Risk factors, engagement in the Sure Start ‘Young Mums to Be’ programme and further social work involvement Fleur-Michelle Coiffait Paula Huddart Karen Love
Overview• Background• Research study• Findings and implications• Summary and references• Questions?
Background• Early years crucial in determining outcomes in childhood and adult life• Recent policy emphasis on intervention in the early years• Complex picture, many risk factors interdependent
Background• Huge economic and social costs: unemployment, residential care, long- term use of specialist services, criminal justice involvement• Often grow up to be parents of children who experience poor outcomes, continuing the cycle
Serendipity• West Lothian Council - Sure Start• NHS - St John’s Clinical Psychology• University of Edinburgh - Centre for Research on Families and Relationships
Speciﬁc risk factors• Early parenthood• Parental substance misuse• Abuse - all types• Poor parental physical/mental health• Parental criminal justice involvement• Housing issues and family disharmony
Early parenthood• Poorer child health• Poorer maternal mental health• Increased likelihood long-term poverty• Less likely to be employed or living with a partner when reach 30, compared with those who give birth age 24 or older
Parental substance misuse• Poor attachment relationships• Inadequate supervision and parenting• Increased likelihood of abuse and neglect• Tangled relationships with other chronic social, psychological, economic and systemic disadvantages
Abuse - all types• Physical abuse rarely occurs in isolation of emotional and other abuse• Negative effects on child development, pre- and post-natally• More likely to begin/escalate in pregnancy• Increased risk if parent is victim
Poor parental mental/ physical health• Parental physical illness risk factor for later child emotional/behavioural difficulties• Impact of poor maternal mental health on attachment and responsiveness• Also linked to poor cognitive, emotional and behavioural development
Criminal justice involvement• Factors also linked to child maltreatment, including substance misuse, mental health issues, family problems and poverty• Children more likely to be in child protection system• More likely to end up in care
Housing issues andother family problems• Likely to reflect chaotic life circumstances, relationship difficulties, substance misuse and unemployment• Linked with behavioural and emotional problems in later childhood
Early intervention• Ante- and postnatal support to address needs, build on strengths/resilience• Significant period for brain development, attachment formation, communication/language development• Crucial time to break cycles of poor outcomes, positive economic returns
Sure Start West Lothian• Preventative, non-stigmatising approach to promoting health/ wellbeing of children and families, from conception through early years• Community outreach support to vulnerable families with children <3• Approx 60% of parents <22 (in 2009/10)
Young Mums to Be (YM2B) Programme• 12 week rolling programme, run jointly by Sure Start and midwives• Specifically for young mothers• Information, education, advice• Peer support, transport
Research study• 43% of young expectant mothers referred to Sure Start do not engage with antenatal support (66% nationally, midwifery) - what happens?• Investigated whether risk factors predicted engagement or further social work involvement• Also explored interdependency of risk factors
Method• Retrospective examination of Sure Start and social work routine records• Screening forms noted risk factors at referral• 90 women referred to YM2B between April 2009 - March 2010
Findings• 44% referred in second trimester• 69% referred by midwife• 60% no known involvement of other services, excl. routine antenatal healthcare)• 57% engaged with and 43% attended over 3 sessions/ completed YM2B• 26% further involvement from social work
Summary of ﬁndingsInterdependency between risk factors• None were predictive of engagementFour key predictors of further social work involvement:• history of substance misuse• criminal justice involvement• abuse• other family problems
Implications• Early identiﬁcation of appropriate crucial to ensuring provision of risk factors support• Multi-agency approach due to interdependency of risk factors• Role for targeted individual support?• How do we gather information?• Further work to explore non-engagement
Summary• Interdependent social, environmental and parental risk factors for poor outcomes transmitted across generations• Young parents particularly vulnerable• Importance of early identiﬁcation and early intervention to avoid poor outcomes• Emphasis on better information gathering?
Key referencesAdvisory Council on the Misuse of Drugs (2003). Hidden harm: Responding to the needs of children of problem drug users. London: Home Office.Barnard, M. & McKeganey, N. (2004). The impact of parental problem drug use on children: What is the problem and what can be done to help? Addiction, 99, 552-559.Barnes, M., Chanfreau, J. & Tomaszewski, W. (2010). Growing up in Scotland: The circumstances of persistently poor children. Edinburgh: RR Donnelley.Barnett, W.S. (2003). Economics of early childhood intervention. In: J.P. Shonkoff & S.J. Meisels (Eds.), Handbook of early childhood intervention. New York: Cambridge University Press.Bromley, C. & Cunningham-Burley, S. (2010). Growing up in Scotland: Health inequalities in the early years. Edinburgh: RR Donnelley.Department for Children, Schools and Families (2010). Teenage pregnancy strategy: Beyond 2010. London: Author.Department for Education and Skills (2006). Teenage pregnancy: Accelerating the strategy to 2010. London: Author.Ermisch, J. (2003). Does a ‘teen birth’ have longer term impacts on the mother? Suggestive evidence from the British Household Panel Study. ISER Working Papers No. 2003-32 http://www.iser.essex.ac.uk/publications/working-papers/iser/2003-32.pdfMarmot, M. (2010). Fair society, healthy lives: Strategic review of health inequalities in England post-2010. London: The Marmot
Key referencesKelley, S.J. (2003). Cumulative environmental risk in substance abusing women: Early intervention, parenting stress, child abusepotential and child development. Child Abuse and Neglect, 27, 993-995.Marmot, M. (2010). Fair society, healthy lives: Strategic review of health inequalities in England post-2010. London: The MarmotReview.Marryat, L. & Martin, C. (2010). Growing up in Scotland: Maternal mental health and its impact on child behaviour anddevelopment. Edinburgh: RR Donnelley.Phillips, S.D., Dettlaff, A.J. & Baldwin, M.J. (2010). An exploratory study of the range of implications of families’ criminal justicesystem involvement in child welfare cases. Children and Youth Services Review, 32, 544-550.Rutter, M. (1999). Psychosocial adversity and child psychopathology. British Journal of Psychiatry, 174, 480–493.Scottish Government. (2008). Early years framework. Edinburgh: RR Donnelley.