Dunedin study of all children born in 1972, to age 21



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Dunedin study of all children born in 1972, to age 21

  • Dunedin study of all children born in 1972, to age 21

  • At age 3, an ‘at risk’ group identified by nurses

  • At age 21, ‘at risk’ males, compared with others:

      • 2.5 times as many with 2+ criminal convictions
      • 55% of their offences violent (18% others)
      • 47% abused their partners (9.5%)


Dunedin study:

  • Dunedin study:

  • ‘At risk’ group offences much more serious

    • (e.g. robbery, rape, homicide)
  • Fewer females conduct disordered, but for those who were:

    • 30% of ‘at risk’ group had teenage births (vs. 0%)
    • 43% were in violent, abusive relationships




Professor Michael Meaney, McGill University

  • Professor Michael Meaney, McGill University

  • Epigenetics - very early life environment - changes function & structure of genes

      • twins with identical DNA could end up with very different effective DNA
  • Disadvantage begins very early, and persists throughout life

      • e.g. through messenger RNA
      • methylation, hypermethylation (caused by early abuse) and acetylation


Professor Vivette Glover, Imperial College

  • Professor Vivette Glover, Imperial College

  • Post-natal depression correlated with poor mental health outcomes for children, later violence and antisocial behaviour

  • Pre-natal depression as damaging as post-natal depression

  • Anxiety during pregnancy even more damaging than depression

  • Pregnancy peak period for domestic violence



Professor Vivette Glover, Imperial College

  • Professor Vivette Glover, Imperial College

  • Cortisol, created by stress, crosses placenta to child

  • Mothers with high stress at 32wks pregnancy produce children with significantly higher social & emotional problems

  • Babies with higher amniotic fluid cortisol did worse on subsequent IQ tests

  • Prenatal plus postnatal anxiety produces worst outcomes



Works via neurons (brain cells) & synapses (connections)

  • Works via neurons (brain cells) & synapses (connections)

  • At birth: 10 trillion synapses - 200 trillion (or more) by age 3

  • Emotional brain largely created by experience in first 18 months; acutely vulnerable to trauma

  • Brains of abused children significantly smaller, less developed



Critical Windows

  • Critical Windows

  • Critical windows of time during which brain hones particular skills or functions

  • Size of window different for different skills

  • If the chance to practise a skill is missed during the window, a child may never learn it (or be impaired)



Critical Windows

  • Critical Windows

  • Synapse formation in visual cortex

    • peaks at 3 months, finished by age 2
  • Auditory map formed by 12 months

    • after this Japanese infant struggles to distinguish “L” and “R”
  • Deaf children need language exposure before age 5

  • Emotional brain largely created in the first 18 months



Infant brain acutely vulnerable to trauma

  • Infant brain acutely vulnerable to trauma

  • If early experience fear: stress hormones wash over brain

  • Children’s brains reflect world in which they are raised

  • If characterized by threat, chaos, unpredictability, fear, trauma

    • development of neural systems for stress and fear responses altered


Brains of abused children significantly smaller

  • Brains of abused children significantly smaller

    • many areas dark on CAT scans (“black hole”)
    • limbic system (emotions) 20-30% smaller, fewer synapses
    • hippocampus (memory) smaller


Alan Schore - 10-year immersion in thousands of scientific papers in neurobiology, psychology, infant development

  • Alan Schore - 10-year immersion in thousands of scientific papers in neurobiology, psychology, infant development







Attunement: parent and child emotionally in tune with each other

  • Attunement: parent and child emotionally in tune with each other

  • Not mimicking: a correspondence of behaviour to their feeling state

  • Responding to emotional needs leaving it feeling understood, cared for, valued

  • Empathy begins with sense of “oneness” with the other – coming from attunement



Lack of attunement means empathy does not develop

  • Lack of attunement means empathy does not develop

  • Low maternal responsiveness at 10-12 months predicted:

    • at 1.5 years: aggression, non-compliance, temper tantrums
    • at 2 years : lower compliance, attention getting, hitting
    • at 3 years : problems with other children
    • at 3.5 years: higher coercive behaviour
    • at 6 years : fighting, stealing


Empathy the single greatest inhibitor of propensity to violence

  • Empathy the single greatest inhibitor of propensity to violence

  • Established early by observation of parental reaction to suffering

  • Babies show empathy by one year old. Not all develop this

  • Abused toddlers react negatively or aggressively to signs of distress

  • Absence of empathy characteristic of violent criminals

      • – worst psychopaths no emotion at all


Research 2002-2006: survey of 19,000 employers

  • Research 2002-2006: survey of 19,000 employers



Research of James Heckman

  • Research of James Heckman

  • Skills needed for success in life multiple in nature

  • Soft skills very important

    • conscientiousness - perseverance
    • self-esteem - motivation
    • ability to pay attention - self-regulation
    • self-esteem - ability to defer gratification
    • sociability (the ability to work with and cooperate with others)
  • These crucial skills mostly created in early years



Research of James Heckman

  • Research of James Heckman

  • Families play essential role in shaping skills of their children

  • Early years before school lay foundations for all that follows

  • Large gaps in abilities between advantaged and disadvantaged open up early before children enter school, and persist



Oxbridge study of children aged 1 to 12, Andhra Pradesh

  • Oxbridge study of children aged 1 to 12, Andhra Pradesh

  • Investigated what determined children's cognitive and non-cognitive skills

  • Parental investment positive effect on skill levels for all ages

  • Pathway: parental care from pregnancy onwards through

  • child health at age 1 through cognitive abilities at age 5



Mannheim Study of Children at Risk (MARS)

  • Mannheim Study of Children at Risk (MARS)

  • ‘Differences in cognitive and non-cognitive capabilities consistently associated with socio-emotional home resources’

  • Adverse consequences of initial risks cumulate and persist until adolescence

  • Individual differences in basic abilities amplify between 3 months and 11 years



Adverse Childhood Experiences (ACE) Study

  • Adverse Childhood Experiences (ACE) Study

  • Emotional abuse

  • Physical abuse

  • Sexual abuse

  • Physical neglect

  • Emotional neglect

  • Alcoholic in household

  • Drug user in household

  • Witnessed domestic violence



Center for Disease Control and Prevention & Kaiser Permanente

  • Center for Disease Control and Prevention & Kaiser Permanente

  • One of largest investigations ever on links between childhood maltreatment and later-life health and well-being

  • 17,000 members at comprehensive physical examinations provided detailed information on childhood abuse, neglect and family dysfunction



Likelihood of Heart Disease with single ACEs:

  • Likelihood of Heart Disease with single ACEs:

  • 1.3 x by Emotional Neglect

  • 1.3 x by Substance Abuse

  • 1.4 x by Physical Neglect

  • 1.4 x by Domestic Violence

  • 1.4 x by Sexual Abuse

  • 1.5 x by Physical Abuse

  • 1.7 x by Emotional Abuse



Health risks which increase with ACEs (17% of popn):

  • Health risks which increase with ACEs (17% of popn):

  • liver disease (x 2)

  • lung disease (x 3)

  • adult smoking, depression, serious job problems (x 3)

  • intercourse by 15, absenteeism from work (x 4)

  • alcoholism and alcohol abuse (x 6)

  • intravenous drug use (x 11)

  • suicide attempts (x 14)













Expert opinion USA:

  • Expert opinion USA:

  • Dr Bruce Perry; James Heckman (Nobel Prize winning economist); RAND Research Institute; Karoly, Kilburn, and Cannon (2005); Felitti and Californian ACE studies; Washington State Institute for Public Policy (WSIPP)

  • Expert opinion UK:

  • WAVE Trust; Croydon Total Place; Government Office for Science; London School of Economics; Action for Children / New Economics Foundation







National and local strategies of prevention rather than reaction

  • National and local strategies of prevention rather than reaction

  • Transformation of attitudes to, and preparation for, parenting

  • Acceptance of children’s rights

  • Understanding and adopting interventions that work



National strategies

  • National strategies

      • Sweden
      • Scotland
  • Local strategies

      • Croydon
      • Derry, Fermanagh and Tyrone
      • Young Ballymun










Scottish Parliament Finance Committee

  • Scottish Parliament Finance Committee

  • The Committee agrees with many of the witnesses that the focus for all decision makers, including the Scottish Parliament and the Scottish Government, should be on the more effective implementation of early years policy.

  • The Committee recommends that both the Scottish Government and the Scottish Parliament take the lead in delivering a radical step change in the existing approach to early years intervention.



Scottish Parliament Finance Committee

  • Scottish Parliament Finance Committee

  • The Committee makes clear its strong support for the concept of preventative spending, particularly on the early years … more effective use of preventative spending has the potential to deliver great social and financial benefits to Scotland. The Committee welcomes the Scottish Government’s shared commitment to this.

  • The Committee considers that the most compelling evidence to have emerged from this inquiry relates to the benefits that could be derived from more effective spending on early intervention support for children … at as early a stage in their lives as possible, including pre-birth.



Children and parents experience system from conception onwards which supports and develops their parenting capabilities

  • Children and parents experience system from conception onwards which supports and develops their parenting capabilities

  • Pre-natal care holistic preparation for parenthood; emotional needs of parents strongly supported

  • All early years practitioners equipped to spot early signs of needs, know how to engage parents quickly in high quality services

  • Geographically based Family Partnership Teams leading



Preparation for parenthood

  • Preparation for parenthood

  • Maternity services within hospitals transformed

      • characterised by holistic preparation for parenthood
      • wider needs and vulnerability identified
  • Parents directed to social networks for support

      • networks supported and developed
  • Early warning signs such as missed appointments followed up

  • Particular care with most vulnerable parents, e.g. teenagers



Early identification

  • Early identification

  • System with capacity to spot and respond to need early and quickly

      • appropriate services available for referral
      • identification and response long before CAF necessary
      • assessment tools available for staff
  • Rapid identification of needs:

      • attachment, motor skills, emotional or behavioural issues
      • speech and language, maternal mental ill-health and domestic conflict
  • Gap in provision before child starts school addressed



Projected costs and savings (preliminary)

  • Projected costs and savings (preliminary)

  • Upfront investment £2.5 million over 2 years

  • Projected savings £8m in 3yrs, £25m in 6yrs, £63m in 13yrs

  • Areas of saving

    • Looked after children Teenage pregnancy
    • NEET Offending
    • Anti-social behaviour Pupil Referral Units
    • Child and adolescent mental health
    • Emotional and Behavioural Difficulties units


Vision for the Infant Mental Health Strategy:

  • Vision for the Infant Mental Health Strategy:

  • WHSCT is committed to supporting families to provide the secure attachments children need to make the best possible start in life

  • Every child living in the WHSCT area has a right to a supportive environment in order to create and support positive mental health and emotional wellbeing throughout their lives

  • We recognise the importance of investment in early years’ child development and positive infant mental health, contributing to lifelong health, social and economic outcomes for the individual



Guiding Principles:

  • Guiding Principles:

  • Whole Child Approach: a holistic systems-based model of Early Intervention

  • Collective Responsibility:

  • 1) Women and Children’s Services plays a primary role in delivering strategy

  • 2) Ante-natal and perinatal services a core universal service access point

  • 3) Every Directorate within WHSCT to actively support delivery of the strategy

  • Quality Service Standards:

  • All service delivery based on timely access to services based on need, transparent outcomes, and informed by service user involvement at all levels

  • Evidence-based best practice and innovation at the core of all services and initiatives with a view to embedding this in future mainstream provision



Key Beneficiaries:

  • Key Beneficiaries:

  • Strategy aims to support every child living within WHSCT area

  • Key principle: to build protective and resilience factors within population to create gradual reduction in number of children and families in crisis

  • Extra support for key vulnerable groups e.g. antenatal and postnatal, ethnic minorities, mental health clients, looked after children, families with domestic abuse, substance or alcohol misuse



Specific Initiatives:

  • Specific Initiatives:

  • Hidden Harm Action Plan for Northern Ireland and Think Child/Think Parent/Think Family project

  • A universal perinatal mental health pathway

    • An example in action is the Early Intervention Service for Alcohol, delivering midwife-led client supports in co-operation with Early Intervention Workers
  • Leading on Roots of Empathy and Nurse Family Partnership

  • NI Regional Healthy Futures strategy principles

    • endorsed by all Health Visitors in WHSCT represent a crucial investment in the support of children and their families during the formative early years


Service aims:

  • Service aims:

  • Improve positive pregnancy and birth experiences

  • Strengthen adaptive protective systems in infancy and toddlerhood

  • Increase confidence and competence of parents

  • Promote healthy infant and child development

  • Reduce childrearing problems



The service has three strands:

  • The service has three strands:

    • Amplify range and increase uptake of ante natal support in collaboration with HSE primary care team, maternity services, local community partners
    • Deliver enhanced baby development clinic in partnership with HSE Public Health Nurse team with increased emphasis on infant social and emotional development.
    • Build capacity of statutory/community services to understand and respond to infant mental health need.
      • through training in competencies and endorsement


Strand I - Preparing for Parenthood

  • Strand I - Preparing for Parenthood

  • Focuses on pregnancy and Infant Mental Health incl. systematic strategy for engaging expectant mothers and partners

  • Supports adaptation to pregnancy & relationship with unborn child

  • Better meets ante natal needs of women and their families

  • Increases capacity of ante natal care



Strand II - Parent-child Psychological Support Programme

  • Strand II - Parent-child Psychological Support Programme

  • Promotes strong parent-child relationships, parental wellbeing and adaptive systems in children

  • Provides parents with information on child development

  • Checks baby’s progress and changing needs

  • Empowers parents to solve conflict



Strand III - Infant Mental Health Promotion

  • Strand III - Infant Mental Health Promotion

  • Focuses on promoting social & emotional development in children

  • Builds capacity of services to respond to infant social and emotional need

    • capacity building for staff, families, programmes, systems
    • identifies, treats and reduces mental health problems, birth – 3 years
    • direct observation of children and care-giving environment
    • design of interventions to change behaviour









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