Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Revised slideshow afternoon session for e circulation june 13th


Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Revised slideshow afternoon session for e circulation june 13th

  1. 1. Primary Prevention – cheaper than cure,better outcomes for childrenAfternoon session June 13th 2012 Supported by
  2. 2. The Health perspective Dr Ann Hoskins, Interim Regional Director of Public Health/Director of Children, Young People & Maternity Supported by
  3. 3. C4EO/ WAVE Trust conference 13th June 2012Dr Ann Hoskins, Interim Regional Director of Public Health / Director Children, Young People and Maternity Services Healthier Horizons
  4. 4. Giving Every Child the Best Start in Life is Crucial to Reducing Health Inequalities Across the Life Course• Ensure high quality maternity services, parenting programmes, childcare and early years education to meet need across the social gradient• Ensuring that parents have access to support during pregnancy is particularly important• An integrated policy framework is needed for early child development to include policies relating to the prenatal period and infancy, leading to the planning and commissioning of maternity, infant and early years family support services as part of a wider multi-agency approach to commissioning children and family services
  5. 5. The Scientific Base1. A child’s early experience has a long lasting impact on the neurological architecture of their brain and their emotional and cognitive development2. Pregnancy and birth a key time for change – parents have an instinctive drive to protect their young and want their child to be healthy and happy and do well in life3. Evidence that effective preventive interventions in early life can produce significant cost savings and benefits in health, social care, educational achievement, economic productivity and responsible citizenship4. There is scientific consensus that origins of adult disease are often found in pregnancy and infancy 5
  6. 6. The Task of Commissioning for PreventionTo prevent early adversities becoming biologically embedded 723,165 new opportunities available each year in the UK
  7. 7. Factors That Can Hamper Positive Development During Pregnancy• Low birth weight in particular is associated with poorer long-term health and educational outcomes• Smoking can cause a range of serious health problems, including lower birth weight, pre-term birth placental complications and perinatal mortality. In addition smoking during pregnancy has been associated with poor child behaviour at age 5.• Drug use in pregnancy can increase the risk of low birth weight, premature delivery, perinatal mortality, cot death and impairment to the unborn child’s development.• Drinking alcohol during pregnancy is associated with increased risk of miscarriage, risk of Fetal Alcohol Syndrome whose features include: growth deficiency for height and weight, a distinct pattern of facial features and physical characteristics and central nervous system dysfunction.• Maternal depression during pregnancy may affect brain development in the foetus, reduce foetal growth and poses risks of premature labour. Antenatal depression has also been linked to altered immune functioning in the baby after birth. Antenatal anxiety at 32 weeks’ gestation has been linked to behavioural and emotional problems in the child at age 4
  8. 8. Commissioning for Prevention
  9. 9. The strength of association
  10. 10. Using maternal factors to consider likely outcomes at 5 years old •Data already collected in maternity units •Predictive for outcomes at population level •Informs commissioners decision making for early years resources/ services Predictive Maps available for, Behaviour, Learning and Development , Health outcomes
  11. 11. Find Out About the Early Years Needs in Your AreaChild Health Learning, Development and Behaviour researchandstatistics/datasets/ a00198391/dfe-early-years- foundation-stage-profile- results-in-england-201011 Navigate to Figures at Local Authority Level
  12. 12. Getting the Best Prevention from theResources you have for early years• Plan strategically at a population level; intervene proportionately at an individual level. E.g. Family Nurse Partnership• Health Visiting Service offers for families; universal children’s service• Promoting a ‘resilience developing’ asset based style to underpin all interactions
  13. 13. Where Should Support for Foundation Years Come From?• Co-ordinated by health visitors: lead a system for solutions, not services• Children’s Centres – PbR pilots• Building from & on citizens capacity• Third sector and charities
  14. 14. What do parents What is HV contribution? want? A community that supports children and families Needs Predicted Services that Assessed give our baby/child Expressed healthy start. Best advice on a being a parent To know our health visitor and how to Health Visitor contact themTo have the right A quick response if wepeople to help over a have a problem and tolonger term when be given expert advice Responsethings are really and support by the Providedifficult right person DelegateTo know those people Referand that they will worktogether July 2012with us. 25 and 15
  15. 15. Health Visiting Services – Offers for Families
  16. 16. FNP Short Term Impact on OutcomesPregnancy & Birth ↓smoking in pregnancy ↓ pregnancy related complications ↑ uptake of antenatal care ↑breastfeeding initiation ↑birth weights in very young teens ↑improved diet & nutrition in pregnancyInfancy ↓A&E visits –all reasons & for injuries and ingestions (indicator of abuse(0-2 years ) and neglect) ↓ hospital admissions for injuries and ingestions ↓language delay ↓punitive parenting ↓subsequent pregnancies and births ↓welfare use ↑ more sensitive care giving ↑ father involvement in parenting ↑better home learning environment ↑employment ↑emotional development
  17. 17. FNP Medium /Long Term Impact On OutcomesMedium term ↓ severe behaviour problems(2-9 years) ↓ future pregnancies & births (greater duration between births) ↓ welfare use ↓involvement with criminal justice system (mother) ↑ employment and participation in education (mother) ↑ sustained relationship with child’s father/partner (mother) ↑ language development ↑ school readiness ↑ school achievement scores (reading and maths) ↑ home learning environments ↑ stimulating parentingLonger term ↓ child abuse and neglect(Age 15+) ↓ Less criminal and anti-social behaviour (child)
  18. 18. Can it Be Justified in Current Economic Climate?• US economic modelling- $1 spend prevents $5 spend. Cost recovery by age 4.• UK – because of licensing, get same outcomes as US; economic analysis will be part of RCT scope• Babies born to teenage parents at higher likelihood of – £2,500/week to keep a child in residential care – £400/week to support a child in need at home – Up £300,000 /year for a child with additional support needs – £1000 /unscheduled ante-natal admission for investigation with overnight stay for under 18 – £15,000/year public service cumulative costs for a child with ’troubled behaviour’
  19. 19. The New Commissioning Landscape Department of Health NHS Public Health England NHS Monitor CQC Commissioning (economic (quality) Board regulator) HealthWatch(Local health Clinical Commissioningimprovement Providers Groups in LAs) Local authorities (via health & Local wellbeing boards) HealthWatch
  20. 20. The universal prevention and early intervention pathway from pre-pregnancy to 5 Pre-pregnancy information and services (e.g. stop smoking clinics) to improve women’s health Woman discovers she is pregnant and chooses which maternity service to book with via the GP or directly with the midwife Conception GP Team Midwife Online resources, books, leaflets and websites Promoting parents’ self-efficacy & helping them to care well for their child. Linking to other community resources and services including SSCCs. Facilitating community groups & community action
  21. 21. How Third Sectororganisations can help to “make it happen”Fiona Sheil, Public Service Delivery Officer, NCVO Supported by
  22. 22. How Third Sector organisationscan help to “make it happen” 13th June 2012 Fiona Sheil @fionapsdn Public Services Team National Council for Voluntary Organisations
  23. 23. What is the voluntary sector?
  24. 24. 58.2% work with children and youngpeopleIncluding-7,910 playgroups and nurseries-7,775 education-6,580 scout groups and youth clubs
  25. 25. Why does this matter to you?
  26. 26. Delivering Services
  27. 27. Government Expenditure on the VCS 2009/10
  28. 28. Workforce &Economic weight Social capital & assets
  29. 29. Participation, Democracy &representation
  30. 30. Information & commissioning Participation, Democracy &representation
  31. 31. Delivering Services Workforce & InformationEconomic weight & commissioning Participation, Social capital Democracy & & assets representation
  32. 32. Thank you!NCVO Public Services Delivery Network – – – 0207 520 2411 – @fionapsdn
  33. 33. Prevention and early intervention – aCroydon perspectiveJon Rouse, CEO, Croydon Council Supported by
  34. 34. Prevention and early intervention – aCroydon perspectiveJon RouseChief Executive
  35. 35. Croydon Borough of contrastsLow wageeconomy withincreasingunemploymentDiverse population Major transport hub40% minority ethnic Good education system Population growth – baby boom
  36. 36. A philosophy – integrated teams around thecitizen to manage complex requirements ● Adult Learning Disabilities ● Adult Mental Health ● Family Justice Centre ● Turnaround Centre ● Youth Homelessness ● Integrated Offender Management ● Family Resilience Team
  37. 37. Croydon’s Journey from Total Place toprevention and early intervention• Customer-led transformation• Evidence based approach• A whole system approach to early help• Continued focus on early ‘early intervention’• Working out the metrics
  38. 38. The Escalating costs of intervention Child looked after in secure accommodation – £134,000 Child looked after in per year placement costs children’s home – £125,000 per year placement costs Cost Multi-dimensional Treatment Foster Care – £68,000 per year Costs increase as for total package of support children get older. Increasing related Child looked after in foster costs such care – £25,000 per yearyi mf / di hc r ept s o C healthcare and the placement costs criminal justice system make it Family Intervention Projects – clear joined up £8-20,000 per family per year working is a core part of cost effectiveness l a l Multi-Systemic Therapy – £7-10,000 per year Parenting programme (e.g. Incredible Years – £900-1,000 per family Family Nurse Partnerships – £3000 per family a yearInformation services –Around £34 via telephone helplineAround £2 via digital services PEIP – £1,200 - 3,000 per parent Children’s Centres - around £600 per user Schools - £5,400 per pupil Severity of assessed need
  39. 39. What our Total Place pilot told us
  40. 40. After Total Place - progressChildren’s Centres - based on collaborations – engaged parents and communities in redesign- hub of their community- universal through to targeted support- early helpFamily Space - website in place and network of children’s centresFamily Advocates & Peer to peer support - ‘Family Navigators’ and commissioned services
  41. 41. After Total Place Geographically based Family Engagement Partnerships with early years practitioners equipped to spot early signs of needs, know how to engage parents quickly in high quality services including early identification and peer2peer supportStruggling with Preparation for Parenthood• children and parents experience system from conception onwards which supports & develops parenting capabilities• pre-natal care holistic preparation for parenthood; emotional needs of parents supported
  42. 42. Continuing to develop preventative andearly intervention service in Croydon• Use a whole system approach and build our evidence base• Use the ‘wedge’ to help us plan interventions• Reduce high cost families so that we can reinvest in preventative services• Continue to work with health colleagues• Develop our metrics across the whole programme of interventions
  43. 43. Mapping Change for Croydon EIFS: Driving better long-term outcomes for children and families Target service level outcomes (Identified atEYS objectives/drivers of change Broader immediate outcomes Long-term outcomes for children & families practitioner workshop) Greater family Sense of control and autonomy over decisions Increased likelihood of parent resilience and Improved social networks & sense of community keeping / finding a job autonomy Stable housing and reduced homelessness Improved emotional Increased likelihood of financial resilience security for the family Stronger home learning environments Reduction in number of children on Child Protection Register/ looked Higher learning achievement among parents after children Improved child Improved educational behaviour at home and achievement Improved learning outcomes among children Reduced likelihood of children school becoming NEET Secure attachment between parent and child Improved long-term and Reduced risk of child intergenerational health including Less abuse/ family violence protection issues reduced risk of mental ill-health Improved parent-child relationship Improved parenting skills Reduced likelihood of drug misuse among parents, children/young Optimise health of children and mothers adults Improvements in child Reduced anti-social and maternal health Having somewhere to play/ be active behaviour/ community Reduced contact of parents with violence criminal justice system Integration of family skills/experience into services Reduced likelihood of children More responsive and entering the criminal justice system Staff awareness of child well-being consistent services Early identification of needs Greater take-up of universal services Well coordinated, consistent services
  44. 44. Early Help & Staged Intervention Support at Stage 1 Support at Stage 2 CRISS; Family Space & Family Practitioner Engagement websites Support at Stage 3 Partnerships Family Peer2peer Resilience Family Navigator Service Parenting Programmes Troubled Family Find me Early Navigators UNIVERSAL LOW/VULNERABLE COMPLEX ACUTEChildren & Young People requiring Children & Young People with low Children, Young People & Children, Young People & personalised universal level additional needs requiring Families with high level needs. Families with complex services single agency support or an additional needs requiring integrated response using a These children/young people specialist/statutory integrated common assessment. include ‘Children in Need’ response; includes child (Section 17) who require protection (Section 47) and integrated, targeted support children whose needs / safety cannot be managed in the community
  45. 45. Croydon – working across the wedge, whole system approach Cost Severity of need R Pb lies mi d Fa ble rou e–T vic Ser ce lien esi bR ly R –P mi es Fa vic ser re ent ’s c ren ild Universal Services Ch s ilie fam all for lp He rly Ea
  46. 46. Reducing High Cost Spend through Croydon’sFamily Resilience Service Av. savings Net saving per year Caseload Caseload Net per family per No. per family savings costs saving yearPhase1 - 60 60 £48.5k £2.91m £840k £2.07m £34.5kWholePilot231 231 £48.5k £11.2m £3.23m £7.9m £34.5k
  47. 47. Capturing net value – a complicatedbusiness• Costs to society include the benefits foregone from not using the resources for some other use• Large differences in the methodologies adopted by studies (few UK studies) aiming to evaluate the economic impact of early years interventions• Difficult to compare results across interventions• BUT emerging UK studies do provide indications that early years interventions generate benefits in the long term that outweigh the costs
  48. 48. Where we need to go next?• Children and parents to experience system from conception onwards which supports and develops parenting capabilities• Pre-natal care holistic preparation for parenthood; emotional needs of parents strongly supported• Maternity services within hospitals transformed and characterised by holistic preparation for parenthood• Continue to build our early intervention approach - evidence based and builds the resilience and autonomy of parents to ensure young children thrive and develop
  49. 49. The journey continues….
  50. 50. Innovation from local areasChoice of Workshops to showcase response from call for evidence Supported by
  51. 51. Q&A’s to panel members Supported by
  52. 52. The benefits of primary prevention Andrea Leadsom, MP Supported by