Conception to age 2 - the age of opportunity

1. Conception to age 2 -the age of opportunity Key Conclusions and Recommendations

2. Pregnancy • Maternal stress, smoking, diet, drug, alcohol consumption in pregnancy can: • Lower IQ, create ADHD, conduct disorder • Severely impair child’s mental functioning • Adversely impact child’s health through to middle age and early death

3. Nutrition • Adequate early nutrition crucial to a child’s physical and intellectual development: • Breastfeeding protective for both mother and baby • Hygiene, home safety, immunisation also important

4. Adverse Childhood Experiences • Abuse, neglect, domestic violence, growing up in household with alcoholism, drug abuse can lead to: • high levels of heart, liver, lung disease • depression, suicide, poor work prospects • alcoholism, drug addiction • Peak age for child abuse, neglect is 0-1

5. Mental Health Risks • 144 thousand babies under 1 in UK live with parent with mental health problem • Significant cross-over between mental health issues and alcohol/substance abuse

6. Primary Prevention • Core message: ‘Primary Prevention’ – prevent harm BEFORE it happens. It is crucial to • intervene early to promote infant mental health • protect babies from abuse and neglect • prevent damage from poor early parent relationship

7. Primary Prevention: Three Essentials • Assess and identify where help is needed • Provide adequate support when needed • Ensure early years workforce have requisite skills, training and supervision

8. Assess, identify where help needed • Mental health risk assessment as early as possible in pregnancy • Edinburgh Post-Natal Depression Scale • Hospital Anxiety and Depression Scale • Other risk factors (domestic violence etc) • Neonatal Behavioural Assessment Scale 3 weeks after birth

9. Assess, identify where help needed • In addition to 6 week Health Visitor assessment: • 3-4 month assessment of parent-child attunement • Parent Infant Observation Scale • KIPS • The CARE-Index • Attachment assessment at 12-15 months • TAS-45

10. Provide adequate support • Full implementation of Healthy Child Programme • Promote attunement, secure attachment: • Video Interactive Guidance, VIPP • Watch, Wait and Wonder • Circle of Security • Family Nurse Partnership

11. Provide adequate support • Parent-Infant Psychotherapy • support systems such as Oxpip, Norpip • 8% of pregnant women warrant a referral to specialist perinatal mental health services • these focus on restoring maternal mental/emotional health and parent-infant relationship

12. Provide adequate support • High quality health-led Children’s Centres • Potential for health visitors to act as team leaders, supervisors and/or mentors • High quality outreach to engage most vulnerable families • Follow principles of highly successful multi-agency work • Integrated services model, Highland Region of Scotland • Local integrated partnerships, Brighton and Hove, Warwickshire, etc.

13. Early years workforce: requisite skills • Health Visitors trained to evaluate mother-baby interaction (e.g.VIG), motivational interviewing • All practitioners have awareness of risk factors that can jeopardise infant mental health • Domestic violence - prioritise identification and support by midwives, GPs, other professionals, especially in pregnancy

14. Early years workforce: requisite skills • Good understanding of pre-birth to 3 child development, attunement and attachment • Emotional intelligence, skills to form empathic relationships with parents • Good quality reflective supervision

15. … and finally • Health and Wellbeing Boards prioritising infant mental health, wellbeing in JSNA • Provide clear guidance to practitioners on importance of very good support from 0-2 • Financial returns on well-designed early years’ interventions far exceed stock market returns, other public policy investments