1. Conception to age 2 - the age of opportunity Key Conclusions and Recommendations

2. Pregnancy Maternal stress, smoking, diet, drug, alcohol consumption in pregnancy can: –Lower IQ, create ADHD, conduct disorder –Severely impair child’s mental functioning –Adversely impact child’s health through to middle age and early death

3. Nutrition Adequate early nutrition crucial to a child’s physical and intellectual development: –Breastfeeding protective for both mother and baby –Hygiene, home safety, immunisation also important

4. Adverse Childhood Experiences Abuse, neglect, domestic violence, growing up in household with alcoholism, drug abuse can lead to: –high levels of heart, liver, lung disease –depression, suicide, poor work prospects –alcoholism, drug addiction Peak age for child abuse, neglect is 0-1

5. Mental Health Risks 144 thousand babies under 1 in UK live with parent with mental health problem Significant cross-over between mental health issues and alcohol/substance abuse

6. Primary Prevention Core message: ‘Primary Prevention’ – prevent harm BEFORE it happens. It is crucial to –intervene early to promote infant mental health –protect babies from abuse and neglect –prevent damage from poor early parent relationship

7. Primary Prevention: Three Essentials Assess and identify where help is needed Provide adequate support when needed Ensure early years workforce have requisite skills, training and supervision

8. Assess, identify where help needed Mental health risk assessment as early as possible in pregnancy –Edinburgh Post-Natal Depression Scale –Hospital Anxiety and Depression Scale –Other risk factors (domestic violence etc) Neonatal Behavioural Assessment Scale 3 weeks after birth

9. Assess, identify where help needed In addition to 6 week Health Visitor assessment: 3-4 month assessment of parent-child attunement –Parent Infant Observation Scale –KIPS –The CARE-Index Attachment assessment at 12-15 months –TAS-45

10. Provide adequate support Full implementation of Healthy Child Programme Promote attunement, secure attachment: –Video Interactive Guidance, VIPP –Watch, Wait and Wonder –Circle of Security Family Nurse Partnership

11. Provide adequate support Parent-Infant Psychotherapy –support systems such as Oxpip, Norpip 8% of pregnant women warrant a referral to specialist perinatal mental health services –these focus on restoring maternal mental/emotional health and parent-infant relationship

12. Provide adequate support High quality health-led Children’s Centres –Potential for health visitors to act as team leaders, supervisors and/or mentors High quality outreach to engage most vulnerable families Follow principles of highly successful multi-agency work –Integrated services model, Highland Region of Scotland –Local integrated partnerships, Brighton and Hove, Warwickshire, etc.

13. Early years workforce: requisite skills Health Visitors trained to evaluate mother-baby interaction (e.g.VIG), motivational interviewing All practitioners have awareness of risk factors that can jeopardise infant mental health Domestic violence - prioritise identification and support by midwives, GPs, other professionals, especially in pregnancy

14. Early years workforce: requisite skills Good understanding of pre-birth to 3 child development, attunement and attachment Emotional intelligence, skills to form empathic relationships with parents Good quality reflective supervision

15. … and finally Health and Wellbeing Boards prioritising infant mental health, wellbeing in JSNA Provide clear guidance to practitioners on importance of very good support from 0-2 Financial returns on well-designed early years’ interventions far exceed stock market returns, other public policy investments