Child health – reducing the risk factors and promoting the

protective factors

Linda de Caestecker

Director of Public Health

NHS Greater Glasgow and Clyde

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1974 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 2006

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Infant Mortality Rates Scotland, 1974-2006Rate per 1,000 Live Births

(Source: GROS )

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SIMD Quintile 1 (LeastDeprived)

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Number of Deaths in Children under 1 Year by Scottish Index of Multiple Deprivation

Scotland, 2006(Source: GROS & ISD Scotland)

Reducing Risks and Enhancing Protection

Critical periods for child health – pregnancy, pre-school (0-3)Modifiable risk factors

Smoking in pregnancy, nutrition, obesityPostnatal depressionSubstance misuse

Modifiable protective factorsParenting skills, parental self-efficacyStimulation – emotional, cognitive, languageHealth related e.g. nutrition, immunisation

Smoking

• Smoking in pregnancy – variations in recording and sensitive enquiry. Routine CO monitoring being implemented.

• Protecting children from second-hand smoke

• Legislation has not led to more smoking at home• Smokefree homes initiative• Training of professionals

Family risk factors

• Poor parenting, • family conflict, • lack of a warm positive relationship with

parents, • insecure attachments, • harsh inflexible rigid or inconsistent discipline

practices, • inadequate supervision or involvement with

children

Lead to risk of……

• Major behavioural and emotional problems

• Substance misuse

• Antisocial behaviour

• Juvenile crime

In contrast…

Supportive family relationships…

• Predict positive adjustment and

• Protect against conduct problems

The need for parent education

• Parenting interventions are amongst the most powerful and cost-effective tools available to prevent and treat serious behavioural and emotional problems in children.

• The majority of parents do not participate in parent education.

• Parenting Survey (2007) showed over 40% had not had any support with parenting and 77% would consider parenting support if available

Triple P, positive parenting programme

• Multi-level, prevention orientated parenting and family support strategy

• Studies conducted on each intervention level and delivery format with consistent results

• Effect sizes large for improved child behaviour

• Independent replication trials in other countries

A population based approach to large-scale implementation of positive

parenting programme

• Establish base rates for Child Problems and Modifiable Parental Risk and Protective Factors;

• Interventions have evidence of effectiveness, are culturally appropriate and widely available;

• Practitioner training and support;• A multi-disciplinary workforce• Consistent implementation and programme

fidelity

Population based approach

• An Effective Engagement strategy• Informed by a theory of inequality • Enable parents to identify their own

parenting objectives so that they are dynamic participants and go at their pace

• Variants that are tailored to the requirements of high-need groups

• Use Community Surveillance Monitoring to track Population-Level Outcomes

Universal interventions for under-3s

• Public awareness campaigns using the media more effectively

• Web resources:– Baby clubs– Netmums

• Bookstart

• Open access large group classes

Interventions

• The Solihull approach

• Use of evidence based parenting programmes - Triple P, Mellow Parenting

• Coordination of parenting activity at CHP level

Take home messages

• Addressing the risk and protective factors for good health must be a multi-agency response

• We need a population level approach to parenting support.