Reducing Child Maltreatment in Pioneer Communities

1. Reducing Child Maltreatment in Pioneer Communities A preventive approach to creating a large scale step reduction in levels of child abuse, neglect and children witnessing domestic violence George Hosking, CEO, WAVE Trust Peter Kelly, DPH, Stockton-On-Tees Borough Council National Children and Adult Services Conference 2014 Thursday 30thOctober, Manchester Central

2. Overview • Short introduction to WAVE Trust • Economic Case for Prevention • Our 70/30 Campaign • The Problem • The Solution • Disorganised Attachment • The Pioneer Community Approach • How to become involved • Advisory Boards, Pioneer Community

3. WAVE Trust • Violence and what to do about it (2005) • International experience of early intervention for children, young people and families (2010) • Conception to age 2 – the age of opportunity (2013) • 1001 Critical Days Manifesto (2013) • Prevention in Practice (2014)

4. Economic case for prevention Essex • Stopped many of the services that do firefighting • Worked really hard to identify earliest signs of a problem • As early as possible, intervened or supported families to keep their children in the community • 500 fewer children in care system than 3 years ago • Saved £30m from children in care • Invested £10m of that into early support and early intervention

5. Economic case for prevention Gloucestershire • Strong preventive element forsocial workers, health visitors, drug, alcohol and mental health workers, speech and language therapists • New initiatives: Family Drug and Alcohol Court, Journey into Early Parenting (health visitor led) • Early identification of parents not able to interact positively with their children inc.Language • Reduced parental substance misuse and poor mental health • Significant cash savings through less numbers in care, less time in care, fewer care proceedings, not instructing experts in care proceedings. Placements easier because children more advanced • Children more school ready, less SEN, better speech and language, less offending in later life

6. Economic case for prevention Staffordshire • Public sector spend of £7.5bn, Children’s services £170m • Children’s Trust  how can we spend more on prevention? • Youth Services how can we spend more on prevention? • Answer  Look at the £7.5bn not the £170m • A lot of Children’s Services too reactive (examples) • Took £200m out of hospitals • Paid for community care and prevention instead of putting people into hospital • KEY: Early Intervention and Prevention is not a project on the side, it’s at the core of how we operate

7. 70-30 Campaign It’s possible to reduce child maltreatment in the UK by at least 70% by 2030. We have developed a strategy to make this a reality, we call it 70/30.

8. 70-30 Campaign “WAVE's visionary 70/30 strategy has my full backing. It tackles the roots of the problems in our society where so many address the symptoms.” Iain Duncan Smith, Secretary of State for Work and Pensions "I do not view 70/30 as either wishful thinking or an unachievable goal. On the contrary, reducing child maltreatment by 70% in the next fifteen years is the minimum acceptable outcome in responding to this unacceptable (and profoundly costly) harm to our youngest children." Sir Harry Burns (Former Chief Medical Officer, Scotland)

9. The Problem • How to secure the commitment before having the proof? • How to • Bring about whole government commitment to providing best possible support in earliest years? • Ensure primary prevention given appropriate priority? • Deal with a problem (child maltreatment) estimated to cost the nation £15bn annually? • Oliver Letwin • Demonstrate financial pay-back within the life of a parliament

10. The Solution • Focus on ages 0 – 2 (peak period for child maltreatment) • Measure impact through disorganised attachment • Show significant reductions can be made inside 5 years • Demonstrate major cost pay-off to both local and national government

11. Disorganised Attachment Mental Illness 15% of children Children into Care Disorganised Attachment Poor Relationships Disruptive Behaviour in Pre-School Aggression Violence

12. Pioneer Community Approach 5 Years

13. Pioneer Community Approach • Population level, preventive approach • Focussing on conception to age 2 • Pop. 50,000 • 3 components

14. Intervention Component

15. Assessment of Risk • Universal risk assessment at ante-natal stage • Carried out by trained midwives or health visitors (potential GP support) • Costings assume extra support signalled for c240 families per year (targeted), 56 families (specialist) • Parental experience of child maltreatment: measure developed at Kings College London • Other screening tools already available but need for special training and adequate resource • Universal assessment at 3 – 4 months • Quality of interaction between mother and baby • Using Video Interaction Guidance/Parent Infant Interaction Observation Scale

16. Targeted Support • Range of programmes • For parents maltreated in childhood, increased provision of psychological therapies and mental heath support • For domestic violence risk, approaches such as Family Foundations, IRIS, Healthy Relationships, Healthy Babies • For substance abuse, Parents Under Pressure • For mental health issues and poor attunement, Video Interaction Guidance, Parent-Infant Psychotherapy, Specialist Perinatal Mental Health Support, • Other support programmes include Baby Steps, Minding the Baby, Solihull Approach, Mellow Bumps, Babies, and Parenting • These will not be imposed on Pioneer Communities • Recommended programmes • Ultimate choice lies with Pioneer Community Partnership • Does need to fit within research protocol

17. Monitoring Outcomes • Key measure Disorganised Attachment at 15 – 18 months (surrogate for maltreatment as heavy overlap) • Additional measures likely to be • Parental Sensitivity • Disconnected Parenting • Child Aggression • Use of existing local data • 6 – 8 week, 1 year and 2 – 2.5 year assessment • Data from child health profiles • Other local data where relevant

18. Community Component • The goal: community engagement and ownership of commitment to creating healthy, successful lives for children, happy relationships in families • Reducing maltreatment a necessary but not focal part of the positive community goals • Proposed approach - Asset Based Community Development – proven results with Nurture Development • Training ‘Community Builders’ • Local assets primary building blocks of sustainable community development • Communities will be active co-producers in design, planning and implementation of Pioneer Community approach • Work will be done with communities not to them

19. Research and Evaluation • Project leader: Professor Pasco Fearon Professor of Developmental Psychopathology University College London, member faculty Child Study Center, Yale University. His research focus: early child development and role of attachment in risk for emotional and behavioural problems. • Strong support team: Professor Peter Fonagy(leading attachment researcher in the UK), Professor Ted Melhuish(who evaluated Sure Start), Professor Martin Knapp (leading health economist at LSE) and Professor David Shemmings (Professor of Child Protection Research, University of Kent) • Matched control group design: Control groups either from same local authority or demographically matched local authority (possibly member of LA Advisory Board)

20. WAVE’s Role

21. Other Elements of WAVE’s Role • Training and support to local authority professionals, early years workforce, CCGs, Health and Wellbeing Boards, voluntary sector, community groups • WAVE-led Local Authority, Public Health and Expert Advisory Boards (already established) supporting effective implementation • Maintaining the momentum of the project • Spreading learning from the project across the Pioneer Communities and to local authorities, health boards and communities across the UK • Working with LSE, UCL, Kings and Birkbeck to monitor and evaluate the project

22. Potential Outcomes • Major reduction in child maltreatment for 0 – 2 years olds (the peak age) in the Pioneer Communities – in just 5 years • Thousands of children rescued from severely damaged lives • Widespread community improvement in child outcomes, health, wellbeing, school readiness • Fewer children in care or needing special support • Reduced inequalities These are not ‘one-off’ benefits They break the intergenerational cycle of violence and abuse

23. The Public Health perspective • Professor Peter Kelly, • Director of Public Health • Stockton-on-Tees