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Give vulnerable children best possible start in life, says NICE

The social and emotional wellbeing of vulnerable children under 5 should be at the heart of early intervention services so all children have a fair chance to succeed in later life, new NICE draft guidance recommends.

Draft recommendations issued for public consultation today (20 April) focus on the importance of better coordinated strategic and local early years services, which include home visiting, early education and childcare, to support all families and children during their early years.

Evidence demonstrates social and emotional wellbeing is the foundation of young children's healthy development and their future life chances. Also, children living in disadvantaged circumstances are more likely to experience social, emotional and behavioural difficulties, and as a result, poor health, education and employment outcomes. For example, measures of ‘school readiness' show that the poorest 20% of children are more likely to display conduct problems at age 5, compared to children from more affluent backgrounds[1]. Local early interventions that support and protect children's social and emotional wellbeing are critical to ensure their healthy development, capacity to learn and achieve at school.

The draft guidance recommends a series of effective evidence-based interventions, designed to identify early vulnerable children (such as those living parents with mental health problems or relationship problems) and provide additional support to the family. Evidence shows the interventions referred to in this guidance are among the most cost effective ways of addressing the inequalities in health and life chances that exist between disadvantaged children and those living in better-off families.

Professor Mike Kelly, NICE Director of Public Health, said: “Most parents provide their children with the love and care they need to grow up into happy and successful adults, no matter what their personal circumstances may be, but we know that children living in difficult circumstances, for example with parents with mental health problems, and exposed to domestic abuse, are more likely to suffer emotional and behavioural problems that can have a life-long, negative effect on their future health and wellbeing.

“This draft guidance responds to a real need to improve the level and quality of early education and childcare services, especially to make sure these services are readily available to those who need them most: vulnerable children and their parents.

“Our draft recommendations are based on the best available evidence and we feel they have the potential to make a real difference to ensure all children get the best possible start in life. As always with our draft public health guidance, we welcome and encourage comments from stakeholders and look forward to receiving feedback. This will help us to shape our final guidance which we expect to publish in October this year.”

Simon Antrobus, Chief Executive, Addaction, said: “At Addaction we believe that to help vulnerable children you must intervene early and that any intervention must include the whole family, we therefore strongly welcome the new NICE draft guidance recommendations. In a recent report Addaction highlighted the dangers of parental substance misuse on children and looked at the need to harness family-based interventions to tackle the intergenerational cycle of addiction.”

Key draft recommendations include:

  • Health and wellbeing boards should ensure the social and emotional wellbeing of vulnerable children features in the ‘Health and wellbeing strategy', as one of the most effective ways of addressing health inequalities. The resulting plan should include outcomes for ensuring healthy child development and ‘readiness for school' and for preventing mental health and behavioural problems[2].
  • All health and early years professionals should develop trusting relationships with vulnerable families and adopt a non-judgemental approach.
  • Others who are in contact with a vulnerable child and his or her family (such as family welfare, housing, voluntary services or the police) should be aware of factors that pose a risk to the child's social and emotional wellbeing. They should raise any concerns with the local GP or health visitor (working in the context of local safeguarding policies).
  • Health visitors or midwives should offer a programme of home visits by specially trained professionals to women assessed to be in need of additional support. For example, they could refer first-time teenage mothers to the Family Nurse Partnership from early pregnancy onwards. They should also offer to provide similar intensive support themselves to other vulnerable women, such as young mothers-to-be presenting late in pregnancy and postnataly to those experiencing domestic violence and abuse.
  • Health visitors or midwives should consider using interactive video guidance to improve maternal sensitivity, mother-infant attachment and the child's behaviour. (For example, this might be necessary when the mother has depression or the infant shows signs of behavioural difficulties.)
  • Ensure all children have the opportunity to attend high quality childcare[3] and early education services outside the home on a part- or full-time basis. Attendance times should be flexible so that parents or carers (including those from vulnerable families) have the opportunity to take on paid employment.
  • Those involved in early education services should ensure vulnerable children have the opportunity to attend high quality preschool education (from the age of 2 years) to enhance their social and emotional wellbeing and build their capacity to learn.

The guidance is for all those responsible for ensuring the social and emotional wellbeing of children aged under 5 years. This includes those planning and commissioning children's services in local authorities (including education), the NHS, and the community, voluntary and private sectors. It also includes midwives, health visitors, GPs, paediatricians, practitioners working in child and adolescent mental health services, social workers, teachers, staff in children's centres, nursery nurses and child minders. It may also be of interest to parents, other family members and the general public. The guidance may also be of interest to parents, other family members and the general public.

Anyone wishing to submit comments on this draft guidance is invited to do so via the NICE website, until 15 June 2012.

Ends

Notes to Editors

About the guidance

1. The Department of Health (DH) asked the National Institute for Health and Care Excellence (NICE) to produce this guidance.

2. The draft guidance will be available on the NICE website from Friday 20 April. Consultation will take place between Friday 20 April and 15 June 2012.

3. Only stakeholders can comment formally on consultations, but organisations can register to be a stakeholder at anytime during this process. View the criteria to become a stakeholder.

Organisations from England and organisations with operations in England can register to comment on this draft guidance.

4. Final guidance is expected in October 2012. Although NICE public health guidance is not statutory, the NHS, local authorities and the wider public, private, voluntary and community sectors are expected to follow it.

5. The term vulnerable is used to describe children who are at risk of, or who are already experiencing, social and emotional problems. Vulnerability may be linked to disadvantage and poverty.

Vulnerable children include those who are exposed to:

  • parental drug and alcohol problems
  • parental mental health problems
  • family relationship problems, including domestic violence
  • criminality.

Vulnerable children may also include those who are in a single parent family or who were born to mothers:

  • aged under 18
  • with a low educational attainment
  • who are (or were as children) looked after (that is, they have been in the care system)

5. Most parents living in poor social circumstances provide a loving and nurturing environment, despite many difficulties. However, children living in a disadvantaged family are more likely to be exposed to adverse factors such as parental substance misuse and mental illness, or neglect, abuse and domestic violence. Consequently, they are more likely to experience emotional and behavioural problems that can impact on their development and opportunities in life (Farrington et al. 2006; Shonkoff and Phillips 2000). For example, measures of ‘school readiness' show that the poorest 20% of children are more likely to display conduct problems at age 5, compared to children from more affluent backgrounds (Aldfogel and Washbrook 2008).

6. For the purposes of this guidance, the following definitions are used:

  • emotional wellbeing - this includes being happy and confident and not being anxious or depressed
  • psychological wellbeing - this includes the ability to be autonomous, problem-solve, manage emotions, experience empathy, be resilient and attentive
  • social wellbeing - has good relationships with others and does not have behavioural problems, that is, they are not disruptive, violent or a bully.

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

  • quality standards -these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients.

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.


[1] Waldfogel and Washbrook 2008

[2] See the ‘Public Health outcomes framework' indicators for early years

[3] As indicated by Ofsted inspection criteria. See consultation document Proposals for a revised framework for the registration, inspection and enforcement of registered early years provision [online].

This page was last updated: 23 April 2012

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.