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Social and emotional wellbeing for children and young people

About

What is covered

This NICE Pathway covers the social and emotional wellbeing of children and young people, including:
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 under 5

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.

Updates

Updates to this NICE Pathway

10 August 2016 Early years: promoting health and wellbeing in under 5s (NICE quality standard 128) added.
24 October 2012 Social and emotional wellbeing: early years (NICE guideline PH40) added.

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.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on supporting the social and emotional wellbeing of children and young people in an interactive flowchart

What is covered

This NICE Pathway covers the social and emotional wellbeing of children and young people, including:
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 under 5

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.

Updates

Updates to this NICE Pathway

10 August 2016 Early years: promoting health and wellbeing in under 5s (NICE quality standard 128) added.
24 October 2012 Social and emotional wellbeing: early years (NICE guideline PH40) added.

Sources

NICE guidance and other sources used to create this interactive flowchart.

Quality standards

Early years: promoting health and wellbeing in under 5s

These quality statements are taken from the early years: promoting health and wellbeing in under 5s quality standard. The quality standard defines clinical best practice in promoting health and wellbeing in under 5s and should be read in full.

Quality statements

Identifying risk

This quality statement is taken from the early years: promoting health and wellbeing in under 5s quality standard. The quality standard defines clinical best practice in promoting health and wellbeing in under 5s and should be read in full.

Quality statement

Parents and carers of children under 5 have a discussion during each of the 5 key contacts about factors that may pose a risk to their child’s social and emotional wellbeing.

Rationale

If factors that may pose a risk to a child’s social and emotional wellbeing are identified during these key face-to-face contacts, early action can be taken to prevent or reduce the potential impact on the child. Factors that may pose a risk can be identified by using a validated tool.
Poor social and emotional wellbeing in young children can lead to behaviour and developmental problems and, later in childhood, severe depression, anxiety, self-harm and other poor mental health outcomes.

Quality measures

Structure
Evidence of local arrangements to ensure that parents of children under 5 have a discussion during each of the 5 key contacts about factors that may pose a risk to their child’s social and emotional wellbeing.
Data source: Local data collection. This can include the NHS England Health visitors service delivery metrics.
Process
a) Proportion of parents and carers who have a discussion at the antenatal health visitor appointment about factors that may pose a risk to their child’s social and emotional wellbeing.
Numerator – The number in the denominator who have a discussion about factors that may pose a risk to their child’s social and emotional wellbeing.
Denominator – The number of parents and carers who are eligible to attend the antenatal health visitor appointment.
Data source: Local data collection and the NHS England Health visitors service delivery metrics.
b) Proportion of parents and carers who have a discussion at the new baby health visitor appointment about factors that may pose a risk to their child’s social and emotional wellbeing.
Numerator – The number in the denominator who have a discussion about factors that may pose a risk to their child’s social and emotional wellbeing.
Denominator – The number of parents and carers who are eligible to attend the new baby health visitor appointment.
Data source: Local data collection and the NHS England Health visitors service delivery metrics.
c) Proportion of parents and carers who have a discussion at the 6–8 week health visitor appointment about factors that may pose a risk to their child’s social and emotional wellbeing.
Numerator – The number in the denominator who have a discussion about factors that may pose a risk to their child’s social and emotional wellbeing.
Denominator – The number of parents and carers who are eligible to attend the 6–8 week health visitor appointment.
Data source: Local data collection.
d) Proportion of parents and carers who have a discussion at the 9–12 month developmental review about factors that may pose a risk to their child’s social and emotional wellbeing.
Numerator – The number in the denominator who have a discussion about factors that may pose a risk to their child’s social and emotional wellbeing.
Denominator – The number of parents and carers who are eligible to attend the 9–12 month developmental review.
Data source: Local data collection and the NHS England Health visitors service delivery metrics.
e) Proportion of parents and carers who have a discussion at the 2–2½ year integrated review about factors that may pose a risk to their child’s social and emotional wellbeing.
Numerator – The number in the denominator who have a discussion about factors that may pose a risk to their child’s social and emotional wellbeing.
Denominator – The number of parents and carers who are eligible to attend the 2–2½ year integrated review.
Data source: Local data collection and the NHS England Health visitors service delivery metrics.
Outcome
a) Behaviour and developmental difficulties.
Data source: Local data collection.
b) Depression, anxiety, self-harm and other poor mental health outcomes later in childhood.
Data source: Local data collection.

What the quality statement means for service providers, health, public health and social care practitioners, and commissioners

Service providers (such as health visiting services, early years providers and other services involved in providing the 5 key contacts) ensure that local protocols are in place for parents and carers to discuss the factors that pose a risk to their child’s social and emotional wellbeing. This offer is made during each of the 5 key contacts.
Health and social care practitioners (such as health visitors, early years practitioners and other practitioners involved in providing the 5 key contacts) ensure that during each of the 5 key contacts they discuss the factors that pose a risk to a child’s social and emotional wellbeing with parents and carers.
Commissioners (such as NHS England, clinical commissioning groups and local authorities) ensure that they commission services with local protocols to discuss the factors that pose a risk to a child’s social and emotional wellbeing with parents and carers. This offer is made during each of the 5 key contacts.

What the quality statement means for patients, service users and carers

Parents and carers of children aged under 5 can discuss any difficulties they have that could affect their child’s development. They have at least 5 appointments with their child’s health visiting team when they can talk about this. (In some cases the early years service will be involved in the fifth appointment.) At these appointments the child is also assessed to check their progress.

Source guidance

Definitions of terms used in this quality statement

Discussing factors that may pose a risk
The discussion should be carried out in accordance with local protocols. Use a validated tool, for example, Early Help Assessment or Outcome Star, to identify what help a child and family may need. It could include an interagency assessment to determine if a child has needs that are not being met by universal services, and, if so, deciding how those needs should be met. The discussion should cover the whole family, not just the child, to reduce the need for multiple assessments. Practitioners should work together to assess, plan and support families to prevent problems escalating to the point where statutory intervention becomes necessary.
[Expert opinion.]
5 key contacts
These face-to-face contacts are part of the 0–5 Healthy Child Programme. They are carried out by health visitors, but other practitioners may be involved if necessary. Sometimes the last key contact also involves early years practitioners. The contacts are at the following stages:
  • antenatal (around 28 weeks into pregnancy)
  • new baby (10–14 days after the baby’s birth)
  • 6–8 weeks
  • 9–12 months developmental review
  • 2–2½ year integrated review.
[Adapted from The universal health reviews – 5 key visits NHS England and expert opinion.]
Risks to a child’s social and emotional wellbeing
This includes factors that could affect the carers’ capacity to provide a loving and nurturing environment. For example, problems with mental health, drug or alcohol misuse and family relationships, or lack of support networks. Signs of problems could include the parent or carer being indifferent, insensitive or harsh towards the child. The child could be withdrawn or unresponsive, showing signs of behavioural problems, delayed speech or poor language and communication skills.
[Adapted from Social and emotional wellbeing: early years (2012) NICE guideline PH40, recommendation 2.]
Social wellbeing
A child has good relationships with others and does not have behavioural problems that is, they are not disruptive, violent or a bully.
[Social and emotional wellbeing: early years (2012) NICE guideline PH40, glossary.]
Emotional wellbeing
This includes the child being happy and confident, not anxious or depressed and ready for, and able to function well at, school.
[Social and emotional wellbeing: early years (2012) NICE guideline PH40, glossary and expert opinion.]

Equality and diversity considerations

There is a risk of stigmatisation when identifying vulnerable children. It is important that practitioners take a non-judgemental approach when discussing with parents and carers any factors that may pose a risk to their child’s social and emotional wellbeing.
Practitioners and local services should ensure that groups who are underserved by, or not in regular contact with, services are contacted and encouraged to attend these 5 key contacts meetings. This could include arranging appointments at children’s centres or at home if they feel uncomfortable about, or have difficulty attending clinics.
Practitioners should take into account cultural factors, educational attainment levels and whether English is the child or family’s first language when discussing risks with the child’s parents and carers, to ensure they understand.

Speech and language

This quality statement is taken from the early years: promoting health and wellbeing in under 5s quality standard. The quality standard defines clinical best practice in promoting health and wellbeing in under 5s and should be read in full.

Quality statement

Children have their speech and language skills assessed at their 2–2½ year integrated review.

Rationale

Children and young people with communication difficulties are at increased risk of social, emotional and behavioural difficulties and mental health problems. So identifying their speech and language needs early is crucial for their health and wellbeing. Many young children whose needs are identified early do catch up with their peers.
The 2–2½ year integrated review is a good time to assess speech and language skills because there is time to offer support before they start school.

Quality measures

Structure
Evidence of local arrangements to ensure that children’s speech and language skills are assessed at their 2–2½ year integrated review.
Data source: Local data collection and the Health and Social Care Information Centre Children and young people’s health services data set.
Process
a) Proportion of children who have the 2–2½ year integrated review.
Numerator – The number in the denominator who have the 2–2½ year integrated review.
Denominator – The number of children aged 2–2½.
b) Proportion of children having the 2–2 ½ year integrated review who have their speech and language skills assessed.
Numerator – The number in the denominator who have their speech and language skills assessed.
Denominator – The number of children who have the 2–2 ½ year integrated review.
Data source: Local data collection and the Health and Social Care Information Centre Children and young people’s health services data set.
Outcome
a) Speech and language skills in children under 5.
Data source: Local data collection and the Health and Social Care Information Centre Children and young people’s health services data set.
b) School readiness of children under 5.
Data source: Local data collection.
c) Social, emotional and behavioural difficulties.
Data source: Local data collection.
d) Mental health difficulties.
Data source: Local data collection.

What the quality statement means for service providers, health, public health and social care practitioners, and commissioners

Service providers (such as health visiting services and early years providers) ensure that they put systems in place to assess speech and language skills at the 2–2½ year integrated review. Locally defined pathways and referral routes ensure that the appropriate services care for children who need support.
Health, social care and early years education practitioners (such as health visitors and pre-school education staff) ensure that they assess the speech and language skills of children at the 2–2½ year integrated review. Locally defined pathways ensure that the appropriate services care for children who need support.
Commissioners (such as clinical commissioning groups and local authorities) ensure that they commission services that assess speech and language skills at the 2–2½ year integrated review. Services have locally defined pathways so that the appropriate services care for children who need support.

What the quality statement means for patients, service users and carers

Parents and carers are offered a review of their child’s health and wellbeing when their child is aged 2–2½. During this review their child’s speech and language is assessed. If their child needs help to develop these skills, they are offered care from the appropriate service.

Source guidance

Definitions of terms used in this quality statement

2–2½ year integrated review
The integrated review of children aged between 24 and 30 months incorporates the Healthy Child Programme assessments and the Early Years Progress Check (at age 2). The aim is to give parents a picture of their child’s health and educational development. Depending on local protocols, the review may be carried out by a health visitor and an early years practitioner, or by a health visitor who will then share information with the early years practitioner.
The Department of Health’s ages and stages questionnaire is used to carry out the review.
[Adapted from Services for children aged 0 to 5: transfer to local authorities, Department of Health and Public Health England, and expert opinion]

Equality and diversity considerations

Practitioners should take into account cultural and language differences when carrying out the review with the child and discussing it with the child’s parents and carers. If the child’s first language is not English it may be necessary for a practitioner with the relevant experience to assess their speech and language skills.

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Implementation

Pathway information

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.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

  • Head teachers, teachers and practitioners working with children in primary education.
  • Those working in (and with) local authority education and children's services (including healthy schools teams), primary care (including school nurses), child and adolescent mental health services (tier one and tier two) and voluntary agencies.
  • Teachers and practitioners working with children in primary education.
Commissioners and providers of services to children in primary education including those working in: local authority education and children's services, schools, healthcare, child and adolescent mental health services and voluntary agencies.
  • Head teachers, governors, teachers, support staff and other practitioners working with young people in secondary education.
  • Those working in (and with) education, children's and youth services within local authorities, primary care, school nursing services, child and adolescent mental health services and voluntary agencies.
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.
The Family Nurse Partnership is the UK name for the US-developed Nurse-Family Partnership. 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.
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 guidance, 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).
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 guidance, 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 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 guidance 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 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.

Glossary

(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)
(provides a profile of the health and social care needs of a local population; used as the basis for developing joint health and wellbeing strategies)
(personal, social, health and economic)
(in the context of these recommendations, 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)
(refers to all education establishments for young people aged 11–19 years including further education colleges, technology colleges, academies, free schools and private sector establishments)
(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 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)
(commonly used to refer to organisation-wide approaches in schools)

Paths in this pathway

Pathway created: December 2011 Last updated: April 2021

© NICE 2021. All rights reserved. Subject to Notice of rights.

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