health inequalities and parenting phil wilson gp, battlefield, glasgow senior lecturer university of...
Post on 05-Jan-2016
214 Views
Preview:
TRANSCRIPT
Health inequalities and Health inequalities and parentingparenting
Phil WilsonPhil Wilson
GP, Battlefield, GlasgowGP, Battlefield, Glasgow
Senior Lecturer Senior Lecturer University of GlasgowUniversity of Glasgow
Health inequalities and Health inequalities and parentingparenting
Focus on relative economic deprivationFocus on relative economic deprivation Because we know deprivation is linked to poor health and Because we know deprivation is linked to poor health and
mortalitymortality
Focus on child behaviourFocus on child behaviour Because we know parenting and child behaviour are Because we know parenting and child behaviour are
inextricably linkedinextricably linked Because child behaviour is easier to assess than parentingBecause child behaviour is easier to assess than parenting Because we know child behaviour problems are linked to Because we know child behaviour problems are linked to
poor health outcomespoor health outcomes Because we know measures which improve child behaviour Because we know measures which improve child behaviour
can reduce health risks (smoking, problem alcohol/drug use can reduce health risks (smoking, problem alcohol/drug use etc)etc)
Glasgow Evaluation Glasgow Evaluation PrinciplesPrinciples
Use of standardised toolsUse of standardised tools Data should be useful for:Data should be useful for:
Professional decision makingProfessional decision making Needs assessmentNeeds assessment Performance managementPerformance management External evaluationExternal evaluation
Universal HV contactsUniversal HV contacts
Pilot data - West Glasgow July-Dec Pilot data - West Glasgow July-Dec 20092009 13 month assessment evaluating 13 month assessment evaluating
parent-child interaction and parent-child interaction and emotional wellbeing of parentemotional wellbeing of parent
30 month assessment of parenting 30 month assessment of parenting stress, child behaviour and language stress, child behaviour and language developmentdevelopment
13 month contact13 month contact Adult wellbeing scale:Adult wellbeing scale:
AnxietyAnxiety DepressionDepression Externally-directed irritabilityExternally-directed irritability Internally-directed irritabilityInternally-directed irritability
Observational assessment of parent-Observational assessment of parent-child interaction*child interaction* ““may be problems / “probably no may be problems / “probably no
problems”problems”* Wilson, Thompson, McConnachie, Puckering, Holden, Cassidy, Gillberg . Community Practitioner 2010: 83(5): 22-5
13m: Adult Wellbeing Scale13m: Adult Wellbeing Scale
Good response (88%) and completion Good response (88%) and completion rates (77.9%)rates (77.9%)
Scores reflect known social patterning of Scores reflect known social patterning of depression, but not anxietydepression, but not anxiety
Irritability relatively uncommon. No clear Irritability relatively uncommon. No clear relationship to deprivationrelationship to deprivation
30 month assessment30 month assessment
Parenting Daily Hassles Parenting Daily Hassles Richman Behaviour ChecklistRichman Behaviour Checklist Language screenLanguage screen
30-month visit - language30-month visit - language
•Half the children with language delay Half the children with language delay are in “core” risk categoryare in “core” risk category
•No clear social patterningNo clear social patterning
n %
Can your child put 2 words together? 10 3
Does your child know 50 words? 33 10
Strengths and Difficulties Strengths and Difficulties Questionnaire at school Questionnaire at school
entryentry For all children entering primary For all children entering primary
school in Glasgow, starting in 2010school in Glasgow, starting in 2010 Completed by Child Development Completed by Child Development
Officers as part of routine Transition Officers as part of routine Transition DocumentationDocumentation
Data available on SEEMIS database Data available on SEEMIS database and linkable to NHS and GROS dataand linkable to NHS and GROS data
The SDQThe SDQ A brief behavioural screening A brief behavioural screening
questionnaire for use with 3-16 year questionnaire for use with 3-16 year olds. olds.
25 questions used to measure five 25 questions used to measure five aspects of the child’s development: aspects of the child’s development: emotional symptomsemotional symptoms conduct problemsconduct problems hyperactivity/inattentionhyperactivity/inattention peer relationship problems peer relationship problems pro-social behaviour.pro-social behaviour.
SDQ and deprivationSDQ and deprivationSIMD QuintileSIMD Quintile 11 22 33 44 55 TotalTotal SignificanceSignificance
Emotional SymptomsEmotional Symptoms
Possible ProblemsPossible Problems 103 (6%)103 (6%) 15 (3%)15 (3%) 21 (5%)21 (5%) 11 (4%)11 (4%) 10 (3%)10 (3%) 160 (5%)160 (5%) p = 0.044p = 0.044
Conduct ProblemsConduct Problems
Possible ProblemsPossible Problems 199 (11%)199 (11%) 45 (9%)45 (9%) 29 (7%)29 (7%) 20 (7%)20 (7%) 22 (7%)22 (7%) 315 (10%)315 (10%) p = 0.002p = 0.002
HyperactivityHyperactivity
Possible ProblemsPossible Problems 300 (17%)300 (17%) 73 (14%)73 (14%) 55 (14%)55 (14%) 29 (11%)29 (11%) 33 (11%)33 (11%) 490 (15%)490 (15%) p < 0.001p < 0.001
Peer ProblemsPeer Problems
Possible ProblemsPossible Problems 268 (15%)268 (15%) 72 (14%)72 (14%) 51 (13%)51 (13%) 24 (9%)24 (9%) 29 (9%)29 (9%) 444 (14%)444 (14%) p = 0.001p = 0.001
ProsocialProsocial
Possible ProblemsPossible Problems 482 (27%)482 (27%) 137(27%)137(27%) 113 (28%)113 (28%) 65 (24%)65 (24%) 69 (23%)69 (23%) 866 (26%)866 (26%) p = 0.130p = 0.130
Total DifficultiesTotal Difficulties
Possible ProblemsPossible Problems 315 (18%)315 (18%) 69 (18%)69 (18%) 60 (15%)60 (15%) 31 (12%)31 (12%) 37 (12%)37 (12%) 512 (16%)512 (16%) p = 0.001p = 0.001
Explaining the patternsExplaining the patterns
Differing respondent thresholdsDiffering respondent thresholds Neighbourhood effectsNeighbourhood effects Variation in service provisionVariation in service provision ““Social drift”Social drift”
Ill healthIll health Genetic factorsGenetic factors
Poverty distracts attention away from Poverty distracts attention away from the child...the child...
What next for Glasgow?What next for Glasgow?• Routine 30 month check – with SDQ, language, Routine 30 month check – with SDQ, language,
parental mental wellbeing assessmentparental mental wellbeing assessment• School-based SDQs at 7 and 10 yearsSchool-based SDQs at 7 and 10 years• Linkage of health and education data:Linkage of health and education data:
• Will be able to plot trajectories from 2 to 10 yearsWill be able to plot trajectories from 2 to 10 years• Identify effects of area, nursery, school, family on these Identify effects of area, nursery, school, family on these
trajectoriestrajectories
• Start trials of interventions (eg for language Start trials of interventions (eg for language delay, early onset conduct problems) with long delay, early onset conduct problems) with long term follow upterm follow up
AcknowledgementsAcknowledgements Lucy ThompsonLucy Thompson Matt Forde, Cathy Holden, and the Matt Forde, Cathy Holden, and the
Glasgow West CHCP Health VisitorsGlasgow West CHCP Health Visitors John Butcher, Amanda Kerr, Michele John Butcher, Amanda Kerr, Michele
McClung, Morag Gunion and City of McClung, Morag Gunion and City of Glasgow Education ServicesGlasgow Education Services
Kim Jones & Kelly ChungKim Jones & Kelly Chung Paula BartonPaula Barton Christine Puckering and Helen MinnisChristine Puckering and Helen Minnis Claire Wilson and Alex McConnachieClaire Wilson and Alex McConnachie
Thank you.Thank you.philip.wilson@glasgow.ac.ukphilip.wilson@glasgow.ac.uk
top related