The contribution of Public
Health Nursing in improving
outcomes for children and
young people
Kate Thompson
Director of Children’s Services and Social Work
Marian Robertson
Assistant Director Child Health
Marian Robertson
Children’s Outcomes Board
Old Warren
Partnership
West Winds
Association
Downpatrick
Partnership
Kilcooley
Partnership
Colin
Partnership
Outcomes Board
Accountability
Trust Board
Steering
Children’s Director (Chair) and 4 ADs, 3 Voluntary
reps, 5 Community Networks
Looked After
Children
Delivery
Group
Mental
Wellbeing
Delivery
Group
Parenting /
Early Years
Delivery
Group
Disability
Group
Delivery
Locality Approach
• Building health and wellbeing capacity with
community groups at a local level (often within a
specific estate)
• Working from the ground-up to identify health and
wellbeing needs
• Supporting communities in taking ownership for their
own health and wellbeing
• Helping with a local health planning process owned
by the community
• Relationships and trust are vital
• Health Improvement Plans being developed
with groups representing deprived
communities within Lisburn and Ards
• Trying to determine performance indicators to
understand improvement
• Need to understand health in its broader
context while not being sidetracked
• It takes time to build up trust and rapport
Children’s: Children’s Outcomes Board
• Looked After Children
• Vulnerable Young People
• Children with Complex Needs
• Family Support
• Emotional Wellbeing
“In my beginning is my end”
T S Eliot, four Quartets
Pathways to crime often laid
down by age 3
Dunedin study from 1973, New Zealand:
• ‘At risk’ male group identified at 3 by nurses, 2.5 X more likely to
offend and offences much more serious
– (e.g. robbery, rape, homicide)
– 47% of group abused partners
•
Fewer females conduct disordered, but for those who were:
– 30% of ‘at risk’ group had teenage births (vs. 0%)
– 43% were in violent, abusive relationships
“Immature mothers, with no strong parenting skills
and violent partners have already borne
the next generation of ‘at risk’ children”
Understanding the infant brain
Californian ACE Study
•
Center for Disease Control and Prevention & Kaiser Permanente
•
One of largest investigations ever on links between childhood maltreatment
and later-life health and well-being
•
17,000 members at comprehensive physical examinations provided detailed
information on childhood abuse, neglect and family dysfunction
ACE Studies
Adverse Childhood Experiences (ACE) Study
•
•
•
•
•
•
•
•
Emotional abuse
Physical abuse
Sexual abuse
Physical neglect
Emotional neglect
Alcoholic in household
Drug user in household
Witnessed domestic violence
Californian ACE Study
Likelihood of Heart Disease with single ACEs:
1.3 x by Emotional Neglect
1.3 x by Substance Abuse
1.4 x by Physical Neglect
1.4 x by Domestic Violence
1.4 x by Sexual Abuse
1.5 x by Physical Abuse
1.7 x by Emotional Abuse
Californian ACE Study
Health risks which increase with ACEs
•
•
•
•
•
•
•
liver disease (x 2)
chronic obstructive pulmonary disease (COPD) (x 3)
adult smoking (x 3)
serious job problems (x 3)
absenteeism from work (x 4)
alcoholism and alcohol abuse (x 6)
suicide attempts (x 14)
Californian ACE Study
Health risks which increase with 4 ACEs
•
•
•
•
•
•
depression (x 3)
intercourse by 15 (x 4)
teenage pregnancy (x 2)
more than 50 sexual partners (x 3)
sexually transmitted diseases (STDs)
intravenous drug use (x 11)
ACE (Adverse Childhood Experiences)
•
CONSEQUENCES FOR SOCIETY
Higher levels of Violence
Higher Levels of Anti-social behaviour
Greater adult mental health problems
Increased school under-performance (lower IQs)
Economic under-performance
Poor personal relationships
Poor physical health, high health expenditure
Lower tax income and less wealth creation
Reduced societal happiness
•
…and higher expenditure on social welfare, criminal justice, prisons, police etc
Implication for optimum investment
Source: J Heckman & D Masterov (2005) Ch 6, New Wealth for Old Nations: Scotland’s Economic Prospects
Early Prevention works
•
MacLeod and Nelson studied 56 programmes designed to promote family
wellness and prevent child maltreatment
• Most interventions are successful
• The earlier the intervention the better
• Prevention (proactive) had greater effect at follow-up
• Reactive interventions tend to fade over time, relapse common
• However,
– Support needs to be targeted at specific families
most in need
– Public Health Nurses need to work in an
integrated way with a wide range of providers
– This leads to the ‘targeted support’ approach
Targeted Support Approach
•
Health Visitors, Midwifes and Social Workers all have an unparalleled
view as to which specific families have the greatest emotional need at
the earliest stages.
•
Excellent community and voluntary groups are working with at risk
families and individuals but can struggle to target the most in need in a
co-ordinated manner
•
Projects managed by the Children’s Outcomes Board as integrated
initiatives
New Parent Support Programme
• Designed for vulnerable mothers during the antenatal and post
natal phase
• Referrals from initial assessment by midwife
• Health Visitor visits the parent/s to be and undertakes an
informal education process
• Empowerment approach where engagement and esteem are
key
• Solihull approach provides the theoretical underpinnings
Conclusion
• The New Parent Programme has been
developed not only to improve
attachment between a vulnerable
mother and her baby but also to:
– Make the largest return possible in relation
to tackling health inequalities
– Deliver significant wider societal benefits
over the long term, which can be quantified