I am writing to thank you for your excellent presentation and contribution to the meeting on the Infant Mental Health and Early Intervention agenda. I have had nothing but really positive feedback and appreciation of the opportunity which you provided for us to consider this important material. We at the Public Health Agency regard this work as a key priority and look forward to further contact with you as we seek to progress this.
— Mary Black CBE, Assistant Director Public Health, Public Health Authority, Northern Ireland
Birth to age 1
A good parent-child relationship in the first year lays the foundation for the child's life. Here are some interventions that support the development of an empathic, attuned relationship between parent and child, leading to secure attachment.
Harlem Children's Zone
The Harlem Children’s Zone seeks to rebuild a very run-down part of New York with an ambitious pipeline which begins with The Baby College (a series of workshops for parents of children ages 0-3) and goes on to include best-practice programmes for children of every age through to college. The programme is judged to have closed the black-white achievement gap in its area of New York.
The Swedish approach to infancy and early childhood consciously puts a strong emphasis on prevention and ensuring the best possible support to parents at the beginning of a child’s life, from having 100% of hospitals qualify for UNICEF baby-friendly status, through 98% of mothers initiating breastfeeding, to high levels of parenting education and support in the early years. Sweden has among the lowest rates of infant mortality and teen pregnancy in Europe. Lifetime health outcomes on measures such as deaths from circulatory disease, liver, cancer and smoking-related illnesses are strikingly better than in the UK.
The study on the effect of early postnatal breastfeeding support from Denmark demonstrates that levels of breastfeeding can be increased significantly by a well-planned intervention. (We could have selected for recommendation a number of other examples which support the same conclusion.)
Nurse Family Partnership is the most thoroughly researched and recommended early intervention in the world and since WAVE worked with its originator, David Olds, between 2004 and 2006 to bring it to the UK, it now runs in this country as the Family Nurse Partnership.
The World Health Organisation recommends all infants be fed exclusively on breast milk from birth to six months of age. Breast-feeding rates in England are among the lowest in Europe. A 2008 report stated that less than a fifth of English mothers are still breast-feeding their babies after the recommended 6 months compared to over 70% in Sweden. Reasons cited include that fewer than 1 in 10 hospitals in England has achieved UNICEF Baby-Friendly Status compared to 100% in Sweden, 64% in Norway and 40% in Switzerland.
The Community Mothers Programme (CMP) in Dublin trains experienced, volunteer mothers from the local community to visit families to provide necessary child-rearing support from the birth of a child until its second birthday. Research on the children and families at age 8 showed superior parenting skills among the programme families, children who are more likely to read books regularly, visit the dentist and have better nutritional intake.
Kraamzorg is a unique Dutch system of universal support for mothers for 8-10 days after they return home following a birth. Help may cover health checks (e.g. stitches clean and healing), hygiene advice, support in breastfeeding, ensuring hygiene levels in the home are high and basic household chores such as cleaning the bathroom, nursery and mother’s room and taking care of meals for the mother.
It is commonly said that the peak age for violent behaviour is mid-adolescence. Four decades of research by Professor Richard Tremblay demonstrate that a more accurate statement would be that while the visible consequences of violence are greatest in mid-adolescence, the peak age for aggression and violence in children is 2-3, with those children destined to be the most troublesome offenders in teenage years already distinguished at age 3 by levels of aggression 10 times higher than the most peaceable 30% of toddlers. Tremblay’s research is summarised and has an important message for the most effective age of intervention to reduce violence in society.
There is good evidence for the effectiveness of Healthy Families America in preventing child maltreatment. It is a national initiative to help parents get their newborns off to a healthy start. While participation is strictly voluntary, outreach is included in the initiative. Crucially, the home visiting is carried out by trained Family Support Workers rather than health visitors.
The Croydon Total Place initiative has similarities with the above Highland Region approach, including team-working across agencies, single points of contact for difficult families, early identification etc, plus a number of additional ideas such as involvement of the community, proactively engaging parents and an Early Years Academy to train staff. An approach combining the best of both the Highland Region and Croydon models could deliver much improved outcomes for children as well as significant cost savings.