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Specialist Community Public Health Nurses (SCPHN)

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Specialist Community Public Health Nurses (SCPHN)

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SCPHN's play a pivotal role in nurturing positive, loving relationships between parents and child. These positive relationships lay the foundation for happy healthy families which in turn has a positive impact in many key life stages (NMC, 2011). Working in a primary care setting, SCPHN's work with an emphasis on public health, although the scope of their role may vary, for instance if they work in a deprived area they may have a large safeguarding caseload and find it difficult to focus on strategic elements of public health.

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Bandura (1977, cited in Aubrey and Riley, 2016) refers to reciprocal determinism, stating that child behaviour is impacted by the environment in which they grow up along with personal characteristics. He suggested that; children would need to pay attention to the behaviour, have capacity to be able to replicate it and have the motivation to want to replicate it. If children observe positive outcomes from a witnessed behaviour they are likely to copy it, however if they observe negative effects, they are not likely to have the motivation to want to copy it.  Domestic violence is more prevalent in households where there is stress, depression or substance misuse and these factors are more often present in households living in poverty. It is estimated that up to 90% of violent incidents within the home are witnessed by children (Underdown, 2007). If the child witnesses violent, aggressive episodes regularly, they may regard it as acceptable behaviour to replicate, leading to their inhibitions regarding aggressive behaviour to weaken (Bandura, 1973, cited in Packer, 2017). Conversely, if a child witnesses violent, aggressive behaviour and observes the negative consequences, for instance their mother living in fear, obtaining injuries, feeling emotional and depressed, they are less likely to have the motivation to want to imitate the behaviour.

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The four key domains of child development are; Physical, which provides the basis for development of all psychological and intellectual domains. Cognitive, which is responsible for language, literacy, numeracy and logical thinking skills. Social and emotional, which governs the process of developing the ability to understand and manage their emotions and those of people around them and is highly associated with forming positive relationships. Behavioural, which is responsible for children to regulate their own behaviour, their attention and impulses. Poverty can affect all of these key areas of development. The environment in which the child grows up and the actions and behaviours of the parents/caregivers along with parental mental ill health, experiences the child is exposed to and having an unsecure attachment can all play a part in inhibiting child development in these key areas (Early Intervention Foundation, 2018).

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GP's are the cornerstone to maintaining the health and wellbeing of their patients. They have a duty of care to their patients to preserve their physical, emotional, intellectual, spiritual health and development (Bhaduri, 2006). They are well placed to refer on to specialists, for instance a paediatrician or dietician, if they had concerns over a child's development or diet. Signpost on to other services; CBT, if a parent is struggling with stress, depression or anxiety for example or CAB if a family is struggling with money issues or debt (some GP surgeries have CAB representatives hold drop in sessions). And they can refer on to early intervention teams, if they feel a family may need extra support, or on to social services if they have immediate safeguarding concerns for a child.

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Social Worker and Early Intervention/Family Support 

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Social Worker and Early Intervention/Family Support 

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It has been shown that children who receive early interventions have improved outcomes and life chances (Early Intervention Foundation, 2018), however government austerity measures have seen over 500 children's centres closed since 2010. Cutting these proactive services has seen a rise in crisis management strategies being put in place (Alston, 2018).
Early intervention or family support workers prevent problems from occurring or tackle existing problems to inhibit development into more serious issues. They 'target selective' children, based on demographic risks or they 'target indicated' children that have been identified by practitioners as requiring intervention (Early Intervention Foundation, 2018).
Social Workers support children and families through difficult times. The early intervention teams will refer cases to social workers, if they are more complex, or if there are safeguarding concerns (Prospects, 2018).

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Citizens Advice Bureau (CAB) Food Banks and Charities 

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Citizens Advice Bureau (CAB) Food Banks and Charities 

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CAB is an organisation, which provides free, impartial, independent advice on a range of issues that can affect people's lives, health and wellbeing. They can provide help and assistance when dealing with problem debts and benefits they may be entitled to. There are £10 billion of unclaimed means tested benefits and the introduction of Universal credit is changing the way that benefits are paid to people and families, leaving them confused as to how much they may receive and unable to manage receiving a lump sum of money every month rather than split up into weekly payments like the old system (CAB, 2018). They can also help people access services they would otherwise not be able to or even know about, they are able to signpost to other organisations which may be able to help, for instance foodbanks and charities to help people in need and families living in poverty; the Trussell Trust, which runs hundreds of foodbanks across the United Kingdom to provide emergency food supplies to people and families in need (The Trussell Trust, 2018), Christian's Against Poverty, a charity 'on a mission to release thousands of families from grinding poverty'. They provide help and support with problem debts and financial issues (CAPuk, 2018), and Pathways, a charity dealing with housing issues and homelessness (Pathways, 2018).

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Teachers, teaching assistants and pastoral support workers are in the perfect position to safeguard children and young people, they are trained in spotting signs of child abuse (NSPCC, 2018). They can refer concerns to the safeguarding lead for the school, who would consider whether the information would need sharing with outside agencies, like social services or the child's General Practitioner (GP).

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These specialist trained professionals deal with the mental and emotional wellbeing of people. They can help people put strategies in place to deal with anxiety, depression and stress. Mental Health Practitioners can prescribe certain medications for mental health issues. They would refer any complex or unmanageable cases on to the GP who would possibly have to refer the patient for further assessment by a Psychiatrist in a secondary care setting.

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Maslow (1987, cited in Bates, 2016) suggested that an individual's response to learning is dominated by the needs of priority. In his hierarchy of needs children must meet the needs at all the other levels to reach self actualisation, where there is realisation of potential and desire to develop. Families living in poverty may struggle to fulfil some of the basic needs for a child; Food, not being able to afford a balanced, healthy diet. Shelter, possibly living in substandard accommodation or accommodation without sufficient heating. And sleep, children living in poverty are more likely to suffer from mental illness, this can affect sleep, leading to insomnia or disturbed sleep, leaving the child feeling exhausted and unable to concentrate at school. Maslow (1987, cited in Bates, 2016) States that both intrinsic and extrinsic factors may contribute to progressing through each level, however, the desire to achieve, intrinsic motivation, is fundamental to Maslow's humanistic approach and expands upon the work of Bandura, stating that learning and development relies on more than just processing information. rather on individuals being self-determining, free to make choices of their own. A child who has built up resilience, through personal or parental bias and who has witnessed the negative effects of living in poverty, may have the motivation and determination to escape the cycle of deprivation

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The Children's Society reported that more than 25% of children living in poverty had faced bullying at school due to their impoverished state (The Children's Society, 2014); their parents not being able to afford new school uniform or school trips and being eligible for free school meals. With the growth of social media as a means of communication among children and adolescents, they struggle to escape, even at home. Gesell (1945, cited in Packer, 2017) stated that cultural environment was merely a covering for development, like a glove to a hand, however Erikson (1968, cited in Packer, 2017) developed a psychosocial model of development, he believed that each distinct stage of development had its own dynamics based on the genetic perspective and social organisation. Examining stage 4 of Erikson's psychosocial model; competence vs inferiority, where children are learning to make sense of the world and shaping their personality, relying on influences other than their parents and family, it can be concluded that negative, bullying behaviour by peers will not allow the child to pass through this stage of development successfully, therefore having a detrimental effect on the child's social and emotional development and hindering their progression through the later stages of development.
Bullying can be classed as a form of child abuse, which is known to increase the risk of; mental health problems, offending, self-harm, social anxiety, low educational attainment and anti-social behaviour in childhood and into adulthood (Wilson and Widom, 2011, cited in Larkin, 2013).

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Ainsworth et al (1974, cited in Packer, 2017) states that, at around one year old, the attachment relationship between child and caregivers starts to form. It is suggested that difference in attachment patterns were linked to the 'sensitivity' mothers gave their child. Secure attachment between child and parent is to establish a relationship based on trust. The child trusts that their needs will be met consistently and is content to explore the world around them, having opportunity to learn and feel protected. Sroufe et al (1999, cited in Packer, 2017) found that infants with secure attachments at one year old were more socially skilled, and built better relationships than those with insecure attachments (avoidant, resistant and disorganised). This trend continued through childhood, adolescence and into adulthood, with secure attachment facilitating more friendships and self-confidence. Insecure attachment is more prevalent in infants whose family have low socio-economic status (NICHD, 2003, cited in Packer, 2017). It has been shown that children who fail to form secure attachment to their parent or primary caregiver, can have raised cortisol levels, which build up over time, inhibiting brain development and leading to the child being more likely to suffer anxiety and depression in later life (Larkin, 2013). They may be more likely to build unsuccessful relationships and suffer substance misuse issues in adulthood. (Rutger and van den Eijnden, 2007, cited in Larkin, 2013).

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Defined as when a household has higher than typical energy costs and, to keep up with these costs would place the household into poverty (GOV.UK 2018). Sometimes parents have to make a choice, whether to heat the house or provide food for the family. Living in cold conditions could disrupt the body's homeostatic state which may lead to the child being more susceptible to illness, as their immune system would be compromised and, long term, this could have an impact on children's growth and cognitive development (Brown, 2010).

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Women living in low socio-economic groups are four times more likely to smoke during pregnancy, resulting in lower birth weights, more risk of sudden infant death and lower levels of educational achievement. They are also less likely to breastfeed their babies. The physical, cognitive and emotional benefits of breastfeeding the baby are many; it reduces the risk of diabetes, allergies and infections and promotes brain and intestinal development (Underdown, 2007).
Poor diet choices, which tend to be higher in fat and sugar but richer in energy and cheaper than fresh fruits and vegetables, are linked to poor health outcomes; certain cancers, obesity, dental decay and heart disease are all more prevalent, along with anaemia, this can lead to a child feeling tired and unable to concentrate and could impact their growth and development (Underdown, 2007). Malnutrition, where a child does not receive enough calories, vitamins and minerals to sustain health could suffer; weight loss, muscle weakness, tiredness, irritability, increased infections and illness, anxiety and slow growth and development (RT, 2014)

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Emotional and behavioural problems are the most prevalent cause of functional disability in children with a higher incidence in families with a low socio-economic status (Underdown, 2007). The effect of bullying, parent's mental health and the environment in which the child lives can all have an impact on their mental health. A feeling of worthlessness can develop whilst in the cycle of deprivation, this can have long term effects on the child's ability to progress in education and work. Moreover, the constant feeling of stress and anxiety which can accompany depression, can lead to raised cortisol levels, which long term can lead to increased blood pressure and cardiac output (NHS, 2010).

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Poverty increases the risk of adults developing mental illness. The constant stress of living in a persistent state of poverty may lead to depression and anxiety. These conditions could cause the parent to withdraw from society and become insensitive to their child's needs, facilitating the development of insecure attachment. Over 25% of people in the poorest 5th of the population experience depression or anxiety (JRF, 2018).
Studies indicate the effects of maternal depression on a child's cognitive and emotional development are more pronounced in low socio-economic groups. Spencer (2000, cited in Underdown, 2007) highlights that parents suffering from depression and low self-esteem can directly affect cognitive and emotional development in children, communication development may be hampered as a result of inappropriate stimulation and inconsistency in the early years, this could also lead on to the child developing emotional or behavioural disorders. Vygotsky (1978, cited in Packer, 2017) suggests that to learn something new a child must be in the 'zone of proximal development', where 'more knowledgeable others' assist the child to learn, providing a 'scaffold' to facilitate learning and development. When a parent is suffering from a mental illness, like depression or anxiety, they may struggle to interact with their child, not providing the 'scaffold' of support the child needs to learn and develop.
Parent's provide a critical influence on the health and wellbeing of the developing child and into later life, most notably on the child's mental health (Larkin, 2013)

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The United Nations report on extreme poverty and human rights reported that; 14 million people currently live in poverty in the United Kingdom (UK) (Alston, 2018), 4.1 million of these are children, this is a rise of 15% in the last 5 years, this level has risen faster than the population growth. (JRF, 2018).  Poverty is defined as the state of deprivation of income and resources (Adams, Dominelli and Payne, 2009), which can deny a child an adequate standard of living. There are gradients of poverty in the UK; destitution, which can be classified as a complete lack of resources, threatening a child's very existence (Underdown, 2007), low income, where income is less than 75% minimum income standard (MIS) where people fail to afford an adequate standard of living and, income below MIS, where people get by day to day but struggle with unexpected costs and events (Joseph Rowntree Foundation, 2018). This can be driven by several factors; low pay, problem debt and worklessness. Living in poverty has detrimental effects on  a child's long-term educational outcomes and life chances (The Children's Society, 2016), along with affecting access to employment and social networks (Adams, Dominelli and Payne, 2009). It has been suggested that children living in poverty suffer more health problems; they have the highest mortality rates, higher rates of acute and chronic illness, mental ill health and behavioural problems along with detrimental effects on their cognitive and social development (Larkin, 2013).
These issues will be explored, analysing the impact on children's health, development and wellbeing, linking the impacts on development to adolescence and into adulthood and considering professionals and agencies which may be involved in the care of the children and families living in poverty.