1. Health inequalities and parenting Phil Wilson GP, Battlefield, Glasgow Senior Lecturer University of Glasgow

2. Health inequalities and parenting Focus on relative economic deprivation Focus on relative economic deprivation Because we know deprivation is linked to poor health and mortality Because we know deprivation is linked to poor health and mortality Focus on child behaviour Focus on child behaviour Because we know parenting and child behaviour are inextricably linked Because we know parenting and child behaviour are inextricably linked Because child behaviour is easier to assess than parenting Because child behaviour is easier to assess than parenting Because we know child behaviour problems are linked to poor health outcomes Because we know child behaviour problems are linked to poor health outcomes Because we know measures which improve child behaviour can reduce health risks (smoking, problem alcohol/drug use etc) Because we know measures which improve child behaviour can reduce health risks (smoking, problem alcohol/drug use etc)

3. Glasgow Evaluation Principles Use of standardised tools Use of standardised tools Data should be useful for: Data should be useful for: Professional decision making Professional decision making Needs assessment Needs assessment Performance management Performance management External evaluation External evaluation

4. Universal HV contacts Pilot data - West Glasgow July-Dec 2009 13 month assessment evaluating parent- child interaction and emotional wellbeing of parent 13 month assessment evaluating parent- child interaction and emotional wellbeing of parent 30 month assessment of parenting stress, child behaviour and language development 30 month assessment of parenting stress, child behaviour and language development

5. 13 month contact Adult wellbeing scale: Adult wellbeing scale: Anxiety Anxiety Depression Depression Externally-directed irritability Externally-directed irritability Internally-directed irritability Internally-directed irritability Observational assessment of parent-child interaction* Observational assessment of parent-child interaction* “may be problems / “probably no problems” “may be problems / “probably no problems” * Wilson, Thompson, McConnachie, Puckering, Holden, Cassidy, Gillberg. Community Practitioner 2010: 83(5): 22-5

6. 13m: Adult Wellbeing Scale Good response (88%) and completion rates (77.9%) Good response (88%) and completion rates (77.9%) Scores reflect known social patterning of depression, but not anxiety Scores reflect known social patterning of depression, but not anxiety Irritability relatively uncommon. No clear relationship to deprivation Irritability relatively uncommon. No clear relationship to deprivation

11. 30 month assessment Parenting Daily Hassles Parenting Daily Hassles Richman Behaviour Checklist Richman Behaviour Checklist Language screen Language screen

14. 30-month visit - language Half the children with language delay are in “core” risk category Half the children with language delay are in “core” risk category No clear social patterning No clear social patterning n% Can your child put 2 words together?103 Does your child know 50 words?3310

15. Strengths and Difficulties Questionnaire at school entry  For all children entering primary school in Glasgow, starting in 2010  Completed by Child Development Officers as part of routine Transition Documentation  Data available on SEEMIS database and linkable to NHS and GROS data

16. The SDQ  A brief behavioural screening questionnaire for use with 3-16 year olds.  25 questions used to measure five aspects of the child’s development:  emotional symptoms  conduct problems  hyperactivity/inattention  peer relationship problems  pro-social behaviour.

17. SDQ and deprivation SIMD Quintile 12345TotalSignificance Emotional Symptoms Possible Problems 103 (6%) 15 (3%) 21 (5%) 11 (4%) 10 (3%) 160 (5%) p = 0.044 Conduct Problems Possible Problems 199 (11%) 45 (9%) 29 (7%) 20 (7%) 22 (7%) 315 (10%) p = 0.002 Hyperactivity Possible Problems 300 (17%) 73 (14%) 55 (14%) 29 (11%) 33 (11%) 490 (15%) p < 0.001 Peer Problems Possible Problems 268 (15%) 72 (14%) 51 (13%) 24 (9%) 29 (9%) 444 (14%) p = 0.001 Prosocial Possible Problems 482 (27%) 137(27%) 113 (28%) 65 (24%) 69 (23%) 866 (26%) p = 0.130 Total Difficulties Possible Problems 315 (18%) 69 (18%) 60 (15%) 31 (12%) 37 (12%) 512 (16%) p = 0.001

24. Explaining the patterns Differing respondent thresholds Differing respondent thresholds Neighbourhood effects Neighbourhood effects Variation in service provision Variation in service provision “Social drift” “Social drift” Ill health Ill health Genetic factors Genetic factors Poverty distracts attention away from the child... Poverty distracts attention away from the child...

25. What next for Glasgow? Routine 30 month check – with SDQ, language, parental mental wellbeing assessment Routine 30 month check – with SDQ, language, parental mental wellbeing assessment School-based SDQs at 7 and 10 years School-based SDQs at 7 and 10 years Linkage of health and education data: Linkage of health and education data: Will be able to plot trajectories from 2 to 10 years Will be able to plot trajectories from 2 to 10 years Identify effects of area, nursery, school, family on these trajectories Identify effects of area, nursery, school, family on these trajectories Start trials of interventions (eg for language delay, early onset conduct problems) with long term follow up Start trials of interventions (eg for language delay, early onset conduct problems) with long term follow up

26. Acknowledgements Lucy Thompson Lucy Thompson Matt Forde, Cathy Holden, and the Glasgow West CHCP Health Visitors Matt Forde, Cathy Holden, and the Glasgow West CHCP Health Visitors John Butcher, Amanda Kerr, Michele McClung, Morag Gunion and City of Glasgow Education Services John Butcher, Amanda Kerr, Michele McClung, Morag Gunion and City of Glasgow Education Services Kim Jones & Kelly Chung Kim Jones & Kelly Chung Paula Barton Paula Barton Christine Puckering and Helen Minnis Christine Puckering and Helen Minnis Claire Wilson and Alex McConnachie Claire Wilson and Alex McConnachie

27. Thank you. philip.wilson@glasgow.ac.uk