Positive environments for early child and family support. Part 3: Implications for early child and family support that is hospital-based

Introduction to the series

In this serialised essay I want to explore positive and favourable environments for providing early child and family support when babies and young children have conditions that potentially reduce their capacity for development and learning.

In the first parts I will contrast the busy and often neurotic atmosphere of the hospital with the quiet and calm space that we generally assume is required for learning in babies and young children. I will then explore the implications for early child and family support much of which is traditionally hospital-based. I will then argue that society’s mind-set and approach to these children and their families should be less medical and more educational.

Positive environments for early child and family support. Part 3: Implications for early child and family support that is hospital-based

In the first part of this serialised essay I suggested hospital and clinics are not favourable environments to promote education/learning in babies and young children who have conditions that affect their development and learning in the long term. I characterised these medical environments as busy, neurotic and morbid and in the second part set them in contrast to places where, typically, babies and children can be relaxed, inquisitive, respected, secure and ready for learning. In this third part I want to suggest some moves from the health atmosphere and mind-set towards the education mind-set that can enhance the education element of early child and family support.

When an early child and family support service is based in a hospital, it is unlikely it can be quickly and easily moved out to an educational setting, though this would be the ideal in the long term and for services being newly established.

Possible short-term approaches and remedies include:

Redesigning the space so it is less clinical, less busy, less neurotic and less morbid. This could be a co-production effort involving parents and older children in discussions and planning
Health practitioners meeting infants and families as much as possible in education settings (for example, nurseries and children’s centres)
Health practitioners meeting infants and families in their own homes.
Health practitioners changing a health mind-set to an education mind-set when they are helping children learn.

For the sake of the child’s learning, the work of the health practitioners in the first three of these bullets will be enhanced if the practitioners can adopt, to some extent, an education mind-set. This, the last bullet, is the main focus for this essay. Health practitioners who have had opportunities to study the science of how babies and young children learn will have a distinct advantage.

To recap, I am defining education as the acquisition of new understanding and skills. With respect to babies and infants who have disabilities, in this definition I am joining together education, development and learning and including all aspects of early child development. Parents too must acquire new understanding and skills so they can bring up their child. Some of this education can come from the child’s practitioners.

There follows a list of twelve elements that can be part of changing a health atmosphere and mind-set to an education mind-set. I offer these with some nervousness as an educationalist because I know some health practitioners have got here before me and could add items to my list.

My list of remedies:

The child is not perceived in negative terms about ‘disability’ – about the things the child cannot do and might never be able to do. Practitioners help parents, when necessary, to move away from such a negative view.
The focus is on the child and not on the disability, syndrome or condition.
The session with the child is not to offer treatment but to help her or him acquire new understanding and skills. The session should also help parents acquire new understanding and skills for their task of bringing up their child.
Work should not begin in any session until the practitioner has appraised the emotional states of the child, of the parent and of herself or himself. Is the child in a positive, neutral or negative state? Is there fear or anxiety? Is the parent tense, nervous, angry, calm, relaxed? Is the parent present or distracted? Is the practitioner present, distracted, calm, disturbed, in listening mode, in expert mode (see below)?
Supporting the child does not have to wait for results of tests and assessment. Even on first meeting it is possible to offers some meaningful activity to the child and some new understanding and skills for the parent. This is modified and enhanced according to child and parent responses.
The practitioner does not come to the child and family as an expert. Practitioners might have valued health-treatment expertise for some illness and injuries, but they do not have expertise in how to help this particular baby or infant acquire new understanding and skills in all aspects of child development during babyhood and the pre-school years.
Replacing the word ‘expertise’ with ‘competence’, health practitioners will acquire collective competence as they collaborate with the other people around the child. This happens in multidisciplinary teamwork and in equal partnership with parents.
Ideally, for each session, the working unit is child + parent + practitioner. Each of the three brings their present understanding and skills to the task and each of the three acquires new understanding and skills in the process.
The focus in each session must expand beyond any single aspect of child development to the whole interconnected child and to the child in relationship with the other members of the family.
The activity in each session can begin with what the child is showing interest in. Babies and infants show us what they are ready to learn if we have the time to tune in to what they are ‘saying’.
Some sessions can be guided by parent’s concerns or expressed learning needs.
Sessions can focus on the new understanding and skills in natural activities. Included here are moving around the house, taking clothes off or putting them on, managing cup and spoon, washing, tidying up, asking for things, answering questions, learning the names of things, making choices, enjoying rhymes and songs, anticipating, remembering, concentrating, etc. All of these can start at very basic levels during babyhood.

Returning to my theme, I accept that hospitals and clinics have atmospheres, attitudes and environments that are entirely appropriate for treating illnesses, disease and injuries in children and adults. Within them are health practitioners who have all necessary competencies to play their part in diagnosis, treatment and care. My essay is not intended to detract from any of this in any way. My argument is that babies and young children who have disabilities do not need, for their development and learning, the treatment regimes that medical establishment are geared up for. They need education at home or in an education setting and this is where early child and family support should be based.

In this argument, helping a child acquire new undestanding and slills in posture, mobility, communication, dexterity, cognition, etc. can be seen as an education issue rather than just a health issue and should be supported by practitioners who are trained in the science of how babies and young children learn. There might also, of course, be health issues needing medical treatment. This view of early child and family support has implications for paediatricians and paediatric therapist and these will be explored in the fourth part of this serialised essay.

If general hospitals can have a busy and neurotic environment and atmosphere, so too can some family homes with (referring back to the Chambers definition) ‘mental disturbance characterised by a state of unconscious conflict, usually accompanied by anxiety and obsessional fears’. Reasons for this include the fiollowing:

Each family has a way of being before the child with disabilities comes along. If this is of a neurotic nature, it might well persist.
Families discovering that their new child has disabilities might suffer mental disturbance that some families and professionals describe as trauma. This can change the atmosphere in the family home.
Some parents can take to heart the perceived message from their hospital that their child has a list of present and future problems that will impinge on health, well-being and even survival. This can create an atmosphere at home in which the new child is more of a patient than a child and the parental role must be largely a nursing one.

In this third situation, there might be an assumption that the child cannot play. The home will have more sadness than joy. It might not occur to these parents that the child can learn new things, with the result that no play or educational opportunities are provided. This atmosphere disempowers parents and child with long-term consequences.

Early child and family support practitioners who perceive this family situation should take it as the priority issue to address, trying to turn negatives into positives, helping the parents see their child from a less medical viewpoint and elevating the baby or infant’s self-esteem and interest in life. This will strengthen the family.

In summary, I have offered some remedies when early child and family support is provided in hospital settings where there is a busy, neurotic and morbid atmosphere and environment. A major part of these counter measures is for health practitioners to adopt an education mind-set as far as possible. In the fourth part of this essay I will explore implications for health practitioners and develop the argument that development and learning for young children who have disabilities is an education issue and not a health issue.

Your comments are welcome.

Peter Limbrick, August 2020