Literature Review - KidsMatter · KidsMatter Early Childhood Component 3 Literature Review 6 3....
Transcript of Literature Review - KidsMatter · KidsMatter Early Childhood Component 3 Literature Review 6 3....
KidsMatter Early Childhood Component 3 Literature Review 2
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© Commonwealth of Australia 2012 Important Notice
KidsMatter Early Childhood Australian Mental Health Initiative
and any other KidsMatter mental health initiatives are not to
be confused with other businesses, programs or services
which may also use the name ‘Kidsmatter’.
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Contents
Component 3: Working with parents and carers 5
Background Information on KidsMatter Early Childhood ....................................................................... 5
Working with parents and carers 7
Collaborative partnerships ......................................................................................................................... 7
Connecting families ................................................................................................................................... 11
Supporting parenting ................................................................................................................................ 13
Summary and Implications for Practice .................................................................................................. 16
References 18
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Component 3: Working with parents and carers
Background Information on KidsMatter Early Childhood
KidsMatter Early Childhood is a national mental health promotion, prevention and early
intervention initiative developed to support the mental health and wellbeing of young
children in early childhood education and care services (ECEC). It has been developed in
collaboration with beyondblue and Early Childhood Australia, with funding from the
Australian Government Department of Health and Ageing and beyondblue. It involves
families, early childhood professionals, and a range of community and health
professionals working together to make a positive difference to young children’s mental
health and wellbeing during this important developmental period of birth to five years.
KidsMatter Early Childhood uses a risk and protective factor framework to focus on four
components that ECEC services can use to strengthen the protective factors and
minimise risk factors for children’s mental health and wellbeing.
All four components are outlined below.
1. CREATING A SENSE OF COMMUNITY
within ECEC services by focusing on
belonging, inclusion, positive relationships
and collaboration.
2. DEVELOPING CHILDREN’S SOCIAL
AND EMOTIONAL SKILLS is fundamental
to children’s mental health. These skills
are developed through adults’ warm,
responsive and trusting relationships with
the children in their care, as well as
through constructive peer relationships.
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3. WORKING WITH PARENTS AND CARERS ECEC services and families can
establish collaborative partnerships in the interests of their children. ECEC services
can support families by helping them to connect with other families and by providing
access to parenting support.
4. HELPING CHILDREN WHO ARE EXPERIENCING MENTAL HEALTH
DIFFICULTIES. ECEC services are well placed to recognise when young children
may be experiencing difficulties, to implement simple strategies to assist children,
and to support families to seek additional help.
Definitions of terms used in this document
Children: Children from birth to five years unless otherwise stated.
Culturally and Linguistically Diverse (CALD): A broad concept that encompasses individual differences,
such as language, dress, traditions, food, societal structures, art and religion.
Early childhood education and care (ECEC) services: Preschools, kindergartens and long day care
services.
Early childhood staff: Educators, teachers, day care staff, integration aides, assistants, and other staff that
are based within ECEC services.
Externalising: Disruptive, impulsive, angry or hyperactive behaviours (i.e. where the child ‘acts out’). These
behaviours are generally readily observed and therefore are relatively easy to detect.
Internalising: Inhibited or over-controlled behaviours (i.e. where the child ‘holds in’ their difficulties),
including withdrawal, worry, and emotional responses that primarily affect the individual child rather than
having effects on others.
Mental health: Early childhood mental health involves being able to experience, manage and express
emotions; form close, satisfying relationships; and explore and discover the environment.
Parents and carers: This includes biological mothers and fathers, parents of adopted children, GLBT
parents, foster parents, grandparents, aunties and uncles. The primary caregivers of a child/children and are
usually the child’s legal guardians.
Protective factors: Strengths that enable children to maintain positive mental health and wellbeing, even
though risk factors for mental health problems are present.
Resilience: A person’s capacity to adapt to adverse situations in ways that enable them to cope positively
and reduce or minimise negative impacts on mental health and wellbeing.
Risk factors: Factors that increase the likelihood that mental health difficulties will develop. The presence of
particular risk factors does not necessarily mean a difficulty will develop. The presence of multiple risk
factors usually increases the likelihood of difficulties developing.
Temperament: Individual characteristics and style of behaviour that a child is born with, now considered to
have a basis in both biology and environment.
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Working with parents and carers
ACHIEVING THE BEST OUTCOMES FOR CHILDREN IN ECEC SERVICES OCCURS
WHEN STAFF AND FAMILIES WORK IN PARTNERSHIP. A large body of research
evidence points to the influence of family factors on children’s mental health and
wellbeing. ECEC services can make a positive difference to children’s mental health and
wellbeing by working with and supporting their families. The literature highlights that
effective ways to collaborate with families include forming partnerships with parents and
carers, arranging opportunities for families to connect with each other and form support
networks, and providing parenting support.
Component 3 of the KidsMatter Early Childhood initiative: Working with parents and carers
focuses on three target areas selected because of their impact on children’s mental health
and wellbeing: collaborative partnerships with families; connecting families; and supporting
parenting. Each of the target areas is discussed in detail below. The numbers appearing
in the text are linked to references listed at the end of the document. If you would like more
information about the ideas presented in this paper, the reference list is a starting point.
Collaborative partnerships
COLLABORATIVE PARTNERSHIPS WITH FAMILIES require positive relationships
where both parties work together toward a common goal and feel a sense of shared
responsibility in reaching that goal (e.g., supporting children's mental health and
wellbeing1,2). In a partnership, each person is valued by the other person and seen as
having a unique perspective and contribution to make.
Collaborative partnerships are
a strengths-based approach to
working with families and are
one of the ways that ECEC
services and families can
effectively work together to
support children’s
development. These
partnerships are protective of
children’s wellbeing because
they encourage important
elements in children’s relationships with others, such as respect, valuing of one another,
trust and understanding.3 Furthermore, partnerships between families and staff act as
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protective factors to children’s mental health by helping children adjust to new
environments (i.e. home versus early childhood service) and ensuring that children’s
experiences in both settings are in synergy.4 Partnerships also promote an understanding
and acceptance of differences in childrearing approaches between families and ECEC
services and create a sense of value for the other’s opinion.4
ECEC services can work towards developing collaborative partnerships with families by
taking a family-centred approach. Family-centred practice seeks out and incorporates
parent expertise and knowledge within an early childhood setting. This can include more
than parents acting as helpers at the service, it can also involve families and staff planning
activities and programs together at the early childhood service.
Family-centred practice is an approach to working with families based on
empowerment, and focuses on the strengths, capabilities and individual needs of
parents and carers.5 This approach is defined by the following principles:
Recognising and respecting one another’s knowledge and expertise.
Sharing information and two-way communication.
Sharing power and decision making.
Acknowledging and respecting diversity
Creating support networks.6
Family-centred practice may look different in various settings, depending on the
environment and the people involved. For example, for some families there may be a
greater emphasis on acknowledging and respecting diversity because of their cultural
background and beliefs, whereas for others it may be that there is a greater focus on
sharing information and creating support networks because of their remote rural location or
lack of informal supports. Two-way communication occurs when both parties are able to
pass information back and forth and can achieve two-way dialogue successfully in every
form of communication.6 This requires both parties to make time and space for the
communication to happen.6 Communication
between families and ECEC staff might occur
in an interactive journal where information
about the child in both environments is
shared, or at a parent-staff meeting where the
child’s experiences at home and the service
are discussed.
As an approach to working with families, family-centred practice moves away from the
expert model where service providers decide what services are in the best interest of the
family and families are passive receivers of this information.7. In a collaborative
partnership and within family-centred practice there is a ‘sharing of power’. A sharing of
power allows for partnerships to form and promotes mutual respect amongst both parties.
Despite the sharing of power, an imbalance of control between the families and ECEC
Collaborative partnerships are
based on a sharing of knowledge,
trust and mutual respect.
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services is typically present, where one party gives up some control to the other.1,7 While
each other’s opinions are still heard and valued, power and decision making may shift
between the parties.
In the field of early childhood education and care, collaborative partnerships are best
practice for working with parents and carers. Collaborative partnerships with families and
communities is included as one of the quality areas in the National Quality Standard for
Early Childhood Education and Care, and School Age Care.8 This quality standard
promotes respectful and supportive relationships, family involvement, parenting support,
and respect for family values and beliefs regarding child rearing.8 In addition, Partnerships
is one of the five principles of The Early Years Learning Framework (EYLF) in Australia.
The EYLF highlights the importance of partnerships in successful outcomes for children.2
When families and early childhood staff work in partnership with each other, there are
many positive effects on children, families and staff, such as supporting the child-parent
and child-staff relationship and actively working together to help children develop good
mental health.1
A core set of characteristics and skills in early childhood staff are considered essential for
building effective collaborative partnerships with families.9,10 These include a positive
attitude towards families and relationships with families10; approaching families as
partners11; and a commitment to communicating effectively with families, a skill that
is considered particularly important to building partnerships.1,12,13 This set of skills
and knowledge are strongly linked to staff values and beliefs about families.9 It is difficult to
form partnerships with families if negative attitudes, beliefs and judgments are made about
them.1
Building partnerships with families can be a challenging task. Family life can be complex
and chaotic, and often the parents who find it most difficult to work in partnership are in
greatest need of support. By engaging in feedback, reflective thinking and practising skills
with colleagues, staff can continuously develop and improve their skills and understanding
of working effectively with parents.9
Collaborative partnerships are facilitated by family involvement.1 When parents are
involved in their child’s activities and experiences at the service and have an opportunity to
contribute to the organisation and direction of the service, partnerships can be fostered.1 A
successful partnership will often begin with family involvement, which develops into a
stronger relationship where there is a shared sense of responsibility.
By engaging in feedback, reflective thinking and practising skills with
colleagues, staff can continuously develop and improve their skills and
understanding of working effectively with parents.
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Creating a sense of community and connection within the service, encouraging families to
feel comfortable and to communicate with staff, and providing opportunities for families to
get to know other families at the service are all beneficial to promoting family involvement
and creating partnerships.1,6 All of these strategies help collaborative partnerships form
and subsequently create an environment where children can thrive in their development.
Friendliness, sincerity and open-mindedness have also been identified as
characteristics that support collaboration. Certain family-centred beliefs and values
such as genuine interest, commitment, acceptance, sensitivity and concern have been
identified as important factors that help families and ECEC services develop positive
collaborative relationships. These characteristics play a key role in establishing protective
factors (such as positive relationships) for children’s mental health and wellbeing in early
childhood.14,15 Surveys of parents and professionals working in an early intervention
context identified communication between parents and professionals and good
interpersonal skills, such as sharing information, sensitivity, openness and listening, as
essential factors in building collaborative relationships.16
Barriers to collaborative partnerships include time constraints, staff turnover, parent’s work
hours, conflict or disagreement between families and service staff, negative beliefs about
disabilities and families who live a long way from the ECEC service. Particular
consideration needs to be given to families who feel alienated or unsure about forming
relationships, even within the ECEC service, based on their experiences or
circumstances.2 Although these barriers can pose challenges, they may be overcome
through a family-centred approach enabling a clear and cooperative communication
process between families and staff with openness to suggestions, responsivity and active
listening between both parties, and a willingness to share information.5,15
The importance of accepting diversity, which is essential to collaborative partnerships, is
outlined in the KidsMatter Early Childhood Component 1 Literature Review. When the
diversity of families, and the aspirations they hold for children are respected, staff can
support children’s rights to have their cultures, identities, abilities and strengths
acknowledged and valued, and respond to the complexity of children’s and families lives.2
Cultural competence is vital in building effective partnerships with families. Cultural
competence can be defined as being able to understand and interpret others in the context
of their culture, however similar or dissimilar to one’s own.17,18 Cultural competence is an
important skill to develop because culture shapes parenting beliefs, values and
practices.4,19,20 For ECEC staff, this means having the understanding, values, knowledge,
skills and behaviour needed to work effectively with people from cultures other than their
“Cultural competence encompasses:
being aware of their own world view;
Developing positive attitudes towards cultural differences;
Gaining knowledge of different cultural practices and world views; and
Developing skills for communication and interaction across cultures.”2 (p 16)
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own. For services working with Aboriginal and Torres Strait Islander communities, being
culturally competent means recognising and respecting the central importance of culture
and identity in promoting social and emotional wellbeing.21
Australian research conducted in ECEC services with a high proportion of Culturally and
Linguistically Diverse (CALD) families enrolled, identified a number of factors that
facilitated the formation of partnerships and communication.22 Some of the key factors for
families were being shown appreciation, ECEC service and staff encouraging families’
confidence and assertiveness in communicating with the service. Staff members’
commitment to the development of relationships with individual families and family
members was also very important and was based on principles such as trust, respect and
openness to diversity. The research identified a variety of strategies that have helped
families develop partnerships with ECEC services when language was a barrier. These
strategies included families being given time to communicate with staff; staff verbally
communicating in the families’ first language whenever possible, or using different
methods of communication when this is not possible (i.e., visual representations); and
using written information in families’ preferred language. 22
Effective partnerships between staff and parents and carers have positive flow on effects
for children; this partnership is considered to be one of the most effective ways for staff to
support children’s mental health and wellbeing.23 Additionally, supportive partnerships
between staff and parents and carers also contributes to children’s adjustment to new
settings.4
It is fundamental that strong and effective partnerships are built between ECEC staff and
families to ensure good mental health in families and children in the service. A good
relationship between ECEC staff and parents
and carers is a protective factor for children’s
mental health, and is one of the factors that
has been targeted in selective prevention
programs for children who are at high risk for
mental health difficulties, such as serious
behaviour problems.24
Connecting families
Social connections are an important part of life. The quality of the relationships parents
and carers have in one domain influences the quality of relationships they in other
domains.25-27 Families who have good relationships with other families generally have
lower stress levels and more positive interactions with their children.22 When parents
experience positive relationships with others it affects their relationships overall,
particularly those with their children through modelling and demonstrating successful
partnerships.28
Good relationships between early
childhood staff and families is a
protective factor for children’s
mental health.
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ECEC services are potentially places and spaces for building social connections
and a feeling of belonging to the community.2 ECEC services can support families by
providing opportunities for parents and carers to be involved in the service and to develop
relationships with other families. The development of connections between families has
many positive outcomes for children and families, both direct and indirect.22 Positive
effects of connecting families include the provision of support and information to families;
increased participation in ECEC services; increased self-esteem; reduced social isolation;
and increased children’s social networks.22
In contrast, a lack of involvement in children’s activities and family social isolation
are considered risk factors for mental health difficulties in children.29 For example,
primary carers who report receiving inadequate social support from family and friends are
more than twice as likely to report experiences of psychological distress than those
receiving adequate support.30 Furthermore, primary carers who are younger, single
parents, or born overseas are more likely to have low levels of community connectedness.
In some cases, primary carers with low levels of community connectedness were almost
twice as likely to report clinically significant psychological distress when compared with
those who had higher community connectedness.30
Assisting parents to develop support networks may reduce parental distress, which
has been shown to predict internalising behavioural difficulties in early childhood.31
In addition, some research suggests that
parental work stress influences the quality of
family interaction and children’s
adjustment.31,32 Helping families to develop
coping resources by decreasing their social
isolation has positive implications for
children’s mental health and wellbeing.
Social support is a protective factor that can have positive effects (e.g., improvements in
self-esteem, confidence and care giving) on parenting, family wellbeing, and children’s
resilience in families who have a child with emotional difficulties. Social support is
protective in that it helps parents build coping mechanisms and deal with their stress.33 It
has been shown that parents and carers who receive more social support from people in
their social network (i.e. friends and family) also receive more parenting support, which is
beneficial for children.30
Developing support networks for families may be especially important for parents
and carers who are experiencing mental health difficulties themselves. It has been
suggested that the presence of social support can diminish the relationship between early
childhood externalising behavioural difficulties and maternal depressive symptoms.34 In
the instance of severe maternal depressive symptoms, research has shown that child care
Social support can have positive
effects on parenting, family
wellbeing, and children’s resilience
in families who have a child with a
serious emotional difficulty.
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attendance was linked to decreased internalising behavioural difficulties in children of
parents with depressive symptoms. This study indicates that social support and child care
attendance can act as protective factors for children who have parents or carers with a
mental health difficulty.34
ECEC services are ideally placed to facilitate social support for families because the
majority of children attend some type of ECEC service. Opportunities to become
involved in the service and meet and network with other families who have children
around the same age can be invaluable to families. Some of the formal and informal
ways that ECEC services can provide this support include having families help at the
service, having family gatherings and events, introducing families to each other, and
buddy systems where parents and carers who already use the service help orient new
families.22
Supporting parenting
Parenting is the most important influence on children’s development, and can be
supported by ECEC services. Parents are usually the primary caregivers of a child,
supporting their physical, social and emotional development through their daily
interactions.35 The parent-child relationship and parenting practices are critically important
for children’s development. The presence of consistent caring, responsive, warm, and
secure parent-child relationships have been well documented as supporting children’s
mental health and wellbeing.29,36-38 The attachment relationship between the child and
parent is a fundamental aspect of social and emotional development and impacts all of
their future relationships.39 Nurturing and responsive caregiving is the gateway to secure
attachment, and through promoting and modelling this relationship parents and caregivers
can establish a positive and secure relationship with their children.23
Research has identified a number of family-related risk and protective factors that
influence children’s mental health and wellbeing. Family-related risk factors for mental
health difficulties in children include negative parenting styles and lack of warmth and
affection in the parent-child relationship. 29,36,37,40,41
In contrast, family-related protective factors include parental caring, affection, secure
attachment, warmth, security and consistency, and experiencing positive
relationships.29,36,37,40-42 Providing children with a warm and secure environment
Surrounding children with positive relationships can act as a buffer
against the detrimental effects of stress.
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surrounded by people that care and show affection assists them in developing good
mental health.
While warm, sensitive and responsive parenting supports children’s mental health and
wellbeing, poor parenting can lead to negative mental health outcomes. In a recently
published longitudinal study, low levels of maternal affection towards eight-month-old
infants were linked to greater level of distress 30 years later in adulthood, compared to
those who received higher levels of affection from their mothers.37 Harsh parenting styles
have been associated with children’s behavioural difficulties, including both internalising
and externalising difficulties.31,43
Negative parenting practices can create stress for the entire family and impact on
children’s mental health. Excessive stress in early childhood can have detrimental
effects on brain development, and place the child at risk of physical and
psychological health problems later in life.44,45 The detrimental effects of stress on
children can be long term, and difficult to reverse.39,44 The frequent activation of the brain’s
stress response systems can increase a child’s vulnerability to a range of mental health
difficulties (e.g., depression, anxiety and behavioural disorders) and can therefore affect
children’s overall brain development.44,46
Reducing negative parenting practices (such as harsh discipline and lack of involvement
with children) and increasing positive parenting practices (such as setting fair and
consistent limits to help children feel safe, and providing warm and responsive care) helps
support children’s mental health.47
ECEC staff can make a difference by:
supporting positive relationships between children and their parents or carers;
encouraging and modelling a caring and supportive approach to children;
setting consistent limits and fair consequences for children’s behaviour; and
supporting families to be involved in children’s experiences at the service.48
Surrounding children with positive relationships can act as a buffer against the detrimental
effects of stress.44 Positive relationships between parents, carers, and early childhood staff
can help families and staff to gain knowledge, and feel supported and better equipped to
develop supportive relationships with children. However, not all experiences of stress are
Positive relationships between parents, carers, and early childhood staff can
help families and staff to gain knowledge, and feel supported and better
equipped to develop supportive relationships with children.
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detrimental to children. The presence of stress can help children build resilience and learn
self-regulation. A child’s experience of manageable stress, with the support of adult
relationships, is important for child development.44,45 Experiencing adverse life events
provides individuals with the opportunity to develop and practice coping strategies in a
supportive environment. ECEC services can be part of the support system for children
and families as they face life challenges, helping children build resilience and acting as a
buffer during life stressors. This may be achieved by supporting parenting during this time
as well as through the staff’s relationships with individual children.
Parents and carers of children who have emotional or behavioural difficulties may
need additional support with their parenting. An Australian survey of parents with
children under 12 years of age showed that parents who thought their child had an
emotional or behavioural difficulty reported greater amounts of stress in parenting and
were less confident in their parenting skills.49 ECEC services are in a position to support
the parenting process and, where possible, link families with health professionals. The
study also found that parents who viewed their parenting experience as positive reported
their child’s behaviour as less difficult.
In addition, the proportion of parents who thought their child’s behaviour was moderately
to extremely difficult was high (one quarter of parents in this sample) but only 33% of that
quarter had sought professional help for this issue. The two most common professionals
consulted by parents and carers were doctors and teachers,49 highlighting the importance
of schools and early childhood service staff in supporting families who may care for
children with emotional and behavioural difficulties.
It is important to note that optimal parenting practices may be different depending
on the temperament of the child.50,51 One of the challenges of parenting is matching
parenting practices with the temperament on an individual child. Parenting that is in tune
with a child’s temperament is beneficial to children’s wellbeing. Parents can be
encouraged to understand different temperament styles, and to use parenting practices
that are responsive to the needs of the child, based on their mix of characteristics.51,52
ECEC services are well placed to offer parenting support and education. Parents
and carers may feel more comfortable accessing informal information and support
in this environment than seeking it from health care providers and organisations
because of the relationships already developed.53 Staff can provide parenting support
in various ways through both general and systematic support.16 General support can be
provided during day-to-day interactions with parents and carers, for example using
opportunities to have discussions that build trust and empathy, reserving judgement and
communicating sensitively, explaining things from a child’s point of view, and purposefully
modelling specific strategies and thoughtfully approaching parents about these
strategies.16
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One of the ways that ECEC services can provide systematic support for families in
their parenting role is through facilitating their access to parenting programs.
Strengthening positive parenting and reducing harsh parenting practices through parenting
programs can have positive effects on children, including enhancing children’s social skills
and positive affect, and reducing children’s conduct problems, negative affect, and non-
compliance.50,52 In addition, implementing parenting programs has been shown to
increase parent’s involvement in children’s education, another protective factor for
children’s mental health.52 For example, a parenting program designed for parents of
children at risk of developing conduct problems (known as Head Start) found that families
who participated in the program became more involved in their children’s education and
were more socially competent than parents that did not participate.52 There are a range of
programs that target parenting to support children’s mental health including Tuning in to
Kids,54,55 Triple P-Positive Parenting Program,56,57 the Incredible Years programs 58,59 and
the Exploring Together Preschool Program.60 Some research has shown that parenting
programs are most effective when children are aged under 9 years, reinforcing the
importance of maximising access to formal support during early childhood.50
A number of other resources available to parents have shown positive effects on parenting
support and education.61 These range from incidental or general information (e.g. tip
sheets, websites, online forums) through to more structured services and programs (e.g.
telephone advice lines, parenting information sessions and parenting programs).35 The
information and support provided can address child development, the parent-child
relationship, or issues residing with the
parent or carer that may impact on their
parenting capacity, such as anxiety about the
parenting role, stress, or financial
difficulties.62 Crucial to any attempts to
support parents and carers is recognition of
their unique needs and strengths.
Supporting parenting is an important part of
children’s mental health and wellbeing. Families are the most powerful influence on
children’s lives and positive outcomes are most likely to be achieved when staff and
families work in partnership. Each family’s wellbeing and, in turn, their capacity to nurture
and support their children is influenced by the community in which they live and the
resources and support available to them.63 Effective parenting with the support of ECEC
services assists both families and ECEC services in understanding their children and
providing a protective factor against mental health difficulties in the future.
Summary and Implications for Practice
Working effectively with parents and carers helps foster development and positive mental
health in young children. In Component 3 of KidsMatter, the target areas discuss the
Families are the most powerful
influence on children’s lives and
positive outcomes are most likely
to be achieved when staff and
families work in partnership.
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importance of collaborative partnerships with families, connecting families and supporting
parenting. The aim of these target areas is to provide preventative strategies and options
for early childhood staff, families and parents/carers. In the literature these areas have
been identified as fundamental elements to children’s mental health and wellbeing. Both
the home and early childhood settings and are influential for a child’s development, hence
the importance of collaborating, connecting families and supporting parenting.
Linking families to appropriate information and education about parenting and child
development can assist them to move towards the common goal of improving children’s
social and emotional wellbeing and mental health. Early childhood staff play a critical role
in sharing important information with parents and carers about the experiences of the
children in their care. Overall, the research shows that the better a parent or carer is
supported, included within an early childhood setting and connected with the community,
the better the mental health outcomes of the child.
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