A preventive approach to creating a large scale step

Reducing Child Maltreatment in Pioneer
A preventive approach to creating a large scale step
reduction in levels of child abuse, neglect and children
witnessing domestic violence
George Hosking, CEO, WAVE Trust
Peter Kelly, DPH, Stockton-On-Tees Borough Council
National Children and Adult Services Conference 2014
Thursday 30th October, Manchester Central
Short introduction to WAVE Trust
Economic Case for Prevention
Our 70/30 Campaign
The Problem
The Solution
Disorganised Attachment
The Pioneer Community Approach
How to become involved
– Advisory Boards, Pioneer Community
WAVE Trust
• Violence and what to do about it (2005)
• International experience of early intervention for children,
young people and families (2010)
• Conception to age 2 – the age of opportunity (2013)
• 1001 Critical Days Manifesto (2013)
• Prevention in Practice (2014)
Economic case for prevention
• Stopped many of the services that do firefighting
• Worked really hard to identify earliest signs of a problem
• As early as possible, intervened or supported families to keep
their children in the community
• 500 fewer children in care system than 3 years ago
• Saved £30m from children in care
• Invested £10m of that into early support and early intervention
Economic case for prevention
• Strong preventive element for social workers, health visitors, drug, alcohol
and mental health workers, speech and language therapists
• New initiatives: Family Drug and Alcohol Court, Journey into Early
Parenting (health visitor led)
• Early identification of parents not able to interact positively with their
children inc. Language
• Reduced parental substance misuse and poor mental health
• Significant cash savings through less numbers in care, less time in care,
fewer care proceedings, not instructing experts in care proceedings.
Placements easier because children more advanced
• Children more school ready, less SEN, better speech and language, less
offending in later life
Economic case for prevention
• Public sector spend of £7.5bn, Children’s services £170m
• Children’s Trust  how can we spend more on prevention?
• Youth Services how can we spend more on prevention?
• Answer  Look at the £7.5bn not the £170m
• A lot of Children’s Services too reactive (examples)
• Took £200m out of hospitals
• Paid for community care and prevention instead of putting
people into hospital
• KEY: Early Intervention and Prevention is not a project on the
side, it’s at the core of how we operate
70-30 Campaign
It’s possible to reduce child maltreatment in the UK by at least
70% by 2030. We have developed a strategy to make this a reality,
we call it 70/30.
70-30 Campaign
“WAVE's visionary 70/30 strategy has my full backing. It
tackles the roots of the problems in our society where so
many address the symptoms.”
Iain Duncan Smith, Secretary of State for Work and Pensions
"I do not view 70/30 as either wishful thinking or an
unachievable goal. On the contrary, reducing child
maltreatment by 70% in the next fifteen years is the
minimum acceptable outcome in responding to this
unacceptable (and profoundly costly) harm to our youngest
Sir Harry Burns (Former Chief Medical Officer, Scotland)
The Problem
• How to secure the commitment before having the proof?
• How to
– Bring about whole government commitment to providing best possible
support in earliest years?
– Ensure primary prevention given appropriate priority?
– Deal with a problem (child maltreatment) estimated to cost the nation
£15bn annually?
• Oliver Letwin
– Demonstrate financial pay-back within the life of a parliament
The Solution
• Focus on ages 0 – 2 (peak period for child maltreatment)
• Measure impact through disorganised attachment
• Show significant reductions can be made inside 5 years
• Demonstrate major cost pay-off to both local and national
Disorganised Attachment
15% of children
Mental Illness
Children into Care
Poor Relationships
Disruptive Behaviour
in Pre-School
Pioneer Community Approach
WAVE Trust
Pioneer Community Approach
• Population level, preventive approach
– Focussing on conception to age 2
• Pop. 50,000
• 3 components
Intervention Component
of Risk
• Universal, identifying families most in need of support
• Risk factors: parental maltreatment as a child,
domestic violence, substance abuse, mental health,
attitude to unborn child
• Range of programmes which address key risk factors
• Prevent problems before they develop
• Address issues before harm done to child
• Local alternatives possible, if research approved
• Many existing measures will provide feedback (e.g.
health visitor assessments)
• Additional measures will include Disorganised
Attachment, Parental Sensitivity, possibly disconnected
parenting, aggression
Assessment of Risk
• Universal risk assessment at ante-natal stage
– Carried out by trained midwives or health visitors (potential GP
– Costings assume extra support signalled for c240 families per year
(targeted), 56 families (specialist)
– Parental experience of child maltreatment: measure developed at Kings
College London
– Other screening tools already available but need for special training
and adequate resource
• Universal assessment at 3 – 4 months
– Quality of interaction between mother and baby
– Using Video Interaction Guidance/Parent Infant Interaction
Observation Scale
Targeted Support
• Range of programmes
– For parents maltreated in childhood, increased provision of psychological therapies
and mental heath support
– For domestic violence risk, approaches such as Family Foundations, IRIS, Healthy
Relationships, Healthy Babies
– For substance abuse, Parents Under Pressure
– For mental health issues and poor attunement,Video Interaction Guidance,
Parent-Infant Psychotherapy, Specialist Perinatal Mental Health Support,
– Other support programmes include Baby Steps, Minding the Baby, Solihull
Approach, Mellow Bumps, Babies, and Parenting
• These will not be imposed on Pioneer Communities
– Recommended programmes
– Ultimate choice lies with Pioneer Community Partnership
– Does need to fit within research protocol
Monitoring Outcomes
• Key measure Disorganised Attachment at 15 – 18 months
(surrogate for maltreatment as heavy overlap)
• Additional measures likely to be
– Parental Sensitivity
– Disconnected Parenting
– Child Aggression
• Use of existing local data
– 6 – 8 week, 1 year and 2 – 2.5 year assessment
– Data from child health profiles
– Other local data where relevant
Community Component
• The goal: community engagement and ownership of commitment to
creating healthy, successful lives for children, happy relationships in
• Reducing maltreatment a necessary but not focal part of the positive
community goals
• Proposed approach - Asset Based Community Development – proven
results with Nurture Development
– Training ‘Community Builders’
– Local assets primary building blocks of sustainable community development
– Communities will be active co-producers in design, planning and
implementation of Pioneer Community approach
– Work will be done with communities not to them
Research and Evaluation
• Project leader: Professor Pasco Fearon Professor of Developmental
Psychopathology University College London, member faculty Child Study Center,
Yale University. His research focus: early child development and role of attachment
in risk for emotional and behavioural problems.
• Strong support team: Professor Peter Fonagy (leading attachment
researcher in the UK), Professor Ted Melhuish (who evaluated Sure Start),
Professor Martin Knapp (leading health economist at LSE) and Professor
David Shemmings (Professor of Child Protection Research, University of Kent)
• Matched control group design: Control groups either from same local
authority or demographically matched local authority (possibly member of LA
Advisory Board)
WAVE’s Role
Guide vision and strategy
Support aligned activities
Establish shared measurement
Build public and agency will
Co-ordinate links between Pioneer Communities
Mobilise funding for the overall project
Maintain ongoing dialogue with ministers, civil servants and
opposition politicians
Other Elements of WAVE’s Role
• Training and support to local authority professionals, early years
workforce, CCGs, Health and Wellbeing Boards, voluntary sector,
community groups
• WAVE-led Local Authority, Public Health and Expert Advisory
Boards (already established) supporting effective implementation
• Maintaining the momentum of the project
• Spreading learning from the project across the Pioneer
Communities and to local authorities, health boards and
communities across the UK
• Working with LSE, UCL, Kings and Birkbeck to monitor and
evaluate the project
Potential Outcomes
• Major reduction in child maltreatment for 0 – 2 years olds
(the peak age) in the Pioneer Communities – in just 5 years
• Thousands of children rescued from severely damaged lives
• Widespread community improvement in child outcomes,
health, wellbeing, school readiness
• Fewer children in care or needing special support
• Reduced inequalities
These are not ‘one-off ’ benefits
They break the intergenerational cycle of violence and
The Public Health perspective
Professor Peter Kelly,
Director of Public Health

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