Parents Under Pressure

1. Parents Under Pressure Every baby should be safe, nurtured and able to thrive

2. Why do pregnancy and babyhood matter?

3. Pregnancy and babyhood matter 1. Immediate moral case ‘Rights for babies will be a new idea to a lot of people and a silly idea to some. But universal recognition of the rights of people who are under one or two years old is both important and urgent… Important because human rights matter just as much (or more if that is possible) to very young, rapidly developing infants as to older children, adolescents or adults. Urgent because this youngest age-group is the most vulnerable to neglect and abuse and currently the most likely to die at the hands of parents, step-parents or ‘carers’. Dr Penelope Leach

4. 2. Developmental case Pregnancy and babyhood matter • A child’s experience and environment – both in the womb and in early life – lay the foundations for life. • http://www.beginbeforebirth.org/for-schools/films#womb • Mothers and fathers are the most important influences on a child’s wellbeing and development • Loving, caring and sensitive parenting, as well as good nutrition and protection from parental stressors (such as toxic substances, mental illness, domestic abuse), are essential for a child’s growth, wellbeing and development

5. Pregnancy and babyhood matter “Early adversity casts a long shadow”Sir Michael Rutter 3. Prevention case

6. Pregnancy and babyhood matter 4. A time of opportunity

7. Pregnancy and babyhood matter 5. Economic case James Heckman’s analysis of the rates of return from programmes across different stages of childhood suggest the smart investor would focus her attentions on the early years

8. How can an understanding of the causes of abuse and neglect inform strategies for intervention?

9. Quality of parenting and relationships matter Development Outcomes in infancy Attachment, neurodevelopment, language, emotional regulation, physical, cognitive and social development MALTREATMENT Ecology Baby Externalities (social costs and consequences) Future development Parenting quality Parental stressors Childhood Adolescence Adulthood Family factors Community Feedback loop (ontogenic) Macro system E.g. attachment, capacity for reflective functioning E.g. parental mental illness, domestic abuse, substance abuse E.g. family structure, size, employment, income, assets, housing E.g. Social networks, peers, neighbourhood E.g. Culture and norms, attitudes to violence [1] Scannapieco & Connell-Carrick, K. (2005) Understanding child maltreatment. An ecological and developmental perspective; [2] Belsky, J (1980) Child maltreatment: an ecological integration;

10. Risk and protective factors for maltreatment

11. Keeping the baby in mind: ‘reflective functioning’ RF refers to a parent’s capacity to make sense of their child’s internal states, emotions, thoughts and intentions • High reflective functioning forms the basis of healthy and secure attachment and effective parenting • Low reflective capacity is associated with poor attachment and is a risk factor for abuse and neglect. • Non-reflective parents: • Focus on child’s personality & behaviour • Make negative attributions • Tantrum = child is mean, bad, selfish • Try to control behaviour • Others seem incomprehensible

12. A framework for prevention Prevention before occurrence Prevention of recurrence ‘Tertiary Prevention’ Long term outcomes Maltreatment Prevention of impairment Universal ‘Primary Prevention’ Targeted ‘Secondary Prevention’ Barlow, J (2010) Safeguarding Children from Emotional Maltreatment. What Works

13. New services • Minding the Baby • Intensive home visiting programme • Third trimester to age 2 • Supporting vulnerable first time mums and their families • Co-delivered by nurses and social workers • Focus on parental Reflective Function and attachment • Clinical supervision from Leeds Uni and Anna Freud Centre • Evaluation by University College London

14. New services • Parents Under Pressure • 20 week home visiting programme • Parents with babies under two and half • Parents engaged with drug or alcohol services • Developed at Griffith University, Australia • 11 teams across UK • Nested RCT Evaluation by Warwick University

15. New services • Preventing NAHI • Parent education DVD (and supporting resources) • Preparation for stresses such as crying and sleeplessness • Coping strategies • Reductions in non-accidental head injuries • Pilot in 18 hospitals across the UK • Rigorous evaluation

16. New services • Baby Steps • Evidence based parent preparation course • Social and emotional transition – as well as physical health • Engaging vulnerable families • Co-facilitated midwives and children’s workers • Teams in 8 areas of the UK • Impact evaluation; thematic learning

17. Where next for NSPCC? • Service development and innovation • Parental mental health and attachment • Pre-birth assessment • Research and policy development • Drugs and alcohol • Parental and infant mental health • Local area studies • Babies of offenders • Survivor mums • Domestic abuse

18. How can policy be transformed to better support early years intervention?

19. ABC Building Blocks: Transforming policy and delivery

20. ABC Building Blocks 1. Clear focus; clear accountability • Widespread understanding of the importance of pregnancy and the first year of a child’s life • Raised awareness of Article 19 of the UNCRC and what it means for babies • Governments ensure that necessary resources are available to support vulnerable babies • Central and local government are held to account for the provision of high quality services and the achievement of improved outcomes, through performance management, inspection, evaluation and client feedback

21. 20% of the new parents need emotional or psychological support Severe or complex disorders and are vulnerable to admission to secondary care. 4% Health budgets Require referral for psychological therapies 8% Local Authority/Children’s Services 8% Social and/or community based support SOURCE: NICE (2008) Antenatal and postnatal mental health commissioning guidance

22. Excellent examples of effective intervention exist - but provision is very patchy across the country Explicit focus on parental and infant mental health Bethlem Royal Hospital Mother & Baby Unit NE London Perinatal Mental Health Service 4% Family Nurse Partnership Home visiting programme for teenage parents Parent-Infant Programme Anna Freud Centre Parents Under Pressure Targets parents with drug and alcohol problems OXPIP Secure Start Children’s Centre based infant mental health service 8% Baby Steps Targeted antenatal education Group-based FNP Targeted at parents with additional needs Mellow Babies Attachment based postnatal depression groups 8% Universal health visiting and maternity services SOURCE: NICE (2008) Antenatal and postnatal mental health commissioning guidance

23. ABC Building Blocks 2. Integrated policy; integrated practice • A seamless policy framework that bridges: • prevention and protection • health and children’s services • maternity and child health • adults’ and children’s services • Services tailored around families’ needs, not the other way around • ‘No wrong door’ to support: contact with any service opens up access to a broader system of support • All professionals recognise prevention and child protection as their responsibility and have the confidence to act decisively

24. ABC Building Blocks 3. World class commissioning; world class services • Local areas are equipped to capture and address local needs: • building a clear and comprehensive picture of needs (one that cuts across agency boundaries) and setting local priorities • identifying effective and promising services; monitoring and reviewing impacts; and responding effectively • Innovation in service design and delivery • Visible improvement in the quality and effectiveness of services • Development of a rigorous evidence base about what works • - and what doesn’t • Proven interventions are taken to scale

25. ABC Building Blocks 4. Professional capacity; professional capability • Evidence based methods are integrated into universal services • The key professions attract and retain high quality talent • Core practitioners have the skills and confidence to work intensively with complex families • Practitioners have access to evidence based tools and resources to underpin assessment and decision making • Commitment and responsibilities of practitioners are matched by quality supervision, freedom to exercise professional judgement and opportunities for development and progression

26. “We join our voice to those who say that a crisis is an opportunity: it is a time to plan to do things differently” Professor Sir Michael Marmott, Independent Review into Health Inequalities

27. All Babies Count Yorkshire 5th November, 2012