset conduct problems and their risk factors are easily identifiable and, in many cases, preventable. An increasingly strong body of evidence demonstrates the effectiveness of a range of family and school-based programmes to prevent or manage conduct problems. Despite the undoubted benefits, the availability of these programmes falls well short of what is needed and the quality of services is variable. A range of barriers hinders the provision of evidence-based interventions. Programmes are not always compliant with what we know works, and many fail to target those who need them most. Take-up rates are low and drop-out rates are high. In a recent report*, we found that good quality parenting programmes save the taxpayer some £8 for every £1 invested. Other evidence-based early interventions also generate substantial savings. They include health-visiting interventions to reduce postnatal depression and schoolbased social and emotional learning programmes. It is clear that early intervention in public mental health is outstandingly good value for taxpayers’ money. It represents a major opportunity for directors of public health and Public Health England to invest in highly cost-effective interventions and dramatically improve the life chances of thousands of vulnerable children. Michael Parsonage Senior Policy Adviser Centre for Mental Health *Mental Health Promotion and Mental Illness Prevention: the Economic Case is published by the Department of Health, the Personal Social Services Research Unit (PSSRU) at the LSE, the Centre for the Economics of Mental Health and Centre for Mental Health www.centreformentalhealth.org.uk IN SCOTLAND, the main government policy statement has been the Early Years Framework (2008), developed with local authorities, leading to a sustained focus on this key area of public health. Across Scotland a number of initiatives are being developed to test specific elements of national guidance. These include population-based parenting programmes, pilots of the Family Nurse Partnership model and evaluations of child development contacts focusing on early communication and behaviour. The guidance, Improving Maternal and Infant Nutrition: A Framework for Action (2011), focuses on activities across the preconceptual, antenatal, postnatal and infant phases in order to improve outcomes for mothers and children through improved nutrition. It is coherent with the Refreshed Framework for Maternity Care in Scotland (2011) and the accompanying guidance, Reducing Antenatal Health Inequalities (2011), and together these documents set out a broad multi-agency approach to tackling antenatal determinants through assetbased work which will foster stronger relationships with families. The Pathway of Care for Vulnerable Families (0-3) (2011) continues the strengths-based theme, emphasises multiagency working and creates a framework to support the systematic search for needs. The document supports multi-professional working in the antenatal period. A New Look at Hall 4 – the Early Years – Good Health for Every Child (2011) sets out a number of changes to child health surveillance across Scotland, including the introduction of a universal face-to-face contact between 24 and 30 months. This contact will assess social and behavioural outcomes, provide health improvement messages and create an opportunity for parental issues to be addressed. In addition to the new contact, there are planned changes to the Health Plan Indicator (HPI). The HPI is a measure of a child’s need. Early years remains a priority in Scotland. Time will tell how financial realities will challenge the public sector to deliver this agenda. Dr John O’Dowd Consultant in Public Health Medicine (Child Health) NHS Greater Glasgow & Clyde 10 PUBLIC HEALTH TODAY
SPECIAL FEATURE: EARLY INTERVENTION It really is good to talk All babies are born ready to communicate but social inequalities can prevent the very natural process of parent/child interaction from fully working, says Liz Kirk HEALTHY interaction between parent and baby is essential. A child’s language development is crucially dependent on the quality of the interaction they experience during infancy. Unfortunately, optimum language-learning environments are not equally available to children across socioeconomic strata. By the time a child starts school, social inequalities have already had a profound and lasting impact on their development and life chances. According to recent data published by the Marmot review team, more than half of children starting school have failed to reach an adequate level of development. Those most likely to be failing are from lowerincome families. Research tells us this is largely due to the fact that the quality and quantity of interactions that children from poorer families receive is significantly impoverished compared to children from more advantaged households. Researchers have found that lower-income mothers tend to talk less to their children, use fewer different words and respond less to their child’s speech. With Hertfordshire Speech and Language Therapy team I have developed an intervention to improve the quality and quantity of interaction between lowerincome parents and their babies. Small Talk is a series of sessions delivered by a therapist at Sure Start children’s centres. Parents with babies aged between six and 12 months are invited to attend these sessions, which encourage them to focus on, respond to and build upon their child’s early non-verbal communication. The sessions are well received by parents, and evaluation points towards a positive impact on the children’s language development. Lower-income mothers tend to talk less to their children and use fewer ‘different words ‘ The charity Best Beginnings is drawing on this work to develop resources for parents and healthcare professionals to support and encourage positive interactions from birth. Best Beginnings is committed to giving every baby the healthiest possible start in life by focusing on the time period between preconception and two years of age. Recognising the inequalities that exist in early parent-child interaction, Best Beginnings has produced short films of parents spending time with their babies that demonstrate positive examples of interaction. These films on baby conversations, nursery rhymes and engaging play are available to watch on the Best Beginnings website alongside a video commentary of tips to encourage baby communication. Go to www.bestbeginnings.org.uk/babycommunication to view it. All babies are born ready to communicate and all parents, regardless of their income or education, have what it takes to support and nurture their child’s development through quality interaction. Best Beginnings aims to empower parents to make a real difference to their child’s development and ultimately close the gap in inequalities. Dr Liz Kirk Research Fellow School of Psychology University of Hertfordshire and Policy and Development Manager Best Beginnings Other organisations promoting communication for children and young people: The Hello campaign – www.hello.org.uk The Communications Trust – www.thecommunicationtrust.org.uk JUNE 2011 11
Page 1 and 2: In this issue > Interview with Grah
Page 3 and 4: UP FRONT Public Health in a Changin
Page 5 and 6: INTERVIEW not fire engines’ The b
Page 7 and 8: Predicting need in the early years
Page 9: SPECIAL FEATURE: EARLY INTERVENTION
Page 13 and 14: Weighing the evidence - what actual
Page 15 and 16: How work can meet our core human ne
Page 17 and 18: ENDNOTES From the CEO WE ARE at thi
Page 19 and 20: Welcome to new FPH members We would

PHT June 2011_Jan 10 - UK Faculty of Public Health

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