Kirsty at six months: Poverty doesn’t have to lead to poor outcomes

Holyrood baby, Dr Christine Puckering - illustration Jenny Proudfoot

The future health and wellbeing of Kirsty, the Holyrood baby, will depend to a substantial extent on the responsive care she receives. The first 1001 days from conception are fundamental in providing a foundation for later learning, social relationships and resilience.

In those 1001 days, the myriad brain cells make connections, and connections made early and used repeatedly become strong while others are “pruned” away.

If Kirsty experiences sensitive responsive care she will learn to trust other people, build sound relationships and develop the capacity for empathy. These life-forming experiences depend on the availability of a small number of caring adults, her mother Caley being the obvious first candidate. 

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Kirsty is already disadvantaged by being born into poverty and its attendant troubles, but Caley’s capacity to make a strong loving bond with her daughter will still count for more.

The Sure Start programme recognised that children born in poverty were disadvantaged. They identified the correlation with households where no one was employed and so set about providing support for parents to get into work while offering childcare from a very early age to their children.

There is a fallacy in the reasoning here. The correlation of poverty with poor outcomes for children does not equate with causation. Yes, poverty is related to poor outcomes, but it does not necessarily cause them.

Propelling parents into poorly paid work and their young children into child care did not prove to be the solution. Research showed that good early years education was helpful, but the most disadvantaged children still fell behind their advantaged peers. The most powerful predictor of good outcome was what was called the Home Learning Environment; parents who interacted daily with their children, involved them in activities and provided opportunities to learn including reading books with them from an early age.

The quality of child care and early education is, of course, important.  Sadly in Scotland we do not invest wisely in the care of our future citizens. Our child care workers are often poorly qualified and poorly paid, failing to attract the brightest and best workers and providing little incentive for them to offer the best opportunities to the children in their care. Child care is also a major expense for families trying to make the family budget stretch. The offer of free childcare and early education hours to three year olds and now to disadvantaged two year olds still does not fill the gaps.

More generous parental leave and an investment in good quality child care workers, and so in early education, would go a long way to addressing the deficits

Caley’s wellbeing, her capacity to use social support and the availability of the right kind of support are key to Kirsty’s future. Caley needs to be free to see, read, and respond to Kirsty’s physical and emotional needs.

Anything that pre-occupies Caley, whether it be financial troubles, domestic violence or depression will interfere with her freedom to respond to Kirsty. There is strong evidence that her own early life and her attachment experiences will be related to the quality of the relationship she can make with Kirsty. If she did not have the opportunity at an early age to make strong trusting relationships, then not only will she find it more difficult to provide these for Kirsty but also to use and trust services and agencies.

What can help to break this cycle? Powerful research from the University of Leiden has identified key features of interventions that might help. It found programmes which are relatively brief, focus on parent-child sensitivity and use video feedback are most effective.

Video interaction guidance and Mellow Babies meet these criteria, but are only patchily available. UK trials of other programmes such as the Nurse Family Partnership and Parent-Infant Psychotherapy have not been demonstrated to make a substantial difference. More behavioural programmes, such as Triple P or Incredible Years are not relevant to the youngest children.

There has also been little mention of Kirsty’s father. Fathers are too often absent in discussions of children’s outcomes, though they play a substantial part. Fathers are marginalised and even demonised as part of the problems rather than part of the solution. Specific services for fathers are few and far between, and men are rarely seen in early child care and education roles, depriving children of an important resource. Better funded paternity leave would start to address this deficit.

The Scottish Government has declared that education is a priority. At school entry, the most deprived children are already eighteen months behind in language and other skills. If we really want to make a difference to attainment, the most fruitful investment is in the parent-child relationship in the preschool period.