Parenting report - early years framework

Descriptionfinal report from the parenting task group for the early years framework
ISBN
Official Print Publication Date
Website Publication DateJuly 10, 2008

Parenting Task Group - Final Draft

1. Why Parenting?

1.1 From conception through to early childhood children are totally dependent on the care and love provided by their parents or primary carers. Young lives cannot be separated from that central relationship, for good or bad. Young children are a reflection of the world in which they develop.

1.2 As children grow, we know that the home learning environment is critical to their educational outcomes, a bigger factor than pre-school or school education. We also know that children's values and behaviour are deeply rooted in their relationship with their parents.

1.3 Parenting is a joy but it is also a struggle. Every family is unique: each has its ups and downs and there will be times in the lives of every family when it needs help. Parenting is the most difficult job that most of us will ever do, but one for which many parents do not feel adequately trained or prepared.

1.4 Even households with many advantages know the strains. How much more difficult it is to bring up small children if your partner has walked away, you are short of money, experienced makeshift parenting in your own childhood, are exposed to domestic violence, have disruptive neighbours or have few qualifications. How much more complex the challenge when you are bringing up children in place of someone else, as a kinship carer, foster parent, adopter or residential care worker. As the number of problems or risk factors grows and resilience factors diminish, the harder it is for parent and child to cope and flourish.

1.5 How we parent and the values we bring to it are dictated by social norms, and we know that norms and culture can and do change: we are not condemned to making the same mistakes or repeating bad behaviour, neglect and abuse from generation to generation.

1.6 The vast majority of parents want to do the best for their child. Sometimes they may not know what the best is or how to achieve it. This is why it is crucial that we let parents know that we understand parenting is the most important, as well as the most difficult job that they will do, and ensure that they have access to the help they need to parent well, as and when they need it.

1.7 The absolute key to improving outcomes for children in the early years is therefore to improve our individual and collective knowledge and capacity to be parents. This is not about the state taking over the role of parents, but rather supporting them in their role and making best use of family, peer and community supports.

1.8 We must do this because, as the United Nations brings to our attention, children have rights; and with these rights come parental responsibilities: article 18 of the UNCRC recognises that parents bear the primary responsibility for the upbringing and development of their children. Children do not choose their parents, have a vote or powerful lobbies advocating their interests. Our motivation may be to improve the well-being of children or create a more cohesive society or a better functioning economy. Regardless, the central message is, for the sake of the children, make sure that parents are given the maximum support possible to do the best job they can.

2. Where are we now?

The Evidence

2.1 There is now greater understanding across professionals working with children and families that very early experiences have powerful and long-lasting effects on children's development.

2.2 This starts in pregnancy, and earlier. The Chief Medical Officer's report from 2006 states that "the suggestion is that an expectant mother living in adverse circumstances will produce high levels of stress hormones which will influence the baby in a number of ways".

2.3 Research on the developing child's brain shows that synapse development is dependent on environmental stimulation. Brain structures form rapidly in infancy, and become less easy to modify over time. Before birth, exposure to high levels of the mother's stress hormones, for example as a result of domestic violence, together with over-production of the baby's stress hormones after birth, can influence a developing brain in ways which increase risk of physical and psychological disorder throughout childhood and beyond . Poor relationships with primary care-givers can lead to insecure infant attachment and a range of problems later in life. Parents who themselves face challenges are less likely to be able to offer the warm, sensitive, responsive and consistent care needed to promote the long-term emotional, social and cognitive development of their child.

2.4 We know that inequalities appear early. Young parents, those with a poor experience themselves of the care system, and people with no qualifications are more likely to become pregnant at an early age. In 2006, there were 772 pregnancies in girls under 16 (a rise of 92 from 2005) with 21 of these girls under 14. While increasing numbers of such pregnancies end in abortion, those that do decide to proceed and keep the baby are less likely to attend antenatal contacts and classes. Incidence of low birth weight are much higher in disadvantaged areas and children of younger parents and those with no qualifications are less likely to be breastfed, and more likely to suffer asthma, have accidental injuries and be subjected to tobacco smoke in the home. By age 3, there can be up to a year difference in child development with this being strongly related to deprivation.

2.5 In terms of child wellbeing, league tables compiled by UNICEF and Barnardos put the UK at the bottom of the table of similar countries.

Strengths, weaknesses, opportunities and threats

2.6 We have some significant strengths to build on, notably that we have a sexual health strategy already in place which has delivered a substantial increase in the number of sexual health services available, particularly to those who need them most. There is also universal antenatal and maternity care free at the point of delivery, a universal home visiting service and relationships/parenting education becoming part of the mainstream curriculum through the health and wellbeing strand of curriculum for excellence.

2.7 However, we face significant threats. More affluent people are having fewer children later, while at the same time there is a section of society that seems trapped in a rapidly repeating cycle of teenage pregnancy, disadvantage, poor educational attainment and lack of employment. Over a fifth of Scotland's children live in poverty, a figure which has remained unchanged for three years. There are also question marks over society's attitude to children and a consequent risk of the role of parenting becoming increasingly marginalised.

2.8 There are multiple policies and projects in place that support parents and parenting, but they are often not part of an integrated strategy or continuum of proven services. They rarely have their primary focus in infancy, which is the time of most rapid development and of most cost-effective intervention. A variety of parenting programmes are in use in various parts of Scotland, including Triple P, Mellow Parenting and Webster Stratton/Incredible Years. However, relatively few areas appear to have a coherent multi-agency approach to supporting parents from family planning through conception, pregnancy, birth and beyond. Integrated approaches to supporting parents e.g. Parent and Child Together (PACT) teams in Glasgow are starting to develop, and about half of all Scottish Local Authorities have or are developing parenting strategies. Parents' perceptions are that the universal system does not prepare them adequately for their role as parents and that there is no "middle tier" of additional support for times when those who normally cope well are under particular strain. They feel concerned about asking for help because they fear the consequences of engagement with social work.

2.9 Family and peer networks have a critical influence on parenting capacity and parenting style. There is also a wide range of professionals and practitioners who can support parents and parenting, including teachers, midwives and various other health professionals, social workers, nursery nurses etc. There is also a range of voluntary sector supports for parents through a variety of projects, including Homestart and young parents projects, but these tend to be relatively small in scale and patchy in coverage.

2.10 Hall 4 has resulted in a number of changes with an evidence-based universal programme of health checks now being carried out enabling more targeted intervention for the more vulnerable children, based on assessed need. However, there remain a number of difficult issues around making various parts of the system as effective as they could be. A key element of the revised programme depends on collaborative working between all those involved in early years work to ensure appropriate support for all parents.

2.11 There is an extensive and expensive system of care for children who need to be accommodated away from their parents. Yet we still can't say with confidence that children will be better off being looked after by the state. Their outcomes are unacceptably poor. We need to strengthen the role of corporate parents in ensuring that looked after children, including those looked after at home, get the intensity and consistency of support they need to achieve the same outcomes as their peers.

Parents and children who have particular needs

2.12 We know that some specific groups of parents face particular challenges in supporting positive outcomes for their children. These groups are:

  • Teenage parents
  • Parents who are substance misusers
  • Parents who are homeless
  • Parents with learning disabilities and learning difficulties
  • Parents who experience domestic abuse
  • Parents who have themselves been looked after
  • Parents, particularly mothers, who have significant other medical or mental health conditions
  • Mothers born in some other countries, especially asylum seekers
  • Parents with an offending history
  • Those who are parenting in place of someone else, either as kinship carers, foster parents, adopters or staff in residential services
  • Carers of other people's children

2.13 Child factors that would/may indicate a need for additional support include:

  • Evidence of maltreatment, neglect or other child protection concerns
  • Developmental concerns or disability
  • Behavioural concerns
  • Being looked after
  • Those who have suffered bereavement of a parent
  • Those who have experienced family break-up
  • Premature and very low birth weight babies, or those with significant medical conditions

2.14 These lists are not exhaustive and are not meant as a screening tool. They simply reflect where an evidence base exists as to general correlations. They are not a substitute for individualised risk assessment and the model of risk assessment being developed under GIRFEC will clearly be a major contribution to the overall aims of this paper.

3 Where do we want to get to?

3.1 Fundamentally, we want to see improved outcomes for children that are reliant to a greater or lesser extent on parental skills and capacity. We want parents to feel equipped to carry out that role and to know where to get more support when they need it and that they can do so in a way that is non-stigmatising.

3.2 Every child has the right to be planned for, prepared for and parented by adults who are aware of and responsive to their growing needs. We have a duty to support parents in developing the skills and capacities that will help them make the most of their role as parents, provide services which assist families with this responsibility and target support to those who need assistance to access those services.

3.3 Parenting is important primarily in terms of the benefits for children. In that regard, we should promote the rights of parents in order to support improved outcomes for children, but the enforcement of parental rights must not be allowed to be used to cause detriment to children.

3.4 We must keep the responsibility for parenting with parents as far as possible, with public services playing a positive and supportive role, helping parents understand how they can support their children's development and resilience. We should see early years as a golden moment within which we must maximise possibilities and where parents can play a critical role in setting children off on a trajectory where they can achieve positive outcomes for themselves, which they can sustain throughout their lives. It is a golden moment because pregnancy, particularly first pregnancy, is a life changing experience. This is a time when a mother and father are more ready to listen, driven by a desire to give their child a better life than they have had and we need to make the most of this, enabling parents to reach out and ask for help as and when they need it.

3.5 Where the child's rights and welfare are at risk, public services must intervene effectively to protect the rights of the child and stop risk becoming harm. While we would aim to strengthen family planning and build parenting and family capacity in such a way that the need for children to be looked after reduces, we must not shy away from difficult decisions and we must be clear that a child has a right to be loved, cared for and nurtured in a home setting and that in some cases a child's interests are best served by being looked after away from their parents. Removal from parental care where parenting capacity is not going to improve needs to be within timeframes that meet the needs of the child, and there is evidence that removal from maltreating environments before one year of age is associated with the best outcomes, although there are opportunities for intervention and treatment for children removed after this stage. We must be confident that the provision we provide in the place of birth parents is at least an improvement, and ideally able to support the child to overcome multiple disadvantage to achieve outcomes as good as its peers.

Principles and Values

3.6 Over time, we want to embed a shared set of values for parenting and early years. The principles and values outlined in Getting it Right for Every Child are relevant to all professionals involved with children and families. The full list of GIRFEC values and principles extends to 14 items and all are relevant in one form or another. The full list is attached at Annex A but the following are particularly significant and relevant to early years and supporting parents. In some cases, these need to be read broadly in order to encompass the pre-birth phase.

· Holistic approach and early intervention: Whatever your professional role, try to consider the whole child. Although your involvement with a child may be short-term, as far as may be appropriate in each case, do consider the child's needs for longer term support.

· Partnership with families: Recognise how parents, family members and those in the child's network, are (or may with help become) the most significant contributors to meeting a child's needs in most situations. In many circumstances they can lead the plan of action. Listen to those who know the child well, have a sharp sense of what the child needs, of what works well for the child in his/her family and of what may not be helpful.

· Bringing help together: Play your part in ensuring that children and families experience a co-ordinated and unified approach when several professionals are involved. Try to ensure that families are not subjected to stressful repetition of information, avoidable delay, or to assessments without a plan of action to help.

· Supporting informed choice: Support children and families in understanding what help is possible and what their choices may be.

· Values across all working relationships: Recognise that respect, patience, honesty, reliability, resilience and integrity are qualities valued by children, families and colleagues. Be sensitive to the impact of the work upon other professionals. Beside the well-being of children and families, consider the well-being of colleagues and value their support.

Good Enough Parents

3.7 The formula of love, care and stimulation works for each child. But we also know the wisdom of the African saying, "It takes a village to bring up a child" highlighting that the community dimension is also important. Our endeavours are to bring up each child in the right circumstances and all children in the right environments. New norms on parenting are needed.

3.8 We need to start from a point of understanding what is a good enough parent. Fifty years ago the analyst and parenting expert Donald Winnicott first documented his idea of the 'good-enough mother'; the mother who wasn't perfect and was free, to some extent, to fail. His writings were revolutionary because he argued that failing was in fact a necessary part of parenting, and through the failure of the parent the child realises the limits of its own power and the reality of an imperfect world. His concept of 'good enough parenting' was used by social workers for many years as a baseline for assessing and working with parents.


3.9 There are now many definitions and criteria for what constitutes parenting. Most conceptions of parenting take account of the care children directed at their physical needs as well as social and emotional ones. Most parents care deeply about 'doing a good job' and there seems to be a consensus that it is one of the most difficult jobs that exists. This, however, is where the consensus on parenting ends and there are very many views on what constitutes a good or good enough parent. However, the following have been identified by many authors as common requirements of parenting for all children in all cultures:

  • Basic physical care
  • Love and affection
  • Security
  • Stimulation and encouragement
  • Guidance and boundary control
  • Age- appropriate responsibility
  • Age appropriate independence
  • Predictability of key routines

3.10 The GIRFEC My World triangle (see Annex A) reflects these competencies, turning them round to be from the child's perspective.

3.11 The age and stage of the child require different approaches to parenting with protection and nurturing being central for babies and small children and allowing independence and exploring as key parenting behaviours in respect of teenagers.

3.12 Of course, the concept of good enough parenting can be seen as lacking ambition. We want all parents to perform their role to the best of their ability and to aspire to being more than "good enough". However, it is a useful concept in helping to know where to start in supporting the development of parenting and family capacity. It can also be used to set benchmarks so that appropriate support is provided or interventions made where parents are struggling.

Outcomes and Indicators

3.13 Some key outcomes that are linked to the quality of parenting and parental support include:

  • Reducing frequency of premature births
  • Reducing incidence of low birth weight babies
  • Improving child mental health and behaviour measures
  • Reducing the gap in development at age 3 and attainment at all ages

These are early stage outcomes. In the longer term, we want to see early years contributing to improved educational attainment and reduced number of children leaving school with no qualifications; reduced incidence of smoking, drug and alcohol use; improved employability; improved health and reduced health inequalities; lower suicide rates amongst young people; reduced crime and violence; and stronger communities. Many of these are captured within the existing National Performance Framework.

3.14 In order to make progress on the outcomes we need to improve a number of other indicators, notably:

  • Reducing incidence of vulnerable pregnancies
  • Increase rates of breastfeeding
  • Reduce rates of mother and father risk behaviours, particularly smoking, drug and alcohol use
  • Earlier and increased engagement with antenatal contacts and classes, particularly by parents assessed as vulnerable or at risk
  • Reducing the number of babies who meet the criteria for child protection registration (although it is possible this may increase in the short term)
  • Availability of help when it is needed for those babies who may be referred to the children's reporter on the grounds of welfare
  • Increased involvement in pro-social activities
  • Improvements in parental skills (if this can be measured)

3.15 Care is needed in interpreting indicators. Some parents who have mental health problems, difficulties in their own attachment histories or who are using drugs or alcohol can struggle to maintain adequate focus on the child's communications, while others manage despite these stresses. For example, a parent using drugs with an out-of-control lifestyle would be unable to provide consistent interaction with a young child whereas the same parent, stable on a methadone maintenance programme, may be capable of providing the kind of attuned parenting that children need. Similarly, some women with postnatal depression are able to continue to communicate effectively with their baby, whereas others are overwhelmed. There is now a solid body of research evidence demonstrating that these differences can be reliably identified. Areas which we know less about include the effects of domestic violence, learning disabilities and poverty. The upshot is that while indicators can be important, they are not a substitute for a better approach to measuring actual outcomes.

3.16 More broadly, issues of poor housing, unemployment, debt, discrimination and other forms of exclusion can add to parental stresses and make it more difficult for them to provide the quality of interaction that will support positive development. There are therefore a wider set of indicators related to the stresses on parents that have relevance to outcomes for children.

3.17 Reducing inequalities should be at the heart of the service philosophy across all services that have an impact on outcomes for children. Therefore, while we would want to see absolute improvements in outcomes and indicators, we also want to see the relative position of those facing greatest disadvantage improve.

Basis of Change

3.18 Projects and pilots may be useful but the main thing we need to do is align mainstream budgets, resources and priorities to an agreed set of priorities. This is not about new nationally imposed targets, but about a focus on outcomes and the key indicators that we know are central to delivering those.

3.19 We want to see a more coherent approach to parenting support on the ground that provides a continuum of support from pre-conception through antenatal care, post-natal support and onwards through a child's life.

3.20 We want to see a staged intervention approach that is firmly embedded within universal services but which provides effective assessment of needs and risks and pathways to more targeted support for those who need it. There needs to be a strong emphasis on targeted support being delivered in a non-stigmatising way. Staff involved in the delivery of mainstream services need to be able to recognise when additional support is needed and who is best placed to provide that support.

3.21 We want to see a less fragmented and more coherent service landscape. At the moment, some families have to deal with a large number of professionals and the relationships which should be the foundation of capacity building do not have a chance to develop. In the medium term, we need to look at how to change roles and functions so that parents, particularly those who need or want more support deal with a few highly qualified people who can meet a range of needs.

4 What we need to do to get there?

Valuing Parenting

4.1 We need to change the public perception of parenting and move from blaming parents when things to wrong to supporting them within families and communities to do the best for their children. We need to achieve a recognition in society that supporting parents is an investment in better communities and better quality of life for the future. We also need prospective parents to recognise that part of the responsibility they are taking on involves them being active participants in developing their own skills and using family, community and service supports available to do so. Ideally, we want a culture where there is a recognition of the scale of responsibility and challenge that parenting involves and where prospective parents make a realistic self-evaluation of their readiness to become parents and take appropriate action with regard to family planning and the development of parenting skills.

4.2 We need every service interacting with adults, particularly vulnerable adults, to consider them as potential or actual parents. We need to take parenting seriously, as the greatest challenge we face individually and collectively.

4.3 We need to identify levers to raise the status of and commitment to parenting. This could include working with employers to support take-up of maternity and paternity leave and options for flexible working; linking enhanced financial or leave entitlements to participation in antenatal classes or services; working with the UK government to strengthen benefit/tax credit/child trust fund entitlement for target groups, where appropriate linking that to participation in services; testing new models to incentivise target groups to delay pregnancy or participate in services.

Establishing Common Principles and Values

4.4 Training and CPD for all professionals should promote and be based on common principles and values as set out above.

Preventing Vulnerable Pregnancies

4.5 We need to follow through effectively on a number of existing priorities within the sexual health strategy, particularly those around signposting and increasing access to services in areas of deprivation that are based on a model of brief interventions. Sexual health services and pre-conception counselling need to be integrated with community services for high risk groups and specific services are needed which can engage young people with sexual health advice. These include the school health service, youth services and services for Looked After children. We need to continue to advocate the use of long-acting reversible contraception for those who are at highest risk of unintended teenage pregnancy although the decision on this must continue to lie with the individual.

4.6 Curriculum for Excellence provides a key opportunity to improve the way that parenting and relationship education is delivered in schools, and it is important that this opportunity is maximised. Equally, we must ensure that the most vulnerable children including those not in school, young offenders and LAAC are prioritised for one to one support. Schools also have an important role in giving children an education more generally as lack of qualifications in the mother is strongly correlated with poor outcomes for children. Young women who become pregnant should therefore be supported to continue their education in a supportive way ( ref Wester Hailes Education Centre model), and schools should strengthen their role in adult/community education.

4.7 We need to understand more about motivations for pregnancy, particularly amongst higher risk groups and to develop effective social marketing and support strategies to try to influence positive choices.

4.8 There is a need for better psycho-social support for parents who have suffered loss or miscarriage and who may go on to have further pregnancies as post-traumatic stress can have a significant negative impact on the mother-infant relationship. This needs to be identified early in pregnancy with appropriate treatment or referral.

A capacity-building model based on evidence

4.9 Our approach must be built around building the capacity of parents and communities to offer the high quality environment and interaction that will promote development and positive outcomes.

4.10 All services that work with families in the early years - antenatal, post-natal, childcare, pre-school and school services - must be oriented to work within such a model. These services need to have development of parental skills and a supportive home environment as a key objective alongside their health and education functions. Community development is equally important in delivering the right environment for children to grow up in.

4.11 The Platforms model developed by Oberklaid provides a useful model for bringing together service, workforce and community elements of a capacity-building approach. It sets aims of improved access to service for families; improved co-ordination of services; improved professional practice; and earlier response to family concerns and identification of child and family issues. These then translate into delivery components of community preparation, early detection of problems and risk factors, evidence-based interventions and community self-assessment. [There is a diagram and fuller description available]

4.12 The parental capacity building approach must be based on evidence of what works. Parenting support and intervention programmes based on social learning theory should be at the heart of what is delivered. If the costs and logistics of universal provision are prohibitive, interventions should be targeted at high risk groups. Suitable programmes include Tripe P, Mellow Parenting and Incredible Years. While these existing evidence-based programmes must be the starting point, we must accept that the evidence base not always complete or simple to transfer to a Scottish context where it is based on US research. Once an evidence-based approach is embedded, we should therefore be prepared to innovate and try out new models that have a good basis in theory and practice and which would add to the knowledge base of what works in a Scottish context.

A continuum of support based on risk assessment and staged intervention

4.13 There should be a continuum of family support available from pre-conception all the way through to primary school at a level dependent on need, based on a staged intervention approach as set out at Annex B. All agencies need to be clear about their role and those roles are likely to have to evolve in order to deliver a coherent approach. The three tiers are not distinct levels as such and should be seen more as points on a continuum.

4.14 Risk assessment is absolutely central to the staged intervention approach. We need a common framework of risk assessment, to be clear about the key points at which risk assessment is needed, who is responsible for carrying out that risk assessment and make sure that those people have the right skills to carry it out effectively. Services then need to be in place to meet the differing needs identified. This is likely to mean ensuring the pattern of service delivery is more concentrated in areas where there are larger numbers of parents and children with higher needs.

4.15 Programme fidelity is another key ingredient. While many existing programmes have been designed around evidence of what works, the key ingredients to success, namely the intensity of the home visiting and the nature of the methods adopted i.e. in-home social modelling, may be the element most likely to be 'watered down' as programmes are rolled-out.

Building Service Capacity

4.16 The staged intervention model above implies a strengthened universal service, a much more effective "middle tier" of support that is fully integrated with universal services and better access to intensive holistic services for those who need it. Delivering the staged intervention model implies a need for increased capacity in antenatal and post-natal services. However, this does not necessarily mean more midwives and health visitors, but probably more likely an integrated cadre of family care workers who can provide a wide range of enhanced non-stigmatising support to families who need it. The voluntary sector has particular skills in delivering family support in a holistic and engaging way and there is likely to be an enhanced role for partnership between health and voluntary sectors.

4.17 More consistent access to intensive family support services that provide a holistic service to families should be a priority. There are several models that could be considered, based on intensive, structured interventions such as Functional Family Therapy and Multi-systemic Therapy or the Dundee Families Project model. These may be costly and resource intensive, but in addition to the positive impact on outcomes for at risk children and families, they are likely to cost less than a quarter of what institutional care of such children would. Again, there is likely to be a strong role for partnership with the voluntary sector in this area.

4.18 We believe all front-line staff should have an awareness of literacy, numeracy and communication. All front line staff should understand how people acquire (or not) literacy and numeracy skills and how this impacts on all aspects of people's lives. Every childcare venue should have some involvement with adult literacy skills training so that they can support inter-generational learning and reach into the home learning environment.

4.19 The formal care system needs to be equipped to work with the right children, at the right time, and in the right ways to transform their life experiences. This means strengthening risk assessment, planning for permanence, range and quality of care, capacity of workforce (in the broadest sense, spanning from kinship carers through to adopters), through-care and aftercare.

4.20 Front line practitioners need to have access to up to date information about research and the evolving body of knowledge on sexual, child, mental and maternal health. This needs to be linked to training and CPD.

Moving from joint planning to integrated delivery

4.21 Although joint planning has developed in recent years, joint delivery is still very immature in many areas. Every local area should have a clear joint structure within which early years services operate, such as the Glasgow PACT model. This should encompass antenatal, post-natal , family support, education, social work and other related services, and link to relevant adult services such as sexual health, housing, addiction services etc. An organisational development approach is needed to support such joint working, and the logical conclusion in some areas may be the creation of joint budgets and eventually a single early years service in some areas. However, we do not want to make this a requirement as we believe it could result in attention and resources being diverted away from improving support to families.

Performance Management and Accountability

4.22 We need to use single outcome agreements and local delivery plans to make sure that services are joined up on the ground. If parenting and early years is to come to the fore within this new environment, we need to consistently push the contribution that we know these can make to the 15 national outcomes, as well as being clear about how we can measure intermediate outcomes from early years policies. The current national indicators are inadequate to measure whether children are getting the best start in life and we need to adjust these or supplement them if we are to achieve a renewed focus on early years and early intervention within SOAs. Section 7 above sets out some outcomes and indicators that should be considered. While local planning structures will vary, it is important that parenting and early years is at the core of multi-agency planning for children and communities and that it has at least parity of esteem with other services.

4.23 In a similar vein, we also need to ensure these outcomes and indicators are reflected in other incentive and accountability structures e.g. primary care contracts, HEAT targets, local authority inspections, HMIE/Care Commission inspections etc.

Not just mothers

4.24 Services should develop a specific focus on the inclusion of fathers at each stage. In some cases, engagement of fathers poses a particular issue e.g. where parents are separated, where there is domestic violence or where the father is otherwise seen as a negative influence. However, in many ways the engagement of fathers where these circumstances prevail can be even more important and services need to develop strategies for doing so in ways that are engaging and which respect the position of the mother.

Life beyond Early Years

4.25 Parenting support should continue throughout children's development stages into adulthood, with a focus on households and communities with more risk factors and fewer protective factors.

5 How do we need to do it?

There are several key areas that emerge:

Developing a "Parenting Culture" at societal, community, family and individual level

  • At societal level, an increased awareness of the role of parents in securing positive outcomes for society in future
  • At community level, an increased willingness to support parents with young children to achieve better outcomes
  • At family level, a willingness to promote and support positive parenting
  • At individual level, an ability to evaluate whether we are ready to become parents and what we should do to manage fertility, and taking responsibility for developing the skills needed to be at least a "good enough" parent
  • Trying out more radical ideas to incentivise parents, particularly vulnerable parents, to engage with services
  • Looking for opportunities for parents to spend more time with their children in the very early stages of life, and embedding this within employment, benefits and other systems

Embedding common values and service philosophy across early years, promoting children's well-being through supporting their parents.

This needs to become a core part of initial training and CPD for a wide range of professionals and practitioners working with children and families

A continuum of support from pre-conception through pregnancy, birth, post natal and onwards

Based around:

· a staged intervention model

· a capacity-building approach

· using family, peer and community supports to build capacity more effectively and efficiently

· more capacity within universal services to deliver a core capacity-building programme

· common risk/needs assessment approaches across services

· A more effective "middle tier" of support that is fully integrated into universal services

· Holistic approaches to additional and intensive support where needed

· linkage across life stages

Enhanced joint planning and delivery models

Able to identify key contributions of each agency which when put together creates a bigger impact but also able to identify when agencies are best to get on with delivering their own services. In the process of enhancing the role of early years and early intervention within community Planning/integrated children's services planning, the following questions are crucial

  • Is the strategy the outcome of multi-agency work?
  • Is there a shared set of outcomes and indicators for all children and for children in their early years that apply across all services
  • Is there a clear accountability structure to accompany this?
  • Are basic levels of need in the local area known/ been measured, and are they taken into account by the strategy?
  • Does the strategy take into account different levels of need that families might have, target services towards these needs, and explain how the services are delivered?
  • Does the strategy provide for support that is suited to the age and developmental stage of children, and take into account different needs within these stages?
  • Does the strategy clearly set out what each service can do, who they can do it for and what it hopes to achieve with families, including follow-up work once they have left the service?
  • Does the strategy acknowledge any gaps in the provision of services and how these will be managed over time?
  • Does the strategy set out criteria for the use of compulsory measures, such as supervision or Parenting Orders?

Delivering successful prevention and intervention, underpinned by common success factors.

  • a strong theory base, clearly stated aims, and programme integrity. Delivery by sufficiently trained and skilled staff
  • attention to engaging families and sustaining engagement .
  • tailoring of service and response to the individual needs of parents and families
  • integration of service approaches
  • holistic approach to a family's needs,
  • multiple 'routes in' to services to ensure accessibility
  • planning of exit strategies to support high risk families withdrawing from specialist services and rejoining mainstream support
  • a continuum of support - a strategic response to need according to stages of child development and risk

Development and dissemination of the knowledge base

  • A structure which continually evaluates the developing knowledge base on parenting and early years internationally and in Scotland
  • Which uses this to inform planning at the local level
  • Which is used to inform training and development of staff
  • Valuing innovation and being prepared to try new approaches in a Scottish context

6 Who needs to do what to ensure delivery?

The key actions we have identified are as follows:

  • The Scottish Government should develop a national programme promoting the value of parenting with aspects aimed at a societal level as well as at individual, family and community level.
  • The Scottish Government and COSLA, in partnership with the NHS and the voluntary sector, to develop a set of intermediate outcomes and indicators for early years. The purpose of these would be to measure progress towards giving children the best start in life and other national outcomes within the context of single outcome agreements.
  • Every local community planning partnership to conduct an audit of existing family support services to check how and whether they are contributing to the outcomes identified; compliance with the success factors set out in section 12; and to provide a baseline for constructing a comprehensive staged intervention model. Where possible, this should include a significant degree of independent evaluation.
  • All partners should seek to agree on a model for integrating community, services and workforce components at the local level, using the Oberklaid Platforms model as a starting point.
  • Every local community planning partnership to develop an integrated staged intervention model appropriate to local needs that stretches from pre-conception up to school age, based on the principles set out in previous sections. This will involve development of an enhanced universal set of supports; a much more effective middle tier of support integrated into universal services; development of holistic, intensive family support services for those that need them that are accessible across Scotland; and clear links to adult services that have an impact on outcomes for children. The staged intervention model should incorporate family and community support/development and not just public service delivery.
  • The Scottish Government and other partners should set up a national structure to establish, develop and disseminate effective practice in family support in early years. This should promote innovation and extension of the knowledge base in a Scottish context.

There are also a number of supporting and enabling recommendations which we believe are important:

  • More research is needed on motivations for pregnancy, particularly amongst those groups where there is a correlation with poor outcomes for children.
  • Local authorities should enhance the role that nurseries and schools play in supporting family learning through making all of them "family learning environments". This could involve enhanced parental involvement in nursery through parent helper rotas; giving nursery and primary staff more of a role in supporting parental skills development; providing outreach and other support where appropriate to enhance the home learning environment and having clear links to adult literacy and numeracy programmes.
  • Antenatal, post-natal and education services should place a much greater emphasis on the involvement of fathers, although there also need to be occasions where mothers can discuss important matters in private with relevant professionals. Invitations to antenatal classes should be sent jointly to both parents.
  • Initial training and CPD for all front line practitioners working with children and families in early years should promote and be based on common values and principles. It should also contain a strong element on early communication, literacy and numeracy development from birth onwards and strategies for building the capacity of children and parents in these areas.
  • The Scottish Government should investigate how incentives can be provided for parents with higher needs to develop their parenting skills and to engage with the supports that are available.
  • The Scottish Government should engage with Whitehall to pursue developments in maternity pay, flexible working entitlement and benefits entitlements that would support parents to spend more quality time with their children in the first year of life in particular.
  • There should be regular, independent evaluation of progress towards the outcomes that have been established at local and national level.

7 What are the resource implications?

The main areas of out recommendations that would have resource implications are as follows.

  • Increased capacity in antenatal and post-natal services to deliver enhanced universal and additional elements of staged intervention model

It is very difficult to quantify the scale of this at this stage but the feeling is that the main growth would be within community teams. However, there are different models that could be adopted and these would involve different skill and professional mix.

  • Intensive family support services

Some unit costs for particular types of intensive family support service are available and can be worked up into detailed costings in quite a short timescale.

  • Enhancing the role of nurseries and schools in family learning

It would be difficult to do this without increasing capacity to some extent. Even small increases in capacity would be very expensive. Pre-school investment is of the order of £200m per annum and school education for 5-8 year olds considerably higher. However, capacity in early primary is already being increased as a result of class size reductions so additional costs might not be huge. Capacity in the pre-school sector could perhaps be enhanced by developing staff skills and linking effectively with community education resources.

At this stage , we anticipate that costs associated with the proposals around improving the value we place on parenting would be small in comparison to the above.

A guesstimate of the rough order of magnitude of costs for the short to medium term in implementing these proposals is a few tens of millions per annum.

8 How will these resources be secured?

Existing spend on antenatal, post-natal, surestart, education and social work services is very significant, of the order of several hundred million pounds. Within this, there is likely to be some scope for reprioritisation in the short term but this may be limited.

Over time, there needs to be a transfer of resources from areas that make less of a direct contribution to outcomes, and the aim would be to establish a virtuous cycle whereby better focusing resources reduces pressure on crisis intervention services, releasing funds for progressively greater investment in the areas identified as priorities above. This would take several years to get moving and the degree to which cash-releasing savings can be identified and transferred is very uncertain.

Some degree of pump-priming resource to try to get a virtuous cycle moving would have some advantages. It would allow more targeted investment in a shorter timescale in the areas that are most likely to produce cash-releasing savings from crisis intervention services.

Annex A

GIRFEC Principles & Values:

1 Child at the centre: The experience and needs of each child are central considerations for all services, especially pre-birth and at those stages when it is difficult or impossible for them to express their view. Involve children in decisions about their lives in ways and at a pace which suits the child, their age, stage and circumstances.

2 Holistic approach and early intervention: Whatever your professional role, try to consider the whole child. Although your involvement with a child may be short-term, as far as may be appropriate in each case, do consider the child's needs for longer term support.

3 Confidentiality and information sharing: Respect the right to confidentiality for children, and for families, while recognising that the duty to safeguard children comes first.

4 Safety: Recognise each child's right to be safe. Being safe and feeling safe are fundamental aspects of well-being. If concerned about risk to a child, be alert to the implications for other, perhaps equally vulnerable children in the situation.

5 Promoting opportunities and valuing diversity: Actively promote opportunities for children who face discrimination and extra barriers. Respond positively and creatively to diversity among children and families, and colleagues.

6 Partnership with families: Recognise how parents, family members and those in the child's network, are (or may with help become) the most significant contributors to meeting a child's needs in most situations. In many circumstances they can lead the plan of action. Listen to those who know the child well, have a sharp sense of what the child needs, of what works well for the child in his/her family and of what may not be helpful.

7 Building on strengths: Work to engage the strengths and resources within the family network in plans to address needs and risks for the child (as far as this is safe and achievable).

8 Bringing help to the child: If you can play a part in a plan of help, consider how help can be brought to the child rather than automatically passing on information and responsibility.

9 Bringing help together: Play your part in ensuring that children and families experience a co-ordinated and unified approach when several professionals are involved. Try to ensure that families are not subjected to stressful repetition of information, avoidable delay, or to assessments without a plan of action to help.

10 Supporting informed choice: Support children and families in understanding what help is possible and what their choices may be.

11 Teamwork between professionals and agencies: Respect the contribution and expertise of other professionals; and co-operate with them to meet the needs of children, as far as may be appropriate for your role and context. For example this may be through consultation, sharing information, shared assessment, planning, action, or material support.

12 Professional boundaries and standards: Recognise that sharing responsibility between agencies does not mean acting beyond our competence or responsibilities. Take action if safety or standards are compromised, whether that means alerting your own manager/employer or another appropriate authority.

13 Individual development: Commit to professional learning and development. This may be through training, supervision, teamwork, or application of research evidence. Commit to improvement upon inter-professional practice in work with children and families

14 Values across all working relationships: Recognise that respect, patience, honesty, reliability, resilience and integrity are qualities valued by children, families and colleagues. Be sensitive to the impact of the work upon other professionals. Beside the well-being of children and families, consider the well-being of colleagues and value their support.

Core components

1 A focus on improving outcomes for children, young people and their families based on a shared understanding of the indicators of well-being

2 An integral role for children, young people and families in assessment, planning and intervention

3 Making the most of universal health and education services to address concerns at the earliest possible time

4 A common approach to gaining consent and to sharing information where appropriate

5 A co-ordinated and unified approach to identifying concerns, actions and outcomes-based indicators of well-being.( A generic risk assessment and practice model is being tested.)

6 Streamlined planning, assessment and decision-making processes that lead to the right help at the right time for children

7 Where more than one agency needs to be involved, consistent high standards of co-operation, joint working and communication across Scotland,

8 A confident and competent workforce

9 A lead professional to co-ordinate and monitor multi-agency activity where necessary

10 The capacity to share demographic, assessment, planning and information electronically within and across agency boundaries through the national eCare programme where appropriate

Annex B

An initial model of staged intervention

The starting point for the initial model below was the Department of Health Child Health Promotion Programme, although it has been added to and adapted for these purposes.

It is important to remember that a staged intervention model does not mean that children or parents should have to go through mainstream programmes before receiving additional support. Rather, it is about there being a universal gateway and early risk identification so that children and families move directly into the level of support that is most appropriate to their needs. There is no point, for example, in giving the parents of an autistic child a mainstream parenting intervention first if what would deliver most benefit is early access to an intensive specialised programme.

Where intensive targeted support is needed, consideration needs to be given to the benefits of also maintaining the child/family's involvement with universal services so that they have social contact with their peers and feel part of mainstream society, with support as required. For many children and families accessing additional or intensive levels of support, the aim will be to build capacity so that they can move towards the universal level over time. However, for some children and families, long term ongoing intensive support will be needed.

Universal

Additional

Intensive

Pre-Conception

Increasing attainment in education

Parenting education within Curriculum for Excellence

Developing life skills that help young people make positive choices within Curriculum for Excellence

Pre-conception counselling for:

- Parents with physical and mental health problems

- Parents with alcohol and drug problems

- Women with medical conditions, eg Diabetes, epilepsy, congenital heart disease, bi-polar depression

Sexual health services integrated into drug, alcohol and social work services for key target groups

Targeted training for those caring for looked-after children and young people not engaged in school.

Early Pregnancy

Promotion of health and wellbeing

Full health and social assessment by 12 weeks

Advice on healthy lifestyle including diet, weight control, physical activity smoking, stress and alcohol intake

Preparation for parenthood

Nutrition and breastfeeding

Involvement of fathers

Enhanced one to one support where there are additional concerns

Treatment/support for anxiety and depression where appropriate

Smoking cessation support where applicable

Weight control advice/activities where appropriate

Enhanced breastfeeding support

Intensive evidence-based support programmes for at-risk first-time mothers

Intensive support for parents with learning disabilities and difficulties

Specialist support for substance abuse where appropriate

Information, support and guidance for those experiencing domestic violence

Specialist support for serious mental illness

Early planning for cases which may result in the child being taken into care at birth

Late Pregnancy

As above plus:

Ongoing identification of families in need of additional support

Antenatal review for prospective mother and father with the child health team

Emotional preparation for birth

Early parental capacity building programme

Access to financial advice

As above

Enhanced early parental capacity building programme

As above

Intensive parental capacity building programme within an multi-agency package of support

Birth to 4 weeks

Infant feeding support

Health promotion and protection screening: Maintaining infant health; birth experiences, promoting sensitive parenting, hearing screening, SIDS

Screening requirements at 5 to 8 days

Health protection immunisation

Childcare advice

Financial advice

Specialist medical and social support for babies with developmental problems or disabilities

Support for families in conflict

Enhanced promotion of sensitive parenting

Enhanced infant feeding and children at risk of obesity

Smoking cessation/protection from tobacco smoke

Enhanced SIDS support

Enhanced financial advice on entitlement for benefits etc

Intensive support for at-risk first time mothers

Specialist programmes for parents with learning difficulties, substance misuse, domestic violence, serious mental illness

Up to 3 years

Core parent capacity building programme

Immunisations

Weaning and feeding advice

Sleeping, behaviour, toilet training advice

Attachment

Enhanced parenting programme

Enhanced one to one support/outreach

Intensive multi-agency family support service matched to family's needs

Intensive outreach service, including from centres such as nurseries, family centres.

Respite care

3 years onwards

Core family support within pre-school and school environment

Enhanced family learning and outreach support linked to pre-school and school

Intensive multi-agency family support service matched to family's needs

Respite care