Children and Young People's Mental Health: A Framework for Promotion, Prevention and Care

4. EARLY YEARS - UNIVERSAL

Context

4.1 Early years and childcare services can encompass pre-school education, day care, out of school care, childminding, fostering and adoption and other services such as family centres. By their nature, they cross traditional sector boundaries - education, social care, and health. Early years and childcare services may also be public, voluntary or private sector services. The Framework assumes the existence of sound communication systems across agencies and boundaries and at transition stages for the children and young people.

4.2 Good parenting is fundamental for the development of a child's mental health and wellbeing. As children's primary carers, all parents need to be supported and helped, but especially when they are parenting in difficult circumstances or facing uncertainty about the way they are bringing up their children. Interventions focused on the time around the birth are likely to be the most effective in preventing mental health problems of a child. These include interventions to improve and enhance the wellbeing of the mother and of the baby, which take into consideration the psychosocial aspects of pregnancy, promote good early parent-child interactions, attachment, support problem-solving skills of the parents and underline the roles of fathers.

4.3 Early years and childcare services are a vital first "frontline" in establishing good mental health and wellbeing among the youngest children. Risk factors and vulnerabilities in infancy and early childhood are associated with mental health problems in children and young people. These in turn are associated with greatly heightened risk of mental illness in adult life. The ability to improve mental health and wellbeing in the early years is therefore a vital area for action. The Executive's Integrated Early Years Strategy³³ includes a joint outcome indicator relating to improving children's cognitive, social and emotional development and notably, their self-esteem, confidence and independence.

Overarching philosophy & culture

4.4 The National Care Standards: Early Education and Childcare³⁴ make clear reference to providing an environment in which children's emotional and social development is considered. They describe an environment in which children and young people:

Will be welcomed, and will be valued as an individual.
Will be nurtured by staff who will promote his or her general wellbeing, health, nutrition and safety.
Will be supported by staff who interact effectively and enthusiastically with him or her.
Receive support from staff who respond to his or her individual needs (personal, emotional, educational and physical).
Experience an environment of mutual respect, trust and open communication.
Can be confident that the service keeps up links and works effectively with partner organisations.

SERVICE ELEMENTS	ACTIVITY	OUTCOMES	KEY PARTNERS
Involvement of expectant parents, parents and children in developing information, resources and services to support their mental health and wellbeing	Development and implementation of a local strategy for the involvement and participation of expectant parents, parents and children. Development and implementation of the local strategy in partnership with expectant parents, parents and childcare support establishments. Occasional public local debates e.g. via local press. Key workers seek the views of individual expectant parents, parents and children.	Expectant parents and parents feel that their views are valued. Service development and redesign is informed by the views of parents and expectant	parents. Parent groups NHS involving people team NHS Primary Care team Voluntary sector Education authority Pre-school education & childcare providers Childcare partnerships Public involvement staff NHS midwifery services NHS CAMHS staff (inc. Primary Mental Health Workers) Learning Disability Local Area Co-ordinators Care staff Community health projects Community learning staff SureStart workers Social workers in children and family teams Family centres Staff working with vulnerable expectant parents
Provision of training and consultation for midwives and Public Health Nurses, and awareness-raising input for staff working in adult mental health services and non-medical staff such as social workers and care staff, including those still in training	NHS CAMHS staff plan and provide multi-agency, multi-disciplinary training opportunities for midwives, Public Health Nurses, social workers and care staff on mental health issues. Midwives, Public Health Nurses, social workers and care staff are supported to participate in mental health training. NHS CAMHS staff provide ongoing consultation and advice to midwives, Public Health Nurses, social workers and care staff on mental health issues. Obstetric mental health liaison services link with CAMHS. NHS CAMHS staff offer dedicated time in support of infant mental health through consultation to and/or direct work in perinatal services. Adult mental health services link with CAMHS to consider and address the potential impact of a patient's mental health problems on any dependent children.	Midwives and Public Health Nurses are able to support parents in developing a basic understanding of attachment issues, infant mental health and their role in supporting their child's mental and emotional development. Midwives, Public Health Nurses, social workers and care staff understand and are able to identify risk factors. Midwives, Public Health Nurses, social workers and care staff are able to ensure that parents' own mental health needs are recognised and addressed (particularly mothers with postnatal depression). Adult mental health staff are aware of the potential impact of their patient's condition on any dependents or young siblings ³⁵. Midwives, Public Health Nurses, social workers and care staff are able to access specialist advice and support. Referral protocols for NHS CAMHS are transparent and accessible and widely available/agreed. Midwives, Public Health Nurses and other agreed professionals are able to refer direct to specialist NHS CAMHS.	NHS Primary Care team Health promotion staff NHS midwifery services NHS CAMHS staff (inc. Primary Mental Health Workers) Care staff SureStart workers Social work services Family centre staff Voluntary sector Obstetric Liaison Psychiatry Adult mental health services Staff across agencies who come into contact with vulnerable expectant parents Scottish Institute for Human Relations (SIHR)
Provision of training and consultation for staff in pre-school and childcare settings	Public Health Nurses and CAMHS staff link with pre-school and childcare settings, SureStart centres and local authority family centres. NHS CAMHS staff work with local authorities and with private and voluntary sector childcare providers to plan and provide training opportunities in mental health (including mental health promotion) for pre-school and childcare staff. NHS CAMHS staff provide ongoing consultation and advice to pre-school and childcare staff. Development and agreement of a referral protocol with pre-school and childcare staff.	Childcare staff have a basic understanding of mental and emotional health and development. Childcare staff recognise the importance of their contribution to children's mental and emotional wellbeing. Childcare staff have a basic understanding of protective factors and how these can be nurtured. Childcare staff understand and are able to identify risk factors. Childcare staff know what specialist advice and support is available to them and how to access it. Referral protocols and pathways for CAMHS are agreed and transparent.	Health promotion staff NHS Primary Care team NHS CAMHS staff (inc. Primary Mental Health Workers) Education authority Pre-school & childcare providers Childcare partnerships Local authority family centres Voluntary sector SureStart staff Social workers Scottish Institute for Human Relations (SIHR)
Links with education authorities and with private and voluntary sector childcare providers to support the mental health and wellbeing of early years staff	Work with local authorities and with private and voluntary sector childcare providers to plan and provide a range of supports for staff to access before they become unwell e.g. counselling/stress management, relaxation opportunities. Build on See Me³⁶ initiatives on mental health in the workplace.	Staff feel valued and supported, and are therefore more able to support others.	Health promotion staff Education authority NHS Primary Care team Early years staff Pre-school & childcare providers Childcare partnerships Staff organisations Voluntary sector See Me staff Scotland's Health At Work ³⁷
Contribute to development and delivery of universal parenting programmes	NHS CAMHS staff (and clinical psychologists) contribute to training for Public Health Nurses in the development and delivery of evidence-based parenting programmes and approaches. Provision of information locally for parents about parenting support and education groups that are available at a range of times and settings. Primary care staff encourage and support parents to participate in parenting programmes. Provision of accessible drop-in services and advice points for parents to discuss problems and access support. Access for primary care practitioners to clinical psychology consultation and advice on families in their care. Arrangements by CAMHS staff to ensure that young parents who are receiving care and treatment are enabled to engage in parenting programmes.	Parents have a basic understanding of mental and emotional health and development. Parents recognise their contribution to children's mental and emotional wellbeing. Parents have a basic understanding of protective factors and how these can be nurtured. Parents are supported by universal services and public messages to feel confident in dealing with their child's behaviour. Parents know how to access advice and support if they suspect there is a problem. Parents' coping skills are developed and affirmed. Parents receiving mental health care are enabled to engage in parenting programmes.	Family centres Education authority NHS Primary Care team Voluntary sector Community learning staff Local community health projects Parents Parent & toddler groups NHS CAMHS staff (inc. Primary Mental Health Workers) NHS Clinical Psychology SureStart workers Scottish Institute for Human Relations (SIHR)
Involvement in provision of support for individual children and families, including targeted parent support	Primary care staff encourage and support parents to participate in tailored parenting programmes. NHS CAMHS staff input to training for key workers on mental health and parenting issues.	Key workers have a full understanding of attachment and are able to support this. Parents have a basic understanding of protective factors and how these can be nurtured. Parents feel confident in dealing with their child's behaviour. Parents' coping skills are developed and affirmed. Parents understand the importance of infant interaction and have the skills to put into practice. Parents know where they can access advice and support. Parents are supported to care for their child.	Education authority Social work services Family centres Voluntary sector NHS Primary Care team Parents NHS CAMHS staff (inc. Primary Mental Health Workers) Learning Disability Local Area Co-ordinators NHS Clinical Psychology Community health projects Pre-school & childcare providers Childcare partnerships Care workers SureStart workers

Page updated: Thursday, May 25, 2006

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