Literature Review Component 3: Working with parents and carers



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Literature Review

Component 3: Working with parents and carers

© Commonwealth of Australia 2012


Acknowledgement


KidsMatter Early Childhood Mental Health Initiative has been developed in collaboration with beyondblue, the Australian Psychological Society, Early Childhood Australia and, with funding from, The Australian Government Department of Health and Ageing and beyondblue.

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’.

Disclaimer


While every care has been taken in preparing this publication, Beyond Blue Ltd, The Australian Psychological Society Ltd and Early Childhood Australia Inc and the Commonwealth of Australia, do not, to the extent permitted by law, accept any liability for any injury, loss or damage suffered by any person arising from the use of, or reliance on, the content of this publication.

Contents


Component 3: Working with parents and carers 1

Acknowledgement 2

Important Notice 2

Disclaimer 2



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 12

Supporting parenting 13

Summary and Implications for Practice 16

References 18

This resource is part of the KidsMatter Early Childhood Initiative. The KidsMatter Early Childhood team welcomes your feedback at www.kidsmatter.edu.au 23





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, the Australian Psychological Society 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.

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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.



  1. 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.



  1. 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.



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 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.4cid:image003.jpg@01cced57.6139fe30
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



Collaborative partnerships are based on a sharing of knowledge, trust and mutual respect.
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 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


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.

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.
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 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)



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 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

Good relationships between early childhood staff and families is a protective factor for children’s mental health.
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


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

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.
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 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




Surrounding children with positive relationships can act as a buffer against the detrimental effects of stress.
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 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


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.

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 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
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

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.
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 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.


References



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24. Webster-Stratton C, Reid MJ, Hammond M. Preventing conduct problems, promoting social competence: A parent and teacher training partnership in Head Start. Journal of Clinical Child Psychology. 2001;30(3):283-302.

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29. Commonwealth Department of Health and Aged Care. Promotion, prevention and early intervention for mental health - A monograph. In: Mental Health Special Programs Branch, ed. Canberra: Author; 2000.

30. Department of Families Housing Community Services and Indigenous Affairs. Social Policy Research Paper No. 34: Parenting and families in Australia. Barton, ACT: Commonwealth of Australia; 2008.

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