Supporting vulnerable families
There are big differences in outcomes in the health and wellbeing of those who live only a few miles apart. The WHO defines these inequalities in health as 'differences in health status or in the distribution of health determinants between different population groups.'
From conception onwards, children's early life circumstances and experiences shape their physical, social, mental, emotional and cognitive development and provide a foundation for their future attainment and health. However, while early negative experiences have a lifelong impact on health, learning and behaviour, unequal outcomes are also apparent during pregnancy and from the very start of a child's life. These outcomes are a consequence of many adverse and complex social factors combining rather than a single cause.
These factors can impact on parents' ability to meet the needs of their children. They are not set in stone, but interact and can be influenced by interventions which tackle the context in which people live. Opportunities to reduce the inequalities that result from these factors decline as a child gets older.
Supporting better outcomes
There are three key areas that services can address to improve outcomes for children and families at risk of poorer outcomes:
1) Reversing health inequalities
Reversing health inequalities is only likely to be achieved through fundamental changes, by implementing socio-economic and political measures which reduce gaps in income and power, for example, interventions which maximise household income and resources and increase economic and employment opportunities for women and families.
2) Undoing or reversing the increase in health inequalities
Social circumstances are improved through the equitable provision of education, employment, and improved living and environmental conditions. For example, by raising the standard of social housing, providing access to high quality pre-school education and child care and safe places for children to play.
3) Mitigating or reducing the impact of social circumstances on health
The progressive universal model of care is the most effective way to identify and support families with additional needs/risks. This includes the support provided by services for all families, such as health visiting and pre-school education, along with the additional/enhanced services provided to families with specific needs and/or risks, such as children and family services, family centres and Family Nurse Partnership programmes. Interventions could include promoting an enriched home environment, developing skills for high quality active play and supporting secure attachment and consistent, responsive care. For example, professionals can promote an enriched home learning environment by encouraging parents to play and read with their children. The play@home books and Bookbug packs are provided free to all parents in Scotland. Professionals can help parents use these resources by talking through the books while they work with families, creating opportunities for play and story times and sharing ideas as the parents' confidence increases
Engaging with parents
In order to effectively reduce or mitigate the impact of inequalities for vulnerable families, professionals must both provide physical access to resources and also work with families to support their understanding of, and ability to act on, information.
The 2012 Health Scotland paper 'Exploration of the information support needs of parents' (www.healthscotland.com/documents/5948.aspx) found that parents preferred 'personal, empathetic support from individuals in dealing with their specific needs for information and support on child health and parenting'.
Three overarching themes emerged:
- Parent information/support is undermined when parents feel marginalised
- 'Trust' shapes how information is sought, received and used
- Parents respond most positively to personalised information and support.
Using an asset-based approach to working with parents, building on the existing strengths of families is one way to respond to the findings in the paper.
Further information
The maternal and early years website has more information for early years professionals on supporting parents, on understanding of the causes of unequal outcomes and on those interventions most likely to mitigate their impact www.maternal-and-early-years.org.uk
The 2013 National Early Years Conference held on 19 June in Glasgow explored the work currently underway in Scotland and the UK to support vulnerable parents. Presentations from the day are at www.maternal-and-early-years.org.uk