PHT June 2011_Jan 10 - UK Faculty of Public Health

More documents

Recommendations

Info

SPECIAL FEATURE: EARLY INTERVENTION On the safe side Local Safeguarding Children Boards need to be both strategic and aware of what is happening on the multi-agency frontline, says Edwina Harrison 6mm ALTHOUGH there were a few independent chairs of Local Safeguarding Children Boards (LSCBs) prior to the Baby Peter case, it was the subsequent report by Lord Laming, The Protection of Children in England: A Progress Report (www.education.gov.uk/publications), which led to around 135 of the 148 chairs being independent. I took up my first post in September 2009. LSCBs became statutory bodies in 2006, replacing the previous, non-statutory Area Child Protection Committees, and the roles and responsibilities of the LSCB are outlined in Working Together to Safeguard Children, 2010 (www.education.gov.uk/publications). To be successful, LSCBs need to perform two different but equally important functions: to be strategic but also to understand what is actually happening at the multiagency frontline. While much progress has been made in embedding effective partnership work in safeguarding children, there are a number of significant challenges facing LSCBs. The unprecedented scale of organisational change among agencies creates the potential for a retreat back into silos and for partnership working to suffer a severe setback. In the absence of specific funding for LSCBs, budgets are a big issue, and memories can be short when it comes to the cost, in terms of morale as well as money, of a failure of multi-agency working. Significant progress has been made in addressing issues which impact on multiagency working. These include agreement on thresholds for intervention, on developing effective training and on audit and quality-assurance processes. The reports presented to LSCBs on the reality of front-line working can be a real The unprecedented scale of organisational change creates the potential for a ‘retreat back into silos ‘ eye-opener for senior managers who may be used to receiving information from their own agencies in isolation. These include information from the first three years of the Child Death Overview Panels as well as the various stages of the child protection processes outlined in Working Together. Many LSCBs have now appointed lay members to provide a much-needed link to local communities. Potentially even more powerful is the work which is taking place incorporating the voices of children and young people to better understand their experience of the systems that are designed to protect them. And while no area would choose to have a Serious Case Review, the combined experiences included in Ofsted’s Learning Lessons reports (www.ofsted.gov.uk) are relevant for all practitioners. The models referred to in the recent reports by Professor Eileen Munro offer a more practice-based method of learning from serious incidents. Some changes of direction have been signalled already, with a return to child protection as the main focus of LSCBs. The first two reports from Professor Munro, The Munro Review of Child Protection: Part One and the Interim Report, The Child’s Journey, have both indicated that she sees a clear and continuing future for LSCBs as statutory bodies with an enhanced responsibility for embedding multi-agency learning. The third and final report, A Child-Centred System, came out last month, but it remains to be seen whether a government committed to localism will understand that child protection is too important to be left to local choice. Edwina Harrison Independent Chair Newcastle Safeguarding Children Board 12 PUBLIC HEALTH TODAY
Weighing the evidence – what actually works SPECIAL FEATURE: EARLY INTERVENTION Child health surveillance – how does it measure up? THE scientific rationale for early intervention to improve the health and life chances of children, particularly vulnerable children, is now strong and well documented (most recently in the independent reviews of Frank Field and Graham Allen). A child’s early experiences and environment have a major influence on his or her social and emotional development and on adult mental health and wellbeing. Exposure to risks such as poor-quality parent-child relationships, maternal depression and poverty are predictive of a range of negative health and social outcomes. These include emotional and behavioural problems, poor educational attainment, substance misuse, conduct disorder and criminality. Early interventions are concerned with addressing risks and enhancing protective factors through direct support to the child and/or increasing the parents’ capacity to provide a nurturing home environment. New government policy has endorsed the principle of ‘proportionate universalism’ (as advocated by the Marmot Review 2010) whereby “the scale and intensity of provision of universal services is proportionate to the level of disadvantage”. This requires a strategy that achieves the most appropriate balance between universal and targeted interventions based on the needs of children and families locally, and evidence on what works. While there is considerable evidence concerning the effectiveness of such interventions as home visiting, parenting, childcare and early education, there are challenges to translating this evidence into mainstream practice locally. Much of the evidence is US-based and does not necessarily easily translate into the UK context. There is a heterogeneity of interventions that have been designed to address specific risks, and a diverse range of child and maternal outcomes. While some programmes have been shown to be effective, others have not. Nevertheless in England we have the foundations of evidence-based practice for improving early child development and readiness for school. For example, since its establishment in1998 the improved effectiveness of the Sure Start Programme has been informed by the findings from the national evaluation (National Evaluation Sure Start 2006 and 2008). The evaluation has demonstrated variation in quality of management and implementation of local programmes. The more recent evaluation of child outcomes shows a range of positive effects across all population groups, including the most disadvantaged (teenaged parents, lone parents, workless households). This improved reach was explained in terms of the increased exposure of children and families to Sure Start Local Programmes that had become more effectively managed over time. The Family Nurse Partnership (FNP) programme is planned to be rolled out following its piloting. It is modelled on a programme developed in the US that has been tested in three randomised controlled trials with benefits shown for mothers and their children and, in particular, more benefits for the most vulnerable. There is important learning from the process evaluation of the FNP pilots (eg Barnes et al 2008, 2010). Although there are gaps in the evidence available to guide commissioning decisions on the most cost effective mix of early interventions, a number of points are clear (Shonkoff & Phillips 2000): Much of the evidence is US-based and does not necessarily translate ‘into the UK context n Early and intensive support to young first-time mothers through home visits by health visitors can produce benefits for both the child and parents. n Children in low-income families can derive proportionately greater benefits (compared to their more well-off peers) from participation in universal high-quality, early-education programmes (3-4 years). n For children living in families with many difficulties, multi-component programmes are required that provide direct support to parents as well as address the needs of the child. For young children exposed to significant stress through neglect or abuse, maternal depression, parental substance misuse or family violence, intensive services matched to the problems can promote better development outcomes. Amanda Killoran Public Health Analyst NICE ‘ IN THE UK a programme of child health surveillance has been in place since the early 20th Century. The current programme was defined in October 2009 when the Department of Health launched the Healthy Child Programme (HCP). The HCP emphasises the needs of at-risk families and includes health and development reviews where the core purpose is to assess family strengths, needs and risks, and also growth and development. Mitch Blair wrote in 2009: “How would we know that we have succeeded in optimising child health and development across the whole child population over time? Clyde Hertzman and colleagues in Canada developed the Early Development Instrument (EDI) as a community measure of young children’s development. It is based on the scores from a teachercompleted checklist of over 100 questions covering language and cognitive skills, emotional maturity, physical health and wellbeing, communication skills and general knowledge and social competence. “The EDI acts as a proxy measure of how well a community is performing in raising their children and has been shown to be a powerful catalyst for community mobilisation and inter-agency collaboration. Results from Canada indicate that where appropriate and accessible early child development and parenting programmes have been implemented, community efforts appear to ameliorate socio-economic risks.” The Child Public Health Interest Group would like to see a surveillance programme along the lines of the EDI being adopted in the UK as a broader, more effective and more efficient use of resources to help shape health and wellbeing policies and practices for the 21st Century. Prof John Harvey Co-chair (FPH) Child Public Health Interest Group JUNE 2011 13
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 and 10: SPECIAL FEATURE: EARLY INTERVENTION
Page 11: SPECIAL FEATURE: EARLY INTERVENTION
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

Create successful ePaper yourself

Delete template?

Save as template?