A joinedup approach to a best start in
A joined-up approach to a best start in life Kim Roberts, Chief Executive
Creating the conditions for a healthy start • Supportive environment – practitioner effectiveness • Emotional readiness and energy for change – confidence and motivation • The space and opportunity to reflect, gain knowledge and understanding – and decide how to put this into practice in own life and family
Readiness for change I sit there giving her advice and I know she’s not going to follow any of it … Health visitor describing her work with the mother of an obese 3 -year old
Catalysts for change The message: a healthy start in life • Early nurture and feeding • Parenting skills • Healthy family routines • A balanced healthy diet for the whole family • Active play, physical activity and sleep • Emotional well-being The messenger: creating the conditions for change • Building relationships based on trust and respect • Working in partnership • Empathy • Strengths-based • Solution-focused support to decide on goals and how to achieve them
Effective practice 2 day training Knowledge: Skills: Relationship Qualities: Nonjudgemental Partnership Modelling Empathy Strengths Raising the issue Solutionfocused Risk factors Whole family healthy lifestyle Healthy start
Confidence in working with families e-survey up to 4 years later; n=354 50% 45% 40% 35% 30% < 12 months 25% > 12 months 85% < 12 months 91% > 12 months 20% 15% 10% 5% 0% 1 Very little impact 2 3 4 5 Significantly improved
Changes to practice up to 4 years later Aspects of Course Regularly, Often, All the Time Value of empathy 76% (276) Key parenting skills 72% (261) Healthy nutrition 71% (256) Working in partnership 70% (250) Solution-focused support 70% (251) How emotions affect behaviour 70% (251) Eating patterns and habits 67% (240) Physical activity 65% (238) Brown et al, Community Practitioner 2013
Working with families Parenting Early feeding Influences, attitudes and habits Healthy nutrition for the whole family Play, activity and sleep Social and emotional wellbeing
Parenting • Desire, knowledge and confidence to provide a best start • Responsive and emotionally literate parenting • Skills and strategies to hold boundaries Now she’s a toddler there are lots of times when I just feel out of my depth and don’t k now what to do when she says no and takes no notice
Parenting styles and feeding styles in charge DICTATORIAL/ AUTHORITARIAN AUTHORITATIVE UNINVOLVED/ NEGLECTFUL responsive INDULGENT
Guided choices “Eat up your DICTATORIAL carrot. ” “Here’s some carrot “What would you like AUTHORITATIVE and some apple for your. INDULGENT snack? ” you – help yourself. ” Here’s some carrot for your snack, eat and tomato for your up snack …. you choose What would you like for your snack?
Early feeding he takes such time and gives really good practical advice and we are still breast feeding four months on and it's P 8 -year pare • Support for breastfeeding • Optimal bottle feeding • Starting solids to her great help. • • I don't know what I would have done without We such are easy still access to breast feeding support. breast feeding four months on and it's very much due to the great help I got.
Taking babies on a taste journey • Window of opportunity to develop a baby’s palate • Babies have an inbuilt preference for familiar tastes – as well as sweet and salty • Start with vegetables • Don’t be put off by some of the expressions! • Repeated exposure
Influences, attitudes and habits • Responsive feeding • Family mealtimes and eating habits • Parental modelling • Using food for nonnutritional reasons I’ve realised I need to eat with him and eat healthier foods – who else is he going to copy?
Responsive feeding
You provide, they decide
Mealtime atmosphere • Sitting together with no distractions such as TV • Sociable – chatting and encouraging • Age-appropriate limits for behaviour • Not rushing – going at their pace • Parents eating and enjoying healthy food with their children
Emotional dimension of food • Bribes, rewards and comfort • What messages do we communicate about food? • Moderation in all things including moderation • Don’t stop it, swap it – non-food praise, encouragement and comfort
Healthy nutrition • Healthy balance • Child-sized portions • Reducing energy dense foods and sweet drinks • Increasing fruit and vegetable consumption That’s why we all came on the HENRY programme. Knowing what’s healthy and how much we should be giving them is worrying, especially when they can’t talk.
Healthy Families group programme • 8 week programme • Group or 1 -to-1 • Delivered by children’s centre staff • 37 local authorities • Experiential and interactive • Popular with parents: average retention rate of 80%
Practice and policy in children’s centres • Positive changes in practitioners’ lifestyles • Enhanced confidence to approach and discuss lifestyle issues with families I think they’re more confident in tackling & bringing up things … I’ve noticed that people are talking about lifestyle more, and are concerned about it • Healthier meals, snacks and portion sizes • Persistent change and impact on the culture and practice of the wider team Willis et al, J Hum Nutr Diet 2012
Parental self-agency Dumka 1996 Pre-course Post-course 18 16 Follow-up *P<0. 001 Parental self-agency Setting limits Mean score 14 12 10 8 6 4 2 0 Willis et al, Pediatric Obesity July 2013 2014 Sure of self Doing a good job Perseverance Problem solving Mealtimes TV/computer Active play Bedtime General
Eating behaviour Golan 1998 Pre-course Post-course Follow-up 16 14 *P<0. 001 Mean score 12 10 *P<0. 001 *P<0. 005 8 6 4 2 0 Willis et al, Pediatric Obesity July 2013 Family eating behaviour Eating together TV off for meals Home cooked food Take away food Children eating with Structured mealtimes adults Parental eating behaviour Lower scores indicate desired behaviours
Food Frequency Questionnaire – Adults Hammond 1993 Pre-course Post-course Follow-up Pre-course *P<0. 02 25 20 *P<0. 001 15 10 Follow-up 14 *P=0. 007 *P<0. 001 5 0 Cooked veg Salads Willis et al, Pediatric Obesity July 2013 Fresh fruit Water No. times consumed / wk 30 Post-course *P=0. 003 12 10 8 *P=0. 005 *P<0. 001 6 4 2 0 Cakes, biscuits Sweets, chocolate Sweet drinks
Changes in children’s food consumption Pre-course Post-course 20 Follow-up * p<0. 001 No. times consumed / wk 18 16 14 12 * p=0. 007 10 8 * *p<0. 02 6 4 2 0 Cooked veg Willis et al, Pediatric Obesity July 2013 Salads Fresh fruit Cakes, biscuits
5 a day • 21% children in families starting HENRY groups eat 5 a day • 44% children of parents completing HENRY programme eat 5 a day
HENRY in action: Bradford Better Start • Multi-layered package: – – – practitioner training Healthy Start in Childcare group programme for parents targeted 1 -to-1 support peer support • HENRY-employed coordinator based within Better Start and public health teams
Effective partnership • Co-delivery with BBS and public health staff • Venues and recruiting families to group and 1 -to-1 programmes - 130 in first year • Embedding HENRY approach across wider team – 70 practitioners trained in first year • Shared learning and supervision across city
Parent Champions • 14 trained parent volunteers • Community activities to engage parents and promote healthy eating
Bringing it all together • What children need to flourish – from pregnancy to starting school • How we can work in partnership with parents so that they have the skills, knowledge and confidence – and motivation – to get babies and young children off to a great start
Contact us info@henry. org. uk www. henry. org. uk @HENRYhealthy
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