Health inequalities and parenting

Health inequalities and Health inequalities and parentingparenting

Phil WilsonPhil Wilson

GP, Battlefield, GlasgowGP, Battlefield, Glasgow

Senior Lecturer Senior Lecturer University of GlasgowUniversity of Glasgow

Health inequalities and Health inequalities and parentingparenting

Focus on relative economic deprivationFocus on relative economic deprivation Because we know deprivation is linked to poor health and Because we know deprivation is linked to poor health and

mortalitymortality

Focus on child behaviourFocus on child behaviour Because we know parenting and child behaviour are Because we know parenting and child behaviour are

inextricably linkedinextricably linked Because child behaviour is easier to assess than parentingBecause child behaviour is easier to assess than parenting Because we know child behaviour problems are linked to Because we know child behaviour problems are linked to

poor health outcomespoor health outcomes Because we know measures which improve child behaviour Because we know measures which improve child behaviour

can reduce health risks (smoking, problem alcohol/drug use can reduce health risks (smoking, problem alcohol/drug use etc)etc)

Glasgow Evaluation Glasgow Evaluation PrinciplesPrinciples

Use of standardised toolsUse of standardised tools Data should be useful for:Data should be useful for:

Professional decision makingProfessional decision making Needs assessmentNeeds assessment Performance managementPerformance management External evaluationExternal evaluation

Universal HV contactsUniversal HV contacts

Pilot data - West Glasgow July-Dec Pilot data - West Glasgow July-Dec 20092009 13 month assessment evaluating 13 month assessment evaluating

parent-child interaction and parent-child interaction and emotional wellbeing of parentemotional wellbeing of parent

30 month assessment of parenting 30 month assessment of parenting stress, child behaviour and language stress, child behaviour and language developmentdevelopment

13 month contact13 month contact Adult wellbeing scale:Adult wellbeing scale:

AnxietyAnxiety DepressionDepression Externally-directed irritabilityExternally-directed irritability Internally-directed irritabilityInternally-directed irritability

Observational assessment of parent-Observational assessment of parent-child interaction*child interaction* ““may be problems / “probably no may be problems / “probably no

problems”problems”* Wilson, Thompson, McConnachie, Puckering, Holden, Cassidy, Gillberg . Community Practitioner 2010: 83(5): 22-5

13m: Adult Wellbeing Scale13m: Adult Wellbeing Scale

Good response (88%) and completion Good response (88%) and completion rates (77.9%)rates (77.9%)

Scores reflect known social patterning of Scores reflect known social patterning of depression, but not anxietydepression, but not anxiety

Irritability relatively uncommon. No clear Irritability relatively uncommon. No clear relationship to deprivationrelationship to deprivation

30 month assessment30 month assessment

Parenting Daily Hassles Parenting Daily Hassles Richman Behaviour ChecklistRichman Behaviour Checklist Language screenLanguage screen

30-month visit - language30-month visit - language

•Half the children with language delay Half the children with language delay are in “core” risk categoryare in “core” risk category

•No clear social patterningNo clear social patterning

n %

Can your child put 2 words together? 10 3

Does your child know 50 words? 33 10

Strengths and Difficulties Strengths and Difficulties Questionnaire at school Questionnaire at school

entryentry For all children entering primary For all children entering primary

school in Glasgow, starting in 2010school in Glasgow, starting in 2010 Completed by Child Development Completed by Child Development

Officers as part of routine Transition Officers as part of routine Transition DocumentationDocumentation

Data available on SEEMIS database Data available on SEEMIS database and linkable to NHS and GROS dataand linkable to NHS and GROS data

The SDQThe SDQ A brief behavioural screening A brief behavioural screening

questionnaire for use with 3-16 year questionnaire for use with 3-16 year olds. olds.

25 questions used to measure five 25 questions used to measure five aspects of the child’s development: aspects of the child’s development: emotional symptomsemotional symptoms conduct problemsconduct problems hyperactivity/inattentionhyperactivity/inattention peer relationship problems peer relationship problems pro-social behaviour.pro-social behaviour.

SDQ and deprivationSDQ and deprivationSIMD QuintileSIMD Quintile 11 22 33 44 55 TotalTotal SignificanceSignificance

Emotional SymptomsEmotional Symptoms

Possible ProblemsPossible Problems 103 (6%)103 (6%) 15 (3%)15 (3%) 21 (5%)21 (5%) 11 (4%)11 (4%) 10 (3%)10 (3%) 160 (5%)160 (5%) p = 0.044p = 0.044

Conduct ProblemsConduct Problems


HyperactivityHyperactivity

Possible ProblemsPossible Problems 300 (17%)300 (17%) 73 (14%)73 (14%) 55 (14%)55 (14%) 29 (11%)29 (11%) 33 (11%)33 (11%) 490 (15%)490 (15%) p < 0.001p < 0.001

Peer ProblemsPeer Problems


ProsocialProsocial

Possible ProblemsPossible Problems 482 (27%)482 (27%) 137(27%)137(27%) 113 (28%)113 (28%) 65 (24%)65 (24%) 69 (23%)69 (23%) 866 (26%)866 (26%) p = 0.130p = 0.130

Total DifficultiesTotal Difficulties


Explaining the patternsExplaining the patterns

Differing respondent thresholdsDiffering respondent thresholds Neighbourhood effectsNeighbourhood effects Variation in service provisionVariation in service provision ““Social drift”Social drift”

Ill healthIll health Genetic factorsGenetic factors

Poverty distracts attention away from Poverty distracts attention away from the child...the child...

What next for Glasgow?What next for Glasgow?• Routine 30 month check – with SDQ, language, Routine 30 month check – with SDQ, language,

parental mental wellbeing assessmentparental mental wellbeing assessment• School-based SDQs at 7 and 10 yearsSchool-based SDQs at 7 and 10 years• Linkage of health and education data:Linkage of health and education data:

• Will be able to plot trajectories from 2 to 10 yearsWill be able to plot trajectories from 2 to 10 years• Identify effects of area, nursery, school, family on these Identify effects of area, nursery, school, family on these

trajectoriestrajectories

• Start trials of interventions (eg for language Start trials of interventions (eg for language delay, early onset conduct problems) with long delay, early onset conduct problems) with long term follow upterm follow up

AcknowledgementsAcknowledgements Lucy ThompsonLucy Thompson Matt Forde, Cathy Holden, and the Matt Forde, Cathy Holden, and the

Glasgow West CHCP Health VisitorsGlasgow West CHCP Health Visitors John Butcher, Amanda Kerr, Michele John Butcher, Amanda Kerr, Michele

McClung, Morag Gunion and City of McClung, Morag Gunion and City of Glasgow Education ServicesGlasgow Education Services

Kim Jones & Kelly ChungKim Jones & Kelly Chung Paula BartonPaula Barton Christine Puckering and Helen MinnisChristine Puckering and Helen Minnis Claire Wilson and Alex McConnachieClaire Wilson and Alex McConnachie

Thank you.Thank [email protected]@glasgow.ac.uk

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Health inequalities and parenting