Welcome to this extended edition of Child Care in Practice presenting international studies which demonstrate the inter-linked and multi-faceted range of the subject of child care.
It brings a broad selection of significant studies effective for informing practitioners, policy makers and researchers regarding a range of programmes—Kirby et al. (2021) provide a generally positive view regarding the outcomes of the “Hopeful Minds” programme delivered in schools in the north-west of Ireland. It provides an initial review of the impact of supporting the development of the concept of hope in adolescents which, although significant, deserves further research. Help-seeking behaviour is an indicator of wellbeing/social skills and resilience and is reflected in the article by Breslin et al (2021) exploring such behaviour, the variants arising between males and females, and how the parental role influences such positive social approaches. Caution is advised as the study highlights concerns where “help seeking” does not always result in “help receiving” indicating systemic issues of concern. Akerman et al (2020) explored a further programme in Sweden with foster carers of young people addressing mentalisation—the ability to reflect on their own and the child’s mental states through their interactions. The programme involved intensive sessions for fosters carers, the child, and support workers. The authors highlight interesting findings in that the foster carers’ view of the young person’s mental health was that there was no change, however, the young people’s perceptions were that there had been improvement in their mental health—the authors comment that this may emanate from the young people feeling they were “held in mind”, and observing the carers trying to mentalise what they were feeling was significant enough for the young person to feel some relief in their suffering. The authors comment that this highlights the need for significant input from young people in future studies.
McKay et al. (2020) extends this territory further through domain-specific research into the way in which individuals think and feel about the past, present, and in particular the future, which presents a challenge to parents, public health, Local and National Governments, to name but a few groups. He and colleagues suggest, such messages concerning health, environment, academic and financial investment need to be argued and presented individually.
McMenemy and Nicolas (2022) provide a fascinating exploration of resilience in families where a young adolescent (11–14 years) has a diagnosis of ADHD. This Canadian study of an under-researched area, identifies interesting sub themes: social misunderstanding of ADHD; supporting family addressing challenges which are both biological and social; families’ adjustment to life with a young person with ADHD; resisting getting labelled and putting together the “puzzle of their child”. This study highlights the narrowness of some definitions of resilience, that it is much more than individual characteristics and is a complex interplay of both physical, relational and environmental resources. It draws attention to parental views for professionals to view ADHD “as a complex, pervasive disability” and linked to the social model of disability which embraces environmental, social and systemic as well as individual experiences.
A further article relevant to issues of child and family resilience is Corliss et al.’s (2021) research regarding effective prevention of children entering “care”, which explores English Local Authorities’ leaders’ views. Reflecting on significant increases in the number of children becoming “Looked after” over the last two decades, a survey was used to ask leaders to list what they considered the three most effective services/approaches. The list was extensive and the study explores what these services/approaches are, to what extent they are evaluated and to see if the implementation of approaches was effective in terms of results, thus contributing to a key issue for any social service regarding the strategic decision making required regarding the commissioning of services or the introduction of a new approach. Whole system approaches were found to dominate the surveyed managers experiences however these were not always backed up with robust evidence. Families and children’s experiences of such interventions is recommended to be at the fore of evaluations and the study highlights the need for a robust evidence base.
When focussing on resilience in children and families there can be a tendency to focus almost exclusively on the mental and the social, without always realising the unity inherent in the human person—which includes the physical. One such article by Tully, Sorensen and O’Malley (2022), describing hospital service use among children with obesity in Ireland, makes an interesting and startling observation that there is consistent evidence from high income countries demonstrating higher health care utilisation among children with obesity compared with those considered to have a “normal/” or “healthy” weight, but that from an Irish perspective there is also an evidence gap for the impact of obesity-related complications on healthcare use. They also comment that there are currently no available cost data for specialist paediatric healthcare resources in the ROI to facilitate estimation of expenditure associated with secondary or tertiary paediatric care. There is no universally available unit cost schedule for health and social care activities in the ROI and the authors recommend an integrated and joined-up care approach, which promotes efficiency, economic benefits, and improvement of child health outcomes.
A Norwegian study considers the increased vulnerability of children with disabilities to poor physical and mental health, Kalleson et al. (2021) and explores the range, consistency and coordination of services for families and young children (under 12) with cerebral palsy. This is an original and longitudinal study mapping a range of services offered but also exploring the issues of coordination of such services, their comprehensiveness and their continuity, carried out over a period of 12–43 months. The need for both comprehensiveness and continuity is not an unexpected finding however this study clearly outlines the gaps, strengths and needs of such services for families with a child with cerebral palsy, many of whom had additional and complex needs. The implications for some families are that services offered may be useful but if not coordinated then can be a cause of stress and confusion rather than support, again reiterating the need for research that informs practice to be inclusive, facilitative and responsive to the voices of those receiving services.
A complement and reality check to some of the above is provided within an article by Loots et al. (2021) examining factors associated with malnutrition among children aged six months to five years in a semi-rural area of the Western Cape. The study quotes Steenkamp and Lategan (2016), in saying that more than half of households in South Africa experience hunger on a daily basis. According to the poverty trends in South Africa, specifically between the year 2011 and 2015, the worsening financial status of households and individuals under the current situation of economic pressures, have intensified in the rise in poverty levels. Much of the advice which the study concludes with would be as relevant to European and American families as well as South African, identifying the need for a balanced diet, as well as a range of affirmative and preventative health promotion messages.
Vis and Lauritzen (2020) explore the international movement to reform assessment of children in need, focussing upon Norwegian child welfare and child protection systems, which have been criticised as not being systematic in process or in content, and is the focus of heated debate in Norway. Similar to Corliss et al. (2021), the study focussed upon managers’ views on implementing change, incorporating theories of change and their role in supporting and implementing changes in their workforce. The conclusion from the study was that managers recognised need for change and the need for standardisation through an assessment framework which might help workflow, however the study had no views of the social workers who would be completing such assessments and the ongoing debate of achieving a balance between people and paperwork (Munro 2011Footnote1) needs further exploration. The authors conclude that managers recognised that systemisation of assessment of children’s needs was necessary to ensure consistency however learning from other nation’s experiences, strengths and weaknesses, including child and family response to such assessments, seems essential in order for Norwegian child protection systems to resolve this strategic and value laden decision to gain the correct balance between consistency and autonomy of professional judgement.
Switching to a pre-school age group, a Dutch study by Doove et al. (2021) explores early life stresses and Adverse Childhood Experiences which cause toxic stress—demonstrating that the interaction between parental ill health was linked with higher levels of stress in the child and reduced 3 years old’s quality of social participation. Preventative interventions in the first 1001 days (HSC PHA 2016(NI)Footnote2) is widely recognised as essential to ensure the wellbeing of the child, and the adult they grow into, and this study adds to the body of evidence where preventative intervention is important to “ease transitions to early parenthood, supporting parental self-efficacy and helping to control toxic stress in the young child”. This study contributes further evidence of the importance of early intervention programmes to promote resilience in the developing child.
Another such study by Woods and colleagues (2021) describes some of the challenges in implementing “Aistear” (the Irish word for “Journey”) the national Early Childhood Curriculum Framework for children aged birth to six years in settings such as crèches, pre-schools, in childminders, by families in the home and in infant classes in primary schools with children across Ireland. It seeks to promotes learning through play in a child-led environment where children’s learning and development are supported and nurtured by the adult. The current study explores the implementation of Aistear in pre-schools and primary schools in the Northeast area of Ireland. Some of the perceived benefits included how children’s communication skills were enhanced, how children learned to take turns in conversation by listening to one another and how this engagement in conversation enabled children to become confident and competent learners and experiment using new vocabulary. In turn, this ensures that children’s voices are heard and that each child’s sense of identity, belonging and well-being are nurtured within the early years and the infant class environment. The only note of caution sounded in some quarters was finding the time within an already over loaded curriculum to integrate and promote such a programme effectively.
From an international perspective, a similar but more confined programme, is described within an article by Majorano et al. (2021) describing a pilot study of an intervention programme for enhancing early literacy skills in pre-school children in Italy. The study (the “Talk Programme”) combines home and school interventions to improve the early literacy skills of Italian pre-schoolers. Enhancing and supporting early language and literacy skills during preschool has an important impact on children’s learning skills at primary school, and the findings suggest that the early assessment of the children’s skills in specific language components in preschool may be an important tool for the early identification of special educational needs and prevent long-term difficulties in reading and writing. The project also aimed to involve the parents in activities to be carried out at home, the aim being to enhance communication and collaboration between the school and the children’s families as well as facilitate early identification of at-risk situations.
Another interesting international reality check related to the aim of involving parents in activities to be carried out at home is provided by Amal J Khatib (2020) in a fascinating description of the level of involvement of Jordanian parents of kindergarten children and its relationship to parents gender and educational qualification. Khatib makes the point that there is little research on parent involvement in early childhood education (ECE) in Arab countries, and that parent partnership with schools is not traditional in Arab culture. Furthermore, in the Arab culture, parents’ interference in their children’s learning at the school may be considered disrespectful. Research evidence also indicates that, in Arab countries, parent involvement in their children’s education is more often found in the form of involvement at home, as opposed to school. In recent years, Jordan has witnessed reforms in childhood education and child development and in light of these developments, this study seeks to explore the growing involvement of Jordanian parents in their children’s education.
From Jordan to Scotland and an article which describes the THRIVE programme (Trial of Healthy Relationships in the Very Early Years) which outside of the educational context, focuses on the increasing need for support for mothers, particularly those who have experienced adversity. Parenting interventions can be an extremely sensitive subject within the current concept of society and while many of the interventions were delivered in group settings, with the support provided through the group context critical to behavioural change, it allowed women to move beyond didactic learning and engage by contributing to the group, and hearing others contribute to it. Generally, the women interviewed and who appeared to have faced the most difficult situations in childhood and/or into adulthood were the ones who valued the groups the most (Robinson et al. 2018). It is plausible that the groups were providing them with the support and affirmation that they were not able to access elsewhere, for example from a supportive partner. Feeling accepted and supported could potentially lead to more positive feelings about parenting, greater confidence and fewer anxieties around motherhood—which can lead to long-term positive effects for parents and children.
So much of the discussion within child-care research at the current time is focussed on improved outcomes for children and families, particularly those who face any combination of adversity or disadvantage. Linking back to the need for inclusion of the physical within any understanding and/or realisation of resilience, an article by Green et al (2021) through a qualitative study, describes some of the barriers to physical activity for Australian young people in residential out-of-home care, which may be generalisable to the same scenario in many countries. Common health concerns experienced by young people in out-of-home care include overweight and obesity, disordered eating, lower levels of physical activity, or nutrition, sexual and/or reproductive health issues, and increased participation in adverse health behaviours such as substance use—which also resonates with some of the findings expressed in the article above by Loots et al. The authors assert that regular physical activity engagement offers an opportunity to foster an improved sense of self, to build assertiveness, increase resilience and coping skills, provide a sense of stability or consistency, and can assist in the development and maintenance of social networks.
Notes
1 Munro-Review.pdf (publishing.service.gov.uk)
2 IMH Plan April 2016_0.pdf (hscni.net)