COAG Mental Health Early Intervention Measure - Early Childhood Component: Study to Scope Potential Service Delivery

4. Contextual considerations

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The scoping study has been underpinned by contemporary theory and understanding about young children and their growth and development, about mental health and wellbeing, and about the role of quality care in enhancing children's life outcomes. Consultation has been undertaken with professionals in the prior-to-school early childhood sector and the report reflects the complex nature of that field.

Theoretical context - child mental health
Contemporary understandings - wellbeing
Field context - early childhood services

Theoretical context - child mental health

Research on early brain development (Mustard, 2002; Sameroff, 2000) has shown that experiences in the first two or three years of life indelibly influence an individual's social and emotional functioning for the rest of the lifespan. Secure attachment has been shown to be a protective factor for infants and children, providing a framework for them to get most benefit from developmental, educational and social opportunities. Secure attachment in infancy is promoted by warm, sensitive and responsive caregiving with the opportunity to develop a secure relationship with one or a few main carers. Infants and toddlers find comfort and security when they experience familiar objects, places and people. There is evidence (Child Psychotherapy Trust, 2002) that insecure attachment results when there is too great a discrepancy between an infant's needs and the quality of the caregiving. Insecure attachment interacts with other risks present in the emotional environment of the growing child, leading to long-term vulnerability to stress-related illnesses.

The extensive literature on child mental health suggests that:

In its simplest terms it's about relationships - promoting and supporting nurturing relationships for all infants [and young children]. It's about having the first relationship be a solid base for the next one and all the ones in the future. It’s about learning to trust that our physical and emotional needs will be met. And it's about being able to use those trusting relationships to become healthy, productive adults. After all, it's because of healthy relationships that we desire to please our parents and become socialized beings. It's because of relationships that we care about our neighbors. So Infant Mental Health is about prevention and early intervention in assuming positive growth and development (Michigan Association for Infant Mental Health, 1993, in Minnesota Infant Mental Health Project, 2002).
Charles Zeanah, editor of the Handbook for Infant Mental Health (1993) and one of the world's leading authorities on attachment, explains that children should have an attachment figure - someone who is available for them. He suggests that if they don’t have someone then every effort should be made to provide this. Top of page

The question arises: 'Are there cultural differences in the interpretation of concepts such as Attachment?' In Indigenous communities, children may be closely connected to a set of caring adults beyond the mother and father. However, there is general agreement that all children need 'a sense of inner peace' and trustworthy relationships with a few significant adults. This is especially the case for infants who are learning to make sense of the world.

Associate Professor Helen Milroy, Child and Adolescent Psychiatrist at the Centre for Aboriginal and Dental Health, University of Western Australia developed a metaphor of 'a swan' to describe ideal conditions for Aboriginal infants (2003):

Watched over by the earthly and spiritual guardians, the father, mother, grandparents and siblings ever present to ensure a baby's safety. Each has a special gift to give. Black for strength and endurance, white for purity and innocence, grey for compassion and warmth.

Cultural differences include recognising that there may be more than one 'mother' in a child's life and that there will be differences between traditional and urban Aboriginal women and parenting and interaction patterns. The Connecting Mums program recognises this (Wendy Thiele, Adelaide).
Dr Milroy suggests (ABC Radio National, 2007) that 'Aboriginal children are at increased risk of difficulties with social and emotional wellbeing and mental health. One of the factors that contributes to that is the number of life stresses that families are living with.' Dr Milroy is developing materials for Aboriginal and Torres Strait Islander communities on the subject of children and mental health.

Contemporary interpretations of 'attachment theory' stress the 'networks of attachment' that can help to support the child. Such views see a child as 'nested' in the ecological systems of their family and community, with interactions between all of the significant people in their life affecting their sense of security and developing self-confidence. For families accessing early childhood services, the adults working there are key elements in the network of social and emotional support.

Silburn (2003) makes the following points about children's vulnerability and the prevention of mental illness:

Current approaches to prevention aim to identify the critical leverage points in human development and to create opportunities in the environments most proximal to children. This includes policies and initiatives to build the capacity of communities and services to ensure that families (and schools) are properly supported in their shared task of child rearing.
While the term 'mental health' is relatively new in early childhood education and care, it is closely connected to children's 'emotional and social wellbeing', which have long been seen as core aspects of quality provision. Skilled early childhood practitioners are aware that all aspects of a child's development and welfare are interrelated and that, as significant adults in young children's lives, they play a crucial role in establishing the foundations for current and future wellbeing and resilience.
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Contemporary understandings - wellbeing

Tracey Simpson, Associate Head of School, School of Teacher Education at Charles Sturt University, and a member of the project's Advisory Group, explains the relationship between the concept of 'mental health' and the concepts of 'wellness' and 'wellbeing':

The highest standard of health is a state of complete physical, mental and social wellbeing, not merely an absence of illness. http://www.who.int

Mental health is a positive state of wellbeing … it involves feeling positive about ourselves, our communities and being able to live life to our fullest capacity. http://www.auseinet.com/atsi
Tracey Simpson (2005) highlights the fundamental role of relationships in good early childhood teaching and service provision, and asserts that 'involvement in authentic experiences with children is the most important role to be played (by early childhood professionals)'.

This scoping study has focused on children aged from birth to five years in children's services settings and associated outreach services such as facilitated playgroups. It explores the concept of provision for children's wellbeing at two levels:

• Providing for the social and emotional wellbeing of all children
• Responding to the social and emotional needs of children at risk of mental health problems. Top of page

Field context - early childhood services

The early childhood services sector in Australia varies enormously in the range of services it delivers, the locations in which services are provided, and in its funding arrangements.

Services include child care centres, sessional preschools, family day care, play groups (both parent-operated and professional-supported), mobile services, and occasional care services. Federal, state and in some places local government are involved in funding, regulation, quality assurance programs and direct service delivery in a complicated pattern of program arrangements that is not integrated. Service operators include community- based committees, large non-government organisations, small commercial operators and large corporations. Neither regulations nor quality assurance systems are based on the evidence about the indicators of quality. What this means is that the majority of services operate with low staff-child ratios, large group sizes, staff with limited or no qualifications, high staff turnover, and significant levels of casual staff. The result is that staff in the many services that are not well-resourced struggle to meet even basic program requirements.

Dedicated services for Aboriginal children and families are generally funded on a 'budget' basis, with funds coming directly from the Australian and state governments and often augmented by fees paid by parents. Services for non Aboriginal children and families ('mainstream' services) are a mix of state government-funded free or low-fee services, and services which are funded entirely or mainly by parent fees. Eligible parents with children in approved long day care services access the Australian Government's rebates and/or means-tested Child Care Benefit.

Many services, both Indigenous and mainstream, struggle for financial viability. Most mainstream services operate as businesses in a competitive market which creates tensions between quality, affordability and accessibility. Salaries in this sector represent up to 85 per cent of centre budgets even though they are among the lowest in our community. The sector is, in general, resource-poor and has low status, and demand outstrips the availability of places in many localities. The participation rate of Aboriginal children in preschool services is declining.

It is important to bear this broad picture in mind when considering the information obtained from the 'good practice' services consulted for this project. It is clear that high quality early childhood experiences contribute significantly to young children's mental health, but it must be emphasised that high quality and innovative programs come at a cost. Those services operating such programs either charge high fees or are subsidised in ways not necessarily available to the broader early childhood sector. It is unrealistic to assume that high- standard support for children, families and staff can happen on a large scale without improvements in funding and service delivery.

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