Number 6: Reinforce universal services to support our most vulnerable parents, writes Christine Puckering
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Infant mental health is a term that still arouses incomprehension and scepticism. Of course, it is not about infants having psychological disorders but giving them the best start in physical and mental health. The pattern of our early relationships persists in our capacity to maintain relationships with family, friends and workmates and eventually, our children. There is strong evidence that a parent’s history of secure or insecure relationships in their childhood predicts the security of the relationship they can make with their own children. What is happening in those months about which we remember nothing consciously? A baby is born with almost all its brain cells but connections between them are built by the baby’s experiences. If a baby’s needs, not just for physical care but sensitive responsiveness, are met, the baby learns to trust that other people understand and will respond. Learning about his or her own emotions also provides the window into empathy.
Conversely, a baby whose needs are not met regularly, or is subjected to harsh and frightening care, will be flooded with stress hormones and on “red alert” at all times. Even in the womb, mothers’ hormones cross the placenta and the baby enters the world primed for stress. This flexibility is both a strength, in that it prepares the baby for meeting the world, but also a weakness as the baby will adapt to environments which are suboptimal. The child on red alert enters school unprepared to sit still, listen and respond and is likely to lack of self-regulation of mood and temper.
The transmission of disadvantage is not just about poverty, though being financially stressed may be the last straw. The Sure Start initiative failed to identify the real proximal cause of children’s failure. Even in the poorest homes, if the parents invested in the children, listening and talking with them, reading books to them from an early age and giving them opportunities to learn, the children did well. Good early years education was valuable but did not outweigh this effect. Children in the least fortunate families continued to drift further in attainment and wellbeing indicators. Offering child care to enable parents to go to work while their children are very young, does not enhance the pivotal parent-child relationship.
The first thing we can do for Scotland’s children is to reinforce the value of universal services like midwifery, health visiting and GPs enabling them to recognise parents who are struggling. They need easy access to effective interventions. Unfortunately, some of the programmes which have received investment, such as the Family Nurse Partnership and Parent-Infant Psychotherapy, have not been shown to help in the UK context. Others which might help, like video Interaction guidance and Mellow Parenting, are not available in every area.
Video interactive guidance helps parents to identify successful communications between themselves and their baby, using brief video clips of the parent and child together with the aim of increasing their frequency. Mellow Parenting is a group intervention which supports very vulnerable families, who are perhaps wary of professional services. It works to support parents with their own issues such a depression, low self esteem or domestic violence and simultaneously build up positive interactions between them and their baby again using video feedback of themselves and their own baby.
Starting to address attainment gaps at school misses the most cost-effective time to intervene, according to James Heckman, Nobel Laureate in economics.
The second thing we can do is to enhance access to good quality child care and education. Our childcare staff are poorly trained and poorly paid. The temptation to find a better paid job stacking shelves in a supermarket means that staff turnover is high, undermining the very stability of care that most benefits young children. Child care costs are a major drain on household resources, even with the free nursery hours. Better training and pay would value workers. If the pay and qualifications were better, more men might even enter the field, offering more diverse experience, especially to children who may not have a resident father.
Christine Puckering is a clinical psychologist and programme director of Mellow Parenting, a charity which develops programmes to support good parent-child relationships from pregnancy to pre-school.