Reduce Child Maltreatment by 70% by 2030: Involving BASPCAN Members

Reduce Child Maltreatment by 70% by 2030:

Involving BASPCAN Members

George Hosking, CEO, WAVE Trust

BASPCAN 2015 Congress – Workshop 17Edinburgh, Tuesday 14th April 2015

WAVE Trust

• Violence and what to do about it (2005)

• Advisors to Social Exclusion Unit, 10 Downing St (2006-10)

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

• Allen Review early years advisors (2010–2011) (with Cabinet Office)

• Under 2s SIG Study jointly with DfE (2011–2013)

WAVE Trust

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

• All Party Parliamentary Group – Conception to age 2 (2013)

• 1001 Critical Days Manifesto (2013)

• Prevention in Practice (2014) (funded by DH)

• Building Great Britons (2015)

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)

70/30 Campaign

Four elements:

• Understanding and Building the Case for action on child maltreatment (2009 – 2020)

• Marshalling support (2010 – 2020)

• Designing detailed action plans (2014)

• Pilot studies to prove concept, with research evaluation– Pioneer Communities Project (2015 – 2020)

70/30: Marshalling support

A. Building national political consensus

B. Building local area support

C. Developing community support

D. Networking

E. Marketing

A) Building national political consensus

• Developed strong support for 70/30 across political spectrum– supporters include Conservative Party Ministers (Welfare,

Education, Junior Ministers in Health and Education), Liberal Democrat Ministers (Deputy Prime Minister, Junior Health Ministers in Health and Education, Chief Secretary to the Treasury); Labour Shadow Ministers (Health Secretary, Children, Equalities); Scottish Nationalists (Children)

• Created with Big Lottery a £215m project to promote primary prevention at local area level, helped steer project

• Worked with Dept of Health to promote implementation of Age of Opportunity recommendations

A) Building national political consensus

• Working intensively with government(s) and with main political parties to embed principles of primary prevention and preventive spending

• Continuing work with Big Lottery, Public Health, local authorities, health trusts, implementing prevention, showing practical benefits

• Crucial need: to get more politicians fired up and supporting 70/30 and preventive strategies

B) Building local area support

• Groundwork created by report Conception to age 2 – the age of opportunity advising local areas on how to apply prevention

• Relationship with local areas strengthened by roles in A Better Start (Big Lottery) and Prevention in Practice (Dept of Health)

• Very active programme of presentations to, meetings with and planned collaborations with local areas

• WHO Europe report on preventing child maltreatment lends weight to case for prevention

C) Developing community support

• Collaboration with Nurture Development using ABCD (Asset Based Community Development) – Northwestern University

• Local assets and community strengths as primary building blocks of sustainable community development

• Building on skills of local residents, power of local associations, supportive of local institutions

• ‘Community Builders’ key in locating and building on community assets – e.g. 49 new projects in Croydon

D) Networking

• Alliances:• Early Years Champions• 70/30 Alliance• Big Lottery• Pioneer Communities • Putting the Baby in the Bathwater (Scotland)

• Ongoing work with Professionals – health visitors, midwives, police, paediatricians, therapists, social workers

• And MPs and civil servants

E) Marketing (not yet started)

• Social networking campaign

• Grass-roots campaign to influence MPs, local councillors, local and national press

• High quality web site

• Celebrity support

• Good marketing of results from pioneer sites

Designing Action Plans

• 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

Action Plans: The Solution

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

• Measure impact through a range of measures, but especially disorganised attachment

• Show significant reductions in maltreatment can be made inside 5 years

• Demonstrate major cost pay-off to 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 (with

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 of interaction 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 of support– 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, ownership of commitment to create 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

Direct DeliveryLocal AuthorityUniversal Risk Assessment at 3-4 months to measure attunementVIG to support parents to improve attunement

PIP / Infant Mental Health Service

Perinatal Mental Health Service

Health ServiceUniversal Risk Assessment during pregnancyBrazelton (by midwives / community midwives)

Perinatal Mental Health Service

WAVE / Nurture DevelopmentCommunity Engagement

Local Authority or Local VCSSolihull ante-natal & parenting classes

Minding the Baby

Parents under Pressure

Baby Steps

Family Foundations

Healthy Relationships, Healthy Babies

Mellow Bumps, Babies & Parenting

Watch, Wait & Wonder / Circle of Security

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, early years workforce, CCGs, Health & Wellbeing Boards, voluntary sector, community groups

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

• Maintaining momentum of the project

• Spreading learning across Pioneer Communities and to local authorities, health boards and communities across UK

• Working with Birkbeck, Kent, Kings, LSE, UCL, Warwick to monitor and evaluate

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

Pioneer Community Criteria

• Commitment to taking a whole system, preventive approach to child maltreatment for ages 0 – 2 over 5 years– In 50,000 population– Broadly following proposed principles and elements– Sign up from CEO, DCS, Health, Councillors

• Willingness to participate in research and evaluation– Sharing and reporting relevant measurement data– Supporting access to selected families for recording DA

Pioneer Communities: 15 Expressions of Interest to date

Bridgend (Wales)

Croydon

Derry (N Ireland)

Haringey

Greater Manchester

Leeds

Luton

Moray (Scotland)

Newcastle

North East Lincolnshire

Renfrewshire (Scotland)

Sheffield

Stockton

Waltham Forest

Westminster

Established Advisory BoardsLocal Authority Advisory

Board• 13 Local Authority CEOs / DCSs

• Bridgend• Coventry• Croydon• Haringey• Hertfordshire County Council

• Leeds Council• London Borough of Waltham Forest Council

• Newcastle Council• Newry & Mourne District Council

• North Yorkshire• Renfrewshire Council• Southampton City Council• Stockton Borough• Wigan

Public Health Advisory Board

• 9 DPHs• Buckinghamshire County Council

• Croydon Council• Hertfordshire• Merton• Oldham Council• Richmond Upon Thames• Stockton-on-Tees• Hampshire• Waltham Forest / Redbridge

Expert

• Dr Cheryll Adams (Institute of Health Visiting)

• Dr Robin Balbernie (AIMH and PIP UK)

• Prof. Jane Barlow (Warwick University)

• Sally Burlington (LGA)• Prof. Pasco Fearon (UCL)• Prof. Peter Fonagy (UCL)• Steve Goodman (Morning Lane Associates)

• Dr Alain Gregoire (Maternal Mental Health Alliance)

• Dr Joanna Hawthorne (Brazelton Centre UK)

• Dr Ann Hoskins (PHE)• Hilary Kennedy (VIG UK)• Prof. Ted Melhuish (Birkbeck)

• Dr Susan Pawlby (Kings)• Prof. David Shemmings (University of Kent)

• Prof. Cathy Warwick (Royal College Midwives)

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), Professor David Shemmings (Professor of Child Protection Research, University of Kent), and Professor Jane Barlow (Professor of Public Health in the Early Years, University of Warwick)

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

We need help• WAVE will provide total commitment and dedication

• But we are small

• We cannot succeed without others who care about creating a society free from child abuse, neglect and domestic violence

• Are YOU willing to transform this blight between now and 70/30?

• African proverb: – ‘If you want to travel fast, travel alone– If you want to travel far, travel together’

Where and how can BASPCAN members make a difference?

Building political

consensus

Building local area support

Developing community

support

Networking

Marketing

Pioneer Communitie

s