Risk factors, engagement in the Sure Start ‘Young Mums to Be’ programme and further social

work involvement

Fleur-Michelle CoiffaitPaula Huddart

Karen Love

Overview

• Background

• Research study

• Findings and implications

• Summary and references

• Questions?

Background

• Early years crucial in determining outcomes in childhood and adult life

• Recent policy emphasis on intervention in the early years

• Complex picture, many risk factors interdependent

Background

• Huge economic and social costs: unemployment, residential care, long-term use of specialist services, criminal justice involvement

• Often grow up to be parents of children who experience poor outcomes, continuing the cycle

Serendipity

• West Lothian Council - Sure Start

• NHS - St John’s Clinical Psychology

• University of Edinburgh - Centre for Research on Families and Relationships

Specific risk factors

• Early parenthood

• Parental substance misuse

• Abuse - all types

• Poor parental physical/mental health

• Parental criminal justice involvement

• Housing issues and family disharmony

Early parenthood

• Poorer child health

• Poorer maternal mental health

• Increased likelihood long-term poverty

• Less likely to be employed or living with a partner when reach 30, compared with those who give birth age 24 or older

Parental substance misuse

• Poor attachment relationships

• Inadequate supervision and parenting

• Increased likelihood of abuse and neglect

• Tangled relationships with other chronic social, psychological, economic and systemic disadvantages

Abuse - all types

• Physical abuse rarely occurs in isolation of emotional and other abuse

• Negative effects on child development, pre- and post-natally

• More likely to begin/escalate in pregnancy

• Increased risk if parent is victim

Poor parental mental/physical health

• Parental physical illness risk factor for later child emotional/behavioural difficulties

• Impact of poor maternal mental health on attachment and responsiveness

• Also linked to poor cognitive, emotional and behavioural development

Criminal justice involvement

• Factors also linked to child maltreatment, including substance misuse, mental health issues, family problems and poverty

• Children more likely to be in child protection system

• More likely to end up in care

Housing issues and other family problems

• Likely to reflect chaotic life circumstances, relationship difficulties, substance misuse and unemployment

• Linked with behavioural and emotional problems in later childhood

Early intervention

• Ante- and postnatal support to address needs, build on strengths/resilience

• Significant period for brain development, attachment formation, communication/language development

• Crucial time to break cycles of poor outcomes, positive economic returns

Sure Start West Lothian

• Preventative, non-stigmatising approach to promoting health/wellbeing of children and families, from conception through early years

• Community outreach support to vulnerable families with children <3

• Approx 60% of parents <22 (in 2009/10)

Young Mums to Be (YM2B) Programme

• 12 week rolling programme, run jointly by Sure Start and midwives

• Specifically for young mothers

• Information, education, advice

• Peer support, transport

Research study

• 43% of young expectant mothers referred to Sure Start do not engage with antenatal support (66% nationally, midwifery) - what happens?

• Investigated whether risk factors predicted engagement or further social work involvement

• Also explored interdependency of risk factors

Method

• Retrospective examination of Sure Start and social work routine records

• Screening forms noted risk factors at referral

• 90 women referred to YM2B between April 2009 - March 2010

Findings

• 44% referred in second trimester

• 69% referred by midwife

• 60% no known involvement of other services, excl. routine antenatal healthcare)

• 57% engaged with and 43% attended over 3 sessions/ completed YM2B

• 26% further involvement from social work

Summary of findingsInterdependency between risk factors

• None were predictive of engagement

Four key predictors of further social work involvement:

• history of substance misuse

• criminal justice involvement

• abuse

• other family problems

Implications

• Early identification of risk factors crucial to ensuring provision of appropriate support

• Multi-agency approach due to interdependency of risk factors

• Role for targeted individual support?

• How do we gather information?

• Further work to explore non-engagement

Summary

• Interdependent social, environmental and parental risk factors for poor outcomes transmitted across generations

• Young parents particularly vulnerable

• Importance of early identification and early intervention to avoid poor outcomes

• Emphasis on better information gathering?

Key references

Advisory Council on the Misuse of Drugs (2003). Hidden harm: Responding to the needs of children of problem drug users. London: Home Office.

Barnard, M. & McKeganey, N. (2004). The impact of parental problem drug use on children: What is the problem and what can be done to help? Addiction, 99, 552-559.

Barnes, M., Chanfreau, J. & Tomaszewski, W. (2010). Growing up in Scotland: The circumstances of persistently poor children. Edinburgh: RR Donnelley.

Barnett, W.S. (2003). Economics of early childhood intervention. In: J.P. Shonkoff & S.J. Meisels (Eds.), Handbook of early childhood intervention. New York: Cambridge University Press.

Bromley, C. & Cunningham-Burley, S. (2010). Growing up in Scotland: Health inequalities in the early years. Edinburgh: RR Donnelley.

Department for Children, Schools and Families (2010). Teenage pregnancy strategy: Beyond 2010. London: Author.

Department for Education and Skills (2006). Teenage pregnancy: Accelerating the strategy to 2010. London: Author.

Ermisch, J. (2003). Does a ‘teen birth’ have longer term impacts on the mother? Suggestive evidence from the British Household Panel Study. ISER Working Papers No. 2003-32 http://www.iser.essex.ac.uk/publications/working-papers/iser/2003-32.pdf

Marmot, M. (2010). Fair society, healthy lives: Strategic review of health inequalities in England post-2010. London: The Marmot

Key referencesKelley, S.J. (2003). Cumulative environmental risk in substance abusing women: Early intervention, parenting stress, child abuse potential and child development. Child Abuse and Neglect, 27, 993-995.

Marmot, M. (2010). Fair society, healthy lives: Strategic review of health inequalities in England post-2010. London: The Marmot Review.

Marryat, L. & Martin, C. (2010). Growing up in Scotland: Maternal mental health and its impact on child behaviour and development. Edinburgh: RR Donnelley.

Phillips, S.D., Dettlaff, A.J. & Baldwin, M.J. (2010). An exploratory study of the range of implications of families’ criminal justice system involvement in child welfare cases. Children and Youth Services Review, 32, 544-550.

Rutter, M. (1999). Psychosocial adversity and child psychopathology. British Journal of Psychiatry, 174, 480–493.

Scottish Government. (2008). Early years framework. Edinburgh: RR Donnelley.

Questions?

Paula.Huddart@westlothian.gsx.gov.uk