Reducing Child Maltreatment in Pioneer Communities

George Hosking, CEO, WAVE TrustPeter Kelly, DPH, Stockton-On-Tees Borough Council

National Children and Adult Services Conference 2014

Thursday 30th October, Manchester Central

A preventive approach to creating a large scale step reduction in levels of child abuse,

neglect and children witnessing domestic violence

Overview

• Short introduction to WAVE Trust• Economic Case for Prevention• Our 70/30 Campaign• The Problem• The Solution• Disorganised Attachment• The Pioneer Community Approach• How to become involved

– Advisory Boards, Pioneer Community

WAVE Trust

• Violence and what to do about it (2005)

• International experience of early intervention for children, young people and families (2010)

• Conception to age 2 – the age of opportunity (2013)

• 1001 Critical Days Manifesto (2013)

• Prevention in Practice (2014)

Economic case for preventionEssex• Stopped many of the services that do firefighting• Worked really hard to identify earliest signs of a

problem• As early as possible, intervened or supported

families to keep their children in the community• 500 fewer children in care system than 3 years ago• Saved £30m from children in care• Invested £10m of that into early support and early

intervention

Economic case for prevention

Gloucestershire• Strong preventive element for social workers, health

visitors, drug, alcohol and mental health workers, speech and language therapists

• New initiatives: Family Drug and Alcohol Court, Journey into Early Parenting (health visitor led)

• Early identification of parents not able to interact positively with their children inc. Language

• Reduced parental substance misuse and poor mental health

• Significant cash savings through less numbers in care, less time in care, fewer care proceedings, not instructing experts in care proceedings. Placements easier because children more advanced

• Children more school ready, less SEN, better speech and language, less offending in later life

Economic case for prevention

Staffordshire• Public sector spend of £7.5bn, Children’s services

£170m• Children’s Trust how can we spend more on

prevention?• Youth Services how can we spend more on

prevention?• Answer Look at the £7.5bn not the £170m• A lot of Children’s Services too reactive

(examples)• Took £200m out of hospitals• Paid for community care and prevention instead

of putting people into hospital• KEY: Early Intervention and Prevention is not a

project on the side, it’s at the core of how we operate

70-30 Campaign

It’s possible to reduce child maltreatment in the UK by at least 70% by 2030. We have developed a strategy to make this a reality, we call it 70/30.

70-30 Campaign

“WAVE's visionary 70/30 strategy has my full backing. It tackles the roots of the problems in our society where so many address the symptoms.”Iain Duncan Smith, Secretary of State for Work and Pensions

"I do not view 70/30 as either wishful thinking or an unachievable goal. On the contrary, reducing child maltreatment by 70% in the next fifteen years is the minimum acceptable outcome in responding to this unacceptable (and profoundly costly) harm to our youngest children." Sir Harry Burns (Former Chief Medical Officer, Scotland)

The Problem

• How to secure the commitment before having the proof?

• How to– Bring about whole government commitment to providing

best possible support in earliest years?– Ensure primary prevention given appropriate priority?– Deal with a problem (child maltreatment) estimated to

cost the nation £15bn annually?

• Oliver Letwin– Demonstrate financial pay-back within the life of a

parliament

The Solution

• Focus on ages 0 – 2 (peak period for child maltreatment)

• Measure impact through disorganised attachment

• Show significant reductions can be made inside 5 years

• Demonstrate major cost pay-off to both local and national government

Disorganised Attachment

Disorganised

Attachment

Mental Illness

Children into Care

Poor Relationships

Disruptive Behaviour in Pre-School

Aggression

Violence

15% of children

Pioneer Community Approach

Pioneer Communi

ty Partnersh

ip

Local Authority

Health

Local Voluntary

Sector

Community Groups

WAVE Trust5

Years

• Population level, preventive approach– Focussing on conception to age 2

• Pop. 50,000• 3 components

Pioneer Community Approach

Intervention

Component

Community

Component

Research &

Evaluation

Intervention Component• Universal, identifying families most in need

of support• Risk factors: parental maltreatment as a

child, domestic violence, substance abuse, mental health, attitude to unborn child

Assessment of Risk

• Range of programmes which address key risk factors• Prevent problems before they develop• Address issues before harm done to child

• Local alternatives possible, if research approved

Targeted Support

• Many existing measures will provide feedback (e.g. health visitor assessments)

• Additional measures will include Disorganised Attachment, Parental Sensitivity, possibly disconnected parenting, aggression

Monitoring

outcomes

Assessment of Risk

• Universal risk assessment at ante-natal stage– Carried out by trained midwives or health visitors

(potential GP support)– Costings assume extra support signalled for c240

families per year (targeted), 56 families (specialist) – Parental experience of child maltreatment: measure

developed at Kings College London– Other screening tools already available but need for

special training and adequate resource

• Universal assessment at 3 – 4 months– Quality of interaction between mother and baby– Using Video Interaction Guidance/Parent Infant

Interaction Observation Scale

Targeted Support

• Range of programmes– For parents maltreated in childhood, increased provision of

psychological therapies and mental heath support– For domestic violence risk, approaches such as Family

Foundations, IRIS, Healthy Relationships, Healthy Babies– For substance abuse, Parents Under Pressure– For mental health issues and poor attunement, Video Interaction

Guidance, Parent-Infant Psychotherapy, Specialist Perinatal Mental Health Support,

– Other support programmes include Baby Steps, Minding the Baby, Solihull Approach, Mellow Bumps, Babies, and Parenting

• These will not be imposed on Pioneer Communities– Recommended programmes– Ultimate choice lies with Pioneer Community Partnership– Does need to fit within research protocol

Monitoring Outcomes

• Key measure Disorganised Attachment at 15 – 18 months (surrogate for maltreatment as heavy overlap)

• Additional measures likely to be– Parental Sensitivity– Disconnected Parenting– Child Aggression

• Use of existing local data– 6 – 8 week, 1 year and 2 – 2.5 year assessment– Data from child health profiles – Other local data where relevant

Community Component

• The goal: community engagement and ownership of commitment to creating healthy, successful lives for children, happy relationships in families

• Reducing maltreatment a necessary but not focal part of the positive community goals

• Proposed approach - Asset Based Community Development – proven results with Nurture Development– Training ‘Community Builders’– Local assets primary building blocks of sustainable

community development– Communities will be active co-producers in design, planning

and implementation of Pioneer Community approach– Work will be done with communities not to them

Research and Evaluation

• Project leader: Professor Pasco Fearon Professor of Developmental Psychopathology University College London, member faculty Child Study Center, Yale University. His research focus: early child development and role of attachment in risk for emotional and behavioural problems.

• Strong support team: Professor Peter Fonagy (leading attachment researcher in the UK), Professor Ted Melhuish (who evaluated Sure Start), Professor Martin Knapp (leading health economist at LSE) and Professor David Shemmings (Professor of Child Protection Research, University of Kent)

• Matched control group design: Control groups either from same local authority or demographically matched local authority (possibly member of LA Advisory Board)

WAVE’s Role

AS BACKBONE ORGANISATION

Guide vision and strategy

Support aligned activities

Establish shared measurement

Build public and agency will

Co-ordinate links between Pioneer Communities

Mobilise funding for the overall project

Maintain ongoing dialogue with ministers, civil servants and opposition politicians

Other Elements of WAVE’s Role

• Training and support to local authority professionals, early years workforce, CCGs, Health and Wellbeing Boards, voluntary sector, community groups

• WAVE-led Local Authority, Public Health and Expert Advisory Boards (already established) supporting effective implementation

• Maintaining the momentum of the project• Spreading learning from the project across the

Pioneer Communities and to local authorities, health boards and communities across the UK

• Working with LSE, UCL, Kings and Birkbeck to monitor and evaluate the project

Potential Outcomes

• Major reduction in child maltreatment for 0 – 2 years olds (the peak age) in the Pioneer Communities – in just 5 years

• Thousands of children rescued from severely damaged lives

• Widespread community improvement in child outcomes, health, wellbeing, school readiness

• Fewer children in care or needing special support• Reduced inequalities

These are not ‘one-off’ benefitsThey break the intergenerational cycle of

violence and abuse

The Public Health perspective

Professor Peter Kelly, Director of Public Health

Stockton-on-Tees