The Early Years Framework

Steps the Scottish Government, local partners and practitioners in early years services need to take to give all children in Scotland the best start in life.

3. Breaking cycles of poverty, inequality and poor outcomes in and through early years

Breaking the Cycle

Children's life chances are determined from the moment of conception. Motivations for pregnancy are complex and there is evidence that raising aspirations, reducing the number of people with low or no qualifications and enhancing life skills are more important than sex and relationships education in preventing vulnerable pregnancies.

Curriculum for Excellence provides a vehicle through which a greater focus can be developed on meeting the needs of young people to develop the qualities that will equip them to make positive choices about pregnancy and parenthood. Schools, youth work, social work and adult services all have an important role to play, and indeed the quality of the relationship between a key person and the young person or adult can have a critical bearing on their life choices. For young mothers who did not complete their education, we need to ensure that they are able to continue or re-enter education to improve their levels of educational attainment and opportunities to become socially and economically active in the future.

Sexual health and relationships remain a core issue, and in particular how people at greater risk of poor outcomes access good quality contraception and family planning advice to assist with the timing of pregnancies which will lead to the best outcome for them and their child. There are 3 critical areas that we need to focus on: more engaging sexual health education and services for young people through accessible drop-in services; integrating sexual health advice and treatment into services for high risk groups such as looked after children and substance misusers; and improving the way that contraception advice is offered at key points such as post-birth and in termination clinics. These services cannot do this alone, however, as aspirations depend to a large extent on family and community. This reinforces the importance of whole-system approaches to these challenges.

A renewed focus on 0-3 services

The period between pregnancy and 3 years is increasingly seen as a critical period in shaping children's life chances, based on evidence of brain formation, communication and language development, and the impact of relationships formed during this period on mental health. It is therefore also a critical opportunity to intervene to break cycles of poor outcomes.

A particular focus must therefore be on putting in place a strong and coherent set of 0-3 services that support children and families at this critical time. Antenatal, maternity and postnatal services will clearly be a strong focus here, working alongside centre-based services such as family centres. A particular challenge will be achieving the right balance between a core universal programme and a much more targeted programme that provides a level and quality of support that is capable of improving outcomes.

NHS Fife - Supporting Families

NHS Fife is developing an integrated approach to supporting families from conception onwards, which aims to reduce health inequalities in the most vulnerable communities and families by means of a public health approach. A clear lead responsibility and reporting structure has been established to connect to the multi-agency Early Years Strategy Group which is to be established to lead planning across Fife.

The key projects involved include:

  • Family Health Project - midwives and nursery nurses focused on supporting families affected by socioeconomic deprivation, teenage pregnancy and parents with learning disabilities.
  • Vulnerable in Pregnancy - substance misuse midwives and nursery nurses focused on pregnant women and families with substance misuse behaviours aiming to improve birth outcomes and maintain the family unit. This project links with other services to provide ongoing care.
  • Smoking Cessation midwives.
  • Acorn Project - child psychology and public health nursing providing additional support by a nursery nurse mentored by child psychology for families where there is an assessed mother/child bonding issue.
  • Breastfeeding - Community Peer Support - developed in pilot areas and now rolled out across Fife.
  • Breastfeeding in Schools - the development of a resource pack to support the delivery of the Curriculum for Excellence in Primaries 3, 5 and 7.
  • Play@Home - to develop family capacity and skills in relation to child development and physical activity from birth to school entry.
  • Sleep Fife - offering a Fife-wide behavioural support service in relation to sleep difficulties.

Alongside this the Specialist Public Health Nurse for families with substance misuse and the Interagency Consultant Nurse for vulnerable families based in Fife Council Social Work Service provide support and guidance.

Sustaining the intervention

The aim is to set children off on a trajectory where they can achieve positive outcomes within the mainstream of universal services. Much can be achieved through early years and early intervention, but there will always be children and families who need continuing support.

It isn't enough for such families to support them effectively in the early years. Benefits from early intervention will fade quickly if family stresses increase, relationships with children come under pressure and peer relationships start to have a negative influence. It is important, therefore, that there is capacity to meet an ongoing level of need throughout childhood, and possibly throughout life. The aim must be, however, that early intervention will reduce the numbers of people requiring such ongoing support over time.

Tackling poverty

Social circumstances are closely linked to outcomes for children, particularly in terms of health and education. While being poor doesn't make someone a bad parent or a child a failure, it does expose children and families to additional stresses that are linked to a higher risk of poor outcomes. We believe that it is unacceptable that a child's life circumstances should determine their chances of enjoying a positive future, and that is why we have established ambitious targets to eradicate child poverty by 2020 and increase the proportion of income received by the poorest 30% of households by 2017.

The Scottish Government has worked closely with COSLA and other stakeholders to develop the anti-poverty strategy Achieving our Potential that aims to support these targets and deliver higher levels of social equity, combined with economic growth and a good quality of life. It proposes work to remove barriers to employment, support those who cannot work and make work pay. There are close links between some of this work and the section of this framework that deals with meeting the needs of children and families for flexible, accessible and affordable services.

As highlighted above, poverty should not condemn children and families to poor outcomes. Indeed, there is strong evidence that what parents do is more important than who they are and that parenting, home learning environment and high quality education are crucial factors for those children who overcome poverty to achieve positive outcomes. We must therefore combine our approach to tackling poverty with promoting those factors that will protect children and families from its effects.

Meeting the highest levels of need

There will continue to be a need for specialist services for those with the greatest levels of need, including a range of specialist services for children and families with specific conditions and disabilities. The National Delivery Plan for Children and Young People's Specialist Services in Scotland will be issued to NHS Boards as guidance setting out the way in which specialist health services should be provided to achieve the best outcomes for children and young people who require these services.

A particular area where there is unmet need at present is intensive, holistic support for families who face a range of interconnected social and medical challenges. For example, some families in greatest need have a complex combination of substance abuse, employability, housing, debt, mental health, parenting and other problems that would be difficult or impossible to address in isolation. Estimates suggest that between 2% and 4% of families face such complex challenges.

More consistent access to intensive family support services should be a priority, and families with young children should be a priority for these services. There are several models that could be considered at the local level, based on intensive, structured interventions such as Nurse Family Partnership, Functional Family Therapy and Multi-Systemic Therapy or the Dundee Families Project model. These may be costly and resource intensive, but in addition to their positive impact on outcomes, they are likely to cost less than a quarter of what institutional care of such children would. There is likely to be a strong role for partnership with the third sector in this area, and in some areas it may be that partnerships between local authorities will be required to bring projects to fruition.

East Ayrshire Council Parenting Support - The Solihull Approach

The Solihull Approach has been pursued within East Ayrshire focused around 2 Nursery and Family Centres with associated professionals from Health and Social Work. 24 cross-sectoral staff (Early Years staff, Educational Psychologists, Social Workers, Health Visitors, Health Visitors CAMHS) attended the 2 day Foundation Course. The material used has focused on work with parents who have children aged 0-5 years.

The Solihull Approach is described as a highly practical way of working with parents using an integrated psychodynamic and behavioural approach for staff working with children and families who are affected by behavioural and emotional difficulties. Teamwork and collaborative working between professionals using the principles of containment, reciprocity and behaviour management help to support parents in a creative and consistent way. Development of this 'shared' approach and language has been effective in a multitude of settings from individual practice through to group settings.

A strength of developing this approach locally, is that it is not an assessment process to be used in certain circumstances to decide upon an intervention. It is a way of working and thinking which helps families to process their own emotions and anxieties which in turn restores their abilities to think and enables them to help their child cope with their emotions or anxieties. This ultimately facilitates the relationship between parent and child and supports the parent to work with their child's behaviour.

The experience of staff using this approach has been very promising with different staff expressing positive views on the practicality and usefulness within their practice.

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