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

fiona.sheil@ncvo-vol.org.uk 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– fiona.sheil@ncvo-vol.org.uk– 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