The Hackney Children Stepping Forward Project
Outline of the Study
This project evaluated an innovative early, nursery-based intervention service for children, with the aim of improving parent-child relationships.
The effectiveness of the service had already been demonstrated for a variety of mental health problems of pre-school children in a collaborative study with a major university department.
The project aimed to establish and evaluate a trial community Pre-school Clinical Child Psychology Intervention Service in Hackney, following a model already established and under evaluation in Camden and Islington.
All children were assessed at intake into each of 8 nurseries, and then at 12 months and at two-year follow-up by an independent research psychologist using standardised psychometric instruments. The study tested the effectiveness of early interventions in preventing middle childhood behaviour problems using a multi-modal parent training intervention, including parents' groups and direct advice with additional psychological consultation.
Policy Relevance of the Research
Early behavioural disorder in children is associated with poor prognosis, such as development of conduct disorder. These children are more likely to come from high-risk backgrounds and remain socially excluded, with, for example, later school drop-out and delinquency. They require increasingly greater resources to treat effectively as the children get older.
As the project started, the large majority of children with emotional and behavioural disorders were undiagnosed and untreated and tended to be referred for services only once the problems had been well established and become troublesome to parents and/or the educational system.
Although early preventative endeavours have been proven the most effective in the mental health field (Effective Health Care Bulletin, 1997; Fonagy, 1998), screening of pre-school children for behavioural problems was and still is problematic from practical and ethical points of view.
Additionally, during the project it had not been established whether children detected by such screening could be adequately treated in the context of primary care or whether they required tier 3 intervention.
An inclusive, universally offered service based within primary care would be preferable, not least because of its greater acceptability to families. The project therefore sought to create a model for a partnership between the nursery educational system and clinical psychologists, and to strengthen the partnership between general practitioners and the psychology profession.