Conception to age 2 the age of opportunity
Key Conclusions and Recommendations
Pregnancy
• Maternal stress, smoking, diet, drug,
alcohol consumption in pregnancy can:
– Lower IQ, create ADHD, conduct disorder
– Severely impair child’s mental functioning
– Adversely impact child’s health through to middle age
and early death
Nutrition
• Adequate early nutrition crucial to a child’s
physical and intellectual development:
– Breastfeeding protective for both mother and baby
– Hygiene, home safety, immunisation also important
Adverse Childhood Experiences
• Abuse, neglect, domestic violence,
growing up in household with alcoholism,
drug abuse can lead to:
– high levels of heart, liver, lung disease
– depression, suicide, poor work prospects
– alcoholism, drug addiction
• Peak age for child abuse, neglect is 0-1
Mental Health Risks
• 144 thousand babies under 1 in UK live with
parent with mental health problem
• Significant cross-over between mental health
issues and alcohol/substance abuse
Primary Prevention
• Core message: ‘Primary Prevention’ –
prevent harm BEFORE it happens. It is
crucial to
– intervene early to promote infant mental health
– protect babies from abuse and neglect
– prevent damage from poor early parent relationship
Primary Prevention: Three Essentials
• Assess and identify where help is needed
• Provide adequate support when needed
• Ensure early years workforce have requisite
skills, training and supervision
Assess, identify where help needed
• Mental health risk assessment as early as
possible in pregnancy
– Edinburgh Post-Natal Depression Scale
– Hospital Anxiety and Depression Scale
– Other risk factors (domestic violence etc)
• Neonatal Behavioural Assessment Scale 3
weeks after birth
Assess, identify where help needed
• In addition to 6 week Health Visitor
assessment:
• 3-4 month assessment of parent-child
attunement
– Parent Infant Observation Scale
– KIPS
– The CARE-Index
• Attachment assessment at 12-15 months
– TAS-45
Provide adequate support
• Full implementation of Healthy Child
Programme
• Promote attunement, secure attachment:
– Video Interactive Guidance, VIPP
– Watch, Wait and Wonder
– Circle of Security
• Family Nurse Partnership
Provide adequate support
• Parent-Infant Psychotherapy
– support systems such as Oxpip, Norpip
• 8% of pregnant women warrant a referral to
specialist perinatal mental health services
– these focus on restoring maternal
mental/emotional health and parent-infant
relationship
Provide adequate support
• High quality health-led Children’s Centres
– Potential for health visitors to act as team leaders,
supervisors and/or mentors
• High quality outreach to engage most vulnerable
families
• Follow principles of highly successful multi-agency
work
– Integrated services model, Highland Region of Scotland
– Local integrated partnerships, Brighton and Hove,
Warwickshire, etc.
Early years workforce: requisite skills
• Health Visitors trained to evaluate mother-baby
interaction (e.g.VIG), motivational interviewing
• All practitioners have awareness of risk factors
that can jeopardise infant mental health
• Domestic violence - prioritise identification and
support by midwives, GPs, other professionals,
especially in pregnancy
Early years workforce: requisite skills
• Good understanding of pre-birth to 3 child
development, attunement and attachment
• Emotional intelligence, skills to form
empathic relationships with parents
• Good quality reflective supervision
… and finally
• Health and Wellbeing Boards prioritising
infant mental health, wellbeing in JSNA
• Provide clear guidance to practitioners on
importance of very good support from 0-2
• Financial returns on well-designed early
years’ interventions far exceed stock market
returns, other public policy investments