Welcome to the 28th edition of our A Better Start Southend Research Bulletin, bringing you the latest on ‘what works’ in early years’ around our outcomes: Social and Emotional Development, Diet and Nutrition, Communication and Language, Community Resilience and Systems Change.

Your regular update, edited by Rachel Wood, also shows how we’re using these findings to influence our work in Southend. In addition, we invite you to help shape our ‘test and learn’ projects and innovations in prevention and early intervention.

If you would like to suggest or contribute an article, or would like to sign up to receive these updates, or have a question, please e-mail: abssresearch@eyalliance.org.uk

Contents:

Evidence Based Practice (Systems Change)
Measures of Parenting Outcomes (Systems Change)
The Development of Co-production in Healthcare (Community Resilience)
Influence on Health and Development (Diet and Nutrition)
Maternal Understanding of Infant Feeding Guidelines (Diet and Nutrition)
Parenting Programme Techniques that Support Child Behaviour (Social and Emotional)
‘Steps to Safety’: Feasibility of a Domestic Abuse Parenting Programme (Social and Emotional)
Shared Book Reading (Communication and Language)


Evidence Based Practice (Systems Change)

Title: Egan, SM. And Pope, J. (2019), From Research Evidence to Evidence Based Practice in Early Childhood Settings, An Lean bn Og, 12 (1), 171-185

Research source: https://www.researchgate.net/publication/335627839_From_Research_Evidence_to_Evidence_Based_Practice_in_Early_Childhood_Settings

Publication date: April 2019

Our Summary:

“Evidence Based Practice has been defined as ‘a decision making process that integrates the best available research evidence with family and professional wisdom and values’ (Buyesse, Wesley, Snyder & Winton, 2006, p. 3)”.

This review looks at some of the finding of the Growing Up in Ireland Study to illustrate how research can impact on practice. This study has followed 9,000 infants from 2006, in conjunction with their families, as well as early education and schools. As with a range of interventions in the UK, the review utilises Brofenbrenner’s learning theory to illustrate that child development is influenced by a wide range of environmental settings including policy changes.

The study focuses on three areas of child development: cognitive (the ‘thinking’ child), physical (the ‘moving’ child), and socio-emotional (the ‘feeling’ child) drawn from Pica, 2006.

Whilst arguing that evidence based practice is not widely adopted in Ireland, they advocate that practitioners explore the following in their evidence based practice:

The ‘thinking child’

  • It is well established in evidence that reading to young children is crucial for language development
  • Parents and care-givers talking to infants whilst doing things has a positive effect on communication and problem solving

The ‘moving child’

  • Children should have access to opportunities for playing outdoors on a daily basis
  • Neighbourhood safety is an issue which prevents or limits opportunity

The ‘feeling’ child

  • A fifth of children in the cohort were reported by parents as having emotional or behavioural difficulties (of which 1% of the study had a formal diagnosis)
  • There was a gap of empathy between girls and boys in the study

How we’re applying this in Southend

  • The ABSS Research Bulletin is one of the ways that we support evidence based practice
  • Our service design and evaluation frameworks and processes illustrate how we use the latest emerging evidence for decision making, impact and innovation

Help us help Southend

  • What other ways can we support evidence based practice and decision making?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


Measures of Parenting Outcomes (Systems Change)

Title: Blower, SL. Gridley, N. Dunn, A. Bywater, T. Hindson, Z. Bryant, M. (2019), Psychometric Properties of Parent Outcome Measures Used in RCTs of Antenatal and Early Years Parent Programs: A Systematic Review, Clinical Child and Family Psychology Review, Volume 22, Issue 3, pp 367–387

Research source: https://link.springer.com/article/10.1007/s10567-019-00276-2

Publication date: February 2019

Our Summary: The authors argue that existing evidence shows that parenting programmes are effective in promoting social and emotional development, as well as behaviour. However, it is argued that more research is needed in relation to this in the early years. A range of reasons for this is discussed including a lack of consistency in measures as well as synthesised information. Exploring this ‘evidential gap’ is viewed as essential to the prevention and early intervention agenda.

Many of the existing Evidence Based Parenting Programmes (EBPP) which have Randomised Controlled Trials (RCTs) attached to them – e.g. Incredible Years and Triple P share many elements including social and attachment theory and cognitive behavioural approaches (p 171). According to the authors the different measurements used to date however have shown inconsistencies in terms of positive outcomes e.g. as in behaviour, attitude, skills, practice and mental health.

It is also identified that having a narrow focus on a singular outcome can be problematic in terms of evaluation, in addition to other practical implementation issues that are not consistently taken into account – e.g. cost, availability and acceptability (such as the length of time to administer) of a measure. On this basis the study sets out to systematically review the most commonly used and most robust measures used within EBPPs. In total 18 parent, child and parent-child measures were reviewed including the Parenting Scale (PS), and the Edinburgh Postnatal Depression Scale (EPDS). The three resulting studies found that:

  • Study 1 – found that the 30 item Parenting Scale (PS) was found to be the most robust measure in terms of validity (the degree to which it is measuring what it is supposed to). This scale focuses on 3 main factors: Laxness (LX), Over-Reactivity (OR) and Hostility (HS).
  • Study 2 – Found that the General Health Questionnaire (GHQ-12) in psychological wellbeing was the most promising, and in only having 12 questions is likely to be high in acceptability
  • Study 3 – Found that in terms of parenting stress that the EPDS and Beck Depression Inventory (BD1-II) were the most promising in terms of both validity and reliability (e.g. free from measurement errors e.g. different raters providing the same scores)

On the basis of these studies it is argued that a range of measures have been found to be useful in real world delivery, policy as well as research and evaluation.

How we’re applying this in Southend

  • Our ‘Being a Parent’ parenting programme is evidence based
  • We have developed an early years’ measures inventory and update it to include all known measures that can be used to support service design and delivery

Help us help Southend

  • What measures do you use that support the impact of delivery of services?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


The Development of Co-production in Healthcare (Community Resilience)

Title: Elwyn, G. 1 Nelson, E.  Hager, A. Price, A. (2019), Co-production: when users define quality, Developmental Medicine and Child Neurology, doi: 10.1136/bmjqs-2019-009830

Research source: https://www.ncbi.nlm.nih.gov/pubmed/31488570

Publication date: August 2019

Our Summary: This US article looks at co-production and how it can impact healthcare. It argues that although life expectancy has increased that improvements are declining, and that both long term conditions and obesity are contributing to this (equivalent to £8,000 per head). There is evidence that co-production is starting to have an impact on services, particularly where self-management of conditions is crucial (where there is a need to reduce illness and need for treatment). It is also argued that where this is done in collaboration and alliance (sharing experiences and solutions) that this can create value, impact and quality.

The authors argue that development in the area of healthcare has been slower, and that access to advice as routine involves appointments, telephone calls, attending a particular location and authorisation delays.

This is against a background in which many issues can be managed using digital solutions (e.g. video conferencing, and user expectation of service delivery which is in line with on-line shopping). Examples are illustrated in which user experience and innovation have contributed to increased levels of satisfaction, cost-effectiveness and quality in care.

The main aim of co-production when applied to health-care is seen as the personalisation of solutions with (p3):

  • Patient resilience and autonomy
  • Time saved
  • Economic efficiency

For some this may seem like a “subtle shift of power” (p3) but this can ultimately lead to major changes in roles, and approaches. However in order to achieve this users need to be enabled to share decision making and concerns. A ‘champion’ and systems leadership approach is often required to take this forward in relation to policy, organisation as well as interpersonally in the following cycle:

  • Co-assess (e.g. are changes needed?)
  • Co-decide (e.g. what are the options?)
  • Co-design (e.g. what are the plans for prevention and early intervention)

Co-deliver (e.g. how can the user contribute to their own care?)

How we’re applying this in Southend

  • Co-design and co-production are at the heart of everything that we do including the design of services
  • Our Service Design Framework is currently under review, and co-production is fundamental to this approach
  • ABSS is co-funding a Co-production Champion to help ensure that it is at the heart of everything that we do

Help us help Southend

  • What other ways can we use co-production to support the development of services that improve satisfaction and quality?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


Influences on Health and Development (Diet and Nutrition)

Title: Gentner, MB. And O’Connor Leppert, ML. (2019), Environmental influences on health and development: nutrition, substance exposure, and adverse childhood experiences, Developmental Medicine and Child Neurology, doi: 10.1136/bmjqs-2019-009830

Research source: https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.14149

Publication date: January 2019

Our Summary: The authors of this article argue that there have been large strides forward in terms of understanding the critical periods in childhood in terms of the interaction with environmental factors and their potential impact into adulthood.

Much of the early research was centred on under and poor nutrition during both pregnancy and early childhood. This was then later further extended into an examination of intergenerational factors. More recently maternal obesity has been seen as significant in terms of later risk in terms of heart disease, cancer and type 2 diabetes (e.g. Helsinki Birth Cohort Studies – MBC-II). It was also found that this seemed not to be linked to socio-economic status. This study however did show that adverse conditions (e.g. toxic stress) can have intergenerational consequences in the child and grandchildren.

The authors identify 10 factors which are influential in terms of risk:

  • Maternal chronic or acute illnessg. epilepsy
  • Substances and toxinsg. drugs and alcohol
  • Nutritiong. obesity
  • Infectionsg. Rubella
  • Endocrine (hormonal) system problems e.g. diabetes
  • Genes
  • Hypoxia (insufficient oxygen)
  • Trauma or stroke
  • Inflammationg. prolonged labour, infection of the placenta
  • Medicationg. anti-depressants

Recent studies have shown that the gut health can be linked to:

  • Method of deliveryg. more diverse in vaginal delivery
  • the child’s nutrition
  • Antibiotic use in the early years

Positively the authors note that research has shown that should a correction be available that such changes can be made (e.g. normalisation of birth weight by the third generation) through good nutrition.

One study[1] for instance showed that where the female has experienced four of more Adverse Childhood Experiences (ACES) that they were more likely to have higher rates of both medical and psycho-social issues. It also showed that such children were more likely to experience a higher level of ACES than their mother.

On this basis the authors argue that prevention or at least mitigation can be achieved in terms of optimising maternal and early childhood nutrition. In summary they argue that, “this type of knowledge brings with it the promise of reducing poor outcomes through optimal environments.” (p1013).

[1] Narayan, AJ. Kalstabakken, AW. Labella, MH. Nerenberg, LS. Monn, AR, and  Masten, AS. (2017), Intergenerational continuity of adverse childhood experiences in homeless families: unpacking exposure to maltreatment versus family dysfunction, Am J Orthopsychiatry, 87: 3–14.

How we’re applying this in Southend

  • As part of our service design process we routinely look at the factors which would improve the outcomes in terms of prevention and early intervention

Help us help Southend

  • What factors do you feel are the most influential in the early years?
  • What services based on these factors do you feel would have the most impact in terms of prevention and early intervention?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


Maternal Understanding of Infant Feeding Guidelines (Diet and Nutrition)

Title: Begley, A. Ringrose, K. Giglia, R. and Scott, J. (2019), Mothers’ Understanding of Infant Feeding Guidelines and Their Associated Practices: A Qualitative Analysis, Int. Journal of Environmental Research and Public Health, 16 (7), 1141

Research source: https://www.mdpi.com/1660-4601/16/7/1141

Publication date: March 2019

Our Summary: This Australian study sets out to explore mother’s experiences of introducing solids. The study included 42 women who lived in areas of deprivation, and whose children were 4-18 months.

The themes that were identified were as follows:

  • Every child is different (judging signs of readiness)
    Reading baby-led cues
    First day reasons (e.g. opportunistic or ad-hoc)
  • Everyone gives you advice (juggling conflicting advice)
    Main influencers (e.g. maternal grandmother and friends)
    Own research
  • Go with your gut (being a good mother)
    Pressure to achieve the milestone (majority 6 months or earlier)
    Solving issues (e.g. insufficient weight gain)
    Preparing your own food (sense of guilt in using commercial or own instincts)
  • It’s not a sin to start them too early or too late (guidelines are advice and are not requirements)
    Role of child health nurses (advice been variable 4-6 months)
    Confusing age guidelines (health professionals changing their advice)

On the basis of the study the authors argue that:

  • Mothers need more education on the ‘true’ signs of readiness
  • That the focus of baby-led weaning was on the signs of readiness and not the type of food consumed
  • As with the UK there are conflicting sources of information
  • Women tended to seek support from peers and family members
  • Women tended to view advice as not scientific but based on opinion
  • Introducing solids was seen as an important milestone
  • Health professionals need to communicate guidelines in a way that is empowering
  • Health professionals need to address the barriers and support enablers of the guidelines
  • That further work is needed to move the introduction of solids from 4-6 months.

How we’re applying this in Southend

  • We have a wide range of services and projects which support infant feeding including breastfeeding group and one to one support, and HENRY. You can read about the latest offer on our website
  • We are working with Southend Borough Council on a Southend Supports Breastfeeding scheme which aims to support and enable mothers to feel confident breastfeeding in public places. If you would like to know more about the scheme you can contact livewell@southend.gov.uk
  • A list of welcoming breastfeeding venues can also be found on our website

Help us help Southend

  • What other ways could we support paternal understanding of infant feeding?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


Parenting Programme Techniques that Support Child Behaviour (Social and Emotional)

Title: Leijten, P. Gardner, F. Melendez-Torres, GJ. van Aar, J. Hutchings, J. Schulz, S. Knerr, W. and Overbeek, G. (2019), Meta-analysis: key parenting program components for disruptive child behaviour, Journal of the American Academy of Child and Adolescent Psychiatry, 58 (2), 180-190

Research source: https://www.ncbi.nlm.nih.gov/pubmed/30738545

Publication date: February 2019

Our Summary: There is much evidence that behaviour based parenting programmes are effective in terms of prevention and early intervention in relation to challenging behaviours. Indeed when delivered skilfully positive outcomes have been seen to be sustained. However, as yet there is little knowledge as to which techniques are crucial in promoting this, despite this information being crucial to effective implementation. It has also been established that effects tend to be stronger when applied as a targeted intervention.

The techniques reviewed by the authors were as follows:

General Technique Definition
Psychoeducation Explaining child development

Explaining parent-child interactions

Positive reinforcement Praise

Rewards

Nonviolent disciplining Time-out

Ignore

Natural / logical consequences

Proactive parenting Direct and positive commands

Rule setting

Monitoring

Relationship enhancement Parent-child play

Empathy

Active listening
Skills for parents themselves Emotion regulation skills

Problem solving skills

Skills parents teach their children Emotion regulation skills

Problem solving skills

Social skills

Table 1 (p26-28)

The content of most evidence based parenting programmes are based on Skinner’s Operant Learning and Bandura’s Social Learning Theories. However, the way that this is translated into practice varies considerably from programme to programme.

Most prevention based programmes are adapted from targeted interventions, which it is argued can make assessing the evidence even more of a challenge. Therefore in order to achieve results most preventions seek to reduce established risk factors e.g. sensitive (rather than harsh) parenting, and more general issues of child development. The 3 techniques in the analyses that were seen to be the most effective in terms of challenging behaviour were seen to be:

  • Positive reinforcement
  • Praise
  • Use of logical consequences (non-violent discipline)

In addition adding techniques e.g. parent-child play and active listening appear to increase the effects in terms of prevention.

How we’re applying this in Southend

  • ABSS supports a range of behaviour supported parenting programmes. You can find out more about our offer on our website https://abetterstartsouthend.co.uk/about/projects/
  • As part of our vision one of our Social and Emotional key developmental outcomes is that children are at lower risk of developing conduct problems and mental health problems

Help us help Southend

  • What innovative ways are there that we could support this outcome?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


‘Steps to Safety’: Feasibility of a Domestic Abuse Programme for Parents (Social and Emotional Development)

Title: MCMillan, AS. and Barlow, J. (2019), Steps to Safety: Report on the Feasibility Study, NSPCC

Research Source: https://learning.nspcc.org.uk/media/1900/steps-to-safety-report-on-the-feasibility-study.pdf

Publication date: 25 November 2019

Our Summary:

“We are looking for families who have internalised that there is something wrong. [But if they] hadn’t understood it for themselves you would not get them engaging at a meaningful level [Practitioner].

“Calming plans worked for me…I just learn how to cool myself down” [Parent]

There is a growing evidence base in terms of the effect of domestic abuse on development in the early years. The authors of the report seek to explore prevention and early intervention in terms of how this might have an effect on parental sensitivity capacity.

The ‘Steps to Safety’ model was designed by the NSPCC (in conjunction with the University of Oxford and the University of South Florida) to support couples where there has been shown to be escalating violence and where there is motivation to change. In terms of service design and development a review of the potential risk factors was undertaken in the following areas including Dialectical Behavioural Therapy – DBT (p8):

  • Increasing parental capacity for mentalisation and reflective functioning
  • Increasing parental capacity for emotional regulation and interpersonal relationships
  • Providing an introduction to early parenting

The programme uses safety planning, screening and utilises Video Interaction Guidance (VIG) as one of its main techniques.

The developers undertook the implementation in Belfast, Southampton and Swansea in conjunction with a mixed methods feasibility study. Delivery was undertaken by 9 in-house Social Workers. This was with a view to assessing:

  • The effectiveness of referral routes
  • Potential for recruitment to a trial
  • The acceptability of outcomes measures
  • Assessing the formative impact on participating families

35 couples were initially recruited, of which 5 completed the programme.

The main findings were as follows:

  • Referral pathways need to include organisations and services that routinely work with the population
  • That there is a need for a steering group to oversee safeguarding and referrals
  • That couples need to be ‘ready’ and motivated to benefit from the programme
  • A wide range of measures were used inc. the Abusive Behaviour Inventory (ABI), Partner Abuse Risk, Treatment and Responsivity Scale (PARTNR) Scale, Audit C (Alcohol Use Disorders Identification), Depression, Anxiety and Stress Scale (DASS-21). These were found to be effective. However, this was seen as needing to be reduced in terms of acceptability
  • That the dynamic assessment model which compliments VIG requires further development for this particular use
  • Although working with couples is advantageous that there were times in the programme where one to one work was seen as being needed
  • The assessment was a useful way of participants gaining insight into motivations and actions
  • There was a need for further personalisation in terms of some of the components (‘one size does not fit all’)
  • That the early parenting components (e.g. praise, reinforcement, routines and emotional coaching) could be embedded into more universal provision
  • That the family provided social support for each other
  • Despite engagement with social care Severe Mental Illness (SMI) was not always identified, and this was seen as essential for specialist support and diagnosis

The programme is no longer in delivery, but has been found to provide valuable learning.

How we’re applying this in Southend

  • As part of our service design and formative evaluation processes we look at the acceptability of the measures that we use, as well as reviewing the effectiveness of the routes through which we engage beneficiaries into our services, projects and activities
  • We recognise that ‘one size does not fit all’ and look to balance the quality and consistency of our delivery along with personalisation
  • Although we have a balanced portfolio our focus is on prevention and early intervention

Help us help Southend

  • In what ways can we ensure that the early parenting techniques that we deliver are consistent?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk


Shared Book Reading (Communication and Language)

Title: Hoyne, C. & Egan, S.M. (2019). Shared Book Reading in Early Childhood: A Review of Influential Factors and Developmental Benefits. An Leanbh Og (Ireland Journal of Early Childhood Studies), 12(1), 77-92.

Research Source: Researchgate.net

Our Summary: It is known that literacy begins at birth, and much evidence has shown that early reading experiences have positive benefits for child development. This is particularly so in the first 3 years of life. The authors set out to review the research that supports such experiences, in conjunction with an examination of the benefits. This is set against a background in which Ireland has been found to have 19.5% of families who do not read together and do not have a national book gifting scheme.

In early childhood reading is a shared experience between an adult and the child. It has been argued that this is crucial to the development of the skills necessary for independent reading. It has also been shown that this supports secure attachment as well as attentional and language acquisition skills.

Additional skills are used when reading to a younger child (e.g. vocalisations and language gestures). The authors argue that the following is crucial to this:

  • Age of reading commencement
  • Frequency of reading
  • Number of books available in the home (e.g. in parents modelling behaviour)

Studies have shown that book gifting (e.g. Bookstart) have some benefit. However, crucial to this was found to be additional support and guidance for parents on effective reading to children that this could show even more encouraging results. Indeed it was found that beneficiaries of such a scheme in the UK could ‘out-perform’ those who did not receive the gifting by 1-5%. Beginning school and reading readiness was also found to be highly influenced by parents, and some studies have shown that this is can be clearly linked to response to reading and literature in school.

Effects were also found in social and emotional development e.g. sensitive parenting. Some studies for instance have shown that reading supports children in learning about friendships, self-esteem development and in their level of general knowledge.

Bookstart in Southend can be contacted at bookstart@southend.gov.uk

How we’re applying this in Southend

Help us help Southend

  • What other ways can we support book sharing and early reading experiences?

Let us know what you think by e-mailing abssresearch@eyalliance.org.uk

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