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Primary Prevention – cheaper than cure,better outcomes for      children     June 13th 2012                      Supported...
Welcome from the ChairChristine Davies, CEO, Centre for  Excellence and Outcomes,              C4EO                       ...
Keynote speaker: EarlyIntervention agenda &    context settingSarah Teather, Children’s Minister,    Department for Educat...
Why BIG Lottery hasgiven it’s support to    this agenda      Dharmendra Kanani Director, England, BIG Lottery             ...
A local governmentperspective on child abuse and neglectDavid Simmonds, Chairman LGAChildren and Young People Board       ...
Better fences - fewer      ambulances           Robin MillarProgrammes Director, Centre for Social              Justice   ...
The importance of alocal area prevention       strategy     George Hosking    CEO, WAVE Trust                      Support...
The importance of a local area prevention               strategy         George Hosking, WAVE Trust             Primary Pr...
The Barnet Graph of DoomWithout dramatic change, within 20 years the Council will beunable to provide any services except ...
The Barnet Graph of Doom
Current reality of budget cuts – 1Matt Dunkley, Director of Children’s Services, East Sussex 2011-12 budget: £20m cuts to ...
Current reality of budget cuts - 2Matt Dunkley (continued)  East Sussex has put 600 more children (most under five years o...
Fundamental choiceContinue on current path    or create aParadigm shift: Invest in primary prevention
Continue on current path?Out of 12 million children under 16 in UK:       Severely maltreated 1 to 1.6 million       Physi...
Costs of continuing on current pathAnnual waste from adverse early years estimated at over £200 billion, nationallyInclude...
The future: doom or hope? What if, instead of doom and gloom, we could find a more up todate way to set policy, using the ...
Implication for optimum investmentSource: Heckman, James J. (2008). "Schools, Skills and Synapses," Economic Inquiry, 46(3...
Pattern of public spending on education in England       & Wales over the life cycle, 2002/2003
A new paradigmNational and local strategies of primary prevention, rather thanreactionTransformation of the quality of par...
Lifelong skills created very earlyResearch of Nobel Prize Winner, James Heckman An open and persevering child learns more ...
Lifelong skills created very earlyResearch of Nobel Prize Winner, James Heckman Achievement gaps between children primaril...
Causes and consequences:   Californian ACE StudyMajor investigation on links between childhood maltreatmentand later-life ...
Californian ACE StudyHealth risks which increase with 4 ACEs (17% of popn):  liver disease (x 2)  lung disease (x 3)  adul...
Pathways to violence by age 3
Pathways to crime often set by age 3Dunedin study of all                           Violent offenceschildren born in 1972, ...
Key: understand infant brainWorks via neurons (brain cells) & synapses (connections)At birth: 10 trillion synapses - 200 t...
Understand the infant brain
Understand the infant brain    Alan Schore - 10-year immersion in thousands of scientific    papers in neurobiology, psych...
Key factors: Attunement and EmpathyAttunement between mother and infant develops empathy.Lack of attunement means empathy ...
Primary Prevention does work
Successful Primary Prevention
Successful Primary Prevention
Need for Primary Prevention                    ?
Early years prevention saves money - 1 Expert opinion USA:   Dr Bruce Perry   James Heckman (Nobel Prize winning economist...
Early years prevention saves money - 2 RAND Research Institute / Karoly, Kilburn, and Cannon   Cost benefit analyses or me...
Early years prevention saves money - 3Federal Reserve Bank of Minneapolis/Rolnick & Grunewald  Internal rates of return fo...
WAVE’s Core Recommendation   Implement a committed primary prevention strategy   for children from conception to age 3US S...
Strategies of preventionNational strategies      Infancy and Early Childhood in Sweden      Every Opportunity for Every Ch...
A National Strategy of PreventionApproach to Infancy and Early Childhood in Sweden 99% of pregnant women access maternity ...
A National Strategy of PreventionApproach to Infancy and Early Childhood in Sweden 100% of hospitals have BFHI (baby-frien...
A National Strategy of Prevention                                               SWEDEN    UK % Live Births to teen mothers...
Infant Mental Health Strategy:     Derry, Fermanagh and TyroneVision for the Infant Mental Health Strategy:  WHSCT committ...
Infant Mental Health Strategy:     Derry, Fermanagh and TyroneWhole Child Approach: a holistic systems-based model of Earl...
Infant Mental Health Strategy:     Derry, Fermanagh and TyroneSpecific Initiatives:  Hidden Harm Action Plan for Northern ...
Ballymun, Dublin: Ready, Steady, Grow Service aims:   Improve positive pregnancy and birth experiences   Strengthen adapti...
Ballymun, Dublin: Ready, Steady, Grow Initiatives:    – Amplify range & increase uptake of ante natal support in      coll...
Ballymun, Dublin: Ready, Steady, Grow Strand I - Preparing for Parenthood   Focus on pregnancy and Infant Mental Health in...
Ballymun, Dublin: Ready, Steady, Grow Strand II - Parent-child Psychological Support Programme   Promote strong parent-chi...
Ballymun, Dublin: Ready, Steady, Grow Strand III - Infant Mental Health Promotion   Focus on promoting social & emotional ...
Early intervention programmes - 1Excellent Parenting programmes  Nurse Family Partnership  Roots of Empathy  First Steps i...
Early intervention programmes - 2 Fostering attunement, breast-feeding, secure attachmentAttunement   Video Interactive Gu...
..
Report on recent study ofpolicies from conception         to age 2            Sally Burlington Deputy Director, Sure Start...
Special Interest Group:   Pregnancy to 2     Sally Burlington Department for Education       13 June 2012                 ...
Conception to 2 is the most crucial       phase of development    The first 2 years of life are critical to a child’s deve...
Poor support at this stage can have life-        long impact on outcomes• Poor attachment in infancy is associated with  b...
Key factors• Health in pregnancy (including maternal stress)• Maternal health and mental health post-birth• Quality of rel...
Early childhood programmes have been shown   to have substantial net benefits and social                       gains• … an...
But care is needed in interpreting                this….• American evidence does not necessarily translate  directly to th...
Nevertheless, some key conclusions:• Full implementation of the Healthy Child Programme  (supported by 4200 new health vis...
Wider policy developments• 4,200 new health visitors• Doubling of Family Nurse Partnerships• Prof Cathy Nutbrown review of...
Some lessons from evidence can be used     to influence ongoing practice• “Spread the word” to all practitioners: understa...
Other Implications• How to target? Stigma vs “deadweight”• Therefore make best use of universal provision, and stop  peopl...
Resources•   Pregnancy Book    http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc...
Lunchwith Social Investment Business      models showcased                           Supported by
Revised slideshow morning session for e circulation june 13th
Revised slideshow morning session for e circulation june 13th
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Revised slideshow morning session for e circulation june 13th

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Revised slideshow morning session for e circulation june 13th

  1. 1. Primary Prevention – cheaper than cure,better outcomes for children June 13th 2012 Supported by
  2. 2. Welcome from the ChairChristine Davies, CEO, Centre for Excellence and Outcomes, C4EO Supported by
  3. 3. Keynote speaker: EarlyIntervention agenda & context settingSarah Teather, Children’s Minister, Department for Education Supported by
  4. 4. Why BIG Lottery hasgiven it’s support to this agenda Dharmendra Kanani Director, England, BIG Lottery Supported by
  5. 5. A local governmentperspective on child abuse and neglectDavid Simmonds, Chairman LGAChildren and Young People Board Supported by
  6. 6. Better fences - fewer ambulances Robin MillarProgrammes Director, Centre for Social Justice Supported by
  7. 7. The importance of alocal area prevention strategy George Hosking CEO, WAVE Trust Supported by
  8. 8. The importance of a local area prevention strategy George Hosking, WAVE Trust Primary Prevention – cheaper than cure, better outcomes for children Central Hall, Westminster, 13th June 2012
  9. 9. The Barnet Graph of DoomWithout dramatic change, within 20 years the Council will beunable to provide any services except adult social care andchildren’s servicesIrrespective of savings planned under One Barnet TransformationStrategy, demographic change – more children, more elderly – willsoak up every available penny‘In 5-7 years … it starts to restrict our ability to do anything verymuch else. Over a 20-year period, unless there was really radicalcorrective action, adult social care and children’s services wouldneed to take up the totality of our existing budget.’ Nick Walkley, Barnet CEO
  10. 10. The Barnet Graph of Doom
  11. 11. Current reality of budget cuts – 1Matt Dunkley, Director of Children’s Services, East Sussex 2011-12 budget: £20m cuts to Children’s Services – ‘We have done the best we can with the challenge we were set’ The challenge: deliver a heavy, frontloaded package of cuts Ringfenced schools budgets off limits. Child protection and looked-after children budgets insulated Cuts fell disproportionately on preventive services inc. early years’ ‘… not the way forward I would have ideally chosen.’
  12. 12. Current reality of budget cuts - 2Matt Dunkley (continued) East Sussex has put 600 more children (most under five years old)on child protection plans in the past two years (2011) Number of looked-after children has almost doubled to 560 Government’s Early Intervention grant cut, in effect, by 20%. Soaring demand, little sign that trigger factors such as parentalsubstance abuse is falling ‘The pace at which we had to do this … led to missed opportunityto do a smarter piece of work … to reshape those services.’
  13. 13. Fundamental choiceContinue on current path or create aParadigm shift: Invest in primary prevention
  14. 14. Continue on current path?Out of 12 million children under 16 in UK: Severely maltreated 1 to 1.6 million Physical neglect over 1 million Alcoholic in household 1 million Witnessing domestic violence ¾ million
  15. 15. Costs of continuing on current pathAnnual waste from adverse early years estimated at over £200 billion, nationallyIncludes cost of welfare benefits, crime, mental health, alcohol and drug abuse, violence, family breakdown, domestic violence, NEETS, prison service, looked after children, young offenders, special educationdoesn’t include...Lost tax revenue and costs of poor physical health
  16. 16. The future: doom or hope? What if, instead of doom and gloom, we could find a more up todate way to set policy, using the latest scientific knowledge? … which will produce far happier, healthier and more prosperouscommunities… Is there a safe and economically viable way to do this?
  17. 17. Implication for optimum investmentSource: Heckman, James J. (2008). "Schools, Skills and Synapses," Economic Inquiry, 46(3): 289-324.
  18. 18. Pattern of public spending on education in England & Wales over the life cycle, 2002/2003
  19. 19. A new paradigmNational and local strategies of primary prevention, rather thanreactionTransformation of the quality of parenting – through changedattitudes and better preparation for parentingRespect for children’s right not to be abused or neglectedUnderstanding and adoption of early years interventions that work
  20. 20. Lifelong skills created very earlyResearch of Nobel Prize Winner, James Heckman An open and persevering child learns more – early success fosters later success, advantages cumulate – young children more flexible and adaptable – much easier to prevent deficits from arising in early years than to remediate laterMannheim Study of Children at Risk (MARS) Individual differences in basic abilities increase between 3 monthsand 11 years
  21. 21. Lifelong skills created very earlyResearch of Nobel Prize Winner, James Heckman Achievement gaps between children primarily due to gaps in skills Hard and Soft skills very important for success in life – conscientiousness - perseverance – motivation - attention – emotional self-regulation - self-esteem – ability to defer gratification – sociability (ability to work with and cooperate with others) These crucial skills mostly created in early years, in the family Gaps in skills emerge early, before pre-school, and persist
  22. 22. Causes and consequences: Californian ACE StudyMajor investigation on links between childhood maltreatmentand later-life health and well-being17,000 Kaiser Permanente members at comprehensive physicalexaminations provided detailed information on their childhoodexperiences of physical and emotional abuse, including beingreared in households with domestic violence, drug and alcoholabuse.WHO now conducting its own international (including UK)ACE study
  23. 23. Californian ACE StudyHealth risks which increase with 4 ACEs (17% of popn): liver disease (x 2) lung disease (x 3) adult smoking, depression, serious job problems (x 3) intercourse by 15, absenteeism from work (x 4) alcoholism and alcohol abuse (x 6) intravenous drug use (x 11) suicide attempts (x 14)
  24. 24. Pathways to violence by age 3
  25. 25. Pathways to crime often set by age 3Dunedin study of all Violent offenceschildren born in 1972, Abused partnersto age 21 Number with 2+ criminal convictions 55% 47% 2.5x 18% 1x 9.5% At risk Normal At risk Normal At risk Normal
  26. 26. Key: understand infant brainWorks via neurons (brain cells) & synapses (connections)At birth: 10 trillion synapses - 200 trillion (or more) by age 3Emotional brain largely created by experience in first 18months; acutely vulnerable to traumaBrains of abused children significantly smaller, less developed
  27. 27. Understand the infant brain
  28. 28. Understand the infant brain Alan Schore - 10-year immersion in thousands of scientific papers in neurobiology, psychology, infant development ‘The child’s first relationship, the one with the mother,acts as a template … permanently moulds the individual’s capacity to enter into all later emotional relationships’
  29. 29. Key factors: Attunement and EmpathyAttunement between mother and infant develops empathy.Lack of attunement means empathy does not develop.Low maternal responsiveness at 10-12 months predicted: – at 1.5 years: aggression, non-compliance, temper tantrums – at 2 years : lower compliance, attention getting, hitting – at 3 years : problems with other children – at 3.5 years: higher coercive behaviour – at 6 years : fighting, stealing Absence of empathy characteristic of violent criminals – worst psychopaths no emotion at all
  30. 30. Primary Prevention does work
  31. 31. Successful Primary Prevention
  32. 32. Successful Primary Prevention
  33. 33. Need for Primary Prevention ?
  34. 34. Early years prevention saves money - 1 Expert opinion USA: Dr Bruce Perry James Heckman (Nobel Prize winning economist) RAND Research Institute / Karoly, Kilburn, and Cannon (2005) Felitti and Californian ACE studies Washington State Institute for Public Policy (WSIPP) Expert opinion UK: Government Office for Science London School of Economics Action for Children / New Economics Foundation Croydon Prevention Strategy WAVE Trust
  35. 35. Early years prevention saves money - 2 RAND Research Institute / Karoly, Kilburn, and Cannon Cost benefit analyses or meta-analyses of early years’ programmes showed payoffs per dollar invested from $1.80 to $17.07 Estimated net benefits from $1,400 to nearly $240,000 per child Chicago Child-Parent Center Program / Reynolds Benefits > $80,000 per child - $10.80 of benefits per $1 invested Children with four or more family risk factors yielded almost double the benefits of those with fewer ($12.8 vs. $7.2) Children from highest poverty neighbourhoods had returns more than four times higher than those from less disadvantaged areas
  36. 36. Early years prevention saves money - 3Federal Reserve Bank of Minneapolis/Rolnick & Grunewald Internal rates of return for early years programmes exceed returnsfrom both stock market and typical public policy investments [would also significantly exceed returns from many UK large-scalepublic investments, including high speed HS2 rail link]Washington State Institute for Public Policy (WSIPP) Rigorously conservative approach to programme evaluation – $1.75 per $1 for Parents as Teachers – $3.23 per $1 for Nurse Family Partnership – $7.00 per $1 for Parent Child Interaction Therapy – $10.32 per $1 for Level 4 Group Triple P
  37. 37. WAVE’s Core Recommendation Implement a committed primary prevention strategy for children from conception to age 3US Surgeon General: ‘Preventing an illness from occurring is inherently better than having to treat the illness after its onset. The classic public health definition of primary prevention refers to interventions which ward off the initial onset of a disorder’
  38. 38. Strategies of preventionNational strategies Infancy and Early Childhood in Sweden Every Opportunity for Every Child, Netherlands Scotland – new Preventive StrategyLocal strategies Croydon Prevention Strategy (joint local authority & PCT) Derry, Fermanagh and Tyrone Ballymun, Dublin
  39. 39. A National Strategy of PreventionApproach to Infancy and Early Childhood in Sweden 99% of pregnant women access maternity healthcare services, 99%of families use child healthcare services, avg. 20 contacts 98% of maternity services offer group parenting education to firsttime mothers, specialist support to teen mums, single mums Parent education c10% of midwives time; Parents invited to joinparent groups when child 1-2 months (61% attended 5+, Stockholm) 65% of midwives receive regular professional training on parentingeducation, 72% instructed by a psychologist
  40. 40. A National Strategy of PreventionApproach to Infancy and Early Childhood in Sweden 100% of hospitals have BFHI (baby-friendly) status (UK<10%) Long periods of paternal and maternal leave to support baby Breastfeeding: 98% of Swedish mums begin breastfeeding (79% UK) 72% breastfeeding at 6 months (22% UK) 15% exclusive breastfeeding at 6 months (less than 1% UK)
  41. 41. A National Strategy of Prevention SWEDEN UK % Live Births to teen mothers 1.6 7.1 Infant Mortality (per 1,000 live) 2.5 5.1 Smoking (% per day aged 15+) 16 25 Alcohol (litres per person p.a.) 7 11 Adult Obesity (% of population) 11 23 Smoking Related Deaths (per 100,000 popn) 196 245 Chronic Liver Disease Deaths, < 65 yrs (per 4 9 100,000) Cancer Deaths, < 65 yrs (per 100,000) 56 67 Circulatory Disease Deaths, Under 65 32 43
  42. 42. Infant Mental Health Strategy: Derry, Fermanagh and TyroneVision for the Infant Mental Health Strategy: WHSCT committed to supporting families to provide secureattachments children need to make best possible start in life Every child has a right to a supportive environment to create andsupport positive mental health and emotional wellbeing Investment in early years’ child development and positive infantmental health, contributing to lifelong health, social and economicoutcomes
  43. 43. Infant Mental Health Strategy: Derry, Fermanagh and TyroneWhole Child Approach: a holistic systems-based model of Early InterventionCollective Responsibility:• 1) Women and Children’s Services plays a primary delivery role• 2) Ante-natal and perinatal services a core universal service• 3) Every Directorate actively supporting delivery of the strategyQuality Service Standards:• All delivery based on timely access to services based on need• Evidence-based best practice and innovation at core of all services
  44. 44. Infant Mental Health Strategy: Derry, Fermanagh and TyroneSpecific Initiatives: Hidden Harm Action Plan for Northern Ireland and Think Child/Think Parent/Think Family project A universal perinatal mental health pathway Leading on Roots of Empathy Programme NI Regional Healthy Futures strategy principles: health visitorssupporting children & families during formative early years Leading on Family Nurse Partnership
  45. 45. Ballymun, Dublin: Ready, Steady, Grow Service aims: Improve positive pregnancy and birth experiences Strengthen adaptive protective systems in infancy and toddlerhood Increase confidence and competence of parents Promote healthy infant and child development Reduce childrearing problems
  46. 46. Ballymun, Dublin: Ready, Steady, Grow Initiatives: – Amplify range & increase uptake of ante natal support in collaboration with primary health care team, maternity services – Enhanced baby development clinic in partnership with Public Health Nurse team – Increased emphasis on infant social and emotional development – Direct support to families and onward referral as appropriate – Build capacity of statutory/community services to understand and respond to infant mental health need
  47. 47. Ballymun, Dublin: Ready, Steady, Grow Strand I - Preparing for Parenthood Focus on pregnancy and Infant Mental Health incl. systematic strategy for engaging expectant mothers and partners Support adaptation to pregnancy & relationship with unborn child Better meet ante natal needs of women and their families Increase capacity of ante natal care
  48. 48. Ballymun, Dublin: Ready, Steady, Grow Strand II - Parent-child Psychological Support Programme Promote strong parent-child relationships, parental wellbeing and adaptive systems in children Provide parents with information on child development Check baby’s progress and changing needs Empower parents to solve conflict
  49. 49. Ballymun, Dublin: Ready, Steady, Grow Strand III - Infant Mental Health Promotion Focus on promoting social & emotional development in children Build service capacity to respond to infant social and emotional need – capacity building for staff, families, programmes, systems – identify, treat, reduce mental health problems birth to 3 years – direct observation of children and care-giving environment – interventions designed to change behaviour
  50. 50. Early intervention programmes - 1Excellent Parenting programmes Nurse Family Partnership Roots of Empathy First Steps in Parenting Leksand Model, Sweden SKIP (Strategies for Kids, Information for Parents)
  51. 51. Early intervention programmes - 2 Fostering attunement, breast-feeding, secure attachmentAttunement Video Interactive GuidanceBreast-feeding Breastfeeding Initiative, BlackpoolSecure Attachment Circle of Security, Sunderland Infant ProgrammeReducing teen pregnancy Enfield
  52. 52. ..
  53. 53. Report on recent study ofpolicies from conception to age 2 Sally Burlington Deputy Director, Sure Start and Early Intervention Division, Department for Education Supported by
  54. 54. Special Interest Group: Pregnancy to 2 Sally Burlington Department for Education 13 June 2012 Supported by
  55. 55. Conception to 2 is the most crucial phase of development The first 2 years of life are critical to a child’s development. How we treat 0-2 yr olds shapes their lives… and ultimately our society.• Period of fastest development – 80% of all brain volume development is complete by age 3; and is fundamentally affected by early relationships and interactions• Lays foundations for all later development Supported by
  56. 56. Poor support at this stage can have life- long impact on outcomes• Poor attachment in infancy is associated with behaviour problems later on (and the effect doesn’t reduce over time)• It can affect anyone: the effects are not less for higher socio-economic groups• Early childhood abuse and neglect affects physical and mental health and life-time outcomes; and the next generation Supported by
  57. 57. Key factors• Health in pregnancy (including maternal stress)• Maternal health and mental health post-birth• Quality of relationship (attachment) with main carer has impact on: – emotional wellbeing (and infant mental health); – capacity to form and maintain positive relationships with others; – brain development; – language development; and – the quality of the home learning environment. Supported by
  58. 58. Early childhood programmes have been shown to have substantial net benefits and social gains• … and net savings to the public purse particularly through better long term health and crime reduction• Cost-benefit analyses show a range of net benefits, up to 1000 x initial costs• James Heckman: highest returns for earliest interventions (0-3)• Best effects are delivered when long-term follow-up Supported by
  59. 59. But care is needed in interpreting this….• American evidence does not necessarily translate directly to the UK• In the UK we already have universal maternity and perinatal health provision: Healthy Child Programme, and Family Nurse Partnership• People tend to quote the most positive effects rather than the most likely• Most striking effects are for groups with a large number of risk factors Supported by
  60. 60. Nevertheless, some key conclusions:• Full implementation of the Healthy Child Programme (supported by 4200 new health visitors by 2015) will give us a world class service (more like Sweden than USA?)• Opportunity to “join up” services for infants and their families when responsibility for public health moves to local authorities from 2015• Implementation – what you do and how you do it – is key• Early findings from FNP evaluation are very positive (suggesting some of the success of American schemes can be replicated here): doubling of capacity is very welcome Supported by
  61. 61. Wider policy developments• 4,200 new health visitors• Doubling of Family Nurse Partnerships• Prof Cathy Nutbrown review of early years workforce• Free early education for disadvantaged 2 year olds• Digital Advice Service for parents just launched• New Early Years Foundation Stage: new focus on very young children; identifying prime areas of Communication and Language; Social and Emotional Development; Physical Development;• New requirement for all EY settings to undertake a progress check for 2 year olds, and to provide a report to parents. This will help to identify development needs – to be integrated with the healthy child review Supported by
  62. 62. Some lessons from evidence can be used to influence ongoing practice• “Spread the word” to all practitioners: understand what very early child development looks like, and importance of secure attachment: do people in childcare settings understand babies’ behaviour?• Publicise good sources of advice• Early years workforce: importance of a key worker; emotionally intelligent staff; effective supervision – role of reflective supervision Supported by
  63. 63. Other Implications• How to target? Stigma vs “deadweight”• Therefore make best use of universal provision, and stop people falling through the net by – Early identification and early help systems (HV, social work and strong multi-disciplinary approaches) – Effective information sharing between professionals – Sure Start Children’s Centres and outreach working effectively to identify and support the most vulnerable families very early in a child’s life – Staff in other EY settings (especially 2YO and earlier childcare) having a good understanding of child development and how to spot and tackle problems appropriately and quickly.• Continue to improve our understanding of what evidence based intensive support can be commissioned: who it works for; what it costs; timescales and management. Supported by
  64. 64. Resources• Pregnancy Book http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107 302• Birth to Five http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107 303• The NHS Choices website also provides a wealth of information relating to pregnancy, maternity and the early years, including an interactive Pregnancy Care Planner (based on ‘The Pregnancy Book’) and Birth to Five guide (based on the ‘Birth to Five’ book) and a range of videos on issues relating to pregnancy, babies and children. http://www.nhs.uk• Start4Life http://www.nhs.uk/start4life/Pages/healthy-pregnancy-baby-advice.aspx• Healthy Start http://www.healthystart.nhs.uk/• Information Service for Parents http://www.nhs.uk/InformationServiceForParents/pages/home.aspx• Age specific downloadable handouts: http://www.zerotothree.org/about-us/areas-of-expertise/free- parent-brochures-and-guides/ http://community.fpg.unc.edu/connect-modules/learners and http://community.fpg.unc.edu/connect- modules/5-step-learning-cycle for an explanation. Supported by
  65. 65. Lunchwith Social Investment Business models showcased Supported by

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