ONE
Taking a fresh look at babies and infants
Each baby and infant is an interconnected whole being and can be treated as such in effective early support. Every child comes complete as a whole child. There is no exception to this. There is no such thing as half a child, almost a child or not quite a child. This wholeness is not diminished by a child’s unique condition. Each and every child is deserving of love, care and respect. Each child has rights. This is worth emphasising because some people will describe others as something less than fully human when discriminating against them or preparing to hurt them. Children and adults who have very special needs all around the world suffer discrimination. This influences their schooling, social activity and employment opportunities. Children who have difference, delay or challenge are first exposed to prejudicial attitudes in babyhood and infancy. To counter this we must fully value each new child whatever their situation, condition or life expectancy.
Those of us who know babies and infants in their wholeness, because we are, for example, parents, teachers, nursery workers or play workers, understand that separate areas of child development (posture, movement, communication, cognition, emotions, seeing, hearing, etc) are not separate at all. The construct of separateness only becomes useful as children get older. Babies and infants put all these aspects of child development together as global activity in everything they do - feeding, cuddling, playing, managing clothes, etc They don’t do this because they can, they do it because they have no choice. So the madness comes when we think the best way to help a child develop and learn when there are plural conditions is to provide a separate practitioner for each of the diagnoses and for each aspect of development. Systems theory and common sense tell us that all the child’s abilities and challenges are interconnected and merge together into a whole functioning child. This is the magic of systems to help us grow beyond the madness of multiples.
When a child develops intention, attention, communication, understanding and dexterity in dressing and undressing tasks, these new skills will also be of benefit at mealtimes and in play and social activity. Impairment in vision will affect how a child learns to move around the room. Impairment of movement will affect visual perception and sense of space. There are no separate parts in a baby or infant. Practitioners who specialise in a single aspect of child development must use their knowledge in the context of the whole child’s learning. Effective joined-up early support systems will simplify a child’s plural diagnoses (of perhaps sensory, physical, intellectual and behavioural challenges) to a single unique multifaceted condition and then develop a whole-child approach to learning. This will bring an end to the fragmented approach that has treated a child in bits and the multiple-practitioner approach that has kept children, parents and practitioners stressed and exhausted.
TWO
Taking a fresh look at families
Without being sentimental or naïve about the vast range in composition, caring and competence of families around the world, we can acknowledge that most children start in some sort of family life being cared for by one or more parents. Baby and birth mother are part of a first interconnected and interdependent whole. This extends to embrace other family members within the close family. This whole family, in its entirety, must be the concern of people who come along to help the baby or infant gain new understanding and skills. This is for three reasons.
Firstly, when a baby or infant is found to have significant conditions that will impact on development and learning, all aspects of family life can be affected including relationships, work, study, leisure, finance, housing and resilience. Families can fall apart, belief systems can change dramatically and there can be overwhelming negative emotions. Asking new parents to focus on their child’s needs for learning and development might not be realistic at first. Effective support for the family’s immediate practical and emotional needs might have to be the priority.
Secondly, support for parents as they promote their new child’s understanding and skills is best begun in the family home within the family and its natural daily activities. All children’s first learning is in the activities of feeding, bathing, nappy/diaper changing, moving around the room, managing clothes, playing, socialising and bedtime. Some clinic sessions outside the home might be necessary but activities here are in danger of not appearing relevant to child or parents. Also, the child might feel unsafe in the clinical environment and therefore not ready to learn. Some parents will also be nervous and not in listening mode.
Thirdly, we must consider new children’s growing attachment to parents and other family members. Our social and emotional life as children, teenagers and adults is influenced by our early attachment or the inadequacy of it. Each new child with very special needs and their family members need calm, unhurried quality time with each other for bonds of attachment to grow. Practitioners who get in the way of attachment are sowing seeds of psychological ill health for child, parents and others in the family. Two steps to promote attachment are, firstly, offering timely emotional support for parents and perhaps siblings and grandparents and, secondly, keeping appointments away from home to a minimum, reducing exposure of the new child to non-family adults with whom they are not familiar and eliminating non-essential home visits. A coherent and sensitive pattern of support will preserve everyone’s calmness, energy and patience and make space for stress-free quality time.
THREE
Recognising the family body and the professional body
Parents and other family members can find themselves being treated as second class citizens. This impacts on their self-esteem and coping strategies and prevents them playing a full part in decision-making in early support. Families suffer persistent prejudice and discrimination in both their communities and within early child and family support organisations. Improving early support means taking a fresh look at families simply because this general impoverished attitude to families is a major obstacle to progress. This impoverished attitude can be described as ‘Us and Them’ or ‘Them and Us’. If we can examine this attitude we will come to a fresh look at families and start to dissolve the obstacle.
So, what are these two camps of Us and Them? Where do you fit? One camp is the professional body and the other is the family body. In the latter are families who have or had children of any age with significant challenges to their development and learning including parents, siblings, grandparents and perhaps other close relatives. Also included can be interested friends and neighbours. This is the unpaid family body.
In the professional body are people who are paid to support children who have significant challenges to their development and learning. There is an army of people here from the worlds of health, education and social care, from the academic world and from the private and voluntary sectors. Like a minority of people, I belong to both camps as a sibling and teacher. I have used the phrase ‘Us and Them’ to suggest that in general terms the people in the two camps have very different life opportunities and experiences.
This fresh look at families is a matter of social injustice and a matter of power and politics. A historical institutional approach during the last fifty or more years, coming in some countries from a strong medical influence, has disempowered families and prevented them being in control of how local early child and family support systems are built and managed. A bitter lesson we keep learning from social and political history is that power is never given away, it has to be taken. Perhaps in the early support world, we can find gentle ways to achieve this without too much blood on the streets.
Where do we start? Firstly, by acknowledging that the family body is potentially as astute and resourceful as the professional body. Why shouldn’t it be? Family members might be more tired, more stressed and poorer but these states are not beyond help. We can insist that any seminar or conference about babies and infants who have significant challenges to their development and learning holds the family body as the major stakeholder. Families should have free access and equal opportunities to speak and lead discussions. The family body must have a place in academic circles to originate and support research.
I acknowledge that in general terms, people in the professional body are good people often struggling against the odds. Similarly, people in the family body are generally good people struggling to bring up their children in difficult circumstances. But unfortunately early child and family support has been allowed to split into these two separate groups of Them and Us. I am not suggesting machine guns in violin cases, but the family body will have to develop some very sharp elbows in this struggle. A change in the power structure from ‘Us and Them’ will help local early child and family support systems to be more relevant, more accountable, more ‘owned’ by local families. Perhaps you can see from your experience what a giant leap forward this would be. It is a political issue.
FOUR
The professional body and the family body coming together
The family body is clearly held in second place by the professional body with the professional body seeing itself as more important and knowledgeable than the family body. This continues to surprise me because, obviously, the babies and infants we are talking about belong in the family body, children belong to their parents and practitioners are very much outsiders. Systems-thinking can come to the rescue. If we take all opportunities to join the two bodies together, we will create new characteristics and potentials that neither the family body nor the professional body has on its own. It is a great pity there is so much professional resistance to this magic.
In good team around the child practice, practitioner-family systems can be created around each individual child with parents having an equal place and an equal voice. The same systems can be created at the higher level in multiagency design of local early child and family support systems. The barriers to these common-sense systems can include professional snobbery and unwillingness to let go of power. In my experience, the educational world is better equipped to work in these practitioner-parent systems than is the medical world where authoritarian traditions can predominate.
FIVE
Taking a fresh look at practitioners and their training
One of my dreams is for each city, region or country is to have a unified early child and family support workforce in which practitioners from the various agencies and services are brought together into a comprehensive body that supports them in their work and offers shared structures for their communication and interaction. Of course, there is a challenge here because at present the practitioners around each child are from different employing organisations with very different training and qualifications. Some practitioners work in hospitals while others work in public and community services, all with different ambitions, priorities and targets in the support they offer. To complicate it further, for some practitioners, early child and family support is only a part of their broader workload.
We can see from the above where many common difficulties that children and families suffer originate, not in the child’s condition but in the lack of a unified structure and system in how support is provided. This situation also provides massive challenges to practitioners and their managers. The advantages to children, families and practitioners once a unified workforce is establishes include:
Parents would know more about what to expect in early support from the first practitioners they meet because those practitioners would share a basic philosophy, terminology and approach to families and their new child
Practitioners would be properly equipped to offer initial practical and emotional support to parents, siblings, and grandparents in addition to their work with the child
Practitioners and managers would get emotional and practical support from being in a recognised workforce
Bringing practitioners into a recognisable and supportive local workforce would facilitate close collaborative teamwork around each baby and pre-school child.
A workforce training programme for the mix of workers involved in early support at various professional levels in any city region or country must be very carefully designed. It will prepare workers of all disciplines for their initial sessions with a child and family because this is where essential effective helping relationships are begun and from which mutual trust and respect can grow. Included in this is a willingness in each worker to sometimes set their particular discipline aside so they can show their basic humanity in response to family needs. The training must teach early support workers how to consider the needs of both the child and the family and how to switch focus from child to parents and back again during each session. It is probable each practitioner is already trained to work with children so the training must offer a grounding in the needs of parents, siblings and grandparents and in approaches to supporting them. Such approaches will require familiarity with relevant local resources that could be referred to. Training will have to be modular because workers will differ in their needs given that they are already trained to some level in their own discipline. Local training will have to take account of culture, available resources, common needs and availability of workers.
A common need will be preparation for joint working in which workers integrate and collaborate to create a whole approach to each child and family. Clearly, this would be helped if practitioners’ original professional training in colleges and universities prepared them for collaborative teamwork with their colleagues in early support workforces. I do not see this happening. A large part of the reason for this is the silo mentality of many academics that keeps university departments for health, education, social care, psychology, etc. insulated from each other. If these barriers could be broken down, there would be improved teaching and research about joined-up work around children and families.