1. Child health – reducing the risk factors and promoting the protective factors Linda de Caestecker Director of Public Health NHS Greater Glasgow and Clyde

2. Infant Mortality Rates Scotland, 1974-2006 Rate per 1,000 Live Births (Source: GROS )

3. Number of Deaths in Children under 1 Year by Scottish Index of Multiple Deprivation Scotland, 2006 (Source: GROS & ISD Scotland)

5. Reducing Risks and Enhancing Protection Critical periods for child health – pregnancy, pre-school (0-3) Modifiable risk factors Smoking in pregnancy, nutrition, obesity Postnatal depression Substance misuse Modifiable protective factors Parenting skills, parental self-efficacy Stimulation – emotional, cognitive, language Health related e.g. nutrition, immunisation

6. Smoking Smoking in pregnancy – variations in recording and sensitive enquiry. Routine CO monitoring being implemented. Protecting children from second-hand smoke Legislation has not led to more smoking at home Smokefree homes initiative Training of professionals

8. Family risk factors Poor parenting, family conflict, lack of a warm positive relationship with parents, insecure attachments, harsh inflexible rigid or inconsistent discipline practices, inadequate supervision or involvement with children

9. Lead to risk of…… Major behavioural and emotional problems Substance misuse Antisocial behaviour Juvenile crime

10. In contrast… Supportive family relationships… Predict positive adjustment and Protect against conduct problems

11. The need for parent education Parenting interventions are amongst the most powerful and cost-effective tools available to prevent and treat serious behavioural and emotional problems in children. The majority of parents do not participate in parent education. Parenting Survey (2007) showed over 40% had not had any support with parenting and 77% would consider parenting support if available

12. Triple P, positive parenting programme Multi-level, prevention orientated parenting and family support strategy Studies conducted on each intervention level and delivery format with consistent results Effect sizes large for improved child behaviour Independent replication trials in other countries

13. A population based approach to large-scale implementation of positive parenting programme Establish base rates for Child Problems and Modifiable Parental Risk and Protective Factors; Interventions have evidence of effectiveness, are culturally appropriate and widely available; Practitioner training and support; A multi-disciplinary workforce Consistent implementation and programme fidelity

14. Population based approach An Effective Engagement strategy Informed by a theory of inequality Enable parents to identify their own parenting objectives so that they are dynamic participants and go at their pace Variants that are tailored to the requirements of high-need groups Use Community Surveillance Monitoring to track Population-Level Outcomes

15. Universal interventions for under-3s Public awareness campaigns using the media more effectively Web resources: –Baby clubs –Netmums Bookstart Open access large group classes

16. Interventions The Solihull approach Use of evidence based parenting programmes - Triple P, Mellow Parenting Coordination of parenting activity at CHP level

17. Take home messages Addressing the risk and protective factors for good health must be a multi-agency response We need a population level approach to parenting support.