The Power of Good Old Fashioned Care: Love, Chat and Adele

A few weeks ago Wave Trust in partnership with the DfE published its report Conception to Age 2 – The Age of Opportunity. I was part of the Special Interest Group that helped shape the report, along with an eclectic group of colleagues representing a variety of areas affecting babies – such as mental health, training, health visiting and psychology. I learned much from this group, chaired by the erudite and softly spoken George Hosking, CEO of Wave Trust. The full report is 135 pages long and a text book in its own right, but the shortened version designed for local busy commissioners is a useful summary with reference to all the relevant links.

The report makes a number of suggestions which all need discussion and probably a whole hour of Panorama. The report is wide-ranging, and examines the role of all the services that touch the lives of every pregnant woman and her subsequent baby until they are two. It is a very thorough report full of links to international research. As ever, the most shocking thing is we have many of the answers already, we just have not put them into action consistently.

The foundations for virtually every aspect of human development – physical, intellectual and emotional are laid in early childhood; what happens during these early years has lifelong effects on many aspects of health and wellbeing.

Professor Michael Marmot

To make it easy for you, I have put the key points as I understand them into an order of what we know and then what we must do. I may well add my own comments. (Ed: this has ended up what must be my longest post ever, so recommend you grab yourself a coffee and get your self comfortable!)

1. Well targeted prevention is likely to be more cost effective if each professional in the sector, from health and maternity services to nurseries and childminders, plays their part in protecting children.
2. It’s important we all share a local understanding of how early intervention operates in practice locally. Each member of the multi-agency team needs to understand their role and take responsibility for referring or providing help.
3. No matter how you measure social return on investment (and the report looked at 7 UK and 15 non UK models), all showed the economic and social benefit of well structured early intervention, especially in the Foundation Stage.
4. The report examined the consequences of abuse, and its most common triggers were unsurprisingly mental ill health, domestic violence, drug and alcohol abuse. There was a higher risk of physical abuse if fathers were misusing, and a higher risk of neglect if the mother was misusing. 1% of babies born each year are to women who are misusing opiates or crack cocaine, whilst 2-3% of children under 16 have parents who are doing so.
5. Prolonged and regular exposure to domestic violence can have a serious impact, not just with a risk of physical injury but also higher levels of distress, anxiety and anti social and criminal behaviour. Children who have been exposed to domestic violence are 158% more likely to be abused, with the risk 115% higher for boys and 229% higher for girls.
6. Poverty plays its part, since a child living in poverty at 9 months and 3 years old has a higher chance of poor behavioural learning and health outcomes by 5 years. This risk increases  two to three fold if child has an unemployed parent, and the risk of mental health problems increases three fold if children remain in poverty.
7. Recurring messages when handling babies’ cases included:
   – Shortcomings in timeliness and assessment of pre-birth assessments
   – Underestimating risks from parents own needs
   – Insufficient support for young parents
   – Marginalising the role of the father
   – Greater need of parenting support
   – Practitioners underestimating the fragility of the baby
   – Health services needing to better communicate among each other, especially in the early days when they are the most involved.
8. Everyone has a duty to make sure a child has the right environment which will support them learn and achieve to the best of their abilities.
9. At birth a child has 10 trillion synapses and by 3 years 200 trillion; this means every second a baby adds a million new synapses until they are three years old.
10. Giving children a sense of well-being and self worth stimulates brain development and their capacity to learn. Parents who develop open participative communication, problem-centred coping, non–punitive patterns of parenting and flexibility tend to manage stress well and help their families do the same. In contrast, harsh, negative and inconsistent discipline, lack of warmth or supervision and parental conflict all increase risk of emotional and behavioural problems that lead to anti-social behaviour, substance misuse and crime.
11. Maternal depression increases the risk of negative parenting and child neglect.
12. Good quality relationships and secure attachments enable the brain to be efficient and provide the basis for future self-control and cognitive development. New born babies respond to this by producing high levels of stress hormone cortisol. Good quality relationships and secure attachments enable a growing brain to become socially effective.
13. Evidence suggests that parenting behaviour and the quality of the parent-child relationship are strongly associated with children’s outcomes; loving, authoritative parenting is important for building resilience and preventing children developing behavioural problems.
14. Children begin to recognise sounds and associate them with objects and people within six months of birth. The brain translates sound into language, but to do so effectively it needs input from the social world in the form of positive and warm interaction with adults.
15. Language development at age two is strongly associated with later school success, and an early communication environment is more influential at age two than social background. The number of books available to the child, frequency of visits to the library, being read to by a parent, parents teaching a range of activities, the number of toys available and attendance at pre school are all important predictors of a two-year-old’s vocabulary.
16. This is further reinforced as children get older, and by five years those from more advantaged groups are over a year ahead in vocabulary compared to those from disadvantaged backgrounds. By the age of three an American study found that children from professional families had heard around 30 million more words than those from underprivileged backgrounds
17. Children with good early years home learning, good nursery and a more effective primary school are more likely to show improved cognitive and social outcomes compared with children who have two, one or none of these experiences.

And for those working with children in particular:

1. Managers and practitioners need to be emotionally competent.
2. Three common core areas of focus for anyone working with under 2s:
   – Core knowledge that informs all interactions with infants and toddlers
   – Core knowledge of child development from pre-birth to three years
   – An effective working knowledge of the interface with safeguarding systems
3. Practitioners should offer warm, responsive and sustained relationships with young children confirmed by visual, auditory and physical contact.
4. Continuity and consistency of primary care is important e.g. key person, as is a good understanding of attachment as it relates to a child’s key relationships and a practitioner’s own relationship with the child.
5. Speech and language is a key service especially as we can show that language development aged two is a great predictor of success later on (see above).
6. The Baby Room Project at Canterbury Christ Church University found that that practitioners working with babies felt isolated, neglected and less valued than other staff.
7. The Families in the Foundation Stage website funded by the DfE will include best practice examples of working with under 2s, with research highlights and the original Birth to Three Matters available.

What we must do:

• Retain the role of Children’s Centres in helping strengthen and improve multi-agency working.
• Strengthen the Healthy Child programme and expand health visiting and the Family Nurse Partnership.
• Continue with ECaT, that was such a great start in supporting language development, and not take our eye off the ball.
• Ensure children have a rich field of affection; stimulate talk to describe what is happening around them to describe things they can see and to think about other people. This is critical for children’s language and cognition, their general capacity to engage with new people and new situations and their ability to learn new skills.
• Move the new Two-Year-Olds review from 2 and a half to 22-24 months; much better to get an early assessment, especially when it comes to language.
• Don’t put your least trained and least qualified staff in the Baby Rooms (see Baby Room Project above; don’t let this happen).
• Develop empathetic relationships with parents; open up the pedagogical conversation.
• Use programmes like Tickle and Giggle to support more confident parenting and language in the home.
• Make sure we build Home Learning into our service, as a key mitigating factor.
• Since reflective supervision is key to delivering positive outcomes for everyone, a well-structured supervision system in the context of a clear organisational approach is a must.
• Policy makers should take this opportunity to spend money which delivers both social and economic benefits at the same time.

If all of this is too much for you, watch two year old Victoria’s rendition of Adele’s Someone Like You below. Enjoy her singing out multi syllable words with great nuance and intonation as she mimics Adele with aplomb! Then think about some of the words from Adele’s song, and finish reading this with the intention that (like the Wave Report) you also wish nothing but the best for our smallest children.