Health of vulnerable children and young people in Nottinghamshire

1. Health of vulnerable children and young people in Nottinghamshire Dr Kate Allen Public Health Consultant Sally Handley Senior Public Health Manager Nottinghamshire Public Health

2. Setting the scene... The paper explores a broad range of areas that create or add to a child or young persons vulnerability. Reflective moment.... Think of a child or young person that you have previously known and recognise as being vulnerable...

3. Consider what facts or triggers informed your opinion that they were vulnerable? • From the things that you were aware of, do you have any thoughts about what was hidden, that may have increased or decreased their vulnerability?

4. Bring you back to the present moment... It can be difficult to see everything that adds to a child or young persons vulnerability. The Johari Window (Luft et al 1950) could be used as an analogy.

5. Johari Window (Luft et al 1950)

6. Definition of vulnerability applied is described in Healthy Children, Safer Communities (DH 2009) • ‘Those who experience multiple problems which restrict their life chances and need extra attention to improve their well being’

7. Nottinghamshire population • 179,500 children and young people aged 0-19 years • Predicted population growth of 13% in the 0-19 year old population across county by 2030 • Largest growth is in the 5-9 year old population

8. We know that a range of factors affect the life chances and outcomes for a child or young person throughout his or her life.Next slide shows the key drivers of life chances throughout childhood (Field 2010)

10. Our time to act... By the age of five, early influences have already had an impact on the future outcomes for a child, be they cognitive, behavioural, social, emotional or health related (Washbrook 2010) The paper sets out the Nottinghamshire response to reduce the factors that contribute to vulnerability or to reduce the negative impact of vulnerability

11. JSNA • Highlights the issues of health inequalities within Nottinghamshire • Correlation between poor health outcomes, child poverty and localities that experience higher levels of deprivation • Socio economic disadvantage can exacerbate chronic stress, family instabilities and parental mental health and can in turn impair parenting

12. Headlines in Nottinghamshire • 17.1% children live in low income households – (23% Mansfield and Ashfield) • There are higher rates of infant mortality in the most deprived groups of the population- Mansfield and Ashfield have higher than the England average of Low Birth Weight babies

13. Disabled children face multiple barriers In addition to the disability itself, families with a disabled child have: • A higher rate of lone parenthood • Parents less likely to be in full time work (& mothers less likely to work) • Black and minority ethnic families with a disabled child are more likely to live in poor quality housing • Educational attainment is acceptably lower than that of non disabled children • Young people with a disability are less likely to engage in education, training or employment

14. Free school meal eligibility... • Children who are eligible for Free School Meals are 4 times more likely to receive a permanent exclusion than children who are not eligible Ethnicity • The link between ethnicity and health outcomes is complex some black and minority ethnic groups experience higher incidences of certain physical and mental health conditions

15. Asylum Seekers • Illegal migrant families are most vulnerable and their needs are more often hidden • Unaccompanied asylum-seeking children (UASC) may have difficulty proving their age with associated risks of being considered an adult when really a child

16. Children and young people in need of a child protection plan... (refer paper) • Children Looked After (CLA) have higher than average rates of poor mental health, drug use, poor sexual health, behaviour problems and poor educational attainment • CLA are four to five times more likely to attempt suicide in adulthood, and have a higher representation in the YJS

17. Missing Children and Child Sexual Exploitation (CSE) • 1012 children and young people were reported missing in Nottinghamshire (2009) • 25% of the 1012 went missing more than once • Highest number of missing children were from Mansfield and Ashfield • Children who go missing have a higher risk of being exposed to CSE • 85% of children / young people exposed to CSE self harmed or attempted suicide as a result of CSE

18. Drugs and alcohol • Increase in problematic substance misuse for those who experience vulnerability • Increase likelihood of unplanned, un protected sex and increased risk of starting sex under the age of 16 • Children exposed to parental substance misuse are particularly vulnerable and their vulnerability is often hidden

19. Teenage mothers • Are 3 times more likely to suffer post natal depression • Have an increased risk of domestic abuse • More likely to smoke during pregnancy and less likely to breastfeed • Have a 63% increased risk of living in poverty compared to mothers in their twenties

20. The paper tells you much more Annex 2 -The governments pledge to improve outcomes for children and young peoples The challenge is... what additional developments should be considered to reduce vulnerability and its impact on the health and wellbeing of children and young people in Nottinghamshire?

21. Thank You A more detailed version of this paper is available please contact Sally1.handley@nottscc.gov.uk Nottinghamshire Public Health