National Institute for Health and Clinical Excellence
PUBLIC HEALTH INTERVENTION GUIDANCE – SOCIAL AND EMOTIONAL WELLBEING:
VULNERABLE CHILDREN AT HOME
Consultation on the Draft Scope from
12th March – 13th April 2010 Comments on the Draft Scope to be submitted
no later than 5pm on Tuesday 13th April 2010
Stakeholder Comments
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Name: Beverley Tydeman
Organisation: Association of Child Psychotherapists
Comments
Section number
Indicate section number or
‘general’ if your comment
relates to the whole document
General
Please insert each new comment in a new row.
We welcome the development of public health intervention
guidance for social and emotional wellbeing of vulnerable preschool children: home-based interventions.
This is an important area of provision and we support the aims of
providing guidance on good practice based on the best available
evidence. The following comments are aimed at helping the project
team define the scope in such a way that they are enabled to
address the Key Questions and Outcomes (4.3).
2 c)
We suggest the scope makes links with the DCSF “Think
Family” programme and the related SCIE guidance on working
with parents who have mental health problems and their
children.
http://www.scie.org.uk/publications/ataglance/ataglance09.asp
3.
There is a tendency to use the terms cognitive, social and
emotional development interchangeably and to understate the
interaction between each. There is a large body of research into
factors influencing personality development that can be drawn on
here.
We suggest the scope includes a definition of cognitive, social
and emotional development.
Please add extra rows as needed
Please return to: childrenwellbeinghome@nice.org.uk
NB: The Institute reserves the absolute right to edit, summarise or remove comments received on during consultation
on draft scope where, in the reasonable opinion of the Institute, they may conflict with the law, are voluminous or are
otherwise considered inappropriate.
National Institute for Health and Clinical Excellence
PUBLIC HEALTH INTERVENTION GUIDANCE – SOCIAL AND EMOTIONAL WELLBEING:
VULNERABLE CHILDREN AT HOME
Consultation on the Draft Scope from
12th March – 13th April 2010 Comments on the Draft Scope to be submitted
no later than 5pm on Tuesday 13th April 2010
Stakeholder Comments
3 c)
We strongly support the view that positive child-parent relationships
and early attachments are crucial to the child’s ability to learn and
develop cognitive, emotional and social capacity. The earlier
interventions can begin the better otherwise attachment problems
and the associated developmental delay can be entrenched and
much harder for services to address.
Therefore it is in the interest of both child and society for attachment
problems to be identified as early as possible, ideally within the first
3 months of life and interventions should be considered urgent at
this stage as each additional month of delay can result in the
escalation of difficulties.
We suggest the scope is more explicit in defining its aims at
different life-stages e.g. 0-3 months, 3-6 months, 1 year+ etc.
4.1
We would draw the project team’s attention to the helpful definition
of “vulnerable groups” included as Annex E of the National CAMHS
Review http://www.dcsf.gov.uk/CAMHSreview
We suggest the scope is defined so as to ensure the explicit
inclusion of the most vulnerable groups of children who are
most in need of progressive interventions.
4.1.1 & 4.2.2 a)
With reference to the use of a child development surveillance
system but the exclusion of assessment of risk of social and
emotional problems and mental health disorders: Children will have
a range of developmental problems on a continuum from mild to
severe. Services need to be able to recognise the degree of
severity and respond appropriately. There is likely to be a point at
which problems will become sufficiently severe that the child will not
be able to make use of positive experiences in good quality
universal services and will require the intervention of more costly
specialist services.
We suggest the scope includes mechanisms for identifying
degrees of severity of social, emotional and cognitive
problems, what influences the parent/child’s ability to make
use of services, and what responses are required to maintain
children within mainstream provision where possible.
Please add extra rows as needed
Please return to: childrenwellbeinghome@nice.org.uk
NB: The Institute reserves the absolute right to edit, summarise or remove comments received on during consultation
on draft scope where, in the reasonable opinion of the Institute, they may conflict with the law, are voluminous or are
otherwise considered inappropriate.
National Institute for Health and Clinical Excellence
PUBLIC HEALTH INTERVENTION GUIDANCE – SOCIAL AND EMOTIONAL WELLBEING:
VULNERABLE CHILDREN AT HOME
Consultation on the Draft Scope from
12th March – 13th April 2010 Comments on the Draft Scope to be submitted
no later than 5pm on Tuesday 13th April 2010
Stakeholder Comments
4.1.2
We wonder about the possible implications of excluding children
with a clinically diagnosed mental disorder. Whilst it is not common
for children under 4 to have a clinical diagnosis this does not mean
that there will not be children with serious, but undiagnosed, mental
disturbance in mainstream services and therefore staff in these
settings need to have the skills to work with them i.e. by excluding
them from the guidance there is a concern that their needs will not
be recognised as part of the training of staff and provision of
services, even though there will, in reality, be children with similar,
but undiagnosed, problems within these services.
We suggest that the scope enables consideration of how staff
can be trained to work with children with mental health
problems regardless of whether or not they have been
clinically diagnosed. See for example the “Everybody’s
Business” programme developed by the National CAMHS
Support Service http://learning.camhs.org.uk
4.2.2
The interface between universal and specialist services is important
and widely recognised as an area for improvement. This relates not
just to referral protocols but also the need that universal staff and
services will have for specialist advice, assessment and
supervision/training. Areas where specialist support are needed
include:
- attachment and parent-infant relationship difficulties
- post-natal depression
- “clinginess” and separation anxiety
- feeding and sleep difficulties
- tantrums and disruptive behaviour
- communication and developmental delay in young children
We suggest that the scope includes consideration of the
interface with specialist services even if direct provision by
these services is excluded from the scope.
4.3.1
Interventions need to be made as early as possible as attachment
difficulties in the first weeks and months of life can result in
potentially severe social, emotional and cognitive problems later on.
We suggest the scope makes specific reference to
interventions and outcomes in the post-natal and infancy
periods.
Please add extra rows as needed
Please return to: childrenwellbeinghome@nice.org.uk
NB: The Institute reserves the absolute right to edit, summarise or remove comments received on during consultation
on draft scope where, in the reasonable opinion of the Institute, they may conflict with the law, are voluminous or are
otherwise considered inappropriate.
National Institute for Health and Clinical Excellence
PUBLIC HEALTH INTERVENTION GUIDANCE – SOCIAL AND EMOTIONAL WELLBEING:
VULNERABLE CHILDREN AT HOME
Consultation on the Draft Scope from
12th March – 13th April 2010 Comments on the Draft Scope to be submitted
no later than 5pm on Tuesday 13th April 2010
Stakeholder Comments
4.3.2
The scope correctly identifies that a lot of children’s problems will
stem from unsatisfactory early relationships/attachments.
Continuity of contact helps vulnerable parents/infants build an
experience of a coherent narrative which is the cornerstone of good
attachment. However, the expressed anxiety of young and
distressed children is disturbing and can impair relationships with
staff and carers at a fundamental level. Training in infant
observation can help a wide range of staff to understand infant and
young children’s behaviour, play and communications, interact
more appropriately and sensitively with young children and also be
able to bear the disturbance of close contact with them.
We suggest the scope includes consideration of how services
can develop a relationship-based approach to children that
models good attachment and that this includes training to help
staff manage the disturbance of working closely with very
young children.
4.3.3
Some children will have had such difficult or traumatic early
experiences that staff will need training in being sensitive to how
these children’s perception of the world and their relationship with
adults will be damaged and will require a different approach to other
children. For example, children who have been physically abused
may have a fear of close contact with adults or may respond in
ways that are violent or dysfunctional. Staff will need specialist
training to be able to work with and respond to these children in an
appropriate and sensitive manner and not react to the child’s
disturbed view of the world in ways that might cause further
damage. Sensitive provision at an early stage can help prevent a
costly trajectory into more severe emotional and behavioural
problems.
We suggest the scope includes consideration of provision that
is sensitive to work with children who have suffered abuse,
neglect or serious deprivation and that appropriate training is
defined.
Please add extra rows as needed
Please return to: childrenwellbeinghome@nice.org.uk
NB: The Institute reserves the absolute right to edit, summarise or remove comments received on during consultation
on draft scope where, in the reasonable opinion of the Institute, they may conflict with the law, are voluminous or are
otherwise considered inappropriate.