Naomi Eisenstadt CB: How can we support all children, young people and families?

A recent Guardian headline read, Record numbers of children in England seek NHS help for mental health. The above question asks how we support all children, assuming all children need support. The Guardian piece reminds us that more and more children are needing support of some kind or another.  This means that their parents may need support as well. But the nature of support, the often intermittent periods of need across the life course and the context in which it is needed is immensely variable.  

Every family is different, and no family is static over time.

Family and individual circumstances, as well as the wider context, play a huge part in the kinds of support needed. In thinking about all children, we need to consider how we can create the conditions so that children do not seek specialist help. Prevention is the key and prevention is dependent on a complex set of circumstances that shape children’s lives.  

At its most basic level, for good physical and mental health we all need love and money. 

• Money matters in its own right, not only in terms of the ability to buy goods and services that promote healthy development, but also because lack of money is a key factor in parental stress. 
• Parents also matter.  A good home learning environment can make a real difference to children’s learning and attainment. But it is harder to provide such an environment for children when income is low. 
• Parents’ - especially mothers’ - educational background and their mental health are particularly important for how children fare. Different aspects of family resources matter for different outcomes: income, education, social class are all important. Persistent poverty and hardship are particularly damaging.
• Relationships matter, not only between mothers, fathers and their children, but also between mothers and fathers, parents, and carers. Good relationships between parents in intact or separated families is a protective factor for children. 

It is clear that an adequate and reliable income gives families choice and control.  It also enables long term planning. Mothers and fathers on very low incomes may have a planning horizon based on week-to-week wages. Their planning will be based on enough to get through a few days.  While money is a key element, services can play a role in mitigating the impact of poverty and if well designed and delivered should help reduce the impact of other forms of disadvantage.  However, discrimination is experienced across all income groups.  

Likewise, discriminatory behaviours and attitudes are evident across all classes. Factors such as race, ethnicity, disability, sexual orientation, sexual identity are among many critical factors in how and what support is needed and how it is provided by local services.  Diverse need is a feature within as well as between families. As mentioned above, poor mental health for a mother can have long lasting consequences for children. Family stress is often present when a child in the family is struggling with an identity different from birth identity.  Likewise, children may struggle with a parent who wishes to change their identity. A mother or father ‘coming out’ may be liberating for the adult but may be confusing or problematic for their child.  There is an infinite variety in differences, which are sometimes celebrated, sometimes tolerated, but all too often seen as problematic. 

Adolescents with long term health conditions will want to have decision making over their treatments and freedom to take risks. Young adults with learning disabilities may long to live independently, while their parents may fear for their safety.  Emerging independence is difficult to navigate for all young people, but even more so for young people for whom risk is higher simply because of who they are based on observable or invisible characteristics. 

So how can we support all children, young people, and families?  

Several key elements come to mind: working together more productively, improving our use of new technologies, and giving front line service providers more freedom to negotiate with users on how to meet their needs.  Flexibility at the front line allows staff to be responsive to needs and to feel valued and trusted by their managers. This is an essential aspect of job satisfaction, which in turn, reduces staff turnover.  

The fundamental features of successful public services are that those on the receiving end should feel heard, should participate in deciding what is needed and influence how it is offered.   Staff at the front line of provision need to respect the person in front of them, engage them in their view of their needs, and work to resolve what may be a difference in the professional view of the ‘problem’ and the user’s view of the problem.  Intersectionality is an important consideration.  Sometimes a specialist provider of services will see the speciality and not the person or will make assumptions about service need based on visual presentation of race, ethnicity, or ability.  It is vital to remember that there is as much diversity within as between groups, and all people are members of more than one group. 

Service providers must work together to ensure the variety of needs of the user and other family members are met. Shared information is key and, in many areas, increasing use of digital solutions to information sharing are proving enormously helpful. But information sharing is not only a technical issue. It is an issue of trust and confidence in the skill of other professionals, including those in the VCSE sector, understanding that rarely can one particular service provide all the answers. The creation of Integrated Care Systems is aiming to break down barriers and ensure greater collaboration across the NHS and local government and, within the complex structures within the NHS.

In truth, we do not have the levers that will ensure all children and young people live their best lives. No one agency or organisation has all the levers to ensure a good childhood. Services are stretched, demand outstrips provision, staff are exhausted. However, if we work more collaboratively, we can ameliorate the effects of low income and deliver better quality services. We also need to ensure our own staff at all levels understand the corroding impact of racism and all the other forms of damaging discrimination experienced by children and young people. Most important of all, staff, and young people themselves need the skills to challenge unacceptable behaviours.