3 Considerations

3 Considerations

The Public Health Interventions Advisory Committee (PHIAC) took account of a number of factors and issues when developing the recommendations.

3.1 PHIAC focused on local interventions to improve children's social and emotional wellbeing – either directly, or by improving the ability of parents to provide a nurturing and loving family environment. However, such family-based services can only form one component of a broader, multi-agency local strategy within a supportive national policy framework. Other elements may include, for example, policies to improve the social and economic circumstances of disadvantaged children.

3.2 PHIAC noted that a range of early years child development programmes that were beyond the scope of this guidance are effective. This includes, for example, certain parenting programmes. PHIAC also recognised that these programmes would complement the home visiting, early education and childcare interventions recommended in this guidance.

3.3 PHIAC was mindful of ongoing policy developments in relation to public health commissioning. It took into account the greater role local government will play in improving and protecting the health and wellbeing of local people. For example, local government will take over responsibility for children's services from the NHS Commissioning Board in 2015. (These services support women in pregnancy and children aged up to 5 years and are delivered as part of the Healthy Child Programme. They include health visiting.)

3.4 Traditionally, child development policy and practice has focused on physical health and cognitive development. However, a series of independent reviews on early intervention, early education and child protection have underlined the importance of social and emotional wellbeing. (The reviews include Allen [2011a; 2011b]; and Department for Education and DH [2011].) Social and emotional wellbeing forms the basis for healthy child development and 'readiness for school'. It can also help prevent poor health and improve education and employment outcomes in adolescence and throughout adulthood.

3.5 There is a lack of consensus on how to define and measure young children's social and emotional wellbeing. Much of the evaluation literature concentrates on the consequences of someone lacking mental or social and emotional wellbeing. Evidence on interventions aiming to improve or sustain social and emotional wellbeing is comparatively limited – and the quality varies significantly. There are a small number of high-quality, long-term UK studies. However, the main body of evidence is from the US and it was sometimes difficult to determine how relevant this was for early years services in the UK.

3.6 Most of the available evidence on early years interventions related to mothers. However, PHIAC recognised the importance of including the father in interventions, where this was possible.

3.7 Within the guidance, the term 'parent' includes mothers, fathers, carers and foster parents. PHIAC noted that both parents are important to children (whether living in the same household or in a relationship with each other or not). PHIAC noted that programmes to encourage the participation of all parents, at all stages (before birth and throughout the early years) and that support their needs, may benefit their children's social and emotional wellbeing greatly.

3.8 Independent reviews (Allen 2011; Field 2010) stressed the critical role of the whole family, including fathers and grandparents, in influencing a child's social and emotional wellbeing and subsequent life chances. There is limited evidence on the most effective ways that fathers and grandparents who provide childcare support can promote social and emotional wellbeing. However, PHIAC recognised that an approach that involves the whole family is important.

3.9 Difficulties with speech, language and communication may contribute significantly to social and emotional wellbeing problems and the resulting behaviour that may ensue. For example, PHIAC noted that, according to one longitudinal study (Silva et al. 1987) 59% of children aged 3 years with language delay had behavioural problems, compared with 14% without language delay. PHIAC also noted that those working with young children and their families have an important role in highlighting the importance of language and communication and in identifying any difficulties in this area.

3.10 The recommendations build on important national developments to promote and protect the social and emotional wellbeing of children, especially vulnerable children. These developments include:

  • Expansion of the health visitor workforce.

  • The new core purpose of children's centres: 'to improve outcomes for young children and their families with a particular focus on the most disadvantaged, so that children are equipped for life and ready for school, no matter what their background or family circumstances' (Department for Education 2011b).

  • Free early education extended to 40% of infants aged 2 years, starting with those who are from disadvantaged families (Department for Education 2012b).

  • The designation of personal, social and emotional development as 1 of the key themes in the new early years foundation stage (Department for Education 2012a). (This statutory framework sets standards for learning, development and care for children from age 1–5 years for all early years settings).

  • Stronger links between the Healthy Child Programme and early years foundation stage processes of assessment and review to help identify and respond to children with particular needs.

3.11 Expert testimony relating to the Family Nurse Partnership programme showed that this model can have a positive effect on children's emotional and behavioural development. (The evidence was derived originally from long-term randomised control trials [RCTs] in the US of targeted, intensive interventions.) PHIAC noted that the current UK randomised control trial, based on the same programme, will provide valuable evidence of its effectiveness in this country. It also acknowledged that long-term follow-up and an analysis of the costs and benefits will be crucial.

3.12 PHIAC was aware of the financial constraints on public sector services and the need to ensure value for money. Members noted that the Allen reviews (2011a; 2011b) set out a strong economic case for early years 'preventive' services. The reviews showed that the greatest cost savings could be achieved by intervening during the early years of life.

3.13 PHIAC judged that, if effective evidence-based interventions are systematically implemented, then cost savings are likely to be achieved over 3 to 4 years – and also in the longer term.

3.14 While prevention of child abuse is not the primary focus of this guidance, neglect and abuse are major risks to a child's social and emotional development (as well as to their overall health and wellbeing). PHIAC believes the recommendations should help prevent child abuse.

3.15 Evidence showed that effective interventions were structured, replicable and auditable. PHIAC also noted that effective interventions require 'high implementation fidelity' with original programmes, that is, they have to be based on the original programme design.

3.16 PHIAC put an emphasis on arrangements that could be widely and systematically implemented to deliver evidence-based interventions.

  • National Institute for Health and Care Excellence (NICE)