JOURNAL TRANSCRIPT
Investing in Children ‐ Size Matters Annual Scientific Meeting of the British Association for Community Child Health
11 & 12 October 2011 Aston University Birmingham
Welcome from the Academic Convenor Welcome to the 2011 BACCH Annual Scientific Meeting and to Aston University in the heart of the West Midlands. I hope you will find much over the next two days to interest, educate, inspire and help you in the challenges we all face in providing high quality services for the children we care for. We hope that the theme of this year's conference " Investing in Children – size matters" will address our need to measure what we do in order to improve the quality of our services as well as looking at one of the most frequently measured characteristic of children _ their size. How can we have effective measures that do not result in the temptation to meet targets at the expense of quality? This is one of the issues raised by Professor Eileen Munro in her recent review of child protection services. We are delighted that that Professor Munro has agreed to deliver the BACCH annual lecture giving us the opportunity to hear how we can improve outcomes in safeguarding. Professor Mitch Blair will start the conference looking at the size of the problem and Dr Phil Wilson will talk about the importance of investing in the pre‐school years. We couldn't avoid the question of growth and obesity so thanks to Professor Mary Rudolph for addressing this, to Dr Trevor Cole for covering the genetic aspects and to Dr Dasha Nicholls for size matters in mental health. Presentation and discussion of evidence based personal practice in workshops has been a hallmark of our meetings over recent years and I hope you will agree that this year we have an interesting mix of topics. We have tried to make them all directly relevant to clinical practice and to the theme of the meeting The submission of free papers and personal practice papers has presented us again with great difficulty in selecting those for presentation from the large number of high quality abstracts we received. Congratulations to those who have been asked to present their papers and commiserations to those who were not successful this time. The subjects of the papers are as far ranging as you would expect from such an eclectic group as BACCH. Don't forget to look at the CATCH posters over coffee and lunch ‐ the judges will have a hard task choosing the prize winner. Finally, the future configuration of community child health services is important to us all and so I hope we will finish the conference with a lively debate led by Dr Zoe Dunhill who has recently reported on the system in Scotland and Dr Simon Lenton who will give the English perspective. Contributions from delegates from Northern Ireland and Wales will be very welcome. One of the most important aspects of our annual meeting is the opportunity to get to know each other and develop peer support networks. Following the success of the ceilidh at last year's meeting in Scotland we thought we would have an English Barn Dance this year so I do hope everyone will join in and have fun. Finally, as I come to the end of my term as Academic Convenor I would like to thank you all for your support and ask you to welcome Raghu Lingam who will take over from me after the AGM. I would also like to thank everyone in the BACCH office and particularly Kelly Robinson who was until recently our BACCH Executive Officer. Kelly has now handed over the reins to Isabelle Robinson (no relation) who has worked extremely hard to ensure the success of this meeting. Dr Angela Moore BACCH Academic Convenor
Programme for Tuesday 11 October 08.45‐9.15
Registration
09.15
Welcome and Opening of Conference Dr Angela Moore, BACCH Academic Convenor
09.20
KEYNOTE LECTURE Investing in Children ‐ priorities now and in the future Professor Mitch Blair
10.00
FREE PAPER PRESENTATIONS X 5
11.20
Morning Coffee, Posters & Exhibition
12.00
12.50
BACCH ANNUAL LECTURE Improving Outcomes in Safeguading Professor Eileen Munro
Lunch, posters & Exhibition
14.00
PERSONAL PRACTICE WORKSHOPS
16.00
Afternoon Tea, Posters & Exhibition
16.30
KEYNOTE LECTURE Investing in the pre‐school years – thinking ahead Dr Philip Wilson
17.10
Closing Comments
17.15
Day One Closes
BACCH Annual General Meeting
Annual Dinner
17.20 19.45
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Speakers, Tuesday 11 October
Professor Mitch Blair: Investing in Children ‐ priorities now and in the future (Keynote Lecture) Consultant Paediatrician and Specialist in Child Public Health, Imperial College London Mitch qualified in medicine MBBS from UCH, London in 1983. Paediatric training posts were at Stoke Mandeville, Charing Cross Hospital, Great Ormond Street, Northwick Park, and Nottingham. After obtaining an MSc in Community Paediatrics from the Institute of Child Health in London, he moved to Nottingham as Consultant Senior Lecturer in Community Paediatrics 1990‐98. He worked in inner city community practice in health centres, schools, day nurseries and specialist out‐ reach to single handed and group practices. He carried out teaching and research into the national child health screening programme and community paediatric out reach to primary care. He returned to London in 1998 and established the River Island Academic Centre for Paediatrics and Child Public Health Teaching and Research at Northwick Park Hospital, Harrow, Imperial College London, His research interests include complementary medicines use in children, international child health indicators, child public health monitoring, and health service evaluation. He co‐authored the Manual of Community Paediatrics and the first textbook on Child Public Health. He was recently seconded to the DH to advise on the Healthy Child Programme and is currently Officer for Health Promotion for the Royal College of Paediatrics and Child Health.
Professor Eileen Munro: Improving Outcomes in Safeguarding (The BACCH Annual Lecture) Professor of Social Policy, School of Economics The lecture will present an overview of my review on child protection, emphasising the analysis and recommendations that explain how I think the set of reforms can lead to a system more focused on improving outcomes for children than on compliance with an excessive level of bureaucratic demands. Eileen Munro was a social worker for many years before taking up an academic career. She has studied philosophy, in particular the philosophy of science, and this has fuelled her interest in the reasoning skills needed in social work. Her current research interests include how best to combine intuitive and analytic reasoning in risk assessment and decision making in child protection, and the role of the wider organisational system in promoting or hindering good critical thinking. At the request of the Secretary of State for Education, she undertook a review of child protection in England and published the final report in April 2011.
Dr Philip Watson: Investing in the pre‐school years ‐ thinking ahead Senior Lecturer in Infant Mental Health, University of Glasgow The arguments for investing in services for children in their preschool years are becoming irrefutable. Changes in NHS policy and patterns of public investment have nevertheless been relatively slow and sometimes misguided. This presentation will focus on early neurodevelopment and the arguments for active early identification and treatment of its disorders. The key (and widely misunderstood) role of universal services in the identification of these problems will be highlighted, and early results from pilot work on the redesign of the child health surveillance programme in Glasgow will be presented. Phil Wilson is a GP and senior lecturer in infant mental health at the University of Glasgow. He trained in medicine after completing a research doctorate in neurochemistry. He contributed to the Scottish Needs Assessment Programme on Child and Adolescent Mental Health and the HeadsUpScotland Infant Mental Health report, and has published numerous academic papers on early childhood mental health. He was part of a group which petitioned the Scottish Parliament to maintain a universal health visiting services linked to primary care teams. He is currently involved in evaluating the parenting support strategy for Glasgow and in research designed to improve early identification and treatment of psychological and psychiatric problems in infancy.
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Free Papers, Tuesday 11 October 10.00 Assessing Severity in Autism Spectrum Disorders (ASD) as a Measure of Long‐Term Outcome Lauren Hamilton Introduction: A question on many parents' lips when faced with a diagnosis of autism, is how severe is it and what does the future hold? Aims: (i) To identify whether there are any diagnostic tools used in clinical practice that measure severity in autism; (ii) To determine whether there is an association between autism severity and long‐term outcome. Methods: A literature review was conducted using Pubmed from November 2010 to April 2011, to identify publications concerned with severity and long‐term outcome in ASD. The Boolean search algorithm was used, examples include: "Autism spectrum disorders AND severity", "Autism AND severity AND outcome". The bibliographies of the articles were then combed for secondary references. Results: Six ASD rating scales that measured severity, were identified and evaluated: the Childhood Autism Rating Scale, the Gilliam Autism Rating Scale, the Autism Diagnostic Schedule, the Autism Diagnostic Interview‐Revised, the Social Responsiveness Scale, the Severity of Autism Scale. The proposed DSM‐V revision has tiered autism severity into 3 levels but the effect this will have on future practice is unknown. Whilst poor outcomes e.g. in education and employment were more likely in children with low IQ, or in those not speaking by 5, previous research has failed to show a consistent link between severity score at diagnosis and long‐term outcome. Links between outcome and regression, co‐morbidities and neuro‐imaging were also explored suggesting only a link between the number and severity of co‐morbidities and outcome. Conclusions: As hypothesised there is not a universal tool to measure severity in clinical practice. If a way to measure severity were to be devised it would need to add something to current clinical practice e.g. levels of interventions and clinical services could be implemented according to a child's severity
10.15 Child and family practitioners' understanding of child development: lessons learnt from a small sample of serious case reviews Catherine Ellis, Marian Brandon, Peter Sidebotham, Sue Bailey and Pippa Belderson Introduction: This study explores a small number of serious case reviews to consider how the knowledge that practitioners, and especially social workers, have of child development might have had an impact on case management and subsequent outcomes for the children. Aims: To consider how the knowledge that practitioner's have of child development might have had an impact on case management and subsequent outcomes for the children. Methods: A qualitative study of six serious case reviews, purposively selected from 33 available, for thematic analysis. Results: The issues raised by these six cases included, bruising to babies, problems with feeding and growth, disability, complex health needs, self harm, disguised parental compliance, and disputed and differing judgements made by health and social care professionals. The findings highlight professional responses to physical and emotional development in infants and young children in the context of bruising and faltering weight and widen out to consider older children and professional responses to social and behavioural development, including behavioural distress among young people, and children with disabilities. The findings also consider `what does the child mean to the parent?' and vice versa. The findings summarise what has been learnt from these six cases about acting on maltreatment and development. Conclusions: Each of the six children's lives and experiences were unique and different. However, there are some recurring themes in agencies' faltering responses to potential warning signs of abuse and neglect that could be seen to link to the child's development, or to an understanding of the child's likely developmental capacity. A central aim in presenting these findings is to highlight the messages from these individual cases for both practitioners and for Local Safeguarding Children Boards.
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Free Papers, Tuesday 11 October 10.30 Long term impact of a programme to help health professionals' work more effectively with parents of young children to prevent childhood obesity Rebecca Brown, Mary Rudolf Introduction: Despite epidemic numbers of obesity in children, health professionals report a lack of confidence in working with parents around lifestyle change. HENRY _ Health Exercise Nutrition for the Really Young _ aims to tackle childhood obesity through training health professionals to work more effectively with parents. The 2‐day training was developed and piloted in 2007 and has since been adopted across the country. Aims: To assess the long‐term impact of HENRY on health professional's knowledge, skills and confidence in tackling obesity prevention. Methods: An online survey comprising both quantitative and qualitative questions was developed using the `google docs' programme. This was piloted on 25 course leaders and then sent to 1601 health professionals who had undergone training over the last four years. All data collected was anonymous. Results: 237 (14.8%) emails were undeliverable. 345 (21.5%) participants completed the online survey to date; 64% to 77% reported using knowledge and skills gained on a regular basis in their professional lives. Areas of greatest impact included working in partnership with clients and the value of empathy, with 69% and 77%, respectively, using these aspects on a regular basis. Respondents also reported an impact on their personal lives, 46% to 69% used the knowledge and skills gained on a regular basis at home. A wealth of anecdotal evidence from the free text responses such as alteration of mealtime behaviours to include the whole family and reduced portion sizes captures this. The effect is longstanding with 82% of participants who had undertaken the training more than 12 months ago stating they continued to use the concept of healthy nutrition in their professional lives and 76% continuing to use the solution focused approach. Conclusions: Brief training can have a long term profound impact on practitioners' professional and personal lives. We have yet to see if this training impacts on levels of childhood obesity.
10.45 A Pilot Study Exploring the Potential of the Wii Fit to Improve Motor Skills in Children with Developmental Coordination Disorder James Hammond, Victoria Jones Introduction: Developmental Coordination Disorder (DCD) is a condition characterised by a marked impairment in motor coordination. Despite its high prevalence and harmful secondary effects, there remains little in the way of intervention for DCD. Aims: To investigate the potential of an innovative new intervention tool, the Wii Fit, used in a school setting, to improve motor proficiency and well‐being in children with DCD. Methods: A cross‐over design was used, with 19 children (age 6 to 10 years) recruited from two schools. Children were screened for likelihood of DCD before inclusion. The study was made up of two phases, each lasting 4 weeks. In Phase 1 children were divided into two groups, group one using the Wii Fit (10 minutes/3 times a week) and the other (group 2) continuing with the school‐ run programme for children with DCD (1 hour/weekly). During Phase 2 the groups were swapped with one another. Measures of motor proficiency (BOT‐2‐SF), children's self‐perceived ability with motor tasks (CSQ) and a parental assessment of emotions and behaviour (SDQ) were made before and after Phase 1 and after Phase 2. Results: There was a mean improvement in motor proficiency of 10.1 percentiles after using the Wii Fit (p=0.01). Improvements in self‐perceived ability in both groups was also made (group one CSQ pre 27.5, post 37 p=0.01). There was also an improvement in emotional and behavioural well‐being in group one at the end of phase one (from total SDQ score of 16 to 12 vs 8.7 to 10.3 in group two p=0.06).
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Free Papers, Tuesday 11 October Conclusion: Use of the Wii Fit in children with DCD is likely to be an effective intervention for improving motor proficiency and overall well‐being. The fact the Wii Fit is cheap, easy to use, requires no professional resources and has no apparent adverse effects further promotes its potential as a future intervention tool.
11.00 Preparing for the future: how does the participation of adolescents with cerebral palsy compare to the general population? Catherine Tuffrey, BJ Bateman, K Parkinson, AC Colver Introduction: Adults with cerebral palsy (CP) have lower rates, as compared to their peers, of employment, independent living, and having a partner. An important aspect of adolescence is the transition to adult roles. In this paper we report the participation of adolescents with CP in preparing for these adult roles. Aims: To determine the participation rates for young people with CP in preparing for adult roles, and to compare this with the general population. Methods: The Questionnaire of Young People's Participation (QYPP) was used to obtain data from adolescents with CP in the North of England and from a group of secondary school students. Results: 68 adolescents with CP and without severe learning disability completed the QYPP as did 540 young people from the general population. The CP group was aged 13.2years to 21.3years, (median 16.1years) and the general population sample, 13years to 17.9years, (median 14.6years). Participation was less frequent in the CP group for having an informal part‐time job (9% vs 36% p