Understanding Each Other Catherine Lowenhoff Independent Public Health Nurse Consultant

1. Understanding Each Other Catherine Lowenhoff Independent Public Health Nurse Consultant Contact : c.lowenhoff@gmail.com Public Health Nursing Conference Galway

2. Content • The catalyst for change • The rationale for improving public health • Developing the intervention • Delivering ‘Understanding Each Other’ • Evaluation • Learning from experience. Public Health Nursing Conference Galway

3. The Catalyst for Change • Braintree District Crime and Disorder Reduction Partnership Conference 2008 • The Roots of Violence • Evidence-based interventions to reduce violence in society • Concerns of the coalition….. Public Health Nursing Conference Galway

4. Question • Is violence a public health issue? • If it is, what should be done about it? AND • Who should do what? Public Health Nursing Conference Galway

5. 1996 – World Health Assembly adopted resolution WHA49.25 which declared violence ‘ a leading worldwide public health problem’. • 2002 – WHO – World Report on Violence and Health Public Health Nursing Conference Galway

6. Violence as a public health issue • Violence is a preventable disease. • While it is one that is difficult to cure, prevention is relatively simple • Children who are loved well in infancy do not become violent teenagers or adults • Foreword by Sir Christopher Ball • WAVE report 2005

7. Crime and Disorder Reduction Partnership Conference 20.11.08

8. George Hosking, business strategist – changing performance through identifying and understanding root causes • Mid career - trained as psychologist then as clinical criminologist • Dedicated to identifying and promoting the most effective methods known, worldwide, to address violence, especially in the form of abuse of children • Conducted an 8 year study into the roots of violence

9. Two components of Violence • The trigger (social factors) • The propensity (personal factors)

10. What can we do? • ‘The single most effective way to stop producing people with the propensity to violence is to ensure infants are reared in an environment that fosters their development of empathy’ • WAVE Trust 2005 Crime and Disorder Reduction Partnership Conference 20.11.08

11. Target audience….. (WAVE) • To-morrows parents while they are still at school • Current parents • Parents-to-be • Selection of one British town or city as a large-scale test area for simultaneous implementation of a full range of effective intervention strategies, to see if their combined efforts might be cumulative • Focused, national crime prevention agency to co-ordinate, fund and drive effective early prevention strategies Crime and Disorder Reduction Partnership Conference 20.11.08

12. What programmes? • WAVE reviewed 400 interventions • Developed an evaluation matrix • Top 5 • Nurse Family Partnership (FNP)(High risk young mothers ) • PIPPIN (parents-to-be) • Circle of security ( high-risk caregiver infant dyads) • Roots of Empathy ( ages 3 - 14) • Promoting Positive Perinatal Mental Health

26. Parenting as a public health issue • ‘Parenting is probably the most important public health issue facing our society. It is the single largest variable implicated in childhood illnesses and accidents; teenage preganacy and substance misue; truenacy; school disruption and underacheivement; child abuse; unemployability ; juvenile crime ; and mental illness.’ • Hoghughi M. BMJ 1998 May 23: 316 (7144) : 1545-1550 Public Health Nursing Conference Galway

27. Why teach parenting in schools….. • ‘The more that we can give young people opportunities to meet with and observe, at first hand, how sensitive, caring parents treat their offspring, the more likely they are to follow suit. • To learn directly from such parents about the difficulties they meet with, and the rewards they obtain, and to discuss with them both their mistakes and their successes, are worth, I believe, hundreds of instructional talks.’ • P.19 Bowlby J (1988) A Secure Base. Routledge. Public Health Nursing Conference Galway

28. ‘In some primary schools, older children already help younger kids with reading, or mentor them to stop bullying. Why not make this universal? Encourage young mums to bring their babies into school, so children can learn to hold and cuddle. As children grow older, don't confine life skills to avoiding unwanted pregnancies. Explain how to nurture those babies that one day they will want to have. Matthew Taylor, The Guardian, Nov 2006 Public Health Nursing Conference Galway

29. ‘Lessons should begin in primary school and culminate in a cross curricular qualification in parenting at GCSE level.’ • Frank Field, The Telegraph. 03.12.10 • Author of independent report on child poverty ‘Preventing Poor Children Becoming Poor Adults.’ Public Health Nursing Conference Galway

30. Back to Braintree, Essex (pop = 143,000) • UK – unhappiest children in the developed world (UNICEF 2007) • England – EYFS profile – 55% of children failing to reach a good level of development in social and emotional development and communication skills by the time they start school.(DfES 2008) • Braintree – concerns about social and emotional well-being of children, teenage pregnancies, substance misuse, antisocial behaviour, abusive relationships, violent crime, suicide and poor educational attainment. Public Health Nursing Conference Galway

31. Not just about violence, not just about parenting…….

32. It’s about the ‘art’ and the ‘science’……. • It’s about promoting understanding, tolerance, empathy, consideration, kindness, friendship, sharing, teamwork, learning about each other, respecting difference. • It’s about encouraging children to think, to make associations, to develop confidence to express their own views and opinions, to observe and reflect, to make sense of their world and the people in it. Public Health Nursing Conference Galway

33. Its about using the building blocks that currently exist.. • SEAL • Circle time • Nurture Club • DINA school • PHEW • Children’s Trust • CAMHS • Parenting programmes Public Health Nursing Conference Galway

34. It’s about thinking differently…… • Authentic learning • consciousness • experience • reflection • International Academy of Education ‘How children learn’ • Brain-based learning • Neuroscience • Cognitive development • Ultradian rhythms • Jensen E P (2008) A Fresh Look at Brain-Based Education. (on-line) Phi Delta Kappan http://pdkintl.org/kappan/k_v89/k0802jen.htm Public Health Nursing Conference Galway

35. It’s about working to-gether…… • Cluster of schools • 3 secondary, 13 primary • Children’s Trust • PMH workers, EWO’s, education support workers, social care, police • PCT • School nurses, health visitors, nursery nurses, health education advisers • The Ministry of Parenting CIC • Mental health, public health, parenting. Public Health Nursing Conference Galway

36. It’s about having a clear rationale and measurable outcomes….. • Steering group • Reviewing evidence, exploring options, action plan’ • Working group • Development of programme • Confidentiality, consent, contingencies, evaluation • Recruitment • Schools – declaration of commitment, training sessions for teachers, letter to parents, introductory session, consent to participate, consent for DVD/ photo, completion of pre/post questionnaires. • Mother buddies – permission to participate, role and responsibilities • Mothers and babies – information sheet, consent forms, declaration of understanding. Public Health Nursing Conference Galway

37. What we did….. • Year 1 • Iterative development of the programme. • Pilot in 14 classes in 10 schools (years 2 and 8) • Develop resources / website • Comprehensive evaluation • Year 2 • Consolidate learning and delivery, refine programme, extend number of classes in years 2 and 8 • Pilot programme in years 5 and 11 (PRU and MDL) • 34 classes Public Health Nursing Conference Galway

38. Delivering the Intervention What is…. ‘Understanding Each Other’ (UEO)? Public Health Nursing Conference Galway

39. UEO is……. • A 30 week programme built around a visit to the classroom by a mother and baby every three weeks • Observation and reflection of how the baby grows and develops based on 9 key themes • What can babies do, understanding temperament, learning to communicate, feelings, relationships, wellbeing and safety, growing and changing, becoming me, celebrations. • Creation of ‘All About Me’ book to chart the progress of the baby and self. • Developed by specialists in public health, primary care, education, mental health, social care and parenting. • Delivered by teachers Public Health Nursing Conference Galway

40. key component is…… ‘baby as teacher’ Public Health Nursing Conference Galway

41. And……‘active learning’ Public Health Nursing Conference Galway

42. UEO……… • Aims to help children understand themselves and the needs of others through observation of the growth and development of a baby. • Provides an opportunity to participate, ask questions, express opinions, engage in fun activities. No such thing as a silly question / wrong answer. • Promotes reflection on the importance of relationships and how needs, abilities and communication skills change over time. • Helps children to understand themselves and others and provides an opportunity to celebrate the uniqueness of every individual by exploring similarities and differences and sharing aspirations and experiences. • Provides an opportunity to integrate the demands of many aspects of the core and PSHE curriculum, SEAL and the requirements for Healthy School accreditation. Public Health Nursing Conference Galway

43. UEO ……should be fun! • What can babies do – Elton John Glasses, taste panel • Temperament – Winnie the Pooh and you / Mr Men • Feelings – ‘random acts of kindness’ day / ‘centenary smilers’ • Relationships – sea of friendships • Safety – hazard spotting at home and at school • Becoming me – fingerprint detectives, when I grow up… • Celebrations - certificate of achievement, box of good wishes, saying good-bye. Public Health Nursing Conference Galway

44. Evaluation • Pre and post SDQ and Griffiths Empathy measure ( parents, teachers and young people) • Focus groups (teachers, parents, young people) • Informal interviews (mothers) • Mother diary • Teacher and mother testimonies • Best bits (year 2) • 2 Masters dissertations • Improvements in self-esteem Public Health Nursing Conference Galway

45. Griffiths Empathy Measure Public Health Nursing Conference Galway

46. Scoring for Griffiths Empathy Measure Dadds et al ( 2007) A Measure of Cognitive and Affective Empathy in Children Using Parent Ratings Child Psychiatry Hum Dev (2008) 39:111–122 Public Health Nursing Conference Galway

47. SDQ’s ( n = 223) difference in average scores per class Public Health Nursing Conference Galway

48. Findings – yr 2 teachers – 1 school (n = 30) difference in individual scores Public Health Nursing Conference Galway

49. Findings – yr 2 teachers – 1 school (n = 30) difference in individual scores Public Health Nursing Conference Galway

50. Findings – yr 2 - teachers Public Health Nursing Conference Galway