Social and emotional wellbeing for children and young people

Short Text

Supporting children and young people's social and emotional wellbeing through home visiting and childcare, and while they are in primary and secondary education.

Introduction

This pathway covers recommendations to improve or ensure the social and emotional wellbeing of children and young people. They are for:
Social and emotional wellbeing is important in its own right, but also because it affects physical health and can determine how well children and young people do in their early years and at school.
Good social, emotional and psychological health helps protect against emotional and behavioural problems, violence and crime, teenage pregnancy and the misuse of drugs and alcoholAdi et al. (2007) Systematic review of the effectiveness of interventions to promote mental wellbeing in children in primary education. London: NICE; Colman et al. (2009) Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort. BMJ 338: a2981; Graham and Power (2003) Childhood disadvantage and adult health: a lifecourse framework. London: Health Development Agency. .
Social and emotional wellbeing is influenced by a range of factors, from individual make-up and family background to the community within which people live and society at large.

Vulnerable children aged under 5 years

Knowledge of the complex range of factors that impact on social and emotional development may help encourage investment at a population level in early interventions. This would ensure children (and families) who are most likely to experience the poorest outcomes get the help they need early on in their lives.
Knowledge of these factors, aside, practitioners' experience and expertise will be paramount in assessing the needs and risks of individual children and their families.
The recommendations for vulnerable under-5s and their parents are aimed at all those responsible for ensuring the social and emotional wellbeing of these children. This includes those planning and commissioning children's services in local authorities (including education), the NHS, and the community, voluntary and private sectors.

Children and young people in primary and secondary education

Activities in primary and secondary education can only form one element of a broader, multi-agency strategy to promote and support social and emotional wellbeing.
These recommendations put the emphasis on ensuring children and young people can participate fully in the development of relevant programmes. They are aimed at everyone with public health as part of their remit working in education, local authorities, the NHS and the wider public, independent, voluntary and community sectors.

Source guidance

The NICE guidance that was used to create the pathway.
Social and emotional wellbeing: early years. NICE public health guidance 40 (2012)
Social and emotional wellbeing in secondary education. NICE public health guidance 20 (2008)
Social and emotional wellbeing in primary education. NICE public health guidance 12 (2008)

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details

Implementation

Costing support

Costing support includes national cost impact reports that summarise the national costs and savings and discuss the assumptions used; costing templates to assess the impact on local budgets; and costing statements when the impact is not significant or impossible to quantify at a national level.

Information resources and templates

These include key points for scrutiny or compliance assessment, signposting to resources, checklists and case studies. They are designed to offer practical help in putting NICE guidance into practice and the format depends on the specific topic.

Slide sets

Slide sets provide a framework for discussion and assist in local dissemination of the guidance. The slides contain the key messages from NICE guidance and can be tailored for local presentations.

Pathway information

National initiatives

The recommendations complement existing national initiatives to promote social and emotional wellbeing within: Healthy lives, healthy people: our strategy for public health in England; No health without mental health; and the schools white paper.
The recommendations for secondary education establishments also help them to meet their statutory responsibilities to promote social and emotional wellbeing and to provide personal, social, health and economic (PSHE) education.

Home visiting, early education and childcare

The recommendations on home visiting, early education and childcare for vulnerable children:
  • Adopt a 'life course perspective', recognising that disadvantage before birth and in a child's early years can have life-long, negative effects on their health and wellbeing.
  • Focus on the social and emotional wellbeing of vulnerable children as the foundation for their healthy development and to offset the risks relating to disadvantage. This is in line with the overarching goal of children's services, that is, to ensure all children have the best start in life.
  • Aim to ensure universal services, as well as more targeted services, provide the additional support all vulnerable children need to ensure their mental and physical health and wellbeing. (Key services include maternity, child health, social care, early education and family welfare.)
  • Should be used in conjunction with local child safeguarding policies.
The term 'vulnerable' is used to describe children who are at risk of, or who are already experiencing, social and emotional problems and who need additional support.

Vulnerable children under 5

A number of factors may contribute, to varying degrees, to making a child vulnerable to poor social and emotional wellbeing. In addition, a child's circumstances may vary with time. However, in this pathway vulnerable children include those who are exposed to:
  • parental drug and alcohol problems
  • parental mental health problems
  • family relationship problems, including domestic violence
  • criminality.
They may also include those who:
  • are in a single parent family
  • were born to parents aged under 18 years
  • were born to parents who have a low educational attainment
  • were born to parents who are (or were as children) looked after (that is, they have been in the care system)
  • have physical disabilities
  • have speech, language and communication difficulties.
These indicators can be used to identify groups of children under 5 who are likely to be vulnerable. However, not all of these children will in fact be vulnerable – and others, who do not fall within these groups, could have social and emotional problems.

Supporting information

A definition of social and emotional wellbeing

Social and emotional wellbeing provides the building block for healthy behaviours and educational attainment. It also helps prevent behavioural problems (including substance misuse) and mental illness. For the purposes of this pathway, the following definitions are used:
  • emotional wellbeing – this includes being happy and confident and not anxious or depressed
  • psychological wellbeing – this includes the ability to be autonomous, problem-solve, manage emotions, experience empathy, be resilient and attentive
  • social wellbeing – has good relationships with others and does not have behavioural problems, that is, they are not disruptive, violent or a bully.

Glossary

Children who are exposed to difficult situations such as bullying or racism, or who are coping with socially disadvantaged circumstances, are at higher risk of anxiety, emotional distress and behavioural problems. They may include: looked-after children (including those who have subsequently been adopted), those living in families where there is conflict or instability, those who persistently refuse to go to school, those who have experienced adverse life events (such as bereavement or parental separation), and those who have been exposed to abuse or violence.
Baby massage techniques are interventions to promote infant massage. Benefits are reported to include improvements in parent and/or child sleep patterns, their interaction and relationship.
Safeguarding policies and activities aim to ensure children receive safe and effective care, are protected from maltreatment and have their health and development needs met. Legislation and related policies describe how individuals and agencies should work together to safeguard children.
The Family Nurse Partnership (FNP) is the UK name for the US-developed Nurse-Family Partnership (NFP). The partnership provides an intensive, structured home-visiting programme for young, first-time mothers from a disadvantaged background and their partners. The emphasis is on building a strong relationship between a specially trained (family) nurse and the parents. Support is available from early pregnancy until the child is aged 2 years. The aim is to improve pregnancy outcomes, the child's health and development and the parents' economic self-sufficiency.
A joint strategic needs assessment (JSNA) provides a profile of the health and social care needs of a local population. JSNAs are used as the basis for developing joint health and wellbeing strategies.
Organisation-wide approaches in secondary education help all young people to develop social and emotional skills, as well as providing specific help for those most at risk (or already showing signs) of problems.
For the purposes of this pathway, social and emotional wellbeing encompasses:
  • happiness, confidence and not feeling depressed (emotional wellbeing)
  • a feeling of autonomy and control over one's life, problem-solving skills, resilience, attentiveness and a sense of involvement with others (psychological wellbeing)
  • the ability to have good relationships with others and to avoid disruptive behaviour, delinquency, violence or bullying (social wellbeing).
Organisation-wide approaches in secondary education help all young people to develop social and emotional skills, as well as providing specific help for those most at risk (or already showing signs) of problems.
For the purposes of this pathway, social and emotional wellbeing encompasses:
  • happiness, confidence and not feeling depressed (emotional wellbeing)
  • a feeling of autonomy and control over one's life, problem-solving skills, resilience, attentiveness and a sense of involvement with others (psychological wellbeing)
  • the ability to have good relationships with others and to avoid disruptive behaviour, delinquency, violence or bullying (social wellbeing).
In the context of this guidance, 'readiness for school' refers to a child's cognitive, social and emotional development. Development during the child's early years may be achieved through interaction with their parents or through the processes of play and learning.
Secondary education refers to all education establishments for young people aged 11–19 years including further education colleges, technology colleges, academies and private sector establishments.
Social and emotional wellbeing provides the building block for healthy behaviours and educational attainment. It also helps prevent behavioural problems (including substance misuse) and mental illness. For the purposes of this pathway, the following definitions are used:
  • emotional wellbeing – this includes being happy and confident and not anxious or depressed
  • psychological wellbeing – this includes the ability to be autonomous, problem-solve, manage emotions, experience empathy, be resilient and attentive
  • social wellbeing – has good relationships with others and does not have behavioural problems, that is, they are not disruptive, violent or a bully.
A targeted service may be distinct from, or an adaptation of, a universal service. For example, a tailored home visiting programme by a nurse, midwife or health visitor may be provided for young parents from a disadvantaged background. This would be separate from the universal home visiting service provided for all new families and might, for example, include longer sessions, goal setting and a range of specific interventions.
Primary care services including those offered by GPs, paediatricians, health visitors, school nurses, social workers, teachers, juvenile justice workers, voluntary agencies and social services.
Child and adolescent mental health services relating to workers in primary care. It includes: clinical child psychologists, paediatricians with specialist training in mental health, educational psychologists, child and adolescent psychiatrists, child and adolescent psychotherapists, counsellors, community nurses/nurse specialists and family therapists.
Universal approaches are curriculum-based programmes and other activities aimed at developing the social and emotional competence of all students.
Universal interventions are curriculum-based programmes and other activities aimed at developing the social and emotional competence of all students.
Universal services, such as general education and healthcare services, are available to everyone. For all children aged up to 5 years, universal provision includes: maternal healthcare, midwife home visits soon after birth and routine health visitor checks..
Interactions between a parent or carer and a child are recorded using audio visual equipment. This is later viewed and discussed, typically with a health or social care professional. Parents and carers are given a chance to reflect on their behaviour, with the focus on elements that are successful. The aim is to improve their communications and relationship with their child.
A number of factors may contribute, to varying degrees, to making a child aged under 5 vulnerable to poor social and emotional wellbeing. In addition, a child's circumstances may vary with time. However, in this pathway vulnerable children include those who are exposed to:
  • parental drug and alcohol problems
  • parental mental health problems
  • family relationship problems, including domestic violence
  • criminality.
They may also include those who:
  • are in a single parent family
  • were born to parents aged under 18 years
  • were born to parents who have a low educational attainment
  • were born to parents who are (or were as children) looked after (that is, they have been in the care system)
  • have physical disabilities
  • have speech, language and communication difficulties.
These indicators can be used to identify groups of children under 5 who are likely to be vulnerable. However, not all of these children will in fact be vulnerable – and others, who do not fall within these groups, could have social and emotional problems.
The term whole-school is commonly used to refer to organisation-wide approaches in schools.

Recommendations on social and emotional wellbeing for those involved with home visiting, early education and childcare for under-5s

Recommendations on social and emotional wellbeing for those involved with home visiting, early education and childcare for under-5s

A definition of social and emotional wellbeing

Social and emotional wellbeing provides the building block for healthy behaviours and educational attainment. It also helps prevent behavioural problems (including substance misuse) and mental illness. For the purposes of this pathway, the following definitions are used:
  • emotional wellbeing – this includes being happy and confident and not anxious or depressed
  • psychological wellbeing – this includes the ability to be autonomous, problem-solve, manage emotions, experience empathy, be resilient and attentive
  • social wellbeing – has good relationships with others and does not have behavioural problems, that is, they are not disruptive, violent or a bully.

Source guidance

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Identifying vulnerable children and assessing their needs

Identifying vulnerable children and assessing their needs

Identifying vulnerable children and assessing their needs

Who should take action?

Early years settings (including children's centres and nurseries).
Primary schools (independent, maintained, private and voluntary) and school nursing services.
The NHS: general practice, health visiting services, maternity services, mental health services (perinatal, child and adolescent and adult) and paediatrics.
Voluntary and community sector organisations.
Police.
Local authority housing departments.

Implementation tools

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Source guidance

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Developing a trusting relationship with vulnerable children and their families

Developing a trusting relationship with vulnerable children and their families

Developing a trusting relationship with vulnerable children and their families

All health and early years professionals should develop trusting relationships with vulnerable families and adopt a non-judgmental approach, while focusing on the child's needs. They should do this by:
  • identifying the strengths and capabilities of the family, as well as factors that pose a risk to the child's (or children's) social and emotional wellbeing
  • talking about the aspirations and expectations for the child
  • seeking to understand and respond to perceived needs and concerns
  • discussing any risk factors in a sensitive manner to ensure families do not feel criticised, judged or stigmatised (see vulnerable children for factors that may affect a child's social and emotional wellbeing).

Source guidance

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Identifying risk factors

Identifying risk factors

Identifying risk factors

Health professionals in antenatal and postnatal services should identify factors that may pose a risk to a child's social and emotional wellbeing. This includes factors that could affect the parents' capacity to provide a loving and nurturing environment. For example, they should discuss with the parents any problems they may have in relation to the father or mother's mental health, substance or alcohol misuse, family relationships or circumstances and networks of support.
Health visitors, school nurses and early years practitioners should identify factors that may pose a risk to a child's social and emotional wellbeing, as part of an ongoing assessment of their development. They should use the 'Early years foundation stage' assessment process to help identify and share any needs and concerns. Specifically, they should look for risk factors that were not evident at an earlier stage. For an infant or child, this could include:
  • being withdrawn
  • being unresponsive
  • showing signs of behavioural problems
  • delayed speech
  • poor language and communication skills.
For parents, this could include indifference to the child or insensitive or harsh behaviour towards them.
Family welfare, housing, voluntary services, the police and others who are in contact with a vulnerable child and their family should be aware of factors that pose a risk to the child's social and emotional wellbeing. They should raise any concerns with the family GP or health visitor (working in the context of local child safeguarding policies).
See also NICE's when to suspect child maltreatment pathway for further information.

Source guidance

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Developing procedures to support identification and assessment of need

Developing procedures to support identification and assessment of need

Developing procedures to support identification and assessment of need

Health and early years professionals should ensure procedures are in place:
  • to make referrals to specialist services, based on an assessment of need
  • to collect, consistently record and share information as part of the common assessment framework (relevant child and adult datasets should be linked)
  • for integrated team working
  • for continuity of care
  • to avoid multiple assessments.

Source guidance

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Antenatal and postnatal home visiting for vulnerable children and their families

Antenatal and postnatal home visiting for vulnerable children and their families

Antenatal and postnatal home visiting for vulnerable children and their families

Who should take action?

Maternity services.
Health visiting services.
Early years services.

Implementation tools

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Source guidance

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General principles

General principles

General principles

Health visitors or midwives should:
  • Explain to parents that home visits aim to ensure the healthy development of the child (see developing a trusting relationship with vulnerable children and their families in this pathway).
  • Take into account the parents' first language and make provision for those who do not speak English.
  • Be sensitive to a wide range of attitudes, expectations and approaches in relation to parenting.
  • Try to ensure both parents can fully participate in home visits, by taking into account their domestic and working priorities and commitments.
  • Try to involve other family members, if appropriate and acceptable to the parents.
Health visitors and midwives should:
  • Encourage parents to participate in other services delivered by children's centres and as part of the Healthy Child Programme.
  • Work in partnership with other early years practitioners to ensure families receive coordinated support. This includes psychologists, therapists, family support workers and other professionals who deliver services provided by children's centres and as part of the Healthy Child Programme.

Source guidance

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Specific programmes

Specific programmes

Specific programmes

Health visitors or midwives should offer a series of intensive home visits by an appropriately trained nurse to parents assessed to be in need of additional support (see identifying risk factors in this pathway).
The trained nurse should visit families in need of additional support a set number of times over a sustained period of time (sufficient to establish trust and help make positive changes)It is not clear from current evidence how many home visits are needed. The Family Nurse Partnership, an evidence-based, intensive home visiting programme, provides weekly or fortnightly home visits for 60-90 minutes throughout most stages of the programme (with more in the early stages and less later).. Activities during each visit should be based on a set curriculum which aims to achieve specified goals in relation to:
  • maternal sensitivity (how sensitive the mother is to her child's needs)
  • the mother-child relationship
  • home learning (including speech, language and communication skills)
  • parenting skills and practice.
The nurse should, where possible, focus on developing the father-child relationship as part of an approach that involves the whole family. This includes getting the father involved in any curriculum activities.
Health visitors or midwives should regularly check the parents' level of involvement in the intensive home visiting programme. If necessary, they should offer them a break, to reduce the risk that they will stop participating. If the parents do decide to have a break, the nurse should continue to communicate with them on a regular basis.
Managers of intensive home-visiting programmes should conduct regular audits to ensure consistency and quality of delivery.
Health visitors and midwives should consider evidence-based interventions, such as baby massage and video interaction guidance, to improve maternal sensitivity and mother-infant attachment. For example, this approach might be effective when the mother has depression or the infant shows signs of behaviourial difficulties.

Source guidance

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Early education and childcare

Early education and childcare

Early education and childcare

Who should take action?

All those involved in providing early education and childcare services. This includes childminders and those working in children's centres, nurseries and primary schools (maintained, private, independent and voluntary).
Health visiting services.
Local authority children's services.
School nursing services.

Source guidance

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Local authority children's services

Local authority children's services

Local authority children's services

Ensure all vulnerable children can benefit from high quality childcare outside the home on a part- or full-time basis and can take up their entitlement to early childhood education, where appropriate. The aim is to give them the support they need to fulfill their potential. Childcare and education services should:
  • offer flexible attendance times, so that parents or carers can take up education, training or employment opportunities
  • address any barriers that may hinder participation by vulnerable children such as geographical access, the cost of transport or a sense of discrimination and stigma
  • be run by well-trained qualified staff, including graduates and qualified teachers
  • be based on an ethos of openness and inclusion.

Source guidance

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Managers and providers of early education and childcare services

Managers and providers of early education and childcare services

Managers and providers of early education and childcare services

Ensure all vulnerable children can benefit from high quality services which aim to enhance their social and emotional wellbeing and build their capacity to learn. Services should:
  • promote the development of positive, interactive relationships between staff and children
  • ensure individual staff get to know, and develop an understanding of, particular children's needs (continuity of care is particularly important for younger children)
  • focus on social and emotional, as well as educational, development.
In line with the statutory framework for the early years foundation stage, managers and providers of early education and childcare services should:
  • provide a structured, daily schedule comprising a balance of adult-led and child-initiated activities
  • ensure parents and other family members are fully involved (for example, by contributing to decisions about service provision, or by participating in learning or other activities, as appropriate)
  • ensure the indoor and outdoor environment is spacious, well maintained and pleasant.

Source guidance

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Delivering services

Delivering services

Delivering services

Who should take action?

Early years settings (including children's centres and nurseries).
Primary schools (independent, maintained, private and voluntary) and school nursing services.
The NHS: general practice, health visiting services, maternity services, mental health services (perinatal, child and adolescent and adult) and paediatrics.
Voluntary and community sector organisations.

Source guidance

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Health and early years providers

Health and early years providers

Health and early years providers

Put systems in place to deliver integrated universal services and targeted services that support vulnerable children's social and emotional wellbeing. This should include systems for sharing information and for multidisciplinary training and development.
Ensure a process is in place to systematically involve parents and families in reviewing services and suggesting how they can be improved. As part of this process, vulnerable parents and families should be asked about their needs and concerns – and their experiences of the services on offer.

Source guidance

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Health and early years practitioners

Health and early years practitioners

Health and early years practitioners

Be clear about your responsibility for improving the social and emotional wellbeing of vulnerable children and their families. This involves developing and agreeing pathways and referral routes that define how practitioners will work together, as a multidisciplinary team, across different services within a given locality.
Be systematic and persistent in your efforts to encourage vulnerable parents to use early years services. (This includes parents who do not use universal services such as primary care.) Activities should include:
  • targeted publicity campaigns
  • making contact by using key workers and referral partners
  • encouraging other parents to help get them involved
  • sending out repeat invitations
  • using local community venues, such as places of worship and play centres to encourage them to participate and to address any concerns about discrimination and stigma
  • home visits by family support workers.
Use outreach methods to maintain or improve the participation of vulnerable parents and children in programmes and activities. Parents who may lack confidence or are isolated will require particular encouragement. (This includes those with drug or alcohol problems and those who are experiencing domestic violence.)
Work with community and voluntary organisations to help vulnerable parents who may find it difficult to use health and early years services. The difficulties may be due to their social circumstances, language, culture or lifestyle.

Implementation tools

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Source guidance

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Paths in this pathway

Pathway created: December 2011 Last updated: October 2012

Copyright © 2013 National Institute for Health and Care Excellence. All Rights Reserved.



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