A joined-up approach to a best start in life Kim Roberts, Chief Executive

Creating the conditions for a healthy start Supportive environment – practitioner effectiveness Emotional readiness and energy for change – confidence and motivation The space and opportunity to reflect, gain knowledge and understanding – and decide how to put this into practice in own life and family

Readiness for change I sit there giving her advice and I know she’s not going to follow any of it … Health visitor describing her work with the mother of an obese 3-year old

Catalysts for change The message: a healthy start in life   The message: a healthy start in life The messenger: creating the conditions for change Early nurture and feeding Parenting skills Healthy family routines A balanced healthy diet for the whole family Active play, physical activity and sleep Emotional well-being Building relationships based on trust and respect Working in partnership Empathy Strengths-based Solution-focused support to decide on goals and how to achieve them

Building confidence and motivation for change Effective practice Qualities: Non-judgemental Partnership Modelling Skills: Relationship Empathy Strengths Raising the issue Solution-focused Knowledge: Risk factors Whole family healthy lifestyle Healthy start 2 day training Building confidence and motivation for change

Confidence in working with families e-survey up to 4 years later; n=354 85% < 12 months 91% > 12 months Very little impact Significantly improved

Changes to practice up to 4 years later Aspects of Course Regularly, Often, All the Time Value of empathy 76% (276) Key parenting skills 72% (261) Healthy nutrition 71% (256) Working in partnership 70% (250) Solution-focused support 70% (251) How emotions affect behaviour Eating patterns and habits 67% (240) Physical activity 65% (238) Brown et al, Community Practitioner 2013

Working with families Parenting Early feeding Influences, attitudes and habits Healthy nutrition for the whole family Play, activity and sleep Social and emotional wellbeing

Parenting Desire, knowledge and confidence to provide a best start Responsive and emotionally literate parenting Skills and strategies to hold boundaries Now she’s a toddler there are lots of times when I just feel out of my depth and don’t k now what to do when she says no and takes no notice  

Parenting styles and feeding styles DICTATORIAL/ AUTHORITARIAN AUTHORITATIVE UNINVOLVED/ NEGLECTFUL INDULGENT in charge responsive

Guided choices DICTATORIAL AUTHORITATIVE INDULGENT Here’s some carrot for your snack, eat up Here’s some carrot and tomato for your snack …. you choose What would you like for your snack? “Eat up your carrot.” “Here’s some carrot and some apple for you – help yourself.” “What would you like for your snack?” 11

Early feeding P8-year pare Support for breastfeeding he takes such time and gives really good practical advice and we are still breast feeding four months on and it's Support for breastfeeding Optimal bottle feeding  Starting solids to her great help.   I don't know what I would have done without such easy access to breast feeding support. P8-year pare We are still breast feeding four months on and it's very much due to the great help I got.  

Taking babies on a taste journey Window of opportunity to develop a baby’s palate Babies have an inbuilt preference for familiar tastes – as well as sweet and salty Start with vegetables Don’t be put off by some of the expressions! Repeated exposure - start to accept a new food more readily by the 4th or 5th time they try it.

Influences, attitudes and habits Responsive feeding Family mealtimes and eating habits Parental modelling Using food for non-nutritional reasons I’ve realised I need to eat with him and eat healthier foods – who else is he going to copy?

Responsive feeding

You provide, they decide

Mealtime atmosphere Sitting together with no distractions such as TV Sociable – chatting and encouraging Age-appropriate limits for behaviour Not rushing – going at their pace Parents eating and enjoying healthy food with their children

Emotional dimension of food Bribes, rewards and comfort What messages do we communicate about food? Moderation in all things including moderation Don’t stop it, swap it – non-food praise, encouragement and comfort Carrot after supermarket Naughty but nice Forbidden fruits Collective family rewards Say it with words and hugs 18

Healthy nutrition Healthy balance Child-sized portions Reducing energy dense foods and sweet drinks Increasing fruit and vegetable consumption Carrot after supermarket Naughty but nice Forbidden fruits Collective family rewards Say it with words and hugs That’s why we all came on the HENRY programme. Knowing what’s healthy and how much we should be giving them is worrying, especially when they can’t talk.   19

Healthy Families group programme 8 week programme Group or 1-to-1 Delivered by children’s centre staff 37 local authorities Experiential and interactive Popular with parents: average retention rate of 80%

Practice and policy in children’s centres Positive changes in practitioners’ lifestyles Enhanced confidence to approach and discuss lifestyle issues with families Healthier meals, snacks and portion sizes Persistent change and impact on the culture and practice of the wider team I think they’re more confident in tackling & bringing up things … I’ve noticed that people are talking about lifestyle more, and are concerned about it Willis et al, J Hum Nutr Diet 2012

Parental self-agency Dumka 1996 Willis et al, Pediatric Obesity July 2013 Willis et al, Pediatric Obesity 2014 Sure of self Doing a good job Perseverance Problem solving Mealtimes TV/computer Active play Bedtime General

Eating behaviour Golan 1998 *P<0.001 *P<0.001 *P<0.001 *P<0.001 *P<0.005 *P<0.005 *P<0.001 *P<0.001 Willis et al, Pediatric Obesity July 2013 Eating together TV off for meals Home cooked food Take away food Lower scores indicate desired behaviours

Food Frequency Questionnaire – Adults Hammond 1993 *P=0.003 *P<0.02 *P<0.02 *P=0.003 *P<0.001 *P<0.001 *P=0.005 *P=0.005 *P<0.001 *P<0.001 *P=0.007 *P=0.007 *P<0.001 *P<0.001 Willis et al, Pediatric Obesity July 2013

Changes in children’s food consumption Willis et al, Pediatric Obesity July 2013

5 a day 21% children in families starting HENRY groups eat 5 a day 44% children of parents completing HENRY programme eat 5 a day 26

HENRY in action: Bradford Better Start Multi-layered package: practitioner training Healthy Start in Childcare group programme for parents targeted 1-to-1 support peer support HENRY-employed coordinator based within Better Start and public health teams 27

Effective partnership Co-delivery with BBS and public health staff Venues and recruiting families to group and 1-to-1 programmes - 130 in first year Embedding HENRY approach across wider team – 70 practitioners trained in first year Shared learning and supervision across city 28

Parent Champions 14 trained parent volunteers Community activities to engage parents and promote healthy eating 29

Bringing it all together What children need to flourish – from pregnancy to starting school How we can work in partnership with parents so that they have the skills, knowledge and confidence – and motivation – to get babies and young children off to a great start 30

Contact us info@henry.org.uk www.henry.org.uk @HENRYhealthy 31