Revised slideshow afternoon session for e circulation june 13th
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Transcript of Revised slideshow afternoon session for e circulation june 13th
Supported by
Primary Prevention – cheaper than cure, better outcomes for
childrenAfternoon session June 13th 2012
Supported by
Supported by
The Health perspective
Dr Ann Hoskins, Interim Regional Director of Public Health/
Director of Children, Young People & Maternity
Healthier Horizons
C4EO/ WAVE Trust conference13th June 2012
Dr Ann Hoskins, Interim Regional Director of Public Health / Director Children, Young People and Maternity Services
Giving Every Child the Best Start in Life is Crucial to Reducing Health Inequalities Across the Life Course
• Ensure high quality maternity services, parenting programmes, childcare and early years education to meet need across the social gradient
• Ensuring that parents have access to support during pregnancy is particularly important
• An integrated policy framework is needed for early child development to include policies relating to the prenatal period and infancy, leading to the planning and commissioning of maternity, infant and early years family support services as part of a wider multi-agency approach to commissioning children and family services
1. A child’s early experience has a long lasting impact on the neurological architecture of their brain and their emotional and cognitive development
2. Pregnancy and birth a key time for change – parents have an instinctive drive to protect their young and want their child to be healthy and happy and do well in life
3. Evidence that effective preventive interventions in early life can produce significant cost savings and benefits in health, social care, educational achievement, economic productivity and responsible citizenship
4. There is scientific consensus that origins of adult disease are often found in pregnancy and infancy
The Scientific Base
5
723,165 new opportunities available
each year in the UK
To prevent early adversities becoming biologically embedded
The Task of Commissioning for Prevention
Factors That Can Hamper Positive Development During Pregnancy
• Low birth weight in particular is associated with poorer long-term health and educational outcomes
• Smoking can cause a range of serious health problems, including lower birth weight, pre-term birth placental complications and perinatal mortality. In addition smoking during pregnancy has been associated with poor child behaviour at age 5.
• Drug use in pregnancy can increase the risk of low birth weight, premature delivery, perinatal mortality, cot death and impairment to the unborn child’s development.
• Drinking alcohol during pregnancy is associated with increased risk of miscarriage, risk of Fetal Alcohol Syndrome whose features include: growth deficiency for height and weight, a distinct pattern of facial features and physical characteristics and central nervous system dysfunction.
• Maternal depression during pregnancy may affect brain development in the foetus, reduce foetal growth and poses risks of premature labour. Antenatal depression has also been linked to altered immune functioning in the baby after birth. Antenatal anxiety at 32 weeks’ gestation has been linked to behavioural and emotional problems in the child at age 4
Commissioning for Prevention
The strength of association
Using maternal factors to consider likely outcomes at 5 years old
Predictive Maps available for, Behaviour, Learning and Development , Health outcomes www.chimat.org.uk
•Data already collected in maternity units •Predictive for outcomes at population level •Informs commissioners decision making for early years resources/ services
Find Out About the Early Years Needs in Your Area
Child Health Learning, Development and Behaviour
http://www.chimat.org.uk/profiles
http://www.education.gov.uk/researchandstatistics/datasets/a00198391/dfe-early-years-foundation-stage-profile-results-in-england-201011
Navigate to Figures at Local Authority Level
Getting the Best Prevention from the Resources you have for early years
• Plan strategically at a population level; intervene proportionately at an individual level. E.g. Family Nurse Partnership
• Health Visiting Service offers for families; universal children’s service
• Promoting a ‘resilience developing’ asset based style to underpin all interactions
Where Should Support for Foundation Years Come From?
• Co-ordinated by health visitors: lead a system for solutions, not services
• Children’s Centres – PbR pilots• Building from & on citizens capacity• Third sector and charities
158 April 2023
A quick response if we have a problem and to be given expert advice and support by the right person
What do parents want?
What is HV contribution?
Services thatgive our baby/child
healthy start.Best advice on a being a parent
To know our health visitor and how to
contact them
A community that supports children
and families
To have the right people to help over a longer term when things are really difficultTo know those people and that they will work together and with us.
NeedsPredictedAssessedExpressed
ResponseProvide
DelegateRefer
Health Visitor
Health Visiting Services – Offers for Families
FNP Short Term Impact on Outcomes
Pregnancy & Birth ↓smoking in pregnancy↓ pregnancy related complications↑ uptake of antenatal care↑breastfeeding initiation↑birth weights in very young teens↑improved diet & nutrition in pregnancy
Infancy (0-2 years )
↓A&E visits –all reasons & for injuries and ingestions (indicator of abuse and neglect) ↓ hospital admissions for injuries and ingestions ↓language delay ↓punitive parenting ↓subsequent pregnancies and births↓welfare use↑ more sensitive care giving ↑ father involvement in parenting↑better home learning environment↑employment↑emotional development
FNP Medium /Long Term Impact On OutcomesMedium term (2-9 years)
↓ severe behaviour problems↓ future pregnancies & births (greater duration between births)↓ welfare use↓involvement with criminal justice system (mother)↑ employment and participation in education (mother)↑ sustained relationship with child’s father/partner (mother)↑ language development ↑ school readiness↑ school achievement scores (reading and maths) ↑ home learning environments↑ stimulating parenting
Longer term (Age 15+)
↓ child abuse and neglect↓ Less criminal and anti-social behaviour (child)
Can it Be Justified in Current Economic Climate?
• US economic modelling- $1 spend prevents $5 spend. Cost recovery by age 4.
• UK – because of licensing, get same outcomes as US; economic analysis will be part of RCT scope
• Babies born to teenage parents at higher likelihood of – £2,500/week to keep a child in residential care – £400/week to support a child in need at home– Up £300,000 /year for a child with additional support needs– £1000 /unscheduled ante-natal admission for investigation with
overnight stay for under 18– £15,000/year public service cumulative costs for a child with
’troubled behaviour’
The New Commissioning Landscape
NHS
NHS Commissioning
Board
Monitor (economic regulator)
Clinical Commissioning Groups
Department of Health
CQC (quality)
Providers
Public Health
England
(Local health improvement
in LAs)
Local authorities (via health & wellbeing boards)
HealthWatch
Local HealthWatch
Pre-pregnancy information and services (e.g. stop
smoking clinics) to improve women’s health
Woman discovers she is pregnant and chooses which maternity service to book
with via the GP or directly with the midwife
Conception
GP Team
Midwife
Online resources, books, leaflets and websites
The universal prevention and early intervention pathway from pre-pregnancy to 5
Promoting parents’ self-efficacy & helping them to care well for their child.
Linking to other community resources and services including SSCCs.
Facilitating community groups & community action
Supported by
How Third Sector organisations can help to
“make it happen”
Fiona Sheil, Public Service Delivery Officer, NCVO
How Third Sector organisations can help to “make it happen”
13th June 2012
Fiona Sheil@fionapsdn
[email protected] Public Services Team
National Council for Voluntary Organisations
What is the voluntary sector?
58.2% work with children and young people
Including-7,910 playgroups and nurseries-7,775 education-6,580 scout groups and youth clubs
Why does this matter to you?
Delivering Services
http://www.ncvo-vol.org.uk/psd/public_services_history
http://www.ncvo-vol.org.uk/commissioning/from_grants_to_contracts
Government Expenditure on the VCS 2009/10
Social capital & assets
Workforce &Economic weight
Participation,Democracy &
representation
Information & commissioning
Participation,Democracy &
representation
Delivering Services
Information & commissioning
Participation,Democracy &
representation
Social capital & assets
Workforce &Economic weight
Thank you!
NCVO Public Services Delivery Network– [email protected]– www.ncvo-vol.org.uk/psdnetwork – 0207 520 2411– @fionapsdn
Supported by
Prevention and early intervention – a
Croydon perspectiveJon Rouse, CEO, Croydon Council
Prevention and early intervention – a Croydon perspective
Jon RouseChief Executive
Croydon
Good education system
Major transport hubDiverse population 40% minority ethnic
Boroughof contrasts
Low wage economy with increasing unemployment
Population growth – baby boom
A philosophy – integrated teams around the citizen to manage complex requirements
● Adult Learning Disabilities● Adult Mental Health● Family Justice Centre● Turnaround Centre● Youth Homelessness● Integrated Offender Management● Family Resilience Team
Croydon’s Journey from Total Place to prevention and early intervention• Customer-led transformation
• Evidence based approach
• A whole system approach to early help
• Continued focus on early ‘early intervention’
• Working out the metrics
Information services – Around £34 via telephone helplineAround £2 via digital services
Cos
t pe
r ch
ild /
fam
ily
Severity of assessed need
Cost
Family Intervention Projects – £8-20,000 per family per year
Family Nurse Partnerships – £3000 per family a year
Child looked after in children’s home – £125,000 per year placement costs
Child looked after in foster care – £25,000 per year placement costs
Schools - £5,400 per pupil
Children’s Centres - around £600 per user
Costs increase as children get older.
Increasing related costs such healthcare and the criminal justice system make it clear joined up working is a core part of cost effectiveness
Multi-dimensional Treatment Foster Care – £68,000 per year for total package of support
Child looked after in secure accommodation – £134,000 per year placement costs
Parenting programme (e.g. Incredible Years – £900-1,000 per family
PEIP – £1,200 - 3,000 per parent
Multi-Systemic Therapy – £7-10,000 per year
The Escalating costs of intervention
What our Total Place pilot told us
After Total Place - progress
Children’s Centres - based on collaborations – engaged parents and communities in redesign
- hub of their community- universal through to targeted support- early help
Family Space - website in place and network of children’s centres
Family Advocates & Peer to peer support - ‘Family Navigators’ and commissioned services
After Total Place Geographically based Family Engagement Partnerships
with early years practitioners equipped to spot early signs of needs, know how to engage parents quickly in high quality services including early identification and peer2peer support
Struggling with Preparation for Parenthood
• children and parents experience system from conception onwards which supports & develops parenting capabilities
• pre-natal care holistic preparation for parenthood; emotional needs of parents supported
Continuing to develop preventative and early intervention service in Croydon
• Use a whole system approach and build our evidence base
• Use the ‘wedge’ to help us plan interventions• Reduce high cost families so that we can reinvest in
preventative services• Continue to work with health colleagues• Develop our metrics across the whole programme of
interventions
Mapping Change for Croydon EIFS: Driving better long-term outcomes for children and families
Greater family resilience and autonomy
More responsive and consistent services
Sense of control and autonomy over decisions
Improved social networks & sense of community
Integration of family skills/experience into services
Early identification of needs
Staff awareness of child well-being
Well coordinated, consistent services
Improved child behaviour at home and school
Reduced risk of child protection issues
Reduced likelihood of drug misuse among parents, children/young adults
Reduced likelihood of children becoming NEET
Improved long-term and intergenerational health including reduced risk of mental ill-health
Reduced likelihood of children entering the criminal justice system
Increased likelihood of financial security for the family
Target service level outcomes (Identified at practitioner workshop)
Broader immediate outcomes Long-term outcomes for children & families EYS objectives/drivers of change
Greater take-up of universal services
Reduced anti-social behaviour/ community violence Reduced contact of parents with
criminal justice system
Stable housing and reduced homelessness Improved emotional resilience
Increased likelihood of parent keeping / finding a job
Improved educational achievement Improved learning outcomes among children
Higher learning achievement among parents
Stronger home learning environments
Improved parent-child relationship
Improved parenting skills
Less abuse/ family violence
Secure attachment between parent and child
Improvements in child and maternal health
Optimise health of children and mothers
Having somewhere to play/ be active
Reduction in number of children on Child Protection Register/ looked after children
Support at Stage 2
Family Engagement Partnerships
Peer2peerFamily Navigator
Parenting Programmes
Find me Early
LOW/VULNERABLEChildren & Young People with low
level additional needs requiring single agency support or an integrated response using a
common assessment.
UNIVERSALChildren & Young People requiring
personalised universalservices
COMPLEXChildren, Young People &
Families with high level needs.
These children/young people include ‘Children in Need’ (Section 17) who require
integrated, targeted support
ACUTEChildren, Young People &
Families with complex additional needs requiring
specialist/statutory integrated response; includes child
protection (Section 47) and children whose needs /
safety cannot be managed in the community
Early Help & Staged Intervention
Support at Stage 1
CRISS;Family Space &
Practitioner websites Support at Stage 3
Family Resilience Service
Troubled Family
Navigators
Severity of need
Cost
Universal Services
Croydon – working across the wedge, whole system approach
Early Help for all fam
ilies
Family R
esilience Service–Troubled Families PbR
Children’s centre services – PbR
Reducing High Cost Spend through Croydon’s Family Resilience Service
No.
Av. savings per year per family
Caseload savings
Caseload costs
Net saving
Net saving per family per year
Phase 1 - 60 60
£48.5k
£2.91m £840k £2.07m £34.5k
Whole Pilot 231 231
£48.5k £11.2m £3.23m £7.9m £34.5k
Capturing net value – a complicated business• Costs to society include the benefits
foregone from not using the resources for some other use
• Large differences in the methodologies adopted by studies (few UK studies) aiming to evaluate the economic impact of early years interventions
• Difficult to compare results across interventions
• BUT emerging UK studies do provide indications that early years interventions generate benefits in the long term that outweigh the costs
Where we need to go next?
• Children and parents to experience system from conception Children and parents to experience system from conception onwards which supports and develops parenting capabilitiesonwards which supports and develops parenting capabilities
• Pre-natal care holistic preparation for parenthood; emotional Pre-natal care holistic preparation for parenthood; emotional needs of parents strongly supportedneeds of parents strongly supported
• Maternity services within hospitals transformed and Maternity services within hospitals transformed and characterised by holistic preparation for parenthoodcharacterised by holistic preparation for parenthood
• Continue to build our early intervention approach - evidence Continue to build our early intervention approach - evidence based and builds the resilience and autonomy of parents to based and builds the resilience and autonomy of parents to ensure young children thrive and developensure young children thrive and develop
The journey continues….
Supported by
Innovation from local areas
Choice of Workshops to showcase response from call for evidence
Supported by
Q&A’s to panel members
Supported by
The benefits of primary prevention
Andrea Leadsom, MP