A joinedup approach to a best start in

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A joined-up approach to a best start in life Kim Roberts, Chief Executive

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 •

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

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 The messenger: creating the

Catalysts for change The message: a healthy start in life The messenger: creating the conditions for change • 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 • 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

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%

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

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

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

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

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

Guided choices “Eat up your DICTATORIAL carrot. ” “Here’s some carrot “What would you like AUTHORITATIVE INDULGENT and some apple for your snack? ” you – help yourself. ” Here’s some carrot What would you for your snack, eat and tomato for your like for your up snack …. you snack? choose

Early feeding he takes such time and gives really good practical advice and we

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 such easy We are still breast access to breast feeding support. 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

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 •

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

Responsive feeding

You provide, they decide

You provide, they decide

Mealtime atmosphere • Sitting together with no distractions such as TV • Sociable –

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

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

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 •

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

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

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

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

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

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

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

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

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

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

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

Contact us [email protected] org. uk www. henry. org. uk @HENRYhealthy