COAG Mental Health Early Intervention Measure - Early Childhood Component: Study to Scope Potential Service Delivery
Question 2: How do practitioners support effective parenting that promotes young children's mental health?
General supportThe extent to which practitioners can support effective parenting depends on whether and how often they have the opportunity to interact with parents and the quality of the relationships they are therefore able to build.
The following examples demonstrate the complexities associated with providing support for parenting:
- In the centre of Sydney, Ashfield Infants Home is able to provide a rich set of expert services for vulnerable children and families.
- In northern Queensland, children travel to preschool on buses, and contact with parents is minimal.
- In Shepparton, staff travel on the buses to collect and return children and connect with parents when they can.
- In Broome, some parents are in a medical treatment centre with their children, but the priority is adult rehabilitation.
- In outlying areas in the Kimberley and in western NSW, families can be reached only by mobile services.
- When children are moved around different foster families the connection between children's services staff and families is often fractured.
Other respondents report that parents 'hand over' their children and do not expect to be involved in solving problems:
Communicating with parents is an issue when often they say 'there's nothing wrong with my child' and some families are tough to work with. They see us as baby sitters and it’s hard to get them to take up their responsibility to work with us in the interests of the child (focus group, urban Sydney).
In general, respondents indicated that their approach to supporting effective parenting is relatively informal and ad hoc - such as using opportunities to discuss children's achievements and/or concerns when parents drop them off or collect them.. On these occasions, some staff model positive ways to manage children's behaviour and are careful to approach the family with comments such as: 'Have you noticed…?', 'I find she responds well when I…'
The most effective practitioners are conscious that fostering children's emotional wellbeing and healthy social development has to be a partnership, and they are very thoughtful about their approach to parents.
We pick up on parents' cues for what they need - information on nutrition, sleeping, behaviour… we are constantly monitoring the whole family so we can help. (urban Sydney)
We should never judge, we're not in their shoes. It's important to build trust, show empathy, model and act it - don't just say it. (focus group, rural NSW)
It helps to really know the family before coming to the conclusion that a referral is necessary. Sometimes all that's necessary is putting parents in touch with others travelling the same line. (regional WA)
We support parents to support children at home because children benefit from continuity, consistency and predictability. We talk gently with parents about children's behaviour, explaining it from a child's point of view and pointing out that our responses give messages: 'What is smacking or shouting saying to the child?' We remind them: 'You're the adult, you're in charge. It might get worse when you first take charge because the child is used to being in control, but they need you to be strong and reliable. Don't give in, look for the positives, encourage them explicitly…'. (suburban Sydney)
We plan for a high level of communication between staff and families. We talk to parents about their babies, drawing their attention to developmental shifts and involving them with any concerns we have. We use Learning Stories and portfolios of children's work that we send home and use in interviews. Many parents write a little story about the child's learning at home and older children read their own and comment. Staff use micro-strategies such as mini-observation forms when children are outside, digital photos which we caption and make into books, kits we send with families when they go on holidays, so the child can keep connected to us… (suburban Adelaide)
We always communicate about sensitive matters orally; a letter can be so cold, it makes people defensive. If we're worried, we'll give parents a ring, but we try to get in touch first for a positive reason. (urban Sydney)
How staff approach families is vital. It's about relationships, so one or at most two staff members should relate to particular families. Having an age, gender and experience mix is good because some families can relate more easily to a particular generation. We need to create a space where parents feel safe to say: 'I'm having problems'. Many parents rely on the expertise of carers. (focus group, urban Sydney)
In working with parents, staff need the capacity to delay judgement, but also to know when, where and how to refer a concern in the interests of the child's safety and welfare. This has implications for training, leadership and supervision, issues which will be taken up in relation to Questions 3 and 4.Top of page
Systematic supportThe consultation also encountered examples of systematic support for effective parenting.
Understanding about 'Attachment' and the 'Circle of Security' provide the theoretical foundations for a number of such programs. Theoretical understandings and strategies that support mental and emotional health should be central to the work of all professionals who work with children and families and included in professional training, even if they are unable to access funded programs such as those described below. Top of page
Home visitingDr Mary Hood, at the Attachment and Relationships Centre in Adelaide, explained the Family Home Visiting Service operated by The Children, Youth and Women's Health Service of SA. The service is based on a 'Universal Contact' model which 'offers an initial contact in the home by a nurse soon after the birth for every child born in South Australia. It enables early identification of family and child development issues…' (Service Outline, p. 5) and is followed up with home visiting for selected families. The program includes Pathways to Parenting - the Indigenous Way which aims to provide a culturally sensitive environment for communication and assessment. Family Home Visiting incorporates attachment theory and practice from the Circle of Security model.
The Circle of Security model uses video tapes which parents watch with an 'expert observer' to learn whether or not they are providing a safe base from which the child can explore and a safe haven to which they can return.
Results suggest that the Circle of Security (COS) protocol is a promising intervention for the reduction of disorganized and insecure attachment in high-risk toddlers and preschoolers. (Hoffman et al., 2006)
Feeling AttachedWendy Thiele, Perinatal Mental Health Coordinator at the Family Unit, Helen Mayo House in Adelaide, described the training she initially developed for GPs and health professionals under the title Feeling Attached. The training provides baseline knowledge and skills in mental health and women's mental health, and a total of 12 programs have been conducted across SA, WA, ACT and Victoria, with an emphasis on highlighting local services and resources and developing cross-disciplinary networks. A related Connecting Mums program has been developed for Aboriginal mothers and babies and has been piloted at Port Augusta, SA.
Through the Looking GlassThe Through the Looking Glass (TtLG) project brings a number of these elements together in a child care environment. Successfully piloted at the Lady Gowrie Child Centre, Adelaide, the program has been expanded to include several other child care sites within the state, and in Perth and Brisbane, with funding from the Australian Government Stronger Families and Communities strategy. The manager, clinician and senior staff at Highway Child Care, Salisbury SA described the program thus: 'Within each of the participating child care sites a clinician is employed specifically to work with families in partnership with the child care staff. An 18-week group program is conducted for two hours per week for mothers as the primary carers. Parents explore attachment relationship needs through video taped segments. Child care is provided so mothers can attend and the sessions are co-facilitated by the clinician and a child care worker. At other times, the co-facilitator releases other staff to discuss concerns with the clinician. In this way, the model builds the capacity of on-site workers and consistency in staff-child-family interactions. Specific group sessions are provided for fathers.' This service also has a systematic commitment to employing qualified staff. Top of page
Community worker modelsAt Coolabaroo Neighbourhood Centre in Thornlie in suburban Perth, an Aboriginal Community Support worker has been funded through Child Protection services to minimise risk in families with children aged 0-3 years. She conducts information sessions on topics selected by participants and undertakes counselling and parenting programs. There is funding for care for children while parents attend sessions, and attendance is voluntary. The worker is 'hands on' in the community, has a say in early years programs, and can voice family needs. She links to other Indigenous groups and programs in the district. Participants help source funding for particular events and are gaining the confidence to present sessions themselves. Mother-and-baby swim sessions have been very popular and have aided attachment.
You've got to be flexible and get to know people really well. Having child care available is really important - and nice food helps! – You've got to be open to difference and listen and learn when people tell you 'that's not how we raise our kids'.
Listening to ChildrenHappy Valley Child Care Centre in South Australia found Listening to Children workshops conducted by Community Transformations valuable to parents and staff. The approach teaches participants how to use listening strategies that foster healthy adult-child connections and enable adults to understand a child's behaviour, rather than simply trying to control it.
Through participating in the program, staff can now talk with parents in an informed way about children's needs for connection and about the reasons for behaviours. The program allows time for sharing successes and concerns and puts adults relating to a child on the same wave length. (suburban SA)