Critical 1001 days: why they matter and local interventions Sally - - PowerPoint PPT Presentation

Sally Johnson, Head of Service (conception to 5 years)

Critical 1001 days: why they matter and local interventions

A time of risk and opportunity

• 41% serious case reviews under 1 year
• Rapid brain growth and development
• Laying the foundation that affects the course of our later lives
• relationships, cognitive, social, emotional development and

physical health

• Parents often receptive
• Can potentially make the biggest difference
• Makes economic sense

‘Taking a person from the potential to the actual’

(Leach, 2017)

In the womb …..

Smoking Diet/ nutrition Alcohol / drugs Emotional and mental health Relationship with partner Housing Social support networks Finance

O’Donnell et al, 2014

Pawlby et al, 2009

Maternal representations in pregnancy

• wn attachment

experiences

• baby, herself as

mother, relationship with own mother

• baby with mind of

their own

• Parent’s representations of self

and others are reactivated and reorganised

• Research shows relationship with

the unborn predicts

• Quality of parent-infant

interaction after birth

• Infant’s attachment at 1 year

(Barlow, 2017)

Early relationships are key

• Psychological and sociological

impact – early attachments influence self-confidence, courage to explore, relate to others and future relationships

• Brain development – attuned to

quality of early relationship and designed to fit into early mothering environment

Brain architecture

• Neurones: the building materials
• Connect to form circuits: foundations
• Experiences and environment shape

brain architecture

• Serve and return interactions

strengthen neural pathways

• Pruning the connections; brain adapts

to environment

• Brain becomes what the brain does!

Building for the future

Nelson, CA (2000)

The impact of stress on brain development

Positive stress – natural day to day stress

e.g. meeting new people

Tolerable stress – very stressful event

e.g. very ill

Toxic stress – prolonged extreme stress

e.g. neglect or abuse

Damaging to brain development Others there to help turn off stress Learns to manage stress Risk a poor long term outcomes – physical and mental health problems, development issues

Relationships are central

Local evidence based programmes

• Family Nurse Partnership
• intensive support for expectant teenage

parents U19 at conception

• Baby Steps
• perinatal group based programme for

vulnerable parents / those who would benefit from additional support.

• Pre-programme home visit followed by

10 interactive sessions (9 group based and one post birth home visit)

Both relationship based programmes

Baby Steps 2 year evaluation: engagement

Stage Overall Safeguarding concerns Referral to home visit 57% 62% Home visit to participation 73% 65% Participants completing ≥6 sessions 74% 62%

Outcomes for validated measures (mothers only)

Measure Before After Difference Direction

• f travel

HADS (Anxiety)* 6.5 5.7

• 0.9

↑ HADS (Depression) 4.3 4.0

• 0.2

↑ PAI* 64.9 68.2 3.3 ↑ RQI 40.0 37.8

• 2.2

↓

Safeguarding concerns downgraded

CASE STUDY

Start of Baby Steps End of the Baby Steps programme A Social care / child protection / 2 previous children adopted Plan downgraded Baby at home with mum B Social care / child in need / violent partner but living alone Universal by Baby Steps session 9 Social worker no longer involved C Social care / LAC / older child with

• grandmother. Unborn baby CIN

Plan downgraded when baby born. New baby stayed with mum. Later moved to universal D Social care / previous DA / previous children adopted / expecting twins / new partner Twins at home after birth, support from

• sister. Partner has gone.

E Social care / LAC / abusive partner / First child adopted due to DA / unborn baby CIN No longer with partner. Moved to refuge. No longer on CIN

Other benefits

• Identifying risks - home visits
• Enabling disclosure
• Parents better prepared, more positive and confident, better

understanding of baby, secure, supported - >90%

• Building client confidence to access support
• Linking client with local support – e.g. children’s centres
• Partnership working

Any questions?