The contribution of public health nursing in improving outcomes for children and young people
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The contribution of Public Health Nursing in improving outcomes for children and young people. Kate Thompson Director of Children’s Services and Social Work Marian Robertson Assistant Director Child Health Marian Robertson. Children’s Outcomes Board. Accountability. Old Warren Partnership.

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The contribution of public health nursing in improving outcomes for children and young people

The contribution of Public Health Nursing in improving outcomes for children and young people

Kate Thompson

Director of Children’s Services and Social Work

Marian Robertson

Assistant Director Child Health

Marian Robertson


Children s outcomes board
Children’s Outcomes Board outcomes for children and young people

Accountability

Old Warren Partnership

West Winds Association

Downpatrick Partnership

Kilcooley Partnership

Colin Partnership

Outcomes Board

Children’s Director (Chair) and 4 ADs, 3 Voluntary reps, 5 Community Networks

Steering

Trust Board

Looked After Children Delivery Group

Mental Wellbeing Delivery Group

Parenting / Early Years Delivery Group

Disability Group

Delivery


Locality approach
Locality Approach outcomes for children and young people

  • Building health and wellbeing capacity with community groups at a local level (often within a specific estate)

  • Working from the ground-up to identify health and wellbeing needs

  • Supporting communities in taking ownership for their own health and wellbeing

  • Helping with a local health planning process owned by the community

  • Relationships and trust are vital


  • Health Improvement Plans being developed with groups representing deprived communities within Lisburn and Ards

  • Trying to determine performance indicators to understand improvement

  • Need to understand health in its broader context while not being sidetracked

  • It takes time to build up trust and rapport


Children’s: representing deprived communities within Lisburn and ArdsChildren’s Outcomes Board

  • Looked After Children

  • Vulnerable Young People

  • Children with Complex Needs

  • Family Support

  • Emotional Wellbeing


“In my beginning is my end” representing deprived communities within Lisburn and Ards

T S Eliot, four Quartets


Pathways to crime often laid down by age 3
Pathways to crime often laid down by age 3 representing deprived communities within Lisburn and Ards

Dunedin study from 1973, New Zealand:

  • ‘At risk’ male group identified at 3 by nurses, 2.5 X more likely to offend and offences much more serious

    • (e.g. robbery, rape, homicide)

    • 47% of group abused partners

  • Fewer females conduct disordered, but for those who were:

    • 30% of ‘at risk’ group had teenage births (vs. 0%)

    • 43% were in violent, abusive relationships

“Immature mothers, with no strong parenting skills

and violent partners have already borne

the next generation of ‘at risk’ children”


Understanding the infant brain
Understanding the infant brain representing deprived communities within Lisburn and Ards


Californian ace study
Californian ACE Study representing deprived communities within Lisburn and Ards

  • Center for Disease Control and Prevention & Kaiser Permanente

  • One of largest investigations ever on links between childhood maltreatment and later-life health and well-being

  • 17,000 members at comprehensive physical examinations provided detailed information on childhood abuse, neglect and family dysfunction


Ace studies
ACE Studies representing deprived communities within Lisburn and Ards

Adverse Childhood Experiences (ACE) Study

  • Emotional abuse

  • Physical abuse

  • Sexual abuse

  • Physical neglect

  • Emotional neglect

  • Alcoholic in household

  • Drug user in household

  • Witnessed domestic violence


Californian ace study1
Californian ACE Study representing deprived communities within Lisburn and Ards

Likelihood of Heart Disease with single ACEs:

1.3 x by Emotional Neglect

1.3 x by Substance Abuse

1.4 x by Physical Neglect

1.4 x by Domestic Violence

1.4 x by Sexual Abuse

1.5 x by Physical Abuse

1.7 x by Emotional Abuse


Californian ace study2
Californian ACE Study representing deprived communities within Lisburn and Ards

Health risks which increase with ACEs

  • liver disease (x 2)

  • chronic obstructive pulmonary disease (COPD) (x 3)

  • adult smoking (x 3)

  • serious job problems (x 3)

  • absenteeism from work (x 4)

  • alcoholism and alcohol abuse (x 6)

  • suicide attempts (x 14)


Californian ace study3
Californian ACE Study representing deprived communities within Lisburn and Ards

Health risks which increase with 4 ACEs

  • depression (x 3)

  • intercourse by 15 (x 4)

  • teenage pregnancy (x 2)

  • more than 50 sexual partners (x 3)

  • sexually transmitted diseases (STDs)

  • intravenous drug use (x 11)


Ace adverse childhood experiences
ACE (Adverse Childhood Experiences) representing deprived communities within Lisburn and Ards

  • CONSEQUENCES FOR SOCIETY

    Higher levels of Violence

    Higher Levels of Anti-social behaviour

    Greater adult mental health problems

    Increased school under-performance (lower IQs)

    Economic under-performance

    Poor personal relationships

    Poor physical health, high health expenditure

    Lower tax income and less wealth creation

    Reduced societal happiness

  • …and higher expenditure on social welfare, criminal justice, prisons, police etc


Implication for optimum investment
Implication for optimum investment representing deprived communities within Lisburn and Ards

Source: J Heckman & D Masterov (2005) Ch 6, New Wealth for Old Nations: Scotland’s Economic Prospects


Early prevention works
Early Prevention works representing deprived communities within Lisburn and Ards

  • MacLeod and Nelson studied 56 programmes designed to promote family wellness and prevent child maltreatment

    • Most interventions are successful

    • The earlier the intervention the better

    • Prevention (proactive) had greater effect at follow-up

    • Reactive interventions tend to fade over time, relapse common


  • However, representing deprived communities within Lisburn and Ards

    • Support needs to be targeted at specific families most in need

    • Public Health Nurses need to work in an integrated way with a wide range of providers

    • This leads to the ‘targeted support’ approach


Targeted support approach
Targeted Support Approach representing deprived communities within Lisburn and Ards

  • Health Visitors, Midwifes and Social Workers all have an unparalleled view as to which specific families have the greatest emotional need at the earliest stages.

  • Excellent community and voluntary groups are working with at risk families and individuals but can struggle to target the most in need in a co-ordinated manner

  • Projects managed by the Children’s Outcomes Board as integrated initiatives


New parent support programme
New Parent Support Programme representing deprived communities within Lisburn and Ards

  • Designed for vulnerable mothers during the antenatal and post natal phase

  • Referrals from initial assessment by midwife

  • Health Visitor visits the parent/s to be and undertakes an informal education process

  • Empowerment approach where engagement and esteem are key

  • Solihull approach provides the theoretical underpinnings


Conclusion
Conclusion representing deprived communities within Lisburn and Ards

The New Parent Programme has been developed not only to improve attachment between a vulnerable mother and her baby but also to:

Make the largest return possible in relation to tackling health inequalities

Deliver significant wider societal benefits over the long term, which can be quantified


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