PROFESSIONAL LINKS
This chapter addresses the following:
The Early Years Foundation Stage framework (DfE, 2017) emphasises the importance of working in partnership with parents and other professionals.
The Special Educational Needs and Disability Code of Practice (DfE and DoH, 2015) emphasises the importance of working in partnership with parents, external agencies and the child in addressing the child’s needs.
CHAPTER OBJECTIVES
By the end of this chapter you will understand:
the importance of working in partnership in the early years;
the barriers to effective partnership working in the early years;
the important contribution of communities of practice to effective partnership working;
strategies to facilitate partnership working in the early years.
INTRODUCTION
This chapter addresses the importance of working in partnership to support young children’s mental health. Throughout this chapter the term ‘parent’ has been used to refer to parents and legal guardians of the child. In this chapter you will learn about the importance of working in partnership with parents, children and external services to support children’s mental health needs. You will also be introduced to some strategies for facilitating these partnerships in the early years. Some of the professional challenges associated with partnership working and ways of overcoming these are addressed.
As an early years practitioner, you will understand the importance of children’s holistic development. If children are not mentally healthy then it is more difficult for them to learn. You will already be aware of the critical link between children’s behaviour and their learning, but you might be less aware of the link between their mental health and their progress across all other areas of learning.
Effective social and emotional environments in the early years promote positive well-being in children. The causes of mental ill-health in children are complex and multifaceted. Effective partnership working will enable you to address some of the many risk factors that can have a detrimental impact on children’s mental well-being. Social care services are well placed to address family factors that might result in mental ill-health. Health care professionals are best able to provide interventions to address health-related factors that arise from mental ill-health. As a practitioner, you play a critical role in developing effective partnerships with parents and children, although it is not always easy to achieve this. This chapter provides examples of how you might develop positive partnerships and advice on when to refer children to external services.
WORKING WITH PARENTS AND CARERS
Parents are children’s first educators. They know the child best and have valuable insights that they can offer to practitioners. Effective parental partnerships in early years settings have a positive impact on outcomes for children (Hill and Taylor, 2004). The Early Years Foundation Stage framework (EYFS framework) highlights the role of practitioners in developing partnerships with parents. The Special Educational Needs and Disability (SEND) Code of Practice (DfE and DoH, 2015) emphasises the importance of working in partnership with parents during the process of identifying children’s needs. Parents will have observed their child’s mood and behaviour in a range of contexts and should be able to support you in your assessment of need(s). Any assessment by practitioners can therefore only be a partial assessment of the child based on your observations within the setting. You will also need to develop effective relationships with grandparents and other family members if you have more contact with the wider family on a daily basis.
If you suspect that a child in your setting has a mental health need then you will need to carry out observations of the child in a range of contexts. These may include observations of the child when they are engaged in both indoor and outdoor learning. You should also observe the child during participation in child-initiated independent learning, child-initiated adult-supported learning and adult-directed learning. You will also need to observe the child when they are learning individually and during participation in collaborative tasks. During these observations you will be trying to ascertain whether the child’s mental health needs are triggered within a specific context or whether the needs are evident across a range of contexts. You will also need to observe the child across a time duration to identify whether the need is temporary or potentially more serious.
Your observations can be supported through parents’ own observations of the child’s mood and behaviour outside of the setting. The following guidance offers a useful way of framing an initial conversation with the parent.
‘In the setting I have noticed that X appears to be [withdrawn/sad/angry/anxious, etc].’
‘Have you observed this also outside of the setting?’
‘Can you suggest any reasons why X is demonstrating these behaviours?’
‘I have noticed that the trigger might be…’
‘Have you also noticed this at home?’
‘How do you manage this at home?’
‘Let’s talk about how we can support X.’
It is critical that you keep an open mind and do not judge the parent. Your role is not to blame the parent for the child’s difficulties but to work together with the parent to identify solutions for the child.
It is also important to bear in mind that parents of children with mental health needs may also have poor mental health. Parents who are experiencing mental ill-health are not well-placed to support their child’s mental health. You play an important role in signposting these parents to external sources of support within the community so that parents who experience mental ill-health can get the support they need. Some settings are also adopting more proactive approaches to supporting parents and the case study that follows illustrates one such strategy.
CASE STUDY
An early years setting was situated in an area of social deprivation in the north of England. Many of the parents were unemployed and were experiencing financial difficulties. Some of them were struggling to pay their household bills on time and buy food for their family. There were those who faced eviction due to non-payment of rent and the threat of homelessness. Many of the parents appeared to be stressed, depressed or anxious or a combination of all three.
The manager of the setting decided to organise a series of workshops for parents to support them with simple financial management. All parents were invited to participate in the workshops and refreshments were provided. Sessions included:
how to manage on a tight budget;
shopping smartly;
managing stress, anxiety and depression;
services in the community that can offer support;
parents as role models;
mindfulness.
Attendance at the sessions was good and evaluations of the workshops were extremely positive. Follow-up sessions were organised to help parents to recognise the signs of mental ill-health in their children. Parents were introduced to the signs and symptoms of mental ill-health and provided with simple techniques to support their child to manage stress, anxiety and depression. Parents were introduced to the importance of physical activity and social connectivity in supporting positive mental health for both children and adults. They were also taught about the important role that volunteering can play in promoting positive mental health. Above all, the sessions had a positive impact on parents’ perceptions of mental health. They had started to talk openly to others about their own mental health and their own mental health literacy improved.
INVOLVING PARENTS IN PLANNING AND REVIEWING PROGRESS
Once initial mental health needs have been identified, your role as a practitioner is to work with parents to identify ways of supporting the child. It is important to review the child’s progress regularly with parents and to decide on ‘next steps’ together, particularly in relation to decisions about interventions that can be implemented or whether to refer the child on to external services for additional support. Generally, parental consent will be necessary before a referral can take place.
During review meetings it is crucial to ascertain information about the child’s mental health outside the context of the setting. This will help to identify whether the child’s mental health is affected by a specific context and therefore this should aid the identification of triggers for mental ill-health.
CRITICAL QUESTIONS
How might you develop effective partnerships with parents who are resistant to mental health?
How might you work with parents who are unable to manage their own mental health so that positive outcomes can be achieved for the child?
Approximately one in six adults in England reported experiencing a mental health problem in the past week.
Over 2 million children are estimated to be living with a parent who has a common mental health disorder.
(www.nspcc.org.uk/preventing-abuse/child-protection-system/parental-mental-health) |
The Effective Provision of Pre-School Education (EPPE) research (Sylva et al, 2004) is a seminal research study into early years provision. The research found that:
what parents do with children at home makes a significant difference to young children’s development;
when parents engage their child in a range of home learning activities, these serve as protective factors to children’s social and emotional development;
examples of these activities include reading with the child, teaching songs and nursery rhymes, painting and drawing, playing with letters and numbers, visiting the library, teaching the alphabet and numbers, taking children on visits and creating regular opportunities for them to play with their friends at home;
these activities were all associated with higher intellectual and social/behavioural scores;
the home learning environment was only moderately associated with parents’ educational or occupational level, so what parents do with their children is more important than who the parents are.
WORKING WITH HEALTH CARE PROFESSIONALS
Health care professionals play a crucial role in supporting children’s development, including their mental health, in the very early stages of their development. All children in England must undertake a ‘progress check’ at the age of two to identify whether their development is age-appropriate. These progress checks are conducted by practitioners and mental health needs will usually be identified through assessment of children’s personal, social and emotional development.
All early years settings are required to work in partnership with health care professionals who can support children’s development. These include nurses and doctors. Doctors can identify whether a child has a diagnosable mental health need and nurses can provide guidance on how to manage specific conditions including stress, anxiety, depression and self-harm. The general principle is that parental consent should be sought before children are referred to health care services.
Nurses can play an important role in facilitating professional learning for staff within the setting. They can lead professional training on how to identify the signs and symptoms of mental ill-health and they can work with specific children within the context of the setting to provide the intervention they need.
WORKING WITH SOCIAL CARE PROFESSIONALS
Some children who display signs of mental ill-health will also be living in families and communities that place them at risk of harm. Children who experience abuse and neglect are more likely to demonstrate signs of mental ill-health. Children who are exposed to family conflict, including domestic violence, are also at greater risk of mental ill-health. Children who do not feel loved or cared for, or those who have not developed secure attachments with a primary caregiver, are at increased risk of developing mental ill-health (Bowlby, 2012; National Institute for Health and Care Excellence, 2016). Children from areas of social deprivation are more significantly at risk of developing poor mental health.
While it is important not to stereotype types of families and communities, it is, nevertheless, important to be aware of the risk factors. If you suspect that a child is at risk of, or is experiencing, neglect, physical, sexual or psychological abuse, then you have a duty to report this to the designated safeguarding leader within the setting. This case will then be picked up through the safeguarding processes that have been developed to meet the statutory safeguarding requirements.
CRITICAL QUESTIONS
What are the challenges associated with partnership working?
How might you overcome these?
WORKING WITH CHILD AND ADOLESCENT MENTAL HEALTH SERVICES
Child and Adolescent Mental Health Services (CAMHS) is a branch of the National Health Service that exists to support children and young people with the most severe mental health needs. The service is made up of health professionals, including counsellors, clinical psychologists, support workers and therapists. Children who are referred to CAMHS have needs that are so severe that they cannot be addressed in the setting or the home. They are used when specialist support is required to help the child to manage their mental health. Services have lengthy waiting lists and referral criteria are strict. This means that not all children successfully secure a referral to access these specialist services.
WHEN TO REFER?
You will need to check the referral criteria of your local CAMHS service. However generally the criteria for referral are that the need(s) must be:
severe;
complex – this means that there may be multiple risk factors that are present, and the child may be experiencing complex family problems;
enduring – usually CAMHS services will not admit children who have demonstrated a mental illness for less than three months.
You will need to support the referral with documentary evidence of your assessments. These should include observations of the child in varying contexts and, where appropriate, progress checks against identified milestones. You will also need to include assessments over a duration of time to demonstrate whether a need is increasing in severity.
CRITICAL QUESTIONS
Rates of mental disorders increase with age: 5.5 per cent of 2–4 year-old children experienced a mental disorder in 2017, compared to 16.9 per cent of 17–19 year-olds.
Lave and Wenger (1991) developed the idea of ‘communities of practice’. A community of practice is characterised by the following.
Domain: this is the area of knowledge that brings the group together. All members of the group share an interest in the domain and have expertise in it, which they wish to share across the group.
Community: a strong sense of community is essential for effective multi-agency collaboration. The community is united by its sense of purpose and commitment to the domain.
Practice: while knowledge is essential, communities of practice exist to develop practices and share these across the group.
Thus, multi-agency teams are communities of practice that exist to support the needs of the child. The multi-agency team may include education practitioners and health and social care practitioners. It should also include the parents and the child. Within this team everyone is able to bring their own unique and sometimes specialised knowledge to the community. Parents are experts in their child and children are also experts in their own lives. Practitioners from education, health and social care also have their own disciplinary knowledge from which the community can benefit.
A strong sense of community within a community of practice is essential. It is therefore important to respect the different roles of people within the team and to value the distinct contribution that different people can make to the community. It is crucial that everyone understands the roles and responsibilities of all community members and the limits to these roles. It is important to take account of professional boundaries and to trust that all members of the community will act honestly and with integrity.
It is important to develop a shared language to facilitate communication between different members of a community of practice. Heath, social care and education all have their own language, and professional jargon associated with specific disciplines can form a barrier to effective communication. The use of acronyms and discipline-specific terminology should be avoided where possible because it can be alienating. It is also important to communicate effectively with parents by avoiding the overuse of professional jargon.
Developing a community of practice that functions effectively can be challenging. Logistical problems might make it difficult for the community to meet together in person. Each discipline may have its own ethical code, which means that information cannot always be shared across the team. This can cause frustration for other community members. Additionally, each service will be managing significant caseloads, and this can delay the speed at which information is shared.
In recent years several high-profile cases of child deaths have gained media publicity due to ineffective multi-agency collaboration. Reviews of these cases have identified several recurrent factors that resulted in the death of the child. These include:
SHARING INFORMATION
Data protection legislation should not be a barrier to sharing information in cases where young people are at risk of harm. If you need to share information about a child, where possible you should explain to children why you need to share information, what information will be shared and who the information will be shared with. It is better to get the child’s consent, but if you believe that a child is at risk you are still able to share the information.
According to HM Government (2018), information that is shared should be:
proportionate: only share the information that is necessary by ensuring that information shared is proportionate to the need to share it and to the potential risks to the child;
relevant: only share relevant information;
adequate: ensure that the information is adequate and enables other professionals to fulfil their professional commitments;
accurate: ensure that the information is accurate and includes facts, not opinions;
timely: information should be shared in a timely way, particularly in cases where the child is at risk or in immediate danger;
secure: follow the school’s policy to ensure that information is stored securely.
When sharing information, you will need to ensure that you are compliant with the new data protection regulations (General Data Protection Regulations, GDPR) which affect all organisations, including schools and early years settings.
CASE STUDY
An early years setting in the south of England wanted to focus on developing partnerships with children. Hannah, a practitioner who had worked at the nursery for 18 months, created a ‘feelings’ board that included photographs and names of each child. At the start of each day the children selected a ‘feelings’ card and matched it to their name. The cards depicted a range of different feelings including happiness, sadness, anger and mixed feelings. The children quickly adapted to this routine. Each day Hannah identified the children who had selected negative feelings and held a conversation with them. The aim of this was to provide the children with an opportunity to talk about their feelings, to identify why they had those feelings and what steps might be taken to change the negative feelings into positive feelings.
The children enjoyed selecting the feelings card and there was no evidence that children were reluctant to select the negative feelings cards. After several weeks Hannah identified a group of children to be well-being champions. These children were taught how to support other children who had identified that they did not feel happy. They were taught how to do ‘kind things’ for these children, which included:
inviting them into their play;
talking to them about how they feel;
offering to play with them at playtime;
offering to sit with them at lunchtime.
This strategy was very successful because the champions were empowered by the role. They enjoyed helping their peers and it made them feel important.
CRITICAL QUESTIONS
How might you select the well-being champions?
How might you monitor the impact of this initiative?
What barriers might you have to overcome if you implemented this approach and how would you address these?
SUMMARY
This chapter has emphasised the importance of working effectively in partnership with parents, external services and the child to support children’s mental health needs. You have been prompted to consider the challenges associate with partnership working and ways of overcoming these. Through the case studies you have been introduced to examples of effective practice in the early years. The chapter has highlighted the risks associated with ineffective multi-agency collaboration. It has emphasised the need for different professional service teams to develop mutual respect and a shared language to aid communication between members of a community of practice.
CHECKLIST
This chapter has addressed:
the key partners that can support you to address mental ill-health in children;
ways of working in partnership with parents;
ways of working in partnership with the child;
referrals to health and social care services.
FURTHER READING
Anning, A, Cottrell, D, Frost, N, Green, J and Robinson, M (2006) Developing Multiprofessional Teamwork For Integrated Children’s Services: Research, Policy and Practice. Milton Keynes: Open University Press.
Gasper, M (2010) Multi-Agency Working in the Early Years: Challenges and Opportunities. London: Sage.