Memorandum by Child Health Advocacy Network
(CHANT) (WP 16)
CHANT is a network of leading professional and
non-governmental organisations who work to improve children's
health. CHANT works collaboratively to promote the mental, emotional
and physical health of all children, particularly those living
in poverty and vulnerable circumstances.
CHANT welcomes the recognition implicit in this
White Paper that child health underpins adult health. It also
welcomes the recognition that children's emotional and social
development is not only an important aspect of their well-being
during childhood, but also a key determinant of their future health
and well-being, and plays a part in determining inequalities in
health. Members are, however, concerned that the potential for
supporting children's emotional and social development through
cost-effective interventions is not fully realised in the text
of the White Paper and more particularly in the Summary of Intelligence
papers which accompanied the White Paper.
The key determinant of children's emotional
and social development and of future mental heath and emotional
well-being is the quality of the relationship between them and
their parents. Relationships with others—for example early
years workers, teachers, social workers and relatives and friends—are
also important, but it is the parental relationship, particularly
in infancy and the early years, which is critical and which in
turn is a key influence on the nature and quality of the other
relationships which children will form in their future lives.
The White Paper proposes to provide additional information and
support for parents. However, it is far from clear what this information
and support will entail. In particular, it is not clear that it
will offer parents the evidence-based programmes which are known
to improve the quality of the parent-child relationship.
Will the proposals enable government to achieve
its public health goals?
In the absence of support for parenting of the
sort that improves relationships, it is unlikely that the Government's
mental health, health related lifestyles or social inequalities
targets will be achieved. The Summary of Intelligence on Mental
Health paper, produced to support the White Paper, makes no mention
of any intention to provide the kind of programmes which would
improve parent-child relationships. It does propose a programme
to support the relationships which early years workers make with
children, and a programme to support parents' involvement in learning.
We acknowledge that both of these are important, but neither will
have more than a peripheral effect on parent-child relationships.
Are the proposals appropriate, will they be effective
and do they represent value for money?
The content of the information and support the
Government proposes to offer to parents is not clearly defined.
Information is critical for public health improvement, but it
is not in itself a sufficient basis for behaviour change or improvements
in relationship quality. Research on parental support shows this
to be widely appreciated by parents, but, on its own, it cannot
be relied on to change these two aspects of parenting.
Structured programmes, provided in acceptable
and accessible settings, which challenge parents in a supportive,
non-judgemental atmosphere, are necessary to enable parents to
change the way they relate to their children. Voluntary sector
experience suggests that providing such programmes as part of
a variety of family support activities, such as cooking skills
and benefits advice, can increase the likelihood of parental engagement.
The provision of a good cre"che facility can also make an
important difference to whether parents commit themselves to attending
a programme.
Although more research in a UK context is needed,
a wide range of systematic reviews now attest to the fact that
it is possible, with relatively low-cost interventions, to improve
the quality of the parent-child relationship. The sort of programmes
which can be effective in this respect are those quoted in the
Case Study on page 47. They are also well described in core standard
2 of the National Service Framework for Children, Young People
and Maternity Services.
Do the necessary public health infrastructure
and mechanisms exist to ensure that the proposals will be implemented
and goals achieved?
The types of parenting programme which would
increase the chances of the White Paper achieving its goals can
be delivered by a range of different practitioners. Many sound
programmes are offered by the voluntary sector. It is essential
that those running programmes are equipped with the necessary
knowledge, skills and support to do so; some of this could be
achieved through continuing professional development. The new
children's centres provide an ideal geographical location for
such programmes, though there is a strong possibility that they
will not reach all the parents who would benefit from such programmes.
January 2005
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