Universal mental health support in the early years in the context of the UK: early years professionals’ views

ABSTRACT

Despite the strong national drive in the UK to improve children’s mental health, significant concerns have been raised about initiatives aimed towards school-age children, excluding the nation’s youngest. Surprisingly, little is known about whether early years training adequately prepares practitioners to support young children’s mental health, as well as investigating how this happens in practice. The present research examined the value of universal mental health provision in early years education in the UK by exploring early years practitioners’ views on training and continuous professional development, as well as their perspectives about practices and procedures they use. Early years practitioners reported that early years qualifications in the UK had failed to prepare them by excluding social and emotional learning almost entirely from basic training. Whilst continuous professional development related to mental health was marginally more available, it remained largely exclusive to a small percentage of the early years workforce, namely those working in local authority settings. The study advances our understanding of the UK early years practitioners’ preparedness to support young children’s mental health by emphasising the importance of a highly skilled workforce, reinforcing the need for increased mental health training for all early years professionals.

KEYWORDS:

• Social and emotional development
• professional development
• early childhood education and care
• early intervention
• teacher–child relationships

Introduction

Recent years have seen the topic of mental health propelled into the limelight, receiving extensive media coverage and featuring at the forefront of numerous campaigns and government initiatives, particularly within the UK education sector. With teachers undertaking specific training in ‘Mental Health First Aid’, the assignment of designated Mental Health Specialists in every school (Department for Health [DfH] and Department for Education [DfE] 2017), and the appointment of Emotional Literacy Support Assistants in local authorities (Wilding and Claridge 2016), there is markedly a strong drive to improve children and young people’s mental health. However, in recent years, these initiatives were aimed towards primary and secondary schools, thereby excluding the nation’s youngest children, 5.5% of whom were found to hold a mental health diagnosis. This figure was based on a nation-wide survey carried out in 2017, including oppositional defiant disorder, autism spectrum disorder and sleeping and feeding disorders (NHS 2018). These figures are likely to have been amplified by COVID-19.

Provision for supporting children’s mental health

The concept of early childhood mental health is not new; research in the 1960s put forward the risk of a negative impact of poor parent–child relationships on children’s mental health and emotional wellbeing (Bowlby 1969; Fraiberg, Adelson, and Shapiro 1975). With priorities at this time directed towards treating diagnosable mental health conditions, recent years have seen a significant shift in thinking (McComish 2015). The multitier approach to mental health support that is favoured today incorporates universal initiatives for all children, targeted interventions for those at risk, and specialist support for children already experiencing mental health difficulties (Walker and Shinn 2002). This approach is centred on prevention, for which the DfE claims that a universal focus is vital in reducing the need for targeted and specialist interventions (DfE 2016, 2017a). If protective measures can be taken to reduce the risk to an individual’s mental health, outcomes for all children could be improved, and the risk of more significant mental health issues from developing can be reduced (Allen 2011; Tremblay 2010).

The case for early intervention in supporting childhood mental health

The interdisciplinary field of childhood mental health is aimed at optimising children’s social and emotional learning (SEL) from birth (McComish 2015) and is defined as the process through which children learn to understand and manage emotions, set and achieve positive goals, feel and show empathy for others, establish and maintain positive relationships, and make responsible decisions. Skills such as self-awareness, self-management, social awareness, relationship skills and responsible decision making are essential to a child’s mental health, enabling them to maintain positive emotional wellbeing (Boyd et al. 2005; Conners-Burrow et al. 2016; Early Education 2012; Early Intervention Foundation 2015; van Poortvliet, Clarke and Gross, 2019). If these skills can be nurtured at the earliest opportunity, the child will have considerably stronger foundations for maintaining positive mental health as they grow up (Boyd et al. 2005; Early Intervention Foundation 2015). As such, it is hoped that positive outcomes will be reached at school and in later life, in relation to physical and mental health, school readiness and academic achievement, crime, employment and income (Domitrovich et al. 2017; Davie 2016; Goodman et al. 2015; Taylor et al. 2017).

However, young children remain significantly less likely to be offered adequate help, in comparison with their primary and secondary school peers (Carter, Briggs-Gowan, and Davis 2004). By overlooking children in the early years, the opportunity for early intervention is missed, despite being a well-established model in all aspects of children’s health and development. As a preventative approach, and based on an understanding that the sooner children at risk are identified and supported, the easier it is to change the direction of negative outcomes, early intervention reduces risk factors and is proven to positively impact future outcomes (Allen 2011). This is particularly true for children considered to be at risk of mental health problems (Tremblay 2010) and children from disadvantaged backgrounds, who on average have weaker SEL skills at all ages than their better off peers (Goodman et al. 2015). Statistics indicate that mental health problems which first present in the early years result in more significant, long-term impact for the individual, as early patterns of behaviour become more deeply embedded and difficult to overcome (Johnston et al. 2014; National Collaborating Centre for Mental Health [NCCMH] [UK] & Social Care Institute for Excellence [SCIE] [UK] 2013).

It has been argued that the most effective way to achieve early intervention is through a universal, classroom-based approach (Hemmeter, Ostrosky, and Fox 2006). Due to the high proportion of time that young children spend in attendance at early years settings, early years professionals have the opportunity to play a key role in shaping and influencing children’s mental health and wellbeing (Conners-Burrow et al. 2016; Patalay et al. 2016). By incorporating the promotion of SEL into the curriculum, including teaching and modelling skills such as empathy, emotional literacy, conflict resolution and relationship building, the impact early years professionals can contribute towards every child’s mental health and future outcomes is greater (Committee for Children 2011, 2019; Conners-Burrow et al. 2016).

However, the suggestion that early years settings are ideally positioned or equipped to provide mental health support is a contested one (Moon, Williford, and Mendenhall 2017). Some suggest that early years settings do not place high enough priority on SEL, in favour of cognitive and language development, negatively impacting the success of early intervention for children at risk of mental health needs (Guralnick 2000). In contrast, others (Tremblay 2010) praise the contribution that early years settings make towards promoting positive mental health and wellbeing for all children. There remains a significant gap in the context of the UK-based research literature exploring how well prepared and equipped early years professionals feel in supporting children’s mental health, which this study aimed to address.

The role of professional development in supporting mental health in the early years

One of the key arguments against the suitability of educational settings in providing mental health support is a lack of adequate staff training, with the early years being no exception (Boyd et al. 2005; Conners-Burrow et al. 2016). The Department for Health and Social Care (DfHSC) and the DfE (2018) recently raised concerns about the lack of support provided to practitioners working on the front line with young children, many of whom have received limited or even no specific training or guidance on mental health provision. At the time of writing, the UK early years training, such as the CACHE Level 3 Diploma, featured no direct mention of mental health or SEL, instead giving priority towards developing children’s communication and language skills (Tassoni et al. 2010). A report published by the Early Intervention Foundation (2015) made recommendations for early years staff to receive more in-depth training for developing children’s SEL, both as part of their initial qualification and additional training throughout their careers, irrespective of their role. Boyd et al. (2005) agreed, claiming that early years practitioners must be prepared and adequately trained to support children’s mental health needs, given that they, along with the child’s parents, hold the greatest influence over their learning and development. While early learning goals related to personal, social and emotional development are clearly stated in the Early Years Foundation Stage Profile (the official government document that describes the statutory requirements in the early years in the UK) and are a key focus of the early years curriculum in the UK, a knowledgeable and confident workforce is needed to support social and emotional learning in the early years.

However, progress has been made, with the Green Paper published by the DfH (2017) recommending future teacher training standards to incorporate mental health training. Whilst this is a positive step, particularly for school-aged children, it could be argued that again the youngest children, and potentially those most at risk are being excluded, with only a very small proportion of the early years workforce holding Qualified Teacher Status (QTS). If these recommendations could be applied to all early years training courses throughout the UK, it would mean that all practitioners, and not just those who hold QTS, would be able to support all children’s mental health needs, through the provision of SEL, as part of daily, standard practice (Boyd et al. 2005; Early Intervention Foundation 2015). Alongside adequate CPD opportunities for practitioners of all levels, it would also create a more balanced skill-set across the workforce, making universal mental health initiatives more effectively implemented within the early years classroom (Omdal 2017).

What does support for social and emotional learning look like in early years settings in the UK?

Most of the evidence regarding support for SEL has been focused on intervention programmes, with little guidance on the types of strategies or practices that early years professionals incorporate into their teaching. The Education Endowment Foundation commissioned a survey to investigate what SEL looks like in primary schools (Wigelsworth et al. 2020) but, to the best of our knowledge, no studies have looked at the different strategies that early years practitioners integrate into their everyday practice in the context of the UK. An investigation into what early years practitioners were doing to support children’s social and emotional development could provide the context for any future recommendations, and identify where there are gaps between current practice and existing research evidence.

The present study

This study aimed to examine the value of universal mental health support in the early years in the context of the UK by evaluating early years training, including CPD, in addition to practices and procedures used by early years professionals to support SEL for all children. The following research questions were addressed:

• In the context of the UK, what were early years practitioners’ views about whether early years training, including continuous professional development, adequately prepares practitioners to support young children’s Social Emotional and Mental Health needs?

• In the context of the UK, what approaches and practices do early years practitioners engage with to support social and emotional learning in their early years settings?

Methods

Research design

An online questionnaire survey was used to examine the capability and preparedness of the early years workforce to support children’s mental health needs, as well as to explore practice in promoting SEL. The design selected provided us with rich and in-depth data in order to address the research questions.

Participants

Practitioners working within the UK early education sector were the target participants for this study, who were accessed via a large Facebook support group dedicated to early years practitioners. A total of 123 participants were reached in this way, comprising 39 participants who were employed in private day nurseries, 6 from local authority children’s centres, 12 from maintained nursery schools, 55 from the early years departments in schools, 2 childminders, and 5 who specified ‘other’. Of these participants, 34 held Qualified Teacher Status qualification, while the remaining participants were qualified to Level 3 and above (from the 9 levels of qualification that exist in the UK, with Level 1 being the lowest and Level 9 the highest level of qualifications). The participant sample appears to be largely representative of the wider UK early years workforce in terms of the proportion and number of childcare providers and their overall qualifications (DfE, 2021).

Data collection

An online questionnaire survey (see Appendix) was used to examine the capability and preparedness of the early years workforce to support children’s mental health needs, and to explore practice in promoting SEL. Aside from standard information-gathering questions (e.g. qualification status, type of setting, etc.), questions were predominantly open and explored practitioner preparedness to support mental health, availability and accessibility of CPD, as well as their suggestions for further training. The second part of the questionnaire asked practitioners to describe the strategies and approaches they use in their everyday practice to support mental health and encourage children’s SEL.

Procedures

A link to the online questionnaire survey was shared on social media, specifically a large Facebook group dedicated to early years practitioners. Participants were given a three-week time frame in which to complete the questionnaire, after which, the data was collated and analysed.

Data analysis

For the quantitative questions of the survey, descriptive statistics were used. Due to the relatively small sample size, the results from the quantitative questions of the survey should be treated with a degree of caution, as the margins of error on small sample sizes are typically wide. For this reason, responses are given as numbers as well as percentages. All percentages have been rounded to the nearest integer and so may not sum to exactly 100%.

For the qualitative, open questions of the questionnaire, we followed the five key stages of the ‘Framework’ approach: ‘familiarisation’ with the data, creating a ‘thematic framework’, ‘indexing’ the data in relation to the framework; ‘charting’ or collating the data under each theme and sub-theme, and finally ‘mapping and interpretation’ of the data. Where words are quoted, the participant is identified only by a randomly assigned unique code, e.g. Participant 4.

Ethics

Ethical approval was given by the University of Bristol Humanities and Social Sciences Research Ethics Committee. Participants were provided with information about the study during the initial stages of completing the questionnaire survey. They were informed that all data would be anonymised and that they were free to withdraw at any time and have their data removed. None of the authors have any competing interests.

Findings

From the analysis of the participant responses, there were eight overarching themes identified, which are illustrated in Figure 1.

Figure 1. Overarching themes.

The section below is divided into two main sections. The first section reports on practitioners’ views on continuous professional development. The second section reports on practitioners’ views on universal mental health support in practice.

Views related to continuous professional development

Based on the analysis, five overarching themes were identified as crucial to whether professional development and learning prepares early years practitioners to support children’s social and emotional learning. These included the overarching themes of ‘Practitioner Qualifications’, ‘Practitioner preparedness’, ‘Availability of CPD’, ‘Accessibility of CPD’ and ‘Suggestions about further training’.

Practitioner qualifications

Of the 123 participants, 81.3% reported that no modules or assignments related to childhood mental health were covered as part of their qualification. Of the 23 participants (18.7%) whose courses did include mental health, 20 (86.8%) came from a Foundation Degree or higher, with 7 (30.4%) holding Qualified Teacher Status. The most common topics featured within these qualifications were attachment, wellbeing, and social-emotional development, although four participants (17.3%) implied that coverage of these topics was vague, being ‘not specifically mental health’ and ‘fairly general with little focus on actual mental health’. Other modules mentioned included Supporting Children with Special Educational Needs, Inclusion, Resilience, and Therapeutic Play. One participant who held a Master’s in Educational Improvement, Development and Change with Early Years Specialism reported that ‘children’s mental health was a continuing theme throughout my MA course. There was no specific module, but it underpinned everything we did’.

Practitioner preparedness to support mental health and social and emotional learning

Despite the 23 participants (18.7%) reporting the inclusion of mental health modules within their initial early years training, only one participant considered their training to be entirely accountable for their readiness to support children’s mental health, reporting, ‘I have been given the tools to help prepare me for children’s mental health’. For the remaining 122 participants, the overall consensus was that their initial training, regardless of level, was not responsible for their knowledge and understanding of childhood mental health. As Participant 1 stated:

… everything I have learnt about childhood mental health I have learnt in the job, from my colleagues and experiences, not from training

Similarly, Participant 60 suggested,

I am not sure if early years training has prepared me, more prepared myself by having interest and passion

Whilst 39 participants (31.7%) felt ‘totally unprepared’, many investigated further into the topic to enhance their studies, with participant 105 claiming

I do lots of reading around Mental Health

I am having to do a lot of independent research to find better ways to support children who are exhibiting low levels of mental well-being. (Participant 27)

Availability of continuous professional development

In addition to initial training, CPD evidently featured heavily within the sector, with 55 participants (44.7%), having undertaken CPD related to children’s mental health. The range of training courses that participants had access to is vast, including Emotion Coaching, Theraplay, and Thrive, which gives practitioners tools to understand and support children’s behaviour and emotions. One course that was mentioned by eight different participants (6.4%) was the CACHE Level 2 Diploma in Understanding Children and Young People’s Mental Health. However, this course is not aimed directly at early years, and as a result, the majority of participants labelled it as ‘not very useful’ and ‘a general overview and the focus was far more on older children (secondary age)’.

Accessibility of continuous professional development

Survey findings show that the accessibility to CPD related to children’s mental health is influenced by the setting as a whole, including its leadership team. Participant 6, from a Private Day Nursery, who had attended a high volume of CPD courses reported,

I feel prepared as my setting does consider children’s mental health

Participant 21 stated,

My headteacher allows me to go on training to deepen my understanding

Of the 41 participants (32.8%) working in the private sector, whether in childminding or at a Private Day Nursery, 14 of them (34.1%) reported to have attended CPD related to children’s mental health, exactly half of whom claim to have ‘self-researched’ and undertaken CPD ‘in my own time’ and ‘off my own back. None provided by my LA’.

In contrast, of the 73 participants (58.4%) working in local authority settings, such as schools, maintained nurseries and children’s centres, 40 participants (54.8%) reported to have undertaken CPD related to mental health, none of whom reported the need to seek out such courses independently.

Suggestions for further training

Overall, the feedback from participants who accessed CPD was positive, and 69 participants (54.4%) expressed a desire for more, with suggestions for further CPD training including ‘bereavement training’, ‘family support’, and ‘emotional literacy training’, as it was felt this ‘is mostly aimed at 5 years and above’.

Of these 69 participants, 20 participants (28.9%) additionally suggested that such training should be ‘mandatory’, ‘ongoing to keep practitioners up-to-date’ and ‘offered within the standard early years training’.

Universal mental health support in practice

Three overarching themes relating to the strategies and approaches used in their everyday practice to promote SEL were identified from the responses of participants. These included the overarching themes of ‘Promoting SEL through the physical environment’, ‘Promoting SEL through the activities and the opportunities’ and ‘Promoting SEL through adult-child interactions’.

Promoting social and emotional learning through the physical environment

When asked to rate their confidence in providing a physical environment that is supportive of SEL, on a scale of 1–10, 81 participants (65.9%) rated themselves at least 8 or above. Of these 81 participants, 66 (81.5%) were trained to Foundation Degree or higher, and 52 (64.2%) worked in local authority-ran settings such as schools, children’s centres, and maintained nursery schools.

When asked how they would promote SEL through the physical environment, the term ‘safe’ was used by 23 different participants, with phrases such as ‘ensuring the environment is safe, welcoming and secure’ and ‘a place where children feel safe and content’. However, no participants specify exactly how they would achieve this sense of safety.

Eighteen participants discussed the importance of carefully structuring the space, with suggestions including ‘quiet spaces’, ‘cosy spaces’, ‘spaces for one’ and ‘reflective areas’.

Access to the outdoor environment was mentioned by 13 participants, with Participant 7 stating:

As I work in a Forest School, our children spend a lot of time outside. Our children can explore nature first-hand and enjoy the physical and mental benefits from being in nature

Six participants highlighted the need for calm and relaxation, which can be achieved through an ‘uncluttered’, ‘not over stimulating’ and ‘homely’ physical environment.

Overall, of the 123 detailed responses to this question, 76 responses (61.8%) were entirely unrelated to the physical environment, with only 4 responses (3.3%) being completely focused on the physical environment alone. The remaining 43 (35%) responses included additional priorities, including adult interactions, setting ethos, and staff training and knowledge.

Promoting social and emotional learning through the activities and opportunities

When asked to rate their confidence in providing activities and opportunities that enable social and emotional learning, on a scale of 1–10, 60 participants (48.8%) rated themselves at least 8 or above. Of these 60 participants, 51 (85%) were trained to Foundation Degree or higher, and 37 (61.7%) worked in Local Authority settings.

Circle time and group activities, where children had the opportunity to ‘take turns’ and participate in ‘team games’, were mentioned most frequently by participants, in total 29 times, but none of these participants specified what group activities they offered children, or why they considered them to be important.

Twenty-five participants discussed the use of activities to support children’s understanding of emotions, including ‘emotion cards’, ‘feelings puppets’ and ‘persona dolls’, with another 14 participants noting the use of stories, specifically those with ‘themes of empathy, emotions and social skills’, or ‘to support feelings’.

There was a significant emphasis on calm, relaxing activities, with 20 participants supporting the provision of ‘yoga and mindfulness’ or ‘meditation for kids’.

Other activities and opportunities mentioned included expressive art, messy play, role play, music and dancing, and adequate opportunity to explore outside. Only one participant mentioned the benefits of risky play, including ‘climbing, jumping from heights, and supervised woodworking’.

Promoting social and emotional learning through adult-child interactions

When asked to rate their confidence in leading adult-child interactions that promote SEL, on a scale of 1–10, 81 participants (65.9%) rated themselves at least 8 or above. Of these 81 participants, 64 (79%) were trained to Foundation Degree or higher, and 49 (60.5%) worked in Local Authority run settings.

When asked what this looks like in practice, the most frequently mentioned technique, of which 57 participants referred to by some means, was to show children that they are valued and respected, with ideas such as ‘listening and being sensitive to children’s needs’, giving children ‘quality time’, ‘respect and listen to the child’s views’ and providing ‘praise and encouragement’.

Another frequently mentioned technique was in recognising, affirming and discussing children’s feelings and emotions, with 35 participants referring to this, one of whom highlighted it to be part of the ‘Emotion Coaching’ method.

Eight participants discussed their body language when interacting with children, including ‘eye contact’, ‘being at the child’s level’, with a ‘friendly facial expression’, whilst 10 participants acknowledged the importance of modelling, both in ‘positive interactions’ and ‘expressing a range of emotions’.

Discussion

Research examining the professional development of the educational workforce to support children’s mental health is limited, with research specific to the early years somewhat lacking. This study is the first retrospective in-depth review of how early years training, including CPD, prepares practitioners to support children’s mental health, through developing SEL within the classroom. Results from our survey showed that, based on early years practitioners’ perspectives, early years qualifications in the UK did not sufficiently prepare practitioners to meet the mental health needs of children in the early years, by excluding SEL almost entirely from standard early years qualifications, at least until undergraduate level or above, and therefore excluding many who work within the sector. Specifically, our survey results revealed that there seems to be a noticeable lack of training in regard to childhood mental health, as part of the standard Level 3 early years qualification. This justifies concerns that the early years workforce is not adequately prepared to support children’s mental health needs (Boyd et al. 2005; Conners-Burrow et al. 2016). However, corresponding to the DfH (2017) Green Paper recommending improved mental health training for trainee teachers, higher rates of mental health training reported amongst participants holding QTS suggests progress. The question of whether QTS training is adequate remains contested, in part due to the small portion of the early years workforce to whom it applies. Additionally, of the participants who reported mental health training during their qualifications, feedback as to its usefulness was largely poor, with a majority consensus that it had done little to further their knowledge on the subject of mental health in the early years, in comparison with experience gained in the workplace. Considering this feedback from participants, there is evidently room for improvement, which supports recommendations from the Early Intervention Foundation (2015) and empirical research (Bonetti and Blanden 2020; Boyd et al. 2005; Manning et al. 2019) that early years training needs to incorporate more focus on mental health, in both initial teacher training and continuing professional development.

Survey findings towards CPD are more promising, with a higher portion of participants, across all qualification levels, claiming to have undertaken CPD related to mental health. This seems justified, given the country-wide drive to improve mental health support over recent years (DfH 2017). Of the courses attended by participants, some were deemed beneficial and others less so, with many being reported to cover the mental health of children and young people across age ranges, some as wide as 0–18 years. Considering that the needs of individuals in their early years differ somewhat from those in their teens, doubts about their benefits are warranted. Additionally, whilst CPD for childhood mental health is available, accessibility is evidently an issue for some, in particular, those working within the private sector. Whilst the DfH (2017) is striving to improve mental health training for those working in the early years, findings from our survey data demonstrate that a high percentage of the workforce was excluded. This strengthens the case for improved training, both at qualification level and through CPD, in order to ensure practitioners are adequately prepared to support and promote good mental health for all children (Early Intervention Foundation 2015). With the majority of the survey participants expressing a desire for further training, and a high number feeling underprepared to support children’s mental health needs, the argument for improved and more accessible training is reinforced further still.

Ample literature and guidance exist on how to develop young children’s SEL, with Personal, Social and Emotional development being one of the prime-learning areas within the Early Years Foundation Stage (DfH 2017; Early Education 2012). However, how this happens in practice, in the context of an early year setting, has received little attention to date, particularly in the UK. Practitioners reported in our survey a variety of strategies to promote SEL, through making adaptions to the learning environment, the activities provided and the ways they interact with children.

Survey responses considering the physical environment highlighted the use of small, quiet, reflective spaces as a well-used tool throughout the early years, in supporting young children’s emotional wellbeing in the classroom. When considering the activities they provide, participants suggested the provision of small-group, turn-taking activities for developing social skills, with the addition of yoga, meditation and stories about feelings for supporting emotional wellbeing. Participants also discussed their interaction techniques, including affirming children’s feelings, expressing a range of emotions, and listening, valuing and respecting the views of all children.

In all three domains, participants gave little attention to social learning, suggesting that higher value is placed on emotional learning when considering young children’s mental health. This could be accounted for by a lack of training, with practitioners uncertain of the link between Personal, Social and Emotional Development, a prime area within the EYFS, and mental health. It also further highlights the unpreparedness amongst the early years workforce to successfully provide universal mental health support within their classrooms.

Limitations and future research

To the best of our knowledge, this is the first study to explore practitioners’ views about whether early years training adequately prepares practitioners to support young children’s mental health. There are, however, several limitations to this study. This research explored participants’ perspectives retrospectively, raising issues about whether practitioners were able to factually recall all facets of their initial teacher training. Also, this research would benefit from an extended, longitudinal study to take place including participants from a wider selection of early years settings, as well as children and their parents as additional participants. This would enable a more in-depth analysis to be undertaken and to thoroughly examine the range of practices used to impact children’s mental health, including SEL.

Conclusion

This research has highlighted concerns raised by early years practitioners that essentially, in the context of the UK, early years training, including CPD, is insufficient in preparing practitioners to support children’s mental health needs. Whilst there is an evident national push to improve this, with increased opportunities for professional development and learning and recommendations for upgraded teacher training, there is extensive room for improvement, with a significant portion of survey participants reporting feeling ill-equipped in the field of childhood mental health. The variety of strategies and techniques reported by participants to be used in their everyday practice emphasises the importance of a highly skilled workforce, reinforcing the argument for increased mental health training for all early years professionals in the UK.

Acknowledgments

This study was not externally funded but was part of an MSc thesis requirement at the University of Bristol.

IB and JS share responsibility for the final version of the work. JS collected and analysed the data in the study. We sincerely thank the study participants for completing the survey with enthusiasm and providing us with their invaluable insights.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Appendix – Questionnaire

SECTION ONE

1. What type of early years setting do you work in?

 o Private Day Nursery.

 o Local Authority Setting (e.g. Children’s Centre, Maintained Nursery School, etc.).

 o School (e.g. Nursery/Pre-School or Reception Class).

 o Nanny.

 o Childminder.

 o Other (please specify) _________________________________________

2. Does your setting have a designated member of staff to lead on mental health support?

Yes/No/Don’t Know.

3a. To what level have you gained Early Years qualifications(please tick you highest qualification).

 o Unqualified.

 o Level 2 (e.g. NVQ, CACHE, etc.).

 o Level 3 (e.g. NVQ, CACHE Diploma, etc.).

 o Foundation Degree/HND.

 o BA Hons.

 o Postgraduate Level (e.g. PGCE, MSc, etc.).

3b. Please specify the name of your course.

3c. Approximately how long have you held this qualification?

 o Less than 1 year.

 o 1-5 years.

 o 5-10 years.

 o 10-15 years.

 o 15-20 years.

 o 20 years +

4a. Thinking back to all Early Years Qualifications you have gained, did any of these include modules/sessions/assignments based around child mental health?

Yes/No.

4b. If yes, please provide the name of the module, session or assignment, including a brief description of the topic (you can include as many as relevant).

5a. Since qualifying, have you undertaken any additional CPD related to childhood mental health?

Yes/No

5b. If yes, please specify the name of the course, including a brief description of what was learnt.

SECTION TWO

A. Physical Environment

8a. On a scale of 1-10, how confident do you feel in providing a supportive environment which promotes positive mental health and wellbeing for children (10 being very confident, and 0 being very unconfident).

1 2 3 4 5 6 7 8 9 10

8b. Please discuss what you consider to be a supportive environment which promotes positive mental health and wellbeing for children (this may include examples from your own workplace).

B. Adult-Child Interactions

9a. On a scale of 1–10, how confident do you feel in leading adult-child interactions that promote positive mental health and wellbeing for children (10 being very confident, and 0 being very unconfident).

1 2 3 4 5 6 7 8 9 10

9b. Please discuss what you consider to be effective adult–child interactions which promote positive mental health and wellbeing for children (this may include examples of phrases or words that you use in your practice).

C. Activities and Opportunities

10a. On a scale of 1–10, how confident do you feel in providing a range of activities and opportunities that promote positive mental health and wellbeing for children (10 being very confident, and 0 being very unconfident).

1 2 3 4 5 6 7 8 9 10

10b. Please discuss what you consider to be appropriate activities to promote positive mental health and wellbeing (this may include examples of activities which you have found to be effective, both adult-led and child-led).

Is there anything else you would like to add?