Early intervention models of practice for better outcomes

Early intervention models of practice for better outcomes for children and young people Prevention, Partnership and Family Support Programme and Adverse Childhood Experiences

Tusla Services The Child and Family Agency’s services include a range of universal and targeted services: • Child protection and welfare services; • Educational welfare services; • Psychological services; • Alternative care; • Family and locally-based community supports; • Early years services; • Domestic, sexual and gender-based violence services.

Policy Context

Policy Context High Level Policy Statement on Supporting Families

First 5 2019 -2028 • The First 5 Strategy sets out how to develop a system of integrated, crosssectoral and high-quality supports and services –an effective early childhood system – that will help all babies and young children in Ireland to have positive early experiences. The family is considered throughout First 5 across all areas given its critical role in supporting positive experiences for young children.

Adverse Childhood Experiences • Children who are routinely exposed to situations such as domestic violence, mental ill health, alcohol and other substance misuse problems in their homes experience a negative impact which can last well into adulthood. • These chronic stress situations are called Adverse Childhood Experiences (ACEs) and are often associated with poorer outcomes for children in educational attainment, employment, involvement in crime, family breakdown, and a range of health and wellbeing measures.

Intergenerational cycle of harm • There is increased awareness of the impact of intergenerational cycle of harm on families and Adverse Childhood Experiences (ACEs). • As the numbers of adverse experiences increase in utero and in the first 2 years of life the risk for negative health outcomes increases and the impact on the child’s developing brain and other biological systems. (Faculty of Public health Medicine).

Harvard Center on the Developing Child- Improving Outcomes • Recent advances in the science of brain development offer us an unprecedented opportunity • Understanding how the experiences children have starting at birth even prenatally affect lifelong outcomes can be combined with new knowledge about the core capabilities adults need to thrive as parents and in the workplace

The Biology of Stress and Science of Hope • Support responsive relationships for children and adults • Strengthen core life skills • Reduce sources of stress in the lives of children and families • https: //www. youtube. com/watch? v=ur. Ua_Fs. S 5 Y

Resilience • Secure base / sense of security and attachment • Self-esteem • Self-efficacy • ‘I HAVE…………. …people I trust and love’ • ‘I AM…………. . a loveable person’ • ‘I CAN…………find ways to solve problems’ • Grotberg, E. (1997) ‘The international resilience project. ’ In M. John (ed) A Charge against Society: The Child’s Right to Protection. London: Jessica Kingsley

Prevention Partnership and Family Support

What is PPFS? Greater participation of children and families New Structure Enhanced public awareness and communication low, medium and high prevention services commissioned based on need, evidence and participation Workforce, learning and development And arranged with all partners into localised Child and Family Support Networks Implementing Meitheal and parenting support approaches l

Tusla’s Early Intervention and Prevention System 17 Area Managers 17 Senior Managers for PP&FS & Steering Committees linked to Children & Young People Services Committees Each of the 17 areas divided into local Child & Family Support Networks with Coordinators

What is Meitheal? Meitheal is a national early intervention practice model to ensure that the needs and strengths of children and their families are effectively identified, understood and responded to in a timely way so that children and families get the help and support needed to improve children’s outcomes and to realise their rights. Meitheal – A National Early Intervention Practice Model for all agencies working with children, young people and their families (2013, p. 1)

Voices of parents, children and practitioners UCFRC's research study: Meitheal and CFSN's Process and Outcomes Study https: //youtu. be/E 2 izf. Nfl_H 4

Step by Step process • Stage 1: Preparation • Considering whether a Meitheal is necessary/introducing it to parents/securing written consent/liaising with Child and Family Support Network Coordinator to initiate the process. • Stage 2: Discussion • Identifying strengths and needs and desired outcomes/considering appropriate response • Stage 3: Delivery • Planning and delivering support/monitoring and reviewing progress/ending and closing

Routes into Meitheal • Directly – as a result of discussion between parent and Lead Practitioner • When referral under Children First does not reach threshold for SW intervention – family can be diverted • Following SW assessment and/or intervention – outstanding unmet need – can be stepped down All three routes require parental consent

Meitheal Case Study REASON FOR REQUEST Request by Youth Service as concerned about 17 year old who was 6 months pregnant at risk of homelessness. Living with her mother and her sister who also had two children under 2

Meitheal Case Study STRENGTHS AND NEEDS • Young person wanted assistance and good network of supports available • Housing – risk of eviction & also concern about housing conditions • Parenting capacity and past unresolved trauma in childhood • Support to remain in Education

Meitheal Case Study DESIRED OUTCOMES • Young person continues in education • Housing issues addressed • Provision of support to develop parenting skills and access to counselling service TEAM AROUND THE CHILD Dublin City Council, Youth Service, Family Resource Centre, PHN, Family Support, Counselling, MABs

Meitheal Case Study SUMMARY OF INTERVENTIONS • Youth Worker agreed to be lead practitioner & obtained consent. • Family support to address housing issues • Link family to MABS • PHN to support mum on basic skills for parenting baby with Family Support Worker to support attendance as appointments arise

Meitheal Case Study POSITIVE OUTCOMES • Baby attending crèche & Mum remains in education • Young mother (now an adult) moved out of the family home which she did in a planned manner with support • Baby has attended all appointments • No Child Protection concerns have arisen

Meitheal Early Intervention Model Research The main findings are that Meitheal is improving family outcomes particularly from the perspective of mothers, showing the potential of Meitheal to improve and sustain improvement in outcomes over time. NUIG Child and Family Research Centre: Rodriguez, L. , Cassidy, A. and Devaney, C. (2018) Meitheal and Child and Family Support Networks -Process and Outcomes Study. Galway: UNESCO Child and Family Research Centre, National University of Ireland Galway.

• Maternal well-being was • Meitheal can have a the most significant positive impact on predictor of family parental attitudes outcomes suggesting that towards help-seeking supporting mothers is key behaviours and accessing to support families. services. • Meitheal was described as • Lead Practitioners feel empowering by parents Meitheal is a structured and families. They valued process that can facilitate being listened to. change in family Challenges remain outcomes and the overall around the participation service provision system. of children and young people in Meitheal.

Early Intervention models in the community • On January 2019 HSE • European Union’s and Tusla jointly INTERREG VA launched their Programme, managed Hidden Harm by the Special EU Strategic Statement Programmes Body and Practice Guide The Multiple Adverse ‘Seeing Through Childhood Hidden Harm to Experiences (MACE) Brighter Futures’ – Breaking the Cycle Project