1. “Don’t Stop Believing” Ethna M. Dillon Manager, Vulnerable Baby Service Summit for Preventing Infant Death LSE 15 th June 2011

2. Greater Manchester

4. Manchester 4 th in Index of Multiple Deprivation England (2010) Population 483,830 (2009) 24% aged 0-19 years 35% primary school children: English a 2 nd language (2010) 13,285 births in M/C hospitals(2010) 7,552 births to residents IMR 6.3 per 1000 births (2006-08, Nat av 4.8)

5. Increased Vulnerability and Hard to Reach Exposure to nicotine Premature babies Alcohol Users Drug Users Mobile Families Victims of violence and abuse Teenagers

6. Why? Environmental factors that cause stress to either the baby or their carer are potential risks ie. Fear Worry Lack of sleep Lack of alertness Change in routine Resistant to change Relationship problems Bonding issues Poor concentration

7. Who are the babies with increased risk of SUDI in Manchester? Analysis of deaths in Manchester shows that there were environmental factors which could have influenced the outcome for these babies; Eg. Alcohol/Substance misuse, Violent criminal history against child or partner, A previous child not living with parent, Late booking for ante natal care, Homelessness with mental health issues/domestic Abuse/probation. Hearing impaired parents Referral Criteria

8. Targeted Specialist Case Planning led and chaired by Vulnerable Baby Service -Family offered opportunity to have a meeting with agencies who can help them to address their needs -Referrals from health or muti- agency partners to VBS if family meet criteria. -Multi agency case planning meeting arranged, chaired and minuted by VBS -Since 2004, 983 families have been referred to VBS (1 of those babies has been SUDI; moved out of area before meeting took pace) Early Intervention is a national strategy Graham Allen and Eileen Munro

9. Meeting eg. Midwife Health Visitor Chair Social Worker Education Mental Health Worker Police Parents Referrer Sure Start

10. Multi agency Partners Family Children’s Social Care PoliceProbation Community Alcohol Team Drug Services Sure Start Voluntary Services Connexions Universal Services Housing

11. Population approach Safe Sleeping Practice Guidance - Every family is given consistent advice by all agencies - All multi agency partners are stakeholders in embedding practice

12. “The attitudes and behaviour of individual practitioners have a major effect on whether families engage” Safeguarding Knowledge Review 2010 Centre for Excellence and Outcomes in Children and Young People’s Services (C4EO)

13. Target Staff Groups Specialist Services, often involved with high risk families ; Foster parents and social workers Housing staff; refuges,temporary accommodation, prisons Probation Connexions Community Alcohol Team Drug Services Police Health Midwives Neonatal teams Health Visitors GPs Obstetricians Paediatricians Appoint a champion to lead in each group

14. Campaigns; targeted message to the population

15. Evaluation Reasons for co sleeping in Manchester Midwife opinion: Breastfeeding (46%) Tiredness To settle baby Cultural Convenience No cot Accidental Public opinion: I get more sleep (53%) I like to sleep with my baby Helps when ill Won’t go in cot No space for cot in bedroom Breastfeeding (12%) Mum did I don’t have a cot Learning led to 3 point process 1. Verbal explanation, reduce the risk advice 2. The wrong picture test 3. Given bib

16. Graph to show comparative rate of unexpected deaths of infants in United Kingdom, and Manchester (Birth - 1 year) UK figures are from the Foundation for the Study of Infant Deaths where data include deaths that remain unexplained after post mortem examination and may be registered as sudden infant death syndrome, SIDS, sudden infant death, sudden unexpected death in infancy, unascertained or cot death. Manchester figures are locally collected unexplained deaths. Manchester UK

17. Summary - Know your demographic, analyse the local SUDI, speak to front line staff - Safe Sleep Practice Guidance - Evaluate, keep looking for gaps or themes and address them - Staff change, training and updates are a way of life - Target specialist staff groups - Keep safety of baby the priority - There is no quick fix, but there is always more that can be done Don’t Stop Believing That you can make a difference

18. Vulnerable Baby Service Safeguarding Children’s Team Walmer Street Rusholme Manchester M14 4NB Ethna.dillon@cmft.nhs.uk