Early Child and Family Support: Principles and Prospects. Part 1

For parents and practitioners who are impatient for change

The following extract is from Chapter 5 of ‘ Early Child and Family Support: Principles and Prospects’ written by Peter Limbrick and published by Interconnections in 2022 (ISBN 978-0-9576601-9-9).

 

Chapter 5: Prospects for offering effective integrated early child and family support to all families

Offering effective integrated early child and family support to all families who want it must be the aim in any country if we want to move beyond projects supporting only a limited number of children and families. There is no logical reason for supporting some families in any city, region or country while leaving others who want help to cope on their own. But this selective approach is happening everywhere. This chapter addresses major barriers to progress with suggested ways forward under five headings: 

1. Out-dated institutional attitudes and medical conservatism
2. General prejudice and discrimination
3. Families as an oppressed minority group
4. The common failings in top-down reform
5. Local early child and family support task forces to accelerate the pace of change

 

1. Out-dated institutional attitudes and medical conservatism

In the UK there has undeniably been in my lifetime a prevalent attitude in public services that ordinary people should passively take what they are given and be grateful for it. The great majority of people have not been accustomed to argue with administrators or to challenge the views of professionals. At worst, people who ask questions have been labelled as trouble-makers. Institutional attitudes were covered in Bringing up babies who have very special needs, pp 85-86. The following (in green print) is an abbreviated version:

‘...we can see outdated support...and the prevalent attitudes within traditional agencies as a halfway point between institutional care and a sensitive respectful approach that fully recognises the rights of children and parents. My reasons for this...include the following: 

• • Parents are suddenly involved with agencies in processes they have not actively opted for over which they have no control.
  • Parents...can [be]...patronised, criticised and disempowered...[while]...in crisis and needing sensitive support.
  • Babies and infants can be subject to medical procedures that take little account of pain or levels of anxiety.
  • When interventions are planned, there might be no thought given to child-parent bonds of attachment.
  • Parent and child might have to travel to a variety of places for treatment sessions. [Often]...to meet agencies' needs with no thought given to the family’s time pressures and tiredness.
  • Attending appointments can be a drain on family finances because of travel, parking, eating out and child care.
  • Appointments...might [give no]...thought to child’s comfort, quality of life...routines for feeding, sleeping and playing.
  • Babies and infants can be parked on waiting lists so that ‘early’ intervention comes later and later.
  • Practitioners give themselves importance they do not give to parents...they want their own understanding and skills to be respected, [but]...do not respect what parents know and do.
  • New parents find themselves having to share their parenting role with practitioners in partnerships – as inferior partners.
  • Support for babies and infants’ education can be offered primarily in clinical treatment sessions though the actual need is for a combined medical, educational and play approach.
  • Babies and infants’ need for natural learning in everyday activities is given secondary importance to goals set by practitioners in their clinical environments.
  • Parents can be asked to continue therapy at home in conditions that are not ideal and with the spoken or unspoken threat that not to do so will disadvantage the child.

I am not suggesting any agency or practitioner wants to be cruel to children or parents, but there can be a prevalent institutional medical hangover that we need to become aware of and address.’

 

The fact that early child and family support, whether a well-organised system or a piecemeal arrangement, commonly has a strong medical input can significantly add to any institutionalisation in the support for children and families. There are two elements to this.

            Firstly, the medical world of doctors and hospitals is a powerful institution that can influence our birth, health, wellbeing, reproduction, mental states, dying and death. In general, citizens rightly value the medical world, have an instinct to trust it and a reluctance to set themselves against it for any reason. Secondly, paediatricians, alongside neurologists and other hospital paediatric specialists, are probably the most highly trained and highly paid professionals many ordinary people are likely to meet and have regular contact with. They hold great power and authority and, socially, inhabit a world very different from most people.

            The medical world is not given to fads and fancies. Instead, it strongly clings to its history, traditions and tried-and-tested approaches. It is a conservative institution that protects its systems and its personnel and offers great rewards to its senior staff members. I have always been aware of the term medical arrogance and have sometimes seen it at work in TAC meetings, but the conservatism of the medical world is much broader and deeper than any particular medic’s professional style. The character of the medical world can present formidable challenges to people arguing for radical change in early child and family support. But I must finish by saying I have worked alongside many medical people of great sensitivity striving to improve support for the children in their care.

 

2. General prejudice and discrimination 

As the task is to improve early child and family support within cities, regions and countries, it might be helpful to consider how their citizens regard these children and families. Social change in any democracy is dependent on prevalent attitudes and perceptions of the general public.

            Disability is generally perceived as a negative. This is not surprising because the word itself means a lack of something. My Chambers Dictionary defines the word as lack of power; lack of legal power or qualification; a difficulty especially physical so it is not surprising that social reformers choose other more positive words in its place. But, so far, the general public do not and the negative view of people labelled as disabled leads to widespread discrimination in education, health, employment, law enforcement, etc. so that disabled people can find life an unequal struggle at school, in or out of work, in their neighbourhoods and in their social and sexual pursuits. At worst, discrimination can lead to a life of poverty and bullying with deep feelings of fear, rejection and loneliness.

            There is no cushion preventing these negative attitudes impinging on babies and infants who have been medically labelled at the beginning of their lives as being disabled. Many parents and siblings speak of suffering discrimination themselves as a result of the new child’s diagnosis. None of this inspires optimism that the general public is likely, as things are now, to demand improvement in early child and family support in their locality or that it will eagerly support any new allocation of public money at the level required. 

            I have made some generalisations here based on my own long experience in early support. I am aware that very many people of all ages labelled by themselves or others as disabled lead entirely happy, productive and fulfilled lives.

Note: Part 2 of this short series will cover:

3. Families as an oppressed minority group

4. The common failings in top-down reform

Peter Limbrick, November 2024. Comments welcome.