Section 5.1 - South Gloucestershire Council

Transcrição

Section 5.1:
Healthy foundations
Section authors
Lead author: Joe Prince - [email protected]
Public health contributors: Lindsey Thomas – [email protected]; Matt Pearce - [email protected]
PCT/CCG contributors: Lindsay Gee – [email protected]
Local authority contributors: Geri Palfreeman –
[email protected];
Katie Harwood – [email protected]
Denis De’Souza – [email protected]
Version number
Date
Changes made by
Version 1.4
Version 1.5
Version 1.6
Version 1.7
Version 1.8
Version 1.9
Version 1.10
Version 1.11
4th July 2012
10th July 2012
11th July 2012
13th July 2012
16th July 2012
20th July 2012
28th September 2012
1st October 2012
Geri Palfreeman / Nick Aslett
Joe Prince
Joe Prince
Geri Palfreeman
Joe Prince& Matt Pearce
Joe Prince
Joe Prince
Joe Prince
Introduction
The specific socio-economic, physical and emotional environment that
children experience during their very early years of life can have a profound
impact on their future outcomes. This is believed to be in part because of the
very rapid brain development from birth to the age of three years. Some
predictors of positive outcomes later in life such as the ability to have positive
relationships with others, to participate positively in society and to lead
personally fulfilling lives are known. Adverse factors in the early years include
poverty and neglect with perhaps the most important predictors being what
Graham Allen describes as the wrong type of parenting (Allen, 2011). A
number of additional vulnerability factors are described in more detail in this
section.
The case for the provision of early intervention to support families who face
particular challenges is strong with calculable social and economic benefits.
1
Early signs that a child may not be thriving include delayed physical and
emotional development, poor educational attainment and childhood obesity.
This section builds on the issues covered in the previous section (section 4)
on maternal health and the first five years of life by addressing some of the
major issues concerning early childhood, with a focus on early signs of
vulnerability including childhood obesity, poor parenting and poor educational
achievement.
Key issues
•
In South Gloucestershire, it has been estimated that the costs of
disease relating to overweight and obesity in 2012 was £54.8 million
expected to rise to £60.8 million in 2015. Data from the National Child
Measurement Programme for South Gloucestershire in 2010/11 shows
that whilst the proportion of children overweight or obese at reception
age was below the national average, the proportion overweight at Year
6 was above the national average. Local analysis of child obesity data
by deprivation quintile shows that for both reception and Year 6
children there is a clear socio-economic gradient where prevalence of
obesity is higher amongst our more deprived communities.
•
Nationally there is a decline in sports participation of 16-25 year olds,
particularly once young people leave school. In 2006/7, the costs of
physical inactivity to NHS South Gloucestershire were estimated at
more than £3.8 million.
•
Over the last few years there has been a considerable increase in the
number of children in South Gloucestershire who are the subject of a
child protection plan (CPP) and a smaller increase in the number of
children who are in care. There has also been an increase in the
number of referrals to social care where the referrer is concerned about
the welfare of the child but the circumstances do not meet the social
care threshold for intervention. With the potential impact of the
economic downturn on families who may already be struggling, there is
likely to be an increased need for a coordinated, multi-agency response
to support those families and prevent an escalation of problems.
•
Particular concerns in relation to parental capacity to adequately care
for their children and significant reasons why children go into care, or
become subject to child protection plans, are parental
alcohol/substance misuse, parental mental ill-health and domestic
abuse – referred to as a ‘toxic-trio’. Alleviating and preventing
occurrences of these issues within families has the potential to greatly
reduce the incidence of acute family stress.
•
Educational attainment in the early Key Stages is relatively high in
South Gloucestershire (top quartile nationally) but outcomes for
vulnerable pupils were significantly lower in 2010-11, i.e. children from
South Gloucestershire’s six Priority Neighbourhoods, pupils from a
Traveller and Irish Heritage/Gypsy Roma background, those entitled to
free school meals (FSM) and those with special educational needs
(SEN). Attainment at Key Stage 4 is relatively weaker (third quartile
2
nationally) with vulnerable groups significantly lower, i.e. pupils entitled
to FSM, those with SEN and certain BME groups.
Recommendations for consideration by commissioners
A.
Childhood obesity, physical activity and play
Obesity
•
Children and young people should have access to complete care
pathways for the treatment of obesity, reflecting the provision of
services that are based on patient need and evidence based practice.
•
Long-term commitment to the commissioning of weight management
services for children aged 2-18 years and their families.
•
Commission a Healthy Schools intervention that supports a wholeschool approach to promote healthy eating and physical activity.
Physical activity
•
Commission a Healthy Schools intervention that supports a whole-school
approach to promote healthy eating and physical activity.
•
Commission services that promote walking and cycling to school.
•
Commission a physical activity service that increases participation in
physical activity and sport by engaging inactive and semi-active
individuals/groups in a variety of settings through an improved range of
opportunities, advice, signposting and information which dovetail with
local healthy eating and weight management services.
•
Widen access and physical activity opportunities to those with mental
health and physical disabilities.
B. Social & emotional resilience, parenting support and bullying
•
Commission sufficient midwifery and health visitor services.
•
Commission services to support parents and carers who need additional
support (including support for families under the Troubled Families
Initiative) to provide good enough parenting to their children, particularly
in the early years, but across all age ranges. Use an integrated approach
so that services are coherent and accessible.
•
Commission free and confidential counselling services for young people
in South Gloucestershire (this is currently a significant gap).
•
Address the gap in the coordination of activity in relation to children’s
emotional wellbeing, resilience and bullying.
•
Address the likely gaps in the provision of diagnosis and treatment
services for alcohol/substance misuse and mental ill-health among
parents. In addition, continue to strengthen the links and referral
pathways between adult social services and children’s social services.
3
•
Address the likely shortfall in services provided to families who
experience domestic abuse.
C. Educational achievement
•
Within the context of deficit reduction, changes in school types and
changing arrangements for services involved with raising attainment
outcomes for children, the local authority needs to ensure that:
o all educational establishments provide high quality education
and that satisfactory is not good enough. 1
o improve the quality of teaching and learning in South
Gloucestershire so that it is mainly good and pupils at all points
of the spectrum are able to fulfil their potential, particularly those
with the lower prior attainment and those that are not achieving
the higher levels that they should. This includes the use and
evaluation of the effectiveness of the new Pupil Premium.
o promote the engagement of parents and carers, especially
where pupils have low prior attainment, in activities to build
confidence that their own actions can lead to higher education
and a better future. We need to aim higher, earlier.
o promote the value of programmes linked to the social and
emotional aspects of learning that improve young people’s
confidence, social, emotional and behavioural skills, giving them
more of a sense of control over their actions and lives.
1) Who is at risk and why?
A. Childhood obesity, physical activity and play
Obesity
•
Obesity increases the risk of many conditions, including type II diabetes,
hypertension, cardiovascular disease 2 and musculoskeletal disease.
Lifestyle behaviors developed in childhood tend to perpetuate into
adulthood. The likelihood that a child will become obese in adulthood is
markedly increased if both of his or her parents are obese with evidence
indicating that around 97% of obese children come from families where at
least one parent is obese or overweight (Zaninotto et.al., 2006; Kramer,
2004).
•
While the real and present danger of obesity in terms of immediate health
risks is largely seen in adults, it also has significant effects on children
and young people. Obese children are likely to suffer stigmatisation. If a
child is obese in their early teens, there is a high likelihood (higher than
that of teenagers with a healthy weight) that they will become an obese
adult, with related health problems in later life. There are a growing
1
Under the revised OfSTED Inspection Framework for Schools the ‘satisfactory’ grading has been
changed to ‘requires improvement’. Source: OfSTED, 2012.
2
Recent research published in the BMJ has highlighted the stronger than previously thought risk of
cardiovascular disease in overweight, and in particular, obese children. Source: Friedemann, C., et al.,
2012.
4
number of reports of obese children suffering type 2 diabetes, a condition
previously found almost entirely in adults.
•
Obesity prevalence is inextricably linked with socio-economic status - the
more deprived the population, the higher the prevalence of child obesity
(National Obesity Observatory, 2011).
•
Obesity prevalence is also related to eligibility for free school meals
(FSM) – a proxy measure for low family income. Children living in areas
with higher rates of eligibility for FSM have significantly higher rates of
obesity than those living in areas with low eligibility rates (National
Obesity Observatory, 2011).
•
According to research, the following sectors of the population are at
considerably higher risk of developing obesity, with an associated
increase in the incidence and prevalence of related co-morbidities.
o For genetic and/or environmental reasons from families where
one or both parents are overweight or obese (Cooper et.al.,
2010).
o Children living within households with the lowest level of
household income have higher rates of obesity than children
from households with the highest level of household income
(National Obesity Observatory, 2011).
o Children who are Asian are four times more likely to be obese
than those who are white (Avenell et.al., 2004).
o Literature reports that there is increased prevalence of obesity
and overweight among children with learning disabilities (Nocon,
2006).
•
Higher consumption of fruit and vegetables is associated with higher
income, and vice versa: 32% of men and 37% of women in the highest
income quintile had consumed five or more portions, but only 18% of men
and 19% of women in the lowest quintile had done so (The Information
Centre for Health and Social Care, 2008).
•
Between 2009 and 2010, the percentage of 5-15 year old boys in England
consuming five or more portions of fruit and vegetables decreased from
21% to 19%. For 5-15 year old girls the corresponding percentages
showed a similar decrease from 22% to 20% (The Health and Social Care
Information Centre, 2011).
•
Thirty six per cent of people from low income groups say they cannot
afford to eat balanced meals (Food Standards Agency, 2007, p.43).
•
There is some evidence to suggest that although breakfast eaters tend to
consume more daily calories, they are less likely to be overweight
(National Obesity Observatory, 2011a).
Physical activity
•
National health surveys show that there are still significant proportions of
young people who are not reaching the recommended levels of physical
activity.
5
•
The majority of data collected on physical activity levels is self-reported;
therefore it is likely to be an overestimation of the true value.
•
The Health Survey for England 2008 found that 32% of boys and 24% of
girls met the government’s recommendations for physical activity.
•
There are clear and significant health inequalities in relation to physical
inactivity according to income, gender, age, ethnicity and disability. For
example, across the UK:
o physical activity is lower in low-income households
o certain ethnic groups have lower levels of physical activity; for
example, in England, physical activity is lower for Black or
minority ethnic groups, with the exception of African-Caribbean
and Irish populations
o boys are more active than girls
o girls are more likely than boys to reduce their activity levels as
they move from childhood to adolescence
o physical activity is lower in older people.
(Department of Health, 2011).
•
There is a significant decline in sports participation in 16-25 year olds.
Whilst participation rates remain relatively high in school (where
curriculum physical dducation (PE) is compulsory), when young people
leave school the proportion who continue to play sport falls dramatically.
The problem is starker for girls, with around only a third participating in
sport at 18 compared to two-thirds of boys (DCMS, 2012).
•
Social and emotional resilience is the social and emotional ability to deal
with the ups and downs of everyday life.
•
The Handbook of Parenting defines parenting as “…purposive activities
aimed at ensuring the survival and development of children.” (Hoghughi,
M. S. and Long, N., 2004). Parenting refers not only to what people do in
the process of looking after and protecting their children, but also to the
values that underpin those actions. It is generally accepted that parents,
and parenting, are the primary – both in the sense of the first, and the
most significant – influence on children (C4EO).
•
Parenting support can be defined as any activity or facility aimed at
providing information, advice and support to parents and carers to help
them in bringing up their children.
•
National research has highlighted the key principles of effective parenting.
These are:
o authoritative (warm and firm), not harsh parenting
o attachment, initiated pre-birth and especially important in early
months
6
o parental involvement, in the form of interest in the child and
parent-child discussions: how parents interact with their children
is key
o positive parental expectations, beliefs and attitude
o parental supervision.
(Parenting Support: Guidance for Local Authorities in England, October
2006).
•
In addition, for parents to display resilience they need to also display the
following additional elements: self-esteem; self-confidence; a belief in
one's own self-efficacy; ability to deal with change and adaptation; and
have a repertoire of social problem solving approaches (Rutter, 1987
cited in Oates, 2010).
•
Children and young people are at risk of poor outcomes if any of these
effective parenting or resilience factors are not present.
•
A number of barriers exist that inhibit positive outcomes and these
include:
o poverty and deprivation 3
o low educational achievement by Parents/carers
o inadequate housing 4
o worklessness 5
o inadequate parenting
o parental and personal substance misuse 6
o parental and personal mental ill-health 7
o domestic abuse. 8
• In addition, children and young people may be at risk of poor outcomes if
they are a member of a vulnerable group. The following groups are
identified as vulnerable (OfSTED, 2010).
o Children and young people in hospital or with severe medical
needs, including mental health needs (Section 5.3 of this JSNA).
o Children and young people in the care of local authorities, i.e.
children in care (Section 5.4 of this JSNA).
3
The extent of poverty in South Gloucestershire is outlined in Section 1.6 of this JSNA and the effects of
poverty are highlighted throughout this JSNA. Deprivation and Priority Neighbourhoods are covered in
Section 1.6 of this JSNA.
4
Non-decent housing and overcrowded housing is covered in detail in Section 5.4 of this JSNA.
Housing, fuel poverty and excess winter deaths are covered in Section 3.6 of this JSNA. Homelessness,
including youth homelessness, is covered in Section 3.6 of this JSNA.
5
The local economy is covered in Section 3.4 of this JSNA.
6
Although parental substance misuse is briefly covered in this section of the JSNA, Section 6.1.3 covers
adult substance misuse more generally.
7
Adult mental ill-health is covered more generally in Section 6.2.4 of this JSNA. Children’s mental illhealth is covered in Section 5.3 of this JSNA.
8
Domestic abuse is covered in more detail in Section 8.2 of this JSNA.
7
o Children and young people who attended more than one
education provider.
o Children and young people with learning difficulties and/or
disabilities (Section 5.3 of this JSNA).
o Children and young people at points of transition in their
education, including late arrivals to education, those affected by
so-called ‘managed moves’ and excluded pupils and students.
o Homeless children and young people, as well as those living in
temporary accommodation, including women’s refuges (Section
3.6.4 of this JSNA).
o Young carers (Section 5.4 of this JSNA).
o Children and young people who have committed offences
(Section 5.4 of this JSNA).
o Children and young people dependent on alcohol or drugs, or
those whose parents or family members misused these
substances (Sections 5.2 and 6.1 of this JSNA).
o Children and young people experiencing or at risk of
homophobic harassment.
o Children and young people being bullied, either directly or
through ‘cyber’ bullying.
o Bereaved children and young people (Section 5.4 of this JSNA).
o Children and young people of Traveller heritage, including those
of Irish, Gypsy and Roma heritage.
o Children and young people who were new arrivals in England
who were learning to speak English as an additional language.
o Children and young people from refugee and asylum-seeking
families.
o Unaccompanied children and young people seeking asylum,
including those who were victims of trafficking.
• A particular concern in relation to parental capacity to adequately care for
their children, and a significant reason why children go into care or become
subject to a child protection plan (CPP) is parental alcohol/substance
misuse. For example, parental alcohol/substance misuse is mentioned in
42%of cases where a child was the subject of a serious case review (SCR)
(Brandon, et al., 2012).Nationally, it is estimated that 8.4% of children and
young people in 2004/05 lived with an adult that had used illicit drugs in the
past year (Manning, et al., 2009, Table 3). Furthermore, it is estimated that
up to 30% of children nationally live with at least one binge drinking adult
(Manning, et al., 2009, Table 2). However, arriving at prevalence figures is
always very difficult due to the different ways substance misuse can be
defined. Recent research published by the Children’s Commissioner has
highlighted the particular issue of parental alcohol misuse and how this is
should be an area of greater concern and focus (Adamson and Templeton,
2012).
8
• The other two significant associated factors mentioned in SCR are
domestic abuse (mentioned in 63% of cases) and parental mental illhealth (mentioned in 58% of cases)(Brandon, et al., 2012). In fact, these
three factors – parental substance misuse, parental mental ill-health and
domestic abuse – have been referred to as a ‘toxic-trio’ and are mentioned
in 86% of SCR (Brandon, et al., 2012). Arriving at a prevalence of mental
illness among parents, as with parental mental health, is fraught with
difficulty due to the issues with multiple definitions (there being many
different types and degrees of mental illness). However, research has
estimated that there are 50,000 - 200,000 young people in the UK living
with a parent with severe mental health problems (Mental Health
Foundation, 2010).
• Bullying is defined as “…behaviour, usually repeated over time, that
intentionally hurts another individual or group, physically or emotionally.”
(DfE, 2009). Bullying includes: name calling; taunting; mocking; making
offensive comments; kicking; hitting; pushing; taking belongings;
inappropriate text messaging and emailing; sending offensive or degrading
images by phone or via the internet; producing offensive graffiti; gossiping;
excluding people from groups; and spreading hurtful and untruthful
rumours. These examples of bullying include both direct (i.e. involving faceto-face contact) and indirect (i.e. where the bullies or victims are not
present) forms of bullying. Although sometimes occurring between two
individuals in isolation, it quite often takes place in the presence of others.
• National research shows that children targeted by bullies show signs of
distress such as depression and anxiety (Hawker, 2000). Furthermore,
national research has found that children from low socio-economic
backgrounds face a higher risk of being bullied than those from middle and
high socio-economic backgrounds (Due, 2009). The association between
childhood exposure to bullying and depression in young adulthood also
seems to be stronger for children from low socio-economic backgrounds
(Due, 2009). Bullying is also an area of growing concern for child safety
and child protection (DfE, 2009).
• National and international research suggests that victims of bullying
constitute two distinct groups of children – ‘pure victims’ who are solely
targets of bullies, and ‘bully-victims’ who are both victims of bullies and
bullies themselves (Arseneault, et al., 2010). Although representing a small
distinct group, ‘bully-victims’ are of particular concern as they display the
highest levels of internalising and externalising problems (Arseneault, et al.,
2010).
• The range of evidence available indicates that children living in low income
families are not a homogenous group (DfE, 2011). Many children and
young people from low income families are successful at school. However,
across the United Kingdom children from poorer families tend to have lower
levels of educational attainment and participation in post-16 education. The
national evidence indicates that the attainment gap is present in the early
years (for the poorest fifth of the cohort) before school entry. In primary
9
years the highest early achievers from poorest backgrounds are overtaken
by the lower achievers from more affluent families by the age of seven, and
this grows through the school years so that at age 16 it is considerable in
terms of those achieving GCSE A*-C grades. In addition, poorer children
are half as likely to go on to further education as their more advantaged
peers.
• Some of the lowest attaining pupils, after controlling for a wide range of
socio-economic variables, are White British pupils from low socio-economic
households (Strand, 2008).
• The specific routes through which affluence and disadvantage can shape
educational attainment are very broad. Research indicates that there is an
association between factors such as ability, attitudes, relationships, selfconcept and resilience. Furthermore these factors may be important in
helping to understand the impact on attainment, but the precise part played
by each in the particular phases of schooling is more controversial.
• Goodman and Gregg (2010) argue that the following factors are associated
with a widening gap between children from poorer and richer backgrounds.
In primary school:
o the aspirations of parents for further education for their children
o the extent to which children and their parents believe their
actions can affect their lives
o children’s behaviour problems (such as hyperactivity, conduct
disorders and peer relationships).
In secondary school, in addition to the aspirations of parents for further
education, the associations are:
o the allocation of material resources towards education (such as
ICT access and private tuition)
o time spent together as a family (meals; outings, with infrequent
quarrelling)
o the young person’s belief in their own ability, and sense of
control over behaviour and actions; view of the value of school;
aspiration to higher education, avoidance of risks; bully free
experiences.
• Some schools in areas of deprivation are able to buck the trend and are
able to raise the attainment of the poorest learners. Schools have a major
role to play and the quality of schooling remains an important factor among
other associations cited above.
• Successive governments have sought to narrow the attainment gap based
on the view that educational attainment is a strong determiner of future life
chances. The current Coalition Government have also indicated that
educational achievement is a route to improved health (see Section 3.5.1),
reducing poverty, promoting social mobility and improving the international
competitiveness of the economy (HM Government, 2011).
10
2) The level of need in the population
Obesity
• Primary school children have their heights and weights measured as part of
the National Child Measurement Programme (NCMP) in reception year
(aged 4 to 5 years) and in year 6 (aged 10 to 11 years).
• Data from the National Child Measurement Programme (NCMP) for South
Gloucestershire in 2010/11 shows that 12.3% of reception age children are
overweight and 7.7% of reception children are obese. This is lower than the
regional average of 14.3%and 8.8% respectively.
• In Year 6, 15.4% are overweight and 16.1% of children were obese. The
number of overweight children in South Gloucestershire is higher than the
national average (14.2%).
• Data in South Gloucestershire support the emerging evidence that the rate
of increase in child obesity has, at the very least, slowed since the previous
decade amongst the under 11s (Figure 1). However, prevalence has
remained high for both Reception and Year 6 children (NOO, 2010).
• When examining prevalence rates it is important to consider how the
participation rate might affect the calculated prevalence figures, particularly
when anecdotal evidence suggests that very overweight children are more
likely to opt out of being measured than other children. In 2010/11, the
coverage rate in South Gloucestershire for both Reception and Year 6 was
approximately 88% which is above the Department of Health’s target of
85%. [Analyses on national NCMP data performed in 2007/08 and
repeated subsequently, concluded that a lower participation rate may lead
to an underestimation of prevalence for obese children for Year 6, but had
little or no effect on prevalence for Reception children (Department of
Health, 2011b)].
%
Figure 1: Percentage of overweight and very overweight children,
South Gloucestershire, 2008/09 to 2010/11
40
35
30
25
20
15
10
5
0
2008/09
2009/10
Reception year
Source: NHS South Gloucestershire.
11
2010/11
Year 6
Figure 2: Percentage overweight and very overweight (obese) in
Reception Year children, South Gloucestershire, quintiles by
ward of residence 2008/09 to 2010/11
12
Figure 3: Percentage overweight and very overweight (obese) in Year 6
children, South Gloucestershire, quintiles by ward of
residence 2008/09 to 2010/11
• Local analysis of child obesity data by deprivation quintile shows that for
both Reception and Year 6 children, there is a clear socio-economic
gradient where prevalence of obesity is higher amongst our more deprived
communities compared to the most affluent communities.
• A prolonged excess energy intake is fundamental to weight gain and the
development of obesity. However, methodological constraints mean that
there is a severe limitation in the accurate assessment of dietary exposures
and under-reporting of dietary intake (SACN, 2011).
• Statistics for 2009/10 identified that 41.6% of South Gloucestershire
primary school children and 31.6% of secondary school children received
school meals (School Food Trust, 2010, p.9). Comparable figures for
2010/11 show very little change for primary school children’s take-up of
school meals (41.7%), but an improvement for secondary school children’s
take-up of school meals (33.5%).
• In South Gloucestershire it was estimated that the costs of disease related
to overweight and obesity in 2010 was £54.8 million. This is projected to
rise to £60.8 million by 2015 (Foresight, 2007).
13
Physical activity
• Prior to 2008/09, participation in high quality physical education (PE)/sports
amongst children and young people (aged 5-16) in South Gloucestershire
was in line with, or above, the national average based on two hours
participation per week (DFE, 2009). The target for school aged children
changed from 2008/09 to measure three hours participation (DCMS, 2008).
• The latest data showed that participation in 2009/10 (45%) had remained
the same as 2008/09, though was significantly lower than the England
average (55%) (DfE, 2010).
• For those aged under five, UK data are only available for three and four
year olds. These data show that the mean total time spent being physically
active is 120-150 minutes per day with 10-11 mean hours spent being
sedentary (Reilly, 2010). The recent guidance advises children of preschool age who are capable of walking unaided to be physically active daily
for at least 180 minutes (three hours), spread throughout the day
(Department of Health, 2011).
• In 2006/7, the costs of physical inactivity to NHS South Gloucestershire
were estimated at more than £3.8 million at the rate of £1,486,772 per
100,000 of population (Department of Health, 2009).
• Available data on levels of physical activity amongst children and young
people suggest that levels begin to decline as children reach their teenage
years. Promoting physical activity amongst children is particularly important
as it may help this decline and encourage lifelong physical activity habits
(SSR sys review).
• Families and children referred and/or identified as potentially requiring
additional support in South Gloucestershire are indicated in Table 1.
14
Table 1:
Number of children and young people/parents/families
referred and/or identified as potentially requiring additional
support, South Gloucestershire
Indicator
Number
Children and Young People living in Poverty (as at 31st August 2009)1
6,100
Troubled Families in South Gloucestershire2
c.295
Children and Young People in Care (as at 31st March 2012)3
212
Children and Young People subject to Child Protection Plan (CPP) (as at
31st March 2012)4
225
Children in Need(as at 31st March 2012)5
1,887
Families subject to at least one Domestic Abuse ‘Contact’ (2011/12)6
870
Parents/Carers entering the formal legal process regarding non-school
attendance (2011/12)7
163
School Incidents against Children and Young People (2010/11)8
173
School Incidents against Children and Young People that were classified
as bullying (2010/11)9
65
Number of pre-school age children receiving an enhanced Health Visiting
Service (during Quarter 1, 2012/13)10
267
Common Assessment Frameworks (CAFs) opened (2011/12)11
319
Parents Commencing Drug and/or Alcohol Treatment (2011/12)12
172
Note: Many of these families and children and young people will be in multiple categories
Sources: (1) HMRC, 2011. (2) DCLG, 2012.(3) Section 5.4 of this JSNA. (4) Section 8.1 of this JSNA.
(5) CYP, South Gloucestershire Council. (6) CYP, South Gloucestershire Council. (7) Education Welfare
Service Annual Report for 2011-12, CYP, South Gloucestershire Council. (8) ‘Extract from Sentinel AntiBullying Systems’, Reportable Incidents 2010-2011, CYP, South Gloucestershire Council. (9) ‘Extract
from Sentinel Anti- Bullying Systems’, Reportable Incidents 2010-2011, CYP, South Gloucestershire
Council.(10) SGSCB Multi-Agency Performance Report, Q1 2012/13. (11) CYP, South Gloucestershire
Council. (12) SGSCB Quarterly Performance Report, Q4 2011/12.
Notes: (1) The proportion of children living in families in receipt of out of work benefits or tax credits
where their reported income is less than 60% median income. (2) Troubled Families are defined as
households who: (a) are involved in crime and anti-social behaviour; (b) have children not in school; (c)
have an adult on an out-of-work benefit; and (d) who cause high costs to the public purse. (3) As at 31st
March 2012. (4) As at 31st March 2012. (5) Number of episodes open as at 31st March 2012. (6) Number
st
st
of DV Contacts recorded to unique addresses throughout the period 1 April 2011 to 31 March 2012.
(7) Number of Attendance Panels recorded by Education Welfare Officers on CSS. (8) Throughout
2010/11 recorded on Sentinel. (9) Throughout 2010/11 recorded on Sentinel. (10) Number of pre-school
age children who received an enhanced Health Visiting Service during the period 1st April to 30th June
st
st
2012.(11) CAFs opened during the period 1 April 2011 to 31 March 2012. (12) Number of parents
commencing drug and/or alcohol treatment during the period 1st April 2011 to 31st March 2012.
15
• During 2011/12 in South Gloucestershire there were 172 parents who
commenced drug and/or alcohol treatment due to their substance misuse
(Table 1). The prevalence of parental alcohol/substance misuse in South
Gloucestershire is not known, but the number of parents in treatment,
especially for alcohol misuse, is likely to be only a fraction of the total
number in the community. This is also likely to be the case for parents with
mental health problems.
• Table 1 indicates that there were 65 incidents of reported bullying in South
Gloucestershire’s schools during the 2010/11 academic year. However, the
last TellUs4 survey carried out in South Gloucestershire’s schools (in
2009/10) reported that 46% of pupils had been bullied at school, with 27%
of these reporting having been bullied in the past year (compared to 26%
nationally). Twenty per cent of pupils report that they have been bullied
outside of school, with a third of these reporting they have been bullied
outside of school in the past year. Around a quarter of pupils (27%) report
that bullying is either not dealt with very well by their school, or is dealt with
badly by their school (compared to 26% nationally).
• Further analysis of the TellUs4 survey found that pupils with a disability in
South Gloucestershire’s schools were significantly more likely to report that
they had been bullied than their peers who did not have a disability. Girls
were also significantly more likely to report that they had been bullied than
boys. Furthermore, FSM pupils were also significantly more likely to report
that they had been bullied than non-FSM pupils.
• Overall educational attainment in South Gloucestershire in Key Stage 1 in
2010/11 is in the top quartile nationally for reading and mathematics at
level 2 and above (DfE, 2011c). In Key Stage 2, attainment in English,
mathematics and English and mathematics together at Level 4 or above for
2010/11 and 2011/12 is in the top quartile nationally (DfE, 2011d; DfE,
2012b). Relative weakness is seen in the smaller percentages of pupils
achieving a level 2 in writing and the level 3 overall at Key Stage1 (DfE,
2011c). In 2011/12 Key Stage 2 cohort, similar weakness is seen in the
lower percentage of pupils achieving level 5 or above in English, where
South Gloucestershire’s performance was in the second quartile nationally
(DfE, 2012b). However, the proportion attaining level 5 or above in
mathematics for the 2011/12 cohort was in the top quartile nationally (DfE,
2012b).
• Performance in the new statutory phonics screening check 9 for all children
in the 2011/12 Year 1 cohort indicates that 57% of pupils in South
Gloucestershire’s schools met the required standard of phonic decoding
ability, slightly lower than the comparable national figure of 58% (DfE,
2012c, Table 7).
9
The purpose of the check is to confirm whether each child has learnt phonic decoding to an ageappropriate standard. The check comprises a list of 40 words and a teacher known to the child is
required to use their professional judgement about which responses are correct. The phonics screening
check was administered during week commencing 18 June 2012.
16
• At Key Stage 1, outcomes for vulnerable pupils were significantly lower this
year for pupils from Priority Neighbourhoods, Travellers of Irish Heritage
and Gypsy Roma pupils, those entitled to free school meals (FSM) and
those with special educational needs (SEN) (DfE, 2011c). At Key Stage 2,
compared to all pupils, those from South Gloucestershire’s six Priority
Neighbourhoods, Travellers of Irish Heritage and Gypsy Roma pupils,
those entitled to FSM, and Black pupils had attainment outcomes that were
significantly weaker (DfE, 2011d). However, the gap between those with
FSM and non-FSM narrowed (DfE, 2011d).
• In the new 2011/12 Key Stage 1 phonics screening check there was a
significant difference between the performance of free school meal pupils
(40%) and non-free school meal pupils (59%) in South Gloucestershire
(DfE, 2012c, Table 7). Furthermore, girls significantly outperform boys in
the new phonics screening check – 61% and 52% respectively (DfE,
2012c, Table 7). In south Gloucestershire, there is a notable difference
between the performance of the various ethnic groups in the new phonics
screening check, with White classified pupils having the lowest
performance (55%) compared to all other main BME groups – 72% for
Black, 75% for Asian and 66% for mixed ethnic minority (DfE, 2012c, Table
5).
• Attainment outcomes at the end of Key Stage 4 are in the third quartile
nationally for the main five or more GCSE’s at A*-C indicator, including
English and mathematics (DfE, 2012). The picture is weaker (bottom
quartile) for five or more GCSE’s at grade A*-C (DfE, 2012). Outcomes for
vulnerable groups for pupils entitled to FSM, those with SEN and some
ethnic groups (Black, Other, First Language other than English) were
significantly below South Gloucestershire averages (DfE, 2012a). The gap
for FSM pupils compared to non-FSM grew for the main five or more
GCSE’s at A*-C indicator including English and mathematics (DfE, 2012a).
3) Current services and assets in relation to need
Obesity
• A range of preventative services are currently provided that focus on
preconception to early years as it has been found that the likelihood of
developing childhood obesity is largely determined by the age of five
(Gardner et.al., 2009).
• Weight management services for children are currently commissioned on
an annual basis to support children aged 4-11years.
• The REACH (Re-thinking Eating and Activity for Children's Health)
programme is a child weight management service targeted at children aged
4-11 years. It is a fun, family, community based programme taking place in
South Gloucestershire to help children to manage their weight.
• The School Health Nurse Service provides health advice in schools either
in groups or individually to children, young people and their families and
17
school staff. They are also responsible for measuring children as part of the
National Child Measurement Programme.
Physical activity
• Built facilities – the key stakeholders owning/managing the 34 built facilities
are South Gloucestershire Council via Circadian Trust, schools and
colleges, academy trusts, dioceses, commercial health and fitness
providers, and private clubs.
• The eight sites operated by Circadian Trust generate approximately 2.2
million visits per year. With the exception of the FE and HE provision and
hotel based facilities, the vast majority of users come from the immediate
neighbourhood of the centres. Sixty-six per cent of facilities operate a pay
and play policy, the remainder a mixture of club/registered membership
use. The quality of facilities in South Gloucestershire is high reflecting a
significant level of investment by the council and other external
organisations in the district.
• Total sports and activity visits to Circadian Trust facilities was 2,202,495;
broken down as follows:
o Bradley Stoke LC
525,423
o Dual use centres
259,609
o Kingswood LC
238,478
o Longwell Green LC
336,209
o Thornbury LC
337,139
o Yate LC
505,637
• Playing fields - a significant degree of variation exists in provision levels,
and the current supply of 1.19 hectares per 1,000 population is significantly
below the recommended 1.60 hectares. There are pockets of ‘Rural &
Other’ areas that exceed these levels. Solutions may involve increased
managed access to school sites and provision arising from new residential
development.
• Breakthrough Project is a mentoring programme that supports vulnerable
and excluded people facing a wide range of challenges.
• A number of schools currently buy in services from previously existing
school sport partnerships. These are based at the Yate International
Academy and The Grange School and Sports College.
• Active Family Club programmes are aimed at families with children aged 411 who find it difficult to engage in sport or physical activity. In 2011, over
111 children were involved in taster sessions which provided different
activities every week, e.g. multi-sports, healthy eating, climbing and
archery, along with information about how to take up a new interest/hobby.
• The Community Sports Coaching Service is operated by South
Gloucestershire Council to provide high quality PE and extra-curricular
sports coaching for ten of South Gloucestershire’s primary schools. This
18
service is bought in as a ‘traded service’ and is based around delivering
high quality and innovative PE lessons based around the core healthy
principles of ‘Every Child Matters’: Being Healthy, Staying Safe, Enjoying
and Achieving, making a Positive Contribution and Economic Well-Being.
• As an inspirational event, the Festival of Youth Sport involves over 1,000
primary school children in structured coaching programmes that lead to a
competitive event. This links into other South Gloucestershire Schools PE
Association events which aim to firmly establish sport and physical activity
within the 4-11 age group.
• Universal: A range of programs and services are provided through
universal settings including early years settings, schools, children’s centres,
youth centres and youth projects. These include extended schools
programs including after school activities and targeted work with families
(Parent Link). Universal health services including health visitors, school
health nurses. A range of parenting programmes including those
coordinated by local authority employed parenting consultants. Many
schools continue to deliver the Social and Emotional Aspects of Learning
(SEAL) program, although there is no longer a centrally funded delivery
mechanism to support the program.
• Additional support: Support provided for those children and families
assessed as having additional needs include targeted health visitor and
school health nursing, vulnerable two year old Nursery Education Grant
(NEG) funding, local authority and voluntary sector family support services
and special educational need (SEN) and disability services. Integrated
support arrangements have been built around the use of the common
assessment framework (CAF) process which is being increasingly used
across the children and young people’s services in South Gloucestershire
including schools, health, local authority and the community and voluntary
Sector. Schools are responsible for developing protocols for preventing and
tackling bullying with some support from the Behaviour Support Team,
voluntary sector agencies such as Support Against Racist Incidents (SARI)
and on-line resources including the health and wellbeing website: South
West Grid for Learning Trust (SWGfL). Furthermore, as part of the Coalition
Government’s Troubled Families Programme, South Gloucestershire is
currently planning the scope and nature of interventions under this initiative
which continues until 2015.
• Specialist services: Services provided for those children and families
assessed as requiring specialist support or intervention include Children’s
Social Services, specialist CAMHS, specialist disability services (including
education, health and social care services), Youth Offending Service
(YOS), substance misuse services (for both young people and adults).
• The number of educational settings in South Gloucestershire is provided in
Table 1 of section 3.5.1 of this JSNA. Ofsted inspection reports during the
period 1st September 2011 to 28th September 2012 for the 24 primary
19
schools inspected show that on overall effectiveness and achievement
three were judged to be outstanding, 15 were judged to be good, five were
judged as satisfactory and one was placed in a category. During the same
period seven secondary schools were inspected, two were judged as good,
three were satisfactory and one was placed in a category.
• The recent 2011 Education Act has endorsed the view that the primary
responsibility for pupil outcomes and improvement lies with schools.
However, the local authority retains statutory powers to identify and
intervene in schools causing concern. The local authority Quality and
Standards Service fulfils these school improvement functions through risk
assessment processes negotiated and agreed with schools. Centrally
commissioned Traded Services are targeted to support schools that are
vulnerable or causing concern. Schools are also able to access the traded
services offer in relation to their identified needs. Increasingly, schools
draw on support from other schools and their accredited leaders, through a
number of networks, partnerships currently in place.
• South Gloucestershire Council is an inclusive local authority with less than
one per cent of its 5-15 year old population educated in special schools. Of
the three special schools that have been inspected Ofsted regards these
schools as mainly good or better (none have been inspected during the last
year). The Education Other than at School Service has been aligned with
the new school for pupils with behaviour, emotional and social difficulties
(BESD) where a service level agreement operates with the local authority.
There is a commissioned Inclusion Support Service which targets its
specialist advice, support and monitoring for pupils with significant needs in
mainstream schools.
• Services are commissioned from the Ethnic Minority and Traveller
Achievement Service (EMTAS) to provide for the growing BME population
including Travellers of Irish Heritage and Gypsy Roma pupils and includes
capacity building in mainstream schools.
• There are around 200 children in public care in the local authority (Table 1)
and the teacher in charge reports directly to the Principal Adviser (Quality
Assurance and Standards) who is the ‘Virtual Headteacher’.
• The council is currently consulting on proposals for services it provides for
children, young people and families, especially those that are
disadvantaged in any way and at risk of not achieving their potential, or the
best quality of life. The implementation of changes once outcomes are
known will most likely begin in April 2013.
20
4) Projected service use and outcomes in 3-5 years and 5-10
years
• The current economic environment is creating additional pressure and is
likely to lead to an increase in demand for services. Nationally, child
poverty is forecast to increase up to at least 2020 (Brewer et.al., 2011).
Furthermore, research for Action for Children, The Children’s Society and
NSPCC has predicted that the number of vulnerable families 10 will “…grow
substantially in coming years.” (Reed, 2012).
• The Office for National Statistics (ONS) is also projecting an increasing
children and young people population – particularly younger children
coming up through the system – an additional 600 0-4 year olds, 2,700 5-9
year olds and 2,000 10-14 year olds during the period 2012 to 2022 (ONS,
2012, Table 2d).
• In order to promote better outcomes across as wide a group of the
population as possible this probable increase in demand needs to be met
through early intervention and prevention.
10
Generally defined by things such as worklessness, living in poor quality and/or
overcrowded housing, no parent with qualifications, mother with mental health problems, etc.
21
Table 2: Projected service use, South Gloucestershire
Indicator
Obesity
3-5
5-10
Notes
Reception Year children – levels of obesity reducing
slowly, but still too high (Figure 1).
Year 6 children – levels of obesity levelling off, but still
too high (Figure 1).
As time has gone on what we have witnessed is more
of a social divide in childhood obesity with higher rates
among children from poorer and/deprived backgrounds
Bullying
Levels of reported incidents of bullying have been static
for the last two years (South Gloucestershire Council,
2012). It may increase if levels of vulnerability continue
to rise.
Troubled Families
(Worklessness,
offending, school
non-attendance)
Likely to increase as the effects of recession and
economic stagnation manifest themselves in family life
(Brewer et.al., 2011 and Reed, 2012).
CYP in Care
Likely to decrease due to impact of Transformation
Programme with focus on early intervention and
prevention (see Section 5.4 of this JSNA for further
details).
Attendance
Static as already very good and approaches are well
embedded across schools and LA support services.
Achievement
The number of FSM pupils has been increasing due to
economic difficulties. Future trend very much
dependent on future economic conditions, but are likely
to increase (Brewer et.al., 2011).
Impact of welfare reforms likely to increase numbers of
families made homeless, particularly so for large
families (DWP, 2010 and Fitzpatrick, et al., 2011).
BME pupil numbers also been increasing with little slow
down evidenced so far, e.g. most recent ONS net
international immigration figures are highest yet for
South Gloucestershire (ONS, 2012a).Non-EU migration
likely to fall, but with no limits or restrictions on EUmigration, numbers could continue to rise.
Medical advances has meant more severely disabled
children survive and therefore has an impact on future
school provision for SEN.
22
• In South Gloucestershire’s primary schools in 2010 there were around
2,300 surplus places, amounting to ten per cent of the total (South
Gloucestershire Council, 2010, p.28). However, the projections for pupil
numbers for the Reception to Year 6 cohorts to 2014 show a deficit of
negative one per cent for 2013 and 2014,which grows to negative five per
cent by 2014 (South Gloucestershire Council, 2010, p.28). Increases to
planned admission numbers and the expansion of existing schools are
expected to meet the shortfall. It is anticipated that beyond 2013 the
development scheduled will require more primary schools. In contrast, the
demand for secondary school places shows a year on year downturn with
significant surpluses projected to 2019, when nine per cent of places (c.
1,300) are projected to be in surplus (South Gloucestershire Council, 2010,
p.31).
• The Coalition Government is committed to reforming and reshaping
secondary education with major changes announced in the schools White
Paper to the secondary curriculum and radical plans for the examination
system at age 16 and beyond (DfE, 2010a). It is not possible, at this stage,
to predict outcomes three to five years ahead or beyond.
• The impact of the major house building programme is difficult to model in
the context where the mix and phasing of new development is either
unknown or changing. However, the revised Core Strategy indicates an
additional 26,855 dwellings during the period 2006-2026 (South
Gloucestershire Council, 2012a, p.75). 11 The next Commissioning of
Places Strategy will reflect this in more detail.
5) Evidence of what works
Obesity
• Obesity is the result of people responding normally to the obesogenic
environments they find themselves in (Swinburn et.al., 2011). The need to
change the current environment we live in that discourages obesity related
behaviour is important.
• Research shows that there are certain key characteristics determining how
effective interventions are in reducing childhood obesity. Involving parents
and intervening in the early years of a child’s life make success more likely.
Multi-component interventions that involve schools, families and
communities should be the treatment of choice (Lavelle, 2011).
• The evidence base for interventions that can prevent obesity, and promote
health have been well documented (Department of Health, 2011a). There is
strong evidence to support beneficial effects of child obesity prevention
11
This represents the latest revision to the Core Strategy and it is likely to be revised further before
being finalised in the adopted Core Strategy.
23
programmes on BMI, particularly for programmes targeted to children aged
six to twelve years.
• Evidence shows that there is sufficient evidence to justify well-targeted
action to prevent and treat childhood obesity. The most recent rigorous and
systematic reviews of the evidence for tackling obesity have been
undertaken by the National Institute for Health and Clinical Excellence
(NICE, 2006) and the Cochrane Collaboration (Waters et.al., 2011).
• A broad range of programme components were used in the research, and
whilst it is not possible to distinguish which of these components
contributed most to the beneficial effects observed, synthesis of the
evidence indicates the following to be promising policies and strategies:
o school curriculum that includes healthy eating, physical activity
and body image;
o increased sessions for physical activity and the development of
fundamental movement skills throughout the school week;
o improvements in nutritional quality of the food supply in schools;
o environments and cultural practices that support children eating
healthier foods and being active throughout each day;
o support for teachers and other staff to implement health
promotion strategies and activities (e.g. professional
development, capacity building activities); and
o parent support and home activities that encourage children to be
more active, eat more nutritious foods and spend less time in
screen based activities.
• Weight management services should be multifaceted and include
behaviour change strategies to increase people’s physical activity levels or
decrease inactivity, improve eating behaviour and the quality of the
person’s diet and reduce energy intake.
• The National Institute for Health and Clinical Excellence (NICE)have
produced a guidance document that outline recommendations to address
obesity:
o CG43: Guidance on the prevention, identification, assessment
and management of overweight and obesity in adults and
children. 12
o PH**: Obesity: Working with Local Communities (expected
October 2012).
Physical activity
• Recent reviews on effectiveness conducted by NICE have highlighted
significant gaps in the evidence base for interventions on physical activity in
a number of areas. However, it is generally agreed that interventions
should focus on activities that fit easily into people’s everyday lives (such
12
Available from the following link: http://www.nice.org.uk/CG43
24
as walking, cycling or dance) and are tailored to people’s individual
preferences and circumstances. However, a larger quantity of activity at
higher intensity (such as playing sport) can bring further benefits, and this
might be the aspiration for many people (Department of Health 2011).
• There is also now good evidence showing higher academic attainment in
children with higher levels of physical activity (Singh, 2012).
• Changing the built environment to encourage and support physical activity
provides the most sustainable method to increase activity levels.
• NICE have produced a number of guidance documents that outline
recommendations to address inactivity:
o PH8: Physical activity & the environment. 13
o PH17:Promoting physical activity, active play and sport for preschool and school-age children and young people in family, preschool, school and community settings. 14
o PH6:Behaviour change at population, community and individual
levels. 15
o PH**: Walking and cycling: local measures to promote walking
and cycling as forms of travel or recreation (expected October
2012).
• The report ‘Early Intervention the Next Steps’, highlighted a number of
evidence based programmes relating to early intervention that had been
shown to produce positive outcomes (Allen, 2011). A number of these
programmes (and programs which include aspects of those interventions)
are currently being delivered in South Gloucestershire. These include
Solihull, Incredible Years, Parents Plus Children, Parents Plus Teens and
Strengthening Families - all parenting programs covering the 0-14 age
ranges. Family therapy is provided by CAMH services with some solution
focussed work undertaken by Family Support Services. FACS (Foster
carers’ and Children’s Support) is a local program to support placement
stability for children in care based on the Multidimensional Treatment
Foster Care program described by Graham Allen. The Family Intervention
Program (FIP) provides an intensive whole family approach to families who
have been identified as having additional levels of risk.
• Many schools continue to deliver the evidence based SEAL program with a
focus on building emotional well-being and resilience. The program was
initially supported by a specific funding stream but this is no longer the case
and it is difficult to ascertain how many schools are still offering the
program.
13
Available from the following link: http://www.nice.org.uk/PH8
15
14
25
• In addition to the above, the principles outlined in the national social justice
strategy are helpful in the design of effective interventions (DWP, 2011,
p.4).
1. A focus on prevention and early intervention.
2. Where problems arise, concentrating interventions on recovery and
independence, not maintenance.
3. Recognising that the most effective solutions will often be designed
and delivered at a local level.
• Effective schools meet the needs of all their pupils and school improvement
processes are a key driver for achieving overall effectiveness.
• Goodman and Gregg (2010) have undertaken a comprehensive analysis of
interventions and concluded that there are three main areas in which future
policy and practice could make a contribution to reducing inequalities and
raising attainment. These are:
o parents and the family home: improving the home learning
environment and helping parents from poorer families to believe
their own actions and efforts can lead to improved outcomes.
o children’s attitudes and behaviours: raising families’ aspirations,
reducing children’s behavioural problems and engagement in
risky behaviours, helping poorer children believe their own
actions and efforts can lead to improved outcomes.
o the school’s approach: allocating funds to pupils from the
poorest backgrounds and direct teaching support to children
falling behind.
• Schools have had access to a wealth of initiatives aimed at improving
outcomes to choose from and while there have been some improvements
in attainment, it is clear that outcomes still fall below those anticipated.
• There is now funding for schools to raise achievement among
disadvantaged children (e.g. the Pupil Premium). The precise mechanisms
for allocation of these funds have been clarified, but the evaluation of
impact remains a challenge. A recent evaluation of most of these schemes
highlighted the variations in cost and impact in terms of maximum
approximate advantage over the course of the school year (Higgins et.al.,
2011). The research indicates a simple fact, that:
“…simply spending more on children from less affluent
backgrounds, however, will not necessarily improve their learning or
their aspirations.”
• OfSTED have recently published their first interim findings of how schools
are using their allocation of Pupil Premium and concluded the following:
“The survey found that many schools did not disaggregate the Pupil
Premium from their main budget, and said that they were using the
26
funding to maintain or enhance existing provision rather than to put
in place new activity. Half of the schools surveyed said the pupil
premium was making little or no difference to the way they work.”
(OfSTED, 2012a).
• OfSTED have recommended that school leaders, including governing
bodies, need to better target their additional resources to disadvantaged
pupils and better evaluate its impact (OfSTED, 2012a).
• In primary and secondary schools: effective feedback, meta-cognition and
self-regulation strategies, peer tutoring, early intervention, one to one
tutoring, homework and ICT can contribute between nine and four months
progress respectively (Higgins et al., 2011). However, there is no substitute
for good teaching as the starting point. This evidence has been brought
together in the Sutton Trust’s new Education Endowment Fund Teaching
and Learning Toolkit which is an independent resource which provides
guidance for teachers and schools on how to use their resources to
improve the attainment of disadvantaged pupils (summary reproduced in
Appendix A).
6) User views on needs, services / assets and gaps
The following include examples of user feedback available across a range of
services relevant to this section. Whilst there are some areas of strength (e.g.
the Barnardos' participation work with North Bristol NHS Health Trust), there
are significant gaps in the collection and use of user feedback in the
commissioning and delivery of services.
Obesity
• As part of the REACH programme, both children and parents are asked to
complete a feedback questionnaire at the end of each programme. The
questionnaire includes multiple-choice questions related to their satisfaction
with various areas of the programme as well as open-ended questions and
space for additional comments. Focus groups were also held as part of the
MEND programme which informed the initial development of the REACH
programme.
Physical activity
• Circadian Leisure Trust (previously South Gloucestershire Leisure Trust)
carry out ‘non-user’ surveys every two years to investigate attitudes and
behaviour around exercise, to find out what the residents of the area think
about the facilities, and what would encourage them to use their leisure
facilities in the future. The Leisure Trust also conduct annual ‘user’ surveys
which gather information on views from current service users.
• Parenting programmes:
o 90% improvement in goals identified by parents by end of
27
course (Parent Defined Goals).
o 83% improvement in problems identified by parents by end of
course (Parent Defined Problems).
o 75% improvement in parents’ perceptions of child’s behaviour at
end of course (Strengths and Difficulties Questionnaire).
• SSCC Stay and Play evaluations: took place from Dec 2010 to Jan 2011.
There were 170 responses, of which 60% felt Stay and Play had led to a
definite increase in parental confidence and a 50% to 80% improvement
rating for a further seven themes.
• Resilience: Pyramid - a focus group evaluation was completed in 2011.
There was a 57% increase (from 37% to 94%) in the number of children
reporting that they were “happy being me”. There was a 47% increase
(from 47%to 94%) in the number of children saying they were “happy about
their friendships”.
• NHS Trust survey in 2011 - young people gave their views on how
services could improve, which included comments on the following:
o accessing services
o staff skills
o communication and sharing information
o improving knowledge of services available.
• The last TellUs Survey (TellUs4, 2010) noted that responses for students in
the local authority were broadly in line with national percentages on
aspects such as: the school was giving them useful skills; that lessons
were made fun and interesting; feedback on work and help was available;
that bullying was dealt with at school. For younger pupils (year 6)
responses were similarly in line for plans to do more studying at college.
However, for year eight and year ten pupils the percentages were
significantly lower compared to national for doing a course at college and
for saying whether they aspire to go to university. Student or parent views
on schooling have not since been specifically sought in the last two years.
This could be a focus of future work.
7) Equality Impact Assessments
• An EIA was conducted on the child weight management programme
REACH (Rethinking, Eating and Activity for Childs Health). Overall, the
data shows that:
o more girls than boys have attended the programme.
o a high number of children from BME backgrounds have attended
the programme. BME groups having attended are: “Arab”,
“Asian/Asian British – Pakistani”, “Mixed/Multiple Ethnic Groups
28
– White & Asian”, “Mixed/Multiple Ethnic Groups – White &
Black Caribbean”, “White – Irish”, “White – Other”.
o a lower number of disabled children have attended a
programme. Impairment types of those having attended are
“sensory impairment”, “learning disability/difficulty”.
• An EIA has been completed on Breakthrough, with data showing that:
o more males than females take part in Breakthrough
o more males than females take part in Choices 4U
o a high number of people from BAME backgrounds use the
Choices 4U programme; however, only one of these users was
female, the remainder being male).
• An EIA has been completed on the leisure centres, with data showing
that:
o there is a fairly even split of boys (52%) and girls (48%)
attending the various sports programmes
o the balanced gender representation is consistent with the way
sport is delivered in South Gloucestershire’s schools and in line
with the principles of sports equity we promote.
• In terms of combating health inequalities, there has been a significant
amount of targeted work in 2011/12 which is borne out by high levels of
uptake from children living in Priority Neighbourhoods (11% of participants)
and those with disabilities (6%).
• An EIA has been carried out for Targeted Support for Parents and
Families. 16
• There has not been a formal EIA for South Gloucestershire’s education
service.
8) Unmet needs and service gaps
Obesity
• There is a significant unmet need for children and young people’s weight
management services across South Gloucestershire in the short and long
term. This unmet need increases inequalities in health.
16
Available from the following link:
http://intranet/content/CYP/Department/StrategyAndQuality/StrategyAccessAndPlanning/equalities/eia.h
tm
29
• Since the demise of the National Healthy Schools programme and the
locally led Healthy School Plus, there is gap in services to ensure a coordinated and whole school approach to tackling obesity.
• More families are being referred to the local Chipping Sodbury and Yate
Foodbank for emergency assistance. 17 There is a likelyhood that more
families are struggling to afford to provide enough food for all members of
their family to have a balanced, healthy and nutritious diet.
Physical activity
• There is a need to improve children’s participation in sport and physical
activity using a range of programmes and interventions including individual
behaviour change, built environment, transport, and school-based
programmes.
• There is a need to improve participation in physical activity, particularly in
groups where uptake is lower (females, post 16 drop off and people who
are classified as being from poorer socio-economic groups).
• After school sports and physical activity provision varies between schools
at both primary and secondary level.
• It will be important to maintain a focus on ensuring there is sufficient
capacity to deliver effective early intervention and preventative services to
meet the needs of families before their problems escalate. In the context of
reduced resources, services are being reconfigured to better target
resources for this purpose. It is likely, however, that there will be
considerable tensions between diverting resources to preventative
interventions whilst responding to those children and families identified as
at most risk and requiring expensive statutory services.
• There is currently a lack of coordination of the work being undertaken
across the authority in relation to the issues of emotional resilience and
parenting. As research and evidence grows regarding what works, a more
coherent approach across agencies and settings would enable better use
of resources and the promotion of programs that are known to improve the
lives of children and young people.
• There is a need to continue to increase multi-agency responses to the
Troubled Families Programme to support the outcomes indicated in the
‘Financial Framework for Troubled Families’ document (DCLG, 2012).
• A focus on pedagogy that builds recovery and independence rather than
maintenance and dependence will better enable families to effectively deal
with problems and issues as they arise.
• Young people in South Gloucestershire have very limited access to
confidential and free counselling and this is a significant gap.
17
Refer to Section 4.2 of this JSNA.
30
• There is likely to be a significant gap between the number of substance
misusing parents and those accessing and receiving treatment for their
substance misuse. This issue is covered more generally in Section 6.1
‘Adult Healthy Lifestyles and Risky Behaviours’ of this JSNA. A recent
report published by the Children’s Commissioner, Dr Maggie Atkinson, has
highlighted the particular issue of parental alcohol misuse, and in particular
how the policy response to this issue has been weak in comparison with
the issue of parental drug misuse (Adamson and Templeton, 2012).
• Similarly, there is likely to be significantly more need in the adult population
for diagnosis and treatment of mental health conditions than there is
current capacity for – covered more generally in Section 6.2.4 ‘Adult Mental
Health’ of this JSNA.
• In view of the large number of domestic abuse incidents reported among
families, it is likely there is also a gap in the provision of services to families
in relation to dealing with this issue – covered more generally in Section 8.2
‘Adults – Domestic Abuse’ of this JSNA.
• There is considerable evidence of emphasis on parenting programmes and
support in the early years, but much less in the primary school years, and
even less in secondary schools. Reaching families while children are of
school age may continue to be as useful as doing so in the early years and
schools have more of a part to play here.
• Intensive programmes, such as those identified by the Sutton Trust,
focussed on helping particular groups of pupils have a significant part to
play in narrowing the gaps. The accountability of schools for the
implementation of such programmes using resources such as the ‘pupil
premium’ is growing. This has been highlighted by the recent OfSTED
report into the use of the new Pupil Premium by schools (OfSTED, 2012a).
• Services (and curricular interventions) that can address the mental health
and emotional wellbeing of pupils and promote resilience, self-belief and an
internal locus of control may have more of a part to play than is currently
recognised because the causal connections have not been established; nor
is there enough robust evidence to show that they would change poorer
pupils outcomes for the better.
9) Recommendations for consideration by commissioners
Obesity
• Children and young people should have access to complete care pathways
for the treatment of obesity, reflecting the provision of services that are
based on patient need and evidence based practice.
• Long-term commitment to the commissioning of weight management
services for children aged 2-18years and their families.
31
• Commission a Healthy Schools intervention that supports a whole-school
approach to promoting healthy eating and physical activity.
Physical activity
• Commission a Healthy Schools intervention that supports a whole-school
approach to promoting healthy eating and physical activity.
• Commission services that promote walking and cycling to school.
• Commission a physical activity service that increases participation in
physical activity and sport by engaging inactive and semi-active
individuals/groups in a variety of settings through an improved range of
opportunities, advice, signposting and information which dovetail with local
healthy eating and weight management services.
• Widen access and physical activity opportunities to those with mental
health and physical disabilities.
• Commission sufficient midwifery and health visitor services.
• Commission services to support parents and carers who need additional
support (including support for families under the Troubled Families
Initiative) to provide good enough parenting to their children, particularly in
the early years but across all age ranges. Use an integrated approach so
that services are coherent and accessible.
• Commission free and confidential counselling services for young people in
South Gloucestershire (this is currently a significant gap).
• Address the gap in the coordination of activity in relation to children’s
emotional wellbeing, resilience and bullying.
• Address the likely gaps in the provision of diagnosis and treatment services
for alcohol/substance misuse and mental ill-health among parents. In
addition, continue to strengthen the links and referral pathways between
adult social services and children’s social services.
• Address the likely shortfall in services provided to families who experience
domestic abuse.
• Within the context of deficit reduction, changes in school types and
changing arrangements for services involved with raising attainment
outcomes for children, the local authority needs to ensure that:
o all educational establishments provide high quality education
and that satisfactory is not good enough. 18
o improve the quality of teaching and learning in South
Gloucestershire so that it is mainly good and pupils at all points
18
Under the revised OfSTED Inspection Framework for Schools the ‘satisfactory’ grading has been
changed to ‘requires improvement’. Source: OfSTED, 2012.
32
of the spectrum are able to fulfil their potential, particularly those
with the lower prior attainment and those that are not achieving
the higher levels that they should. This includes the use and
evaluation of the effectiveness of the new Pupil Premium.
o promote the engagement of parents and carers, especially
where pupils have low prior attainment, in activities to build
confidence that their own actions can lead to higher education
and a better future. We need to aim higher, earlier.
o promote the value of programmes linked to the social and
emotional aspects of learning that improve young people’s
confidence, social, emotional and behavioural skills, giving them
more of a sense of control over their actions and lives.
10) Recommendations for further needs assessment work
• Feedback from children, young people, parents and carers: with the
demise of the national TellUs survey in schools there is an emerging gap in
relation to the collection and analysis of the views of children, young
people, parents and carers. Whilst the majority of services do have
processes for collecting and using feedback, there is no coherent
methodology and it is currently difficult to draw out themes and issues for
the purpose of service improvement.
33
References
Adamson, J. and Templeton, L. (2012), Silent Voices: Supporting children and
young people affected by parental alcohol misuse, Children’s Commissioner,
available from the following link:
http://www.childrenscommissioner.gov.uk/content/publications/content_619
Allen, G. (2011), Early Intervention: The Next Steps, available from the
following link: http://www.info4local.gov.uk/documents/publications/1839949
Arseneault, L., Bowes, L. and Shakoor, S. (2010), Bullying victimization in
youths and mental health problems: ‘Much ado about nothing’?, Psychological
Medicine, 40, pp. 717-729, available from the following link:
http://journals.cambridge.org/action/displayAbstract;jsessionid=F95CA94D188
C6D44D16A214886AFFA9F.journals?fromPage=online&aid=7436200
Avenell, A.et. al. (2004), Systematic review of the long term effects and
economic consequences of treatments for obesity and implications for health
improvement, Health Technology Assessment, 2004; Vol. 8: No. 21, available
from the following link: http://www.hta.ac.uk/execsumm/summ821.htm
Brandon, M., et.al. (2012), New learning from serious case reviews: a two
year report for 2009-2011, available from the following link:
https://www.education.gov.uk/publications/RSG/AllPublications/Page1/DFERR226
Brewer, M., Browne, J. and Joyce, R. (2011), Child and working-age poverty
from 2010 to 2020, Institute for Fiscal Studies, available from the following
link: http://www.ifs.org.uk/publications/5711
C4EO (2011), Grasping The Nettle: Early intervention for children, families
and communities, available from the following link:
http://www.c4eo.org.uk/themes/earlyintervention/default.aspx?themeid=12&ac
cesstypeid=1
Cooper, R., Hyppönen, E.,Berry, D. and Power, C. (2010), Associations
between parental and offspring adiposity up to midlife: Thecontribution of adult
lifestyle factors in the 1958 British Birth Cohort Study, American Journal of
Clinical Nutrition; 92(4): 946–53.
DCMS (2008), The PE and Sport Strategy for Young People (PESSYP),
available from the following link: http://www.ssponline.co.uk/backgroundPESSYP.htm
DCMS (2012), Creating a Sporting Habit for Life: A New Youth Sport Strategy,
http://www.culture.gov.uk/publications/8761.aspx
Department for Communities and Local Government (2012), Financial
framework for the Troubled Families programme’s payment-by-results
scheme for local authorities, available from the following link:
http://www.communities.gov.uk/publications/communities/troubledfamiliesfram
ework
34
Department for Education (2009), Safe from Bullying: guidance for local
authorities and other strategic leaders on reducing bullying in the community,
http://www.teachernet.gov.uk/wholeschool/behaviour/tacklingbullying/
Department for Education (2009a), PE and Sport Survey 2008/9, available
from the following link:
https://www.education.gov.uk/publications/eOrderingDownload/DCSFRR168.pdf
Department for Education (2010), PE and Sport Survey 2009/10, available
from the following link:
https://www.education.gov.uk/publications/RSG/AllRsgPublications/Page9/DF
E-RR032
Department for Education (2010a), The Importance of Teaching - The Schools
White Paper 2010, available from the following link:
https://www.education.gov.uk/publications/standard/publicationdetail/Page1/C
M%207980#downloadableparts
Department for Education (2011a), Children Looked After by Local Authorities
in England (including adoption and care leavers) - year ending 31 March
2011, available from the following link:
http://www.education.gov.uk/rsgateway/DB/SFR/s001026/index.shtml
Department for Education (2011b), Referrals, assessments and children who
were the subject of a child protection plan (2010-11 Children in Need census,
Provisional), available from the following link:
http://www.education.gov.uk/rsgateway/DB/STR/d001025/index.shtml
Department for Education (2011c), DfE: National Curriculum Assessments at
Key Stage 1 in England, 2011, available from the following link:
Department for Education (2011d), National Curriculum Assessments at Key
Stage 2 in England 2010/2011 (revised), available from the following link:
Department for Education (2012), GCSE and Equivalent Results in England,
2010/11 (Revised), available from the following link:
Department for Education (2012a), GCSE and Equivalent Attainment by Pupil
Characteristics in England, 2010/11, available from the following link:
Department for Education (2012b), National Curriculum Assessments at Key
Stage 2 in England, 2012 (provisional), available from the following link:
Department for Education (2012c), Phonics Screening Check and National
Curriculum Assessments at Key Stage 1 in England, 2012, available from the
following link:
35
Department for Work and Pensions (2010), Housing Benefit: Changes to the
Local Housing Allowance Arrangements, Impact Assessment, available from
the following link: http://www.dwp.gov.uk/docs/lha-impact-nov10.pdf
Department for Work and Pensions (2011), Social Justice: transforming lives,
available from the following link: http://www.dwp.gov.uk/policy/social-justice/
Department of Health (2009), Be Active, Be Healthy: A Plan for Getting the
Nation Moving, available from
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPol
icyAndGuidance/DH_094358
Department of Health (2010), Our Health and Wellbeing Today, available from
the following link:
Department of Health (2011), Start Active, Stay Active: A report on physical
activity for health from the four home countries, Chief Medical Officers,
Department of Health (2011a), Strategic high impact changes: childhood
obesity,available from the following link:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAn
dGuidance/DH_126104
Department of Health (2011b), National Child Measurement Programme:
England, 2010/11 school year,NHS Information Centre for Health and Social
Care available from the following link:http://www.ic.nhs.uk/ncmp
Due, P. et.al.. (2009), Is bullying equally harmful for rich and poor children?: a
study of bullying and depression from age 15 to 27, European Journal of
Public Health, 19:5, 464-469.
Fitzpatrick, S., Pawson, H., Bramley, G. and Wilcox, S. (2011), The
Homelessness Monitor Tracking the Impacts of Policy and Economic Change
in England 2011-2013, Institute for Housing, Urban and Real Estate
Research, Heriot-Watt University &Centre for Housing Policy, University of
York, available from the following link: http://www.crisis.org.uk/publicationssearch.php?fullitem=332
Food Standards Agency (2007), Low income diet and nutrition survey,
http://tna.europarchive.org/20110116113217/http://www.food.gov.uk/science/
dietarysurveys/lidnsbranch/
Foresight (2007), Tackling Obesities: Future Choices – Project
Report,Government Office for Science, available from the following link:
http://webarchive.nationalarchives.gov.uk/+/http://www.bis.gov.uk/foresight/ou
r-work/projects/current-projects/tackling-obesities
Friedemann, C., Heneghan, C., Mahtani, K., Thompson, M., Perera, R. and
Ward, A. (2012), Cardiovascular disease risk in healthy children and its
36
association with body mass index: systematic review and meta-analysis, BMJ
2012;345:e4759, available from the following link:
http://www.bmj.com/content/345/bmj.e4759
Gardner, D.S., Hosking, J., Metcalf, B.S., Jeffery, A.N., Voss, L.D. and Wilken
(2009), Contribution of Early Weight Gain to Childhood Overweight and
Metabolic Health: A longitudinal study (early bird 36),Paediatrics, Vol. 123 (1):
pp67-73, available from the following link:
http://pediatrics.aappublications.org/content/123/1/e67.abstract
Goodman, A. and Gregg, P. (2010), Poorer children’s educational attainment:
how important are attitudes and behaviour?, Joseph Rowntree Foundation,
York, available from the following link:
http://www.jrf.org.uk/publications/educational-attainment-poor-children
Hawker, D. and Boulton, M. (2000), Twenty years’ research on peer
victimisation and psychological maladjustment: a meta-analytic review of
cross-sectional studies, Journal of Child Psychology and Psychiatry, 41:441455.
The Health and Social Care Information Centre (2011),Statistics on obesity,
physical activity and diet: England, 2011, available from the following link:
http://www.ic.nhs.uk/pubs/opad11
Higgins, S., Kokotsaki, D. and Coe, R. (2011), Toolkit of Strategies to Improve
Learning Summary for Schools Spending the Pupil Premium, The Sutton
Trust, available from the following link:
http://www.suttontrust.com/research/toolkit-of-strategies-to-improve-learningtechnical-appendices/
HM Government (2011), A New Approach to Child Poverty: Tackling the
Causes of Disadvantage and Transforming Families' Lives, available from the
following link:
https://www.education.gov.uk/publications/standard/publicationDetail/Page1/C
M%208061
HM Revenue and Customs (2011), Personal Tax Credits: Related Statistics Child Poverty Statistics, available from the following link:
http://www.hmrc.gov.uk/stats/personal-tax-credits/child_poverty.htm
Hoghughi, M. S. and Long, N. (2004), Handbook of Parenting: Theory and
Research for Practice, SAGE, London.
The Information Centre for Health and Social Care (2008), Health Survey for
England 2008, London: The Information Centre for Health and Social Care,
http://www.ic.nhs.uk/pubs/hse08physicalactivity
Kramer, M.S. (2004), Commentary: Maternal nutrition, body proportions at
birth, and adult chronic disease, International Journal of Epidemiology, 33(4):
837-838, available from the following link:
http://ije.oxfordjournals.org/content/33/4/837.full
Lavelle, H., Mackay, D. and Pell, J. (2011), Systematic review and metaanalysis of school-based interventions to reduce body mass index, Journal of
37
Public Health, available from the following link:
http://jpubhealth.oxfordjournals.org/content/early/2012/01/20/pubmed.fdr116.s
hort?rss=1
Manning, V., Best, D., Faulkner, N. and Titherington, E. (2009), New
estimates of the number of children living with substance misusing parents:
results from UK national household surveys, BMC Public Health, 9:377,
available from the following link: http://www.biomedcentral.com/14712458/9/377/abstract/
Mental Health Foundation (2010), MyCare, available from the following link:
http://www.mentalhealth.org.uk/publications/mycare-report/
NICE (2006),Obesity: the prevention, identification, assessment and
management of overweight and obesity in adults and children, National
Institute for Health and Clinical Excellence, Clinical Guidance 43, available
from the following link: http://www.nice.org.uk/guidance/CG43
NICE (2008),Improving the nutrition of pregnant and breastfeeding mothers
and children in low-income households,Public Health Guidance 11, London,
http://guidance.nice.org.uk/PH11/Guidance/pdf/English
Nocon, A. (2006),Background evidence for the DRC’s formal investigation into
health inequalities experienced by people with learning disabilities or mental
health problems, Disability Rights Commission, available from the following
link: http://www.leeds.ac.uk/disabilitystudies/archiveuk/nocon/Evidence_paper_2006.pdf
National Obesity Observatory (2010),National Child Measurement
Programme: Changes in children’s body mass index between 2006/07 and
2008/09, NOO: Oxford, available from the following link:
http://www.noo.org.uk/NCMP/National_report
National Obesity Observatory (2011), Child Obesity and Socioeconomic
Status, NOO: Oxford, available from the following link:
http://www.noo.org.uk/NOO_pub/Key_data
National Obesity Observatory (2011a), Does skipping breakfast help with
weight loss?, October 2011, available from the following link:
http://www.noo.org.uk/NOO_pub
Oates, J. (2010), Supporting Parenting, Early Childhood in Focus 5, Open
University, Milton Keynes, available from the following link:
http://oro.open.ac.uk/21201/2/ECiF5-final-corrected.pdf
Office for National Statistics (2012), Subnational Population Projections, 2010based projections, ONS, available from the following link:
http://www.ons.gov.uk/ons/rel/snpp/sub-national-population-projections/2010based-projections/index.html
Office for National Statistics (2012a), Migration Statistics Quarterly Report,
May 2012, available from the following link:
http://www.ons.gov.uk/ons/publications/re-referencetables.html?edition=tcm%3A77-262229
38
OfSTED (2010), Equalities in Action, available from the following link:
http://www.ofsted.gov.uk/resources/equalities-action
OfSTED (2012), The framework for school inspection from September 2012,
http://www.ofsted.gov.uk/resources/framework-for-school-inspectionseptember-2012-0
OfSTED (2012a), The Pupil Premium, Ref. 120197, 20th September 2012,
available from the following link: http://www.ofsted.gov.uk/resources/pupilpremium
Prince, J. (2010), Children’s and Young People’s Needs Assessment, South
Gloucestershire Council, available from the following link:
http://www.sgcyp.org/LinkClick.aspx?fileticket=vGogpf6iTAU%3D&tabid=80&
mid=420
Reed, H. (2012), In the Eye of the Storm: Britain's forgotten children and
families, Action for Children, The Children’s Society and NSPCC, available
from the following link: http://www.childrenssociety.org.uk/news-views/pressrelease/joint-report-warns-dramatic-rise-disadvantaged-children-and-families
Reilly, J.J. (2010), Low levels of objectively measured physical activity in preschoolers in child care, Medicine & Science in Sports & Exercise, 2010
Mar;42(3):502-7.
School Food Trust (2010), Take up of school lunches in England 2009-2010,
available from the following link: http://www.schoolfoodtrust.org.uk/schoolcooks-caterers/reports/statistical-release-take-up-of-school-lunches-inengland-2009-2010
Scientific Advisory Committee on Nutrition (2011),Dietary Recommendations
for Energy (Pre-publication copy), SACN.
Singh, A.,et al.(2012), Physical Activity and Performance at School:A
Systematic Review of the Literature Including a Methodological Quality
Assessment,Archives of Pediatric and Adolescent Medicine, 166(1):49-55.
South Gloucestershire Council (2010), Draft Commissioning of Places
Strategy 2009-14, available from the following link:
http://www.southglos.gov.uk/_Resources/Publications/CYP/10/0200/CYP-100115
South Gloucestershire Council (2012), Extract from Sentinel Anti- Bullying
Systems, CYP, unpublished.
South Gloucestershire Council (2012a), South Gloucestershire Council – Core
Strategy: Schedule of Rolling Suggested Changes, Version 3: 30/07/12,
https://consultations.southglos.gov.uk/gf2.ti/f/251202/7379333.1/PDF//SRC3%20Schedule%20of%20Rolling%20Changes%20Web%20version%20
3.pdf
Strand, S. (2008), Minority Ethnic Pupils in the Longitudinal Study of Young
People in England - Extension Report on Performance in Public Examinations
at Age 16, available on-line from:
39
https://www.education.gov.uk/publications/standard/publicationDetail/Page1/D
CSF-RR029
Waters, E. et.al. (2011), Interventions for preventing obesity in children, The
Cochrane Collaboration, available from the following link:
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001871.pub3/abstract
Zaninotto, P., Wardle, H., Stamatakis, E., Mindell, J. and Head. J. (2006),
Forecasting Obesity to 2010, London: National Centre for Social Research,
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsSt
atistics/DH_4138630
Key contacts
Public health
Lindsey Thomas – [email protected]
Matthew Pearce - [email protected]
Lindsay Gee – [email protected]
Local authority
Geri Palfreeman, Service Manager - Preventative Services –
[email protected]
Katie Harwood, Service Manager - Preventative Services –
[email protected]
Denis D’Souza, Quality Assurance Senior Adviser, Vulnerable Groups –
[email protected]
Joe Prince, Research Officer – [email protected]
40
Appendix A
Education Endowment Foundation and Sutton Trust Teaching and
Learning Toolkit Summary for Improving the Attainment of
Disadvantaged Children
Overview of value for money
Promising
10
May be worth it
Feedback
Effect Size (months gain)
Meta‐cognitive
Pre‐school
Peer tutoring
1‐1 tutoring
Homework
Learning styles
0
£0
Summer schools
Parental AfL
involvement
Individualised Sports
learning
Arts
Ability grouping
Performance pay
ICT
Smaller classes
After school
Not
worth it
£1000
Cost per pupil
Source: Higgins (2012), The teaching and learning toolkit.
41
Teaching assistants

Section 5.1 - South Gloucestershire Council

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