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
The quality of family life is fundamental to the well-being of children. Family relationships in general and the parent-child relationship in particular have a pervasive influence eon the psychological, physical social and economic well-being of children. Many significant mental health social and economic problems are linked to disturbances in family functioning.
Epidemiological studies indicate that family risk factors such as poor parenting family conflict and marriage breakdown strongly influence children’s development. Specifically a lack of a warm positive relationship with parents;insecure attachment; harsh inflexible rigid or inconsistent discipline practices ; inadequate supervision of and involvement with children; marital conflict and breakdown; parental psychopathology particularly maternal depression increase the risk that children develop problems such as
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9. Lead to risk of…… Major behavioural and emotional problems
Substance misuse
Antisocial behaviour
Juvenile crime
These previous factors increase the risk that children will develop major behavioural and emotional problems including substance misuse, antisocial behaviour and juvenile crime.

10. Supportive family relationships…
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
A wealth of evidence showing that parenting interventions are among the most powerful and cost effective tools to prevent and treat conduct disorders in children.
If we really want to make a difference in these areas, believe we must adopt strategies at a population level. By improving parenting practices in the whole population, changes in those families with the highest risk factors of conduct disorder and mental health problems will also occur. We are also more likely to change the culture and attitudes towards parenting education so that attendance at a parenting group is considered to be the norm. Everyone expects to get training and support and attending a group is as routine as attending for antenatal care or going to parents nights at schools.

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
The evaluation of Triple P is within the context of a broader context of research into the effects of behavioural family intervention for which there have been several recent comprehensive reviews that have documented its efficacy in benefiting children with disruptive behavioural disorders particularly oppositional defiant disorders. Treatment outcome studies often report large effect sizes with good maintenance of treatment gains.
On Triple P alone there have been 11 controlled single case trials, 23 RCT efficacy trials, 7 effectiveness trials and 3 dissemination trials – all showing consistent positive results. Studies have been conducted on each intervention level and delivery format with moderate to large effect sizes. The measurement of effect size allows us not just to know if the intervention shows a significant difference from a control but is the effect clinically meaningful so effect sizes of are small, 0.5 –0.8 moderate and more than that large.

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.