Child health

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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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Infant Mortality Rates Scotland, 1974-2006 Rate
per 1,000 Live Births (Source GROS )
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Number of Deaths in Children under 1 Year by
Scottish Index of Multiple Deprivation
Scotland, 2006 (Source GROS ISD Scotland)
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Reducing Risks and Enhancing Protection

• Critical periods for child health pregnancy,
  pre-school (0-3)
• Modifiable risk factors
• Smoking in pregnancy, nutrition, obesity
• Postnatal depression
• Substance misuse
• Modifiable protective factors
• Parenting skills, parental self-efficacy
• Stimulation emotional, cognitive, language
• Health related e.g. nutrition, immunisation

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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

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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

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Lead to risk of

• Major behavioural and emotional problems
• Substance misuse
• Antisocial behaviour
• Juvenile crime

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In contrast

• Supportive family relationships
• Predict positive adjustment and
• Protect against conduct problems

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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

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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

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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

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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

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Universal interventions for under-3s

• Public awareness campaigns using the media more
  effectively
• Web resources
• Baby clubs
• Netmums
• Bookstart
• Open access large group classes

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Interventions

• The Solihull approach
• Use of evidence based parenting programmes -
  Triple P, Mellow Parenting
• Coordination of parenting activity at CHP level

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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.