Mind The Gaps Improving services for vulnerable children

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Mind The GapsImproving services for vulnerable
children

• John ODowd
• Maternal and Child Public Health Team
• Linda de Caestecker
• Director of Public Health
• Catriona Renfrew
• Director of Policy and Planning

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Outline

• Purpose
• Context
• Impacts
• Local responses

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Purpose

• Vulnerable children in NHSGGC
• HMIE inspection of child protection
• Emerging policy landscape around vulnerability
  and early intervention

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Context poverty

• 1 in 3 children within Glasgow City Council area
  live within workless households
• 64 of Glaswegian children live within low-income
  families (Walsh, 2008)
• 38 of children live in poverty, one of the
  highest rates in the UK
• 58 of pregnant women in Glasgow live in the most
  deprived circumstances

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Context vulnerability

• substance misuse affects around 20,000 children
  in Glasgow
• 10,000 children are known to social work, but
  only 300 are in formal child protection
  procedures
• More than 25 Scotlands children are in Glasgow,
  but the city contains only 20 of Scotlands
  looked after children
• 34 of Glasgows children have significant
  educational challenges and have significantly
  poorer educational outcomes

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Context vulnerability

• 17,000 families resident within Glasgow City were
  classified as vulnerable, and in need of
  additional support from services

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Impacts child protection

• Bristol ALSPAC cohort estimated that child
  protection concerns were more than 11 times more
  likely to be registered in the most disadvantaged
  communities in comparison with their more
  affluent counterparts.
• The majority of child protection issues in
  Glasgow City are as a result of parental neglect.
• Glasgows rate of statutory registration is 3.1
  per 1000 children (same as Scottish average)
• Thresholds differ.

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Impacts biology of neglect
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Impacts conduct disorder
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Economic case for early intervention
Adapted from Carneiro and Heckman, 2003
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Local solution

• Parenting
• Family support
• Early intervention skills

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Parenting

• When parents are inexperienced in child-rearing
  or overwhelmed by economic insecurity, effective
  parent education and family support programmes
  can help them.
• Parenting interventions are amongst the most
  powerful and cost-effective tools available to
  prevent and treat conduct problems in children.
• The single most important thing we can do to
  prevent serious behavioural and emotional
  problems and abuse of children is to improve
  parenting at a population level.

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Triple P
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Triple P RCT

• Randomised 18 counties (South Carolina) to Triple
  P system (9) versus usual services (9)
• Trained hundreds of service providers in wide
  variety of settings
• Triple P readily accessible to parents throughout
  the communities
• Co-ordinated media strategies
• Large effect sizes for child maltreatment
  indicators - injuries, substantiated cases and
  taken into care

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Family support

• Develop David Olds work and experience from
  Starting Well to develop Family Support Workers
• Case management
• 1 worker for 30 vulnerable families

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Early intervention skills

• Locally, 5 integrated health and social care
  partnerships
• Need for participative redesign of professional
  approaches and priorities
• Importance of Inequality Sensitive Practice in
  childrens services
• Need to refocus organisations on early
  intervention

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Conclusions

• Early intervention will allow children to fulfil
  potential and break the intergenerational cycle
  of poverty
• Moving to early intervention will require the
  reallocation of significant resource