'... we are all making very slow progress in establishing effective integrated early child and family support'
In the first two parts of this essay I have suggested a top-down approach can be ineffective, whether the impetus comes from regional or national government, from chief executives in local services or from an outside agency acting as catalyst or consultant. I have also suggested we are all making very slow progress in establishing effective integrated early child and family support.
To start with, it is worth asking who really wants effective integrated early child and family support. Of course, the people directly involved as family members or practitioners do. But does anyone else? The general public is oblivious to the plight of this very small population of children and families. These children are never mentioned in mainstream press and media ̶ unless there is a court case about taking a particular child off life support or, equally sadly, when a desperate and unsupported parent has murdered their ‘special needs’ infant. Support for these children and families is simply not part of our culture.
I mentioned in the second part of the essay that there has never been any significant interest from academics in the twenty years since the Team Around the Child (TAC) approach was first published. Nor have I seen a significant number of examples in UK colleges and universities of integration between education, health and social care departments. This academic integration would have two levels:
- Integration on shared research projects in the field of early child and family support.
- Integrated courses in which students are properly prepared for multiagency and multidisciplinary teamwork in a whole-child approach.
My own investigation into what colleges and universities are doing in the UK and Ireland has been entirely depressing and I can see that, as it stands now, it is pointless to rely on academia to help improve early child and family support in any significant way. Is it a brighter picture in your country?
Perhaps there are two mechanisms for influencing the public in any campaign. One mechanism is academic research with published papers and the other is real stories about actual people for a much wider audience. I feel sure that in the UK and other countries, for the time being, the latter is going to be the most effective in increasing public awareness about early child and family support.
In the bottom-up and top-down approach I am advocating in this essay, the power to allocate resources is held at the top of each agency’s management hierarchy while the ‘stories’ about children and families, about their strengths, about their needs, about the lives they live and about how they can best be supported, is held at the grassroots by parents and practitioners. When parents (and other family members) and their practitioners get together they can take power with each other to influence how senior people manage and resource effective integrated early child and family support in their city, region or country. A necessary offshoot of this will be grassroots stories in press and media to influence public awareness and opinion.
This approach to building effective integrated early child and family support fits well with the idea of co-production. Do you know about co-production?
‘Co-production is an approach to decision-making and service design rather than a specific method. It stems from the recognition that if organisations are to deliver successful services, they must understand the needs of their users and engage them closely in the design and delivery of those services.
‘Co-production rejects the traditional understanding of service users as dependents of public services, and instead redefines the service/ user relationship as one of co-dependency and collaboration. Just like users need the support from public services, so service providers need the insights and expertise of its users in order to make the right decisions and build effective services.
‘In practice, it means that those who are affected by a service are not only consulted, but are part of the conception, design, steering, and management of services. It is often essential to support the participants and professionals throughout the exercise to ensure that they are able to contribute on an equal footing, e.g. by providing information, training, mentoring, etc.’ This is extracted from https://www.involve.org.uk/resources/methods/co-production
There are many ways to start and develop this bottom-up and top-down approach. It could start with a few parents talking with some of their trusted practitioners about a starting a shared initiative. Where it goes from there would depend on their first discussions. The approach could start with one or two senior managers wanting to enhance local early child and family support and deciding to facilitate a grassroots parent-practitioner forum or TAC Council. An outside agency coming in to a city, region or country as consultants could design a simultaneous two-pronged approach by talking to senior people (about need, resources, etc.) at the same time as talking to people at the grassroots (about parents and practitioners getting together). As I mentioned in the second part of the essay, the grassroots effort could involve representative parents of children have grown beyond early support and might now have the energy and time to participate.
This three-part essay has been about babies and pre-school children who have conditions that can present significant obstacles to their development and learning – and about their families. I have defined an effective service as coming when needed, addressing issues that are relevant to the child and family and leaving the family feeling they have received the support they needed and asked for. I have argued that a valid system of early child and family support must reach the vast majority of children in all parts of each city, region or country ̶ otherwise it is yet another pilot project for a select group.
In my view progress towards achieving this is extremely slow in all countries whether they have high, medium or low economies. A great sense of urgency comes when we realise that babies born as I write will have passed through their early years by 2026/7 – only a few short years away.
It is my hope the essay will contribute to discussions about how more can be achieved. I will be happy to disseminate responses to it. It would be good to hear of projects in any part of the world that are progressing well towards a valid integrated early child and family support system.
See sections ‘Partnership with service users’ and ‘Academic responsibilities in integration’ in Integration made possible: A practical manual for joint working by Peter Limbrick (2020).