infant mental health: a national policy issue george hosking, wave trust infant mental health policy...

Infant Mental Health: A National Policy Issue Infant Mental Health:

A National Policy Issue

George Hosking, WAVE TrustGeorge Hosking, WAVE Trust

Infant Mental Health Policy & Practice ForumInfant Mental Health Policy & Practice Forum

Dublin, 7Dublin, 7thth October 2011 October 2011

When is the key period in a child’s life?When is the key period in a child’s life?

Pathways to crime often laid down Pathways to crime often laid down by age 3by age 3


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

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

At age 21, ‘at risk’ males, compared with others:At age 21, ‘at risk’ males, compared with others:– 2.5 times as many with 2+ criminal convictions2.5 times as many with 2+ criminal convictions– 55% of their offences violent (18% others)55% of their offences violent (18% others)– 47% abused their partners (9.5%)47% abused their partners (9.5%)



Dunedin study:Dunedin study:

‘‘At risk’ group offences much more seriousAt risk’ group offences much more serious– (e.g. robbery, rape, homicide)(e.g. robbery, rape, homicide)

Fewer females conduct disordered, but for those who were:Fewer females conduct disordered, but for those who were:– 30% of ‘at risk’ group had teenage births (vs. 0%)30% of ‘at risk’ group had teenage births (vs. 0%)

– 43% were in violent, abusive relationships43% were in violent, abusive relationships

Pathways to violence by age 3Pathways to violence by age 3Pathways to violence by age 3Pathways to violence by age 3

Professor Michael Meaney, McGill UniversityProfessor Michael Meaney, McGill University

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

twins with identical DNA could end up with very twins with identical DNA could end up with very different different effectiveeffective DNADNA

Disadvantage begins very early, Disadvantage begins very early, and persists throughout lifeand persists throughout life e.g. through messenger RNAe.g. through messenger RNA methylation, hypermethylation (caused by early abuse) methylation, hypermethylation (caused by early abuse)

and acetylationand acetylation

We need to start in the wombWe need to start in the womb

Professor Vivette Glover, Imperial CollegeProfessor Vivette Glover, Imperial College

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

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

Anxiety during pregnancy even more damaging than Anxiety during pregnancy even more damaging than depressiondepression

Pregnancy peak period for domestic violencePregnancy peak period for domestic violence


Professor Vivette Glover, Imperial CollegeProfessor Vivette Glover, Imperial College

Cortisol, created by stress, crosses placenta to childCortisol, created by stress, crosses placenta to child

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

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

Prenatal Prenatal plusplus postnatal anxiety produces worst outcomes postnatal anxiety produces worst outcomes


Understanding the infant brainUnderstanding the infant brainUnderstanding the infant brainUnderstanding the infant brain

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

EmotionalEmotional brain largely created by experience in first 18 brain largely created by experience in first 18 months; acutely vulnerable to traumamonths; acutely vulnerable to trauma

Brains of abused children significantly smaller, less developedBrains of abused children significantly smaller, less developed


Critical WindowsCritical Windows

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

Size of window different for different skillsSize of window different for different skills

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


Critical WindowsCritical Windows

Synapse formation in visual cortexSynapse formation in visual cortex– peaks at 3 months, finished by age 2peaks at 3 months, finished by age 2

Auditory map formed by 12 months Auditory map formed by 12 months – after this Japanese infant struggles to distinguish “L” and “R”after this Japanese infant struggles to distinguish “L” and “R”

Deaf children need language exposure before age 5Deaf children need language exposure before age 5

EmotionalEmotional brain largely created in the first 18 monthsbrain largely created in the first 18 months


Infant brain acutely vulnerable to traumaInfant brain acutely vulnerable to trauma

If early experience fear: stress hormones wash over brainIf early experience fear: stress hormones wash over brain

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

If characterized by threat, chaos, unpredictability, fear, traumaIf characterized by threat, chaos, unpredictability, fear, trauma– development of neural systems for stress and fear responses altereddevelopment of neural systems for stress and fear responses altered


Brains of abused children significantly smallerBrains of abused children significantly smaller

– many areas dark on CAT scans (“black hole”)many areas dark on CAT scans (“black hole”)

– limbic system (emotions) 20-30% smaller, fewer synapseslimbic system (emotions) 20-30% smaller, fewer synapses

– hippocampus (memory) smallerhippocampus (memory) smaller


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

““The child’s first relationship, the one with the mother,The child’s first relationship, the one with the mother,

acts as a template … permanently moulds the individual’s capacityacts as a template … permanently moulds the individual’s capacity

to enter into all later emotional relationships”to enter into all later emotional relationships”

Keys: Keys: Attunement Attunement and Empathyand Empathy Keys: Keys: Attunement Attunement and Empathyand Empathy

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

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

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

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

Keys: Keys: AttunementAttunement and Empathyand EmpathyKeys: Keys: AttunementAttunement and Empathyand Empathy

Lack of attunement means empathy does not developLack of attunement means empathy does not develop

Low maternal responsiveness at 10-12 months predicted:Low maternal responsiveness at 10-12 months predicted:

– at 1.5 years: aggression, non-compliance, temper tantrumsat 1.5 years: aggression, non-compliance, temper tantrums

– at 2 years : lower compliance, attention getting, hittingat 2 years : lower compliance, attention getting, hitting

– at 3 years : problems with other childrenat 3 years : problems with other children

– at 3.5 years: higher coercive behaviourat 3.5 years: higher coercive behaviour

– at 6 years : fighting, stealingat 6 years : fighting, stealing

Keys: Keys: Attunement andAttunement and EmpathyEmpathyKeys: Keys: Attunement andAttunement and EmpathyEmpathy

Empathy the single greatest inhibitor of propensity to violenceEmpathy the single greatest inhibitor of propensity to violence

Established early by observation of parental reaction to sufferingEstablished early by observation of parental reaction to suffering

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

Abused toddlers react negatively or aggressively to signs of distressAbused toddlers react negatively or aggressively to signs of distress

Absence of empathy characteristic of violent criminalsAbsence of empathy characteristic of violent criminals

– – worst psychopaths no emotion at allworst psychopaths no emotion at all

Skill deficiencies of concern to employersSkill deficiencies of concern to employersResearch 2002-2006: survey of 19,000 employersResearch 2002-2006: survey of 19,000 employers

Lifelong skills created very earlyLifelong skills created very early

Research of James HeckmanResearch of James Heckman

Skills needed for success in life multiple in natureSkills needed for success in life multiple in nature

Soft skills very important Soft skills very important – conscientiousnessconscientiousness - perseverance- perseverance– self-esteemself-esteem - motivation- motivation– ability to pay attentionability to pay attention - self-regulation- self-regulation– self-esteemself-esteem - ability to defer gratification- ability to defer gratification– sociability (the ability to work with and cooperate with others)sociability (the ability to work with and cooperate with others)

These crucial skills mostly created in early yearsThese crucial skills mostly created in early years

Research of James HeckmanResearch of James Heckman

Families play essential role in shaping skills of their children Families play essential role in shaping skills of their children

Early years before school lay foundations for all that followsEarly years before school lay foundations for all that follows

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


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

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

Parental investment positive effect on skill levels for all agesParental investment positive effect on skill levels for all ages

Pathway: Pathway: parental care from pregnancy onwardsparental care from pregnancy onwards through through

child health at age 1 through child health at age 1 through cognitive abilities at age 5cognitive 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 Differences in cognitive and non-cognitive capabilities consistently associated with socio-emotional home resources’consistently associated with socio-emotional home resources’

Adverse consequences of initial risks cumulate and persist until Adverse consequences of initial risks cumulate and persist until adolescenceadolescence

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


ACE StudiesACE StudiesACE StudiesACE Studies

Adverse Childhood Experiences (ACE) Study Adverse Childhood Experiences (ACE) Study

Emotional abuseEmotional abuse Physical abusePhysical abuse Sexual abuseSexual abuse Physical neglectPhysical neglect Emotional neglectEmotional neglect Alcoholic in householdAlcoholic in household Drug user in householdDrug user in household Witnessed domestic violenceWitnessed domestic violence

Californian ACE StudyCalifornian ACE StudyCalifornian ACE StudyCalifornian ACE Study

Center for Disease Control and Prevention & Kaiser PermanenteCenter for Disease Control and Prevention & Kaiser Permanente

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

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


Likelihood of Heart Disease with single ACEs:Likelihood of Heart Disease with single ACEs:

1.3 x by Emotional Neglect1.3 x by Emotional Neglect

1.3 x by Substance Abuse1.3 x by Substance Abuse

1.4 x by Physical Neglect1.4 x by Physical Neglect

1.4 x by Domestic Violence1.4 x by Domestic Violence

1.4 x by Sexual Abuse1.4 x by Sexual Abuse

1.5 x by Physical Abuse1.5 x by Physical Abuse

1.7 x by Emotional Abuse1.7 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)liver disease (x 2) lung disease (x 3)lung disease (x 3) adult smoking, depression, serious job problems (x 3)adult smoking, depression, serious job problems (x 3) intercourse by 15, absenteeism from work (x 4)intercourse by 15, absenteeism from work (x 4) alcoholism and alcohol abuse (x 6)alcoholism and alcohol abuse (x 6) intravenous drug use (x 11)intravenous drug use (x 11) suicide attempts (x 14)suicide attempts (x 14)

Early prevention makes economic senseEarly prevention makes economic sense

Source: J Heckman & D Masterov (2005) Ch 6, Source: J Heckman & D Masterov (2005) Ch 6, New Wealth for Old Nations: Scotland’s Economic ProspectsNew Wealth for Old Nations: Scotland’s Economic Prospects

Implication for optimum investmentImplication for optimum investment

Source: J Heckman & D Masterov (2005) Ch 6, Source: J Heckman & D Masterov (2005) Ch 6, New Wealth for Old Nations: Scotland’s Economic ProspectsNew Wealth for Old Nations: Scotland’s Economic Prospects

Pattern of public spending on education in England & Wales Pattern of public spending on education in England & Wales over the life cycle, 2002/2003over the life cycle, 2002/2003

0

1000

2000

3000

4000

5000

6000

Under 5s Primary Secondary FE HE

£s per student

Source: Speech by Charles Clarke, Labour Party Conference, Bournemouth, 30 September 2003Source: Speech by Charles Clarke, Labour Party Conference, Bournemouth, 30 September 2003

Is early prevention spending wisely?Is early prevention spending wisely?

Expert opinion USA:Expert opinion USA:

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

Expert opinion UK:Expert opinion UK:

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

Cutting waste – spending wisely Cutting waste – spending wisely Cutting waste – spending wisely Cutting waste – spending wisely

Where is the waste created by the wrong type of early years?Where is the waste created by the wrong type of early years?

£150 billion p.a. Welfare benefits£150 billion p.a. Welfare benefits £78 billion p.a. Costs of crime£78 billion p.a. Costs of crime £77 billion p.a. Mental health problems£77 billion p.a. Mental health problems £55 billion p.a. Alcohol abuse£55 billion p.a. Alcohol abuse £20 billion p.a. Violence£20 billion p.a. Violence £20 billion p.a. Family breakdown£20 billion p.a. Family breakdown £15 billion p.a. Drug abuse£15 billion p.a. Drug abuse £6 billion p.a. Domestic violence (plus human cost £10 bn?)£6 billion p.a. Domestic violence (plus human cost £10 bn?) £8 billion p.a. NEETS, Prison Service, Young Offenders Institutes, £8 billion p.a. NEETS, Prison Service, Young Offenders Institutes,

Pupil Referral Units, Special EducationPupil Referral Units, Special Education

Cutting waste – spending wisely Cutting waste – spending wisely Cutting waste – spending wisely Cutting waste – spending wisely

What would it cost to transform the situation totally?What would it cost to transform the situation totally? WAVE’s 70/30 strategy: (economic model work-in-progress): WAVE’s 70/30 strategy: (economic model work-in-progress):

£100 billion over 16 years£100 billion over 16 years Action for Children/NEF:Action for Children/NEF:

£620 billion over 20 years£620 billion over 20 years

What cost if we don’t switch to prevention?What cost if we don’t switch to prevention? Assuming 12% of the waste figures, more than £1 trillionAssuming 12% of the waste figures, more than £1 trillion Action for Children estimate £4 trillionAction for Children estimate £4 trillion

National and local strategies of prevention National and local strategies of prevention rather than reactionrather than reaction

Transformation of attitudes to, and preparation for, parentingTransformation of attitudes to, and preparation for, parenting

Acceptance of children’s rightsAcceptance of children’s rights

Understanding and adopting interventions that workUnderstanding and adopting interventions that work

What would it take to succeed?What would it take to succeed?

National strategiesNational strategies SwedenSweden ScotlandScotland

Local strategiesLocal strategies CroydonCroydon Derry, Fermanagh and TyroneDerry, Fermanagh and Tyrone Young BallymunYoung Ballymun

Strategies of preventionStrategies of prevention

A National Strategy of PreventionA National Strategy of Prevention

Approach to Infancy and Early Childhood in SwedenApproach to Infancy and Early Childhood in Sweden

99% of pregnant women access maternity healthcare services99% of pregnant women access maternity healthcare services– typically 11 individual contacts, mostly with midwivestypically 11 individual contacts, mostly with midwives

98% of maternity healthcare clinics offer group parenting 98% of maternity healthcare clinics offer group parenting education to first-time parentseducation to first-time parents

Additional specialist support for young mothers, single Additional specialist support for young mothers, single mothers, those expecting twinsmothers, those expecting twins


100% of hospitals have BFHI (baby-friendly) status (UK <10%)100% of hospitals have BFHI (baby-friendly) status (UK <10%)

Long periods of maternity and parental leave support attention to Long periods of maternity and parental leave support attention to needs of the child in its earlier monthsneeds of the child in its earlier months

Breast-feedingBreast-feeding 98% of Swedish mothers begin breast-feeding (79% UK)98% of Swedish mothers begin breast-feeding (79% UK) 72% breastfeeding at 6 months (22% UK)72% breastfeeding at 6 months (22% UK) 15% exclusive breastfeeding at 6 months (<1% UK)15% exclusive breastfeeding at 6 months (<1% UK)



99% of all families make use of child healthcare services 99% of all families make use of child healthcare services – an average of 20 individual contacts, primarily with nursesan average of 20 individual contacts, primarily with nurses

Parents invited to join parent groups when child 1-2 monthsParents invited to join parent groups when child 1-2 months– in Stockholm County 61% of first-time parents in at least five sessions in Stockholm County 61% of first-time parents in at least five sessions

(Bremberg 2006)(Bremberg 2006)

Parent education around 8-10% of midwives’ working timeParent education around 8-10% of midwives’ working time

65% of midwives received regular professional training on the 65% of midwives received regular professional training on the subject, and 72% instructed by a psychologistsubject, and 72% instructed by a psychologist


SWEDENSWEDEN UKUK

% Live Births to teen mothers% Live Births to teen mothers 1.61.6 7.17.1

Infant MortalityInfant Mortality (per 1,000 live)(per 1,000 live) 2.52.5 5.15.1

Smoking Smoking (% per day aged 15+)(% per day aged 15+) 1616 2525

Alcohol Alcohol (litres per person p.a.)(litres per person p.a.) 77 1111

Adult ObesityAdult Obesity (% of population)(% of population) 1111 2323

Smoking Related DeathsSmoking Related Deaths (per 100,000 popn)(per 100,000 popn) 196196 245245

Chronic Liver Disease Deaths,Chronic Liver Disease Deaths, < 65 yrs (per < 65 yrs (per 100,000)100,000)

44 99

Cancer Deaths,Cancer Deaths, < 65 yrs (per 100,000)< 65 yrs (per 100,000) 5656 6767

Circulatory Disease Deaths,Circulatory Disease Deaths, Under 65Under 65 3232 4343


Scottish Parliament Finance CommitteeScottish Parliament Finance Committee

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

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



Scottish Parliament Finance CommitteeScottish Parliament Finance Committee

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

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

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

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

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

Geographically based Family Partnership Teams leadingGeographically based Family Partnership Teams leading Preparation for parenthoodPreparation for parenthood Early identificationEarly identification Family advocatesFamily advocates Early years academy to train staffEarly years academy to train staff Peer2peer supportPeer2peer support

Local Strategy of Prevention: CroydonLocal Strategy of Prevention: CroydonLocal Strategy of Prevention: CroydonLocal Strategy of Prevention: Croydon

Preparation for parenthoodPreparation for parenthood

Maternity services within hospitals transformedMaternity services within hospitals transformed – characterised by holistic preparation for parenthoodcharacterised by holistic preparation for parenthood– wider needs and vulnerability identifiedwider needs and vulnerability identified

Parents directed to social networks for supportParents directed to social networks for support– networks supported and developednetworks supported and developed

Early warning signs such as missed appointments followed upEarly warning signs such as missed appointments followed up

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


Early identificationEarly identification

System with capacity to spot and respond to need early and System with capacity to spot and respond to need early and quicklyquickly

– appropriate services available for referralappropriate services available for referral– identification and response long before CAF necessaryidentification and response long before CAF necessary– assessment tools available for staffassessment tools available for staff

Rapid identification of needs: Rapid identification of needs: – attachment, motor skills, emotional or behavioural issues attachment, motor skills, emotional or behavioural issues – speech and language, maternal mental ill-health and domestic conflictspeech and language, maternal mental ill-health and domestic conflict

Gap in provision before child starts school addressedGap in provision before child starts school addressed


Projected costs and savingsProjected costs and savings (preliminary) (preliminary)

Upfront investment Upfront investment £2.5 million over 2 years£2.5 million over 2 years

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

Areas of saving Areas of saving – Looked after childrenLooked after children Teenage pregnancyTeenage pregnancy– NEETNEET OffendingOffending– Anti-social behaviour Anti-social behaviour Pupil Referral UnitsPupil Referral Units– Child and adolescent mental healthChild and adolescent mental health– Emotional and Behavioural Difficulties unitsEmotional 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 WHSCT is committed to supporting families to provide the secure attachments children need to make the best possible start in lifeattachments children need to make the best possible start in life

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

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

Infant Mental Health Strategy: Derry, Infant Mental Health Strategy: Derry, Fermanagh and TyroneFermanagh and Tyrone


Guiding Principles:Guiding Principles:

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

Collective Responsibility: Collective Responsibility: 1) Women and Children’s Services plays a primary role in delivering strategy 1) Women and Children’s Services plays a primary role in delivering strategy 2) Ante-natal and perinatal services a core universal service access point2) Ante-natal and perinatal services a core universal service access point3) Every Directorate within WHSCT to actively support delivery of the strategy3) Every Directorate within WHSCT to actively support delivery of the strategy

Quality Service Standards:Quality Service Standards: All service delivery based on timely access to services based on need, transparent All service delivery based on timely access to services based on need, transparent outcomes, and informed by service user involvement at all levelsoutcomes, and informed by service user involvement at all levelsEvidence-based best practice and innovation at the core of all services and Evidence-based best practice and innovation at the core of all services and initiatives with a view to embedding this in future mainstream provisioninitiatives with a view to embedding this in future mainstream provision



Key Beneficiaries:Key Beneficiaries: Strategy aims to support every child living within WHSCT areaStrategy aims to support every child living within WHSCT area

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

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



Specific Initiatives:Specific Initiatives:

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

A universal perinatal mental health pathwayA universal perinatal mental health pathway– An example in action is the Early Intervention Service for Alcohol, delivering midwife-led An example in action is the Early Intervention Service for Alcohol, delivering midwife-led

client supports in co-operation with Early Intervention Workersclient supports in co-operation with Early Intervention Workers

Leading on Roots of Empathy and Nurse Family PartnershipLeading on Roots of Empathy and Nurse Family Partnership

NI Regional Healthy Futures strategy principlesNI Regional Healthy Futures strategy principles– endorsed by all Health Visitors in WHSCT represent a crucial investment in the support of endorsed by all Health Visitors in WHSCT represent a crucial investment in the support of

children and their families during the formative early yearschildren and their families during the formative early years



Service aims:Service aims:

Improve positive pregnancy and birth experiencesImprove positive pregnancy and birth experiences

Strengthen adaptive protective systems in infancy and toddlerhoodStrengthen adaptive protective systems in infancy and toddlerhood

Increase confidence and competence of parentsIncrease confidence and competence of parents

Promote healthy infant and child development Promote healthy infant and child development

Reduce childrearing problemsReduce childrearing problems

Young Ballymun: Ready, Steady, GrowYoung Ballymun: Ready, Steady, GrowYoung Ballymun: Ready, Steady, GrowYoung Ballymun: Ready, Steady, Grow

The service has three strands:The service has three strands:

– Amplify range and increase uptake of ante natal support in Amplify range and increase uptake of ante natal support in collaboration with HSE primary care team, maternity services, collaboration with HSE primary care team, maternity services, local community partnerslocal community partners

– Deliver enhanced baby development clinic in partnership with Deliver enhanced baby development clinic in partnership with HSE Public Health Nurse team with increased emphasis on HSE Public Health Nurse team with increased emphasis on infant social and emotional development.infant social and emotional development. provide direct support to families and onward referral as appropriateprovide direct support to families and onward referral as appropriate

– Build capacity of statutory/community services to understand Build capacity of statutory/community services to understand and respond to infant mental health need.and respond to infant mental health need. through training in competencies and endorsementthrough training in competencies and endorsement


Strand I - Strand I - Preparing for ParenthoodPreparing for Parenthood

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

Supports adaptation to pregnancy & relationship with unborn childSupports adaptation to pregnancy & relationship with unborn child

Better meets ante natal needs of women and their familiesBetter meets ante natal needs of women and their families

Increases capacity of ante natal careIncreases capacity of ante natal care


Strand II - Strand II - Parent-child Psychological Support ProgrammeParent-child Psychological Support Programme

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

Provides parents with information on child developmentProvides parents with information on child development

Checks baby’s progress and changing needsChecks baby’s progress and changing needs

Empowers parents to solve conflict Empowers parents to solve conflict


Strand III - Strand III - Infant Mental Health PromotionInfant Mental Health Promotion

Focuses on promoting social & emotional development in childrenFocuses on promoting social & emotional development in children

Builds capacity of services to respond to infant social and Builds capacity of services to respond to infant social and emotional needemotional need– capacity building for staff, families, programmes, systemscapacity building for staff, families, programmes, systems

– identifies, treats and reduces mental health problems, birth – 3 yearsidentifies, treats and reduces mental health problems, birth – 3 years

– direct observation of children and care-giving environmentdirect observation of children and care-giving environment

– design of interventions to change behaviourdesign of interventions to change behaviour


Parenting programmesParenting programmes

Nurse Family PartnershipNurse Family Partnership

Roots of EmpathyRoots of Empathy

First Steps in ParentingFirst Steps in Parenting

Leksand Model, SwedenLeksand Model, Sweden

SKIP (Strategies for Kids, Information for Parents)SKIP (Strategies for Kids, Information for Parents)

Early intervention programmesEarly intervention programmes

Fostering attunement, breast-feeding, secure attachmentFostering attunement, breast-feeding, secure attachment

AttunementAttunement Video-feedback Intervention to Promote Positive ParentingVideo-feedback Intervention to Promote Positive Parenting Video Interactive GuidanceVideo Interactive Guidance

Breast-feedingBreast-feeding Effect of early postnatal breast-feeding support, DenmarkEffect of early postnatal breast-feeding support, Denmark Breastfeeding Initiative, BlackpoolBreastfeeding Initiative, Blackpool

Secure AttachmentSecure Attachment Circle of SecurityCircle of Security


RemedialRemedial

Parent Child Interaction Therapy (PCIT)Parent Child Interaction Therapy (PCIT)

Family CheckupFamily Checkup

Dorset Healthy Alliance ProjectDorset Healthy Alliance Project

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Further information on WAVE website: www.wavetrust.orgFurther information on WAVE website: www.wavetrust.org


infant mental health: a national policy issue george hosking, wave trust infant mental health policy...

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