An evaluation of a newly established psychoanalytically informed Under-fives Service in four children’s centres

Bithell, Julie (2022) An evaluation of a newly established psychoanalytically informed Under-fives Service in four children’s centres. Professional Doctorate thesis, Tavistock and Portman NHS Foundation Trust/University of East London. Full text available

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A new community CAHMS Under-fives Service was commissioned by the local NHS commissioning group CCG to address unmet mental health provision for children under five, their families and allied professionals in health and social care. The research did not commission the service. Under-fives clinicians are co-located one day a week in each of the four children’s centres, attending universal stay and play sessions, consultations with parents and staff and deliver clinical intervention, parent–infant psychotherapy. The study investigates the experiences of children’s centre practitioners who have worked alongside under-fives clinicians or made use of the consultations The views of six children’s centre practitioners, from four centres, were gathered using semi-structured interviews and analysed using Thematic Analysis. Four core themes emerged: presence in the children’s centres; a different way of thinking; learning and development; and organisational challenges. The findings suggest the co-location of the Under-fives Service has generated a working alliance and broken-down barriers of engagement. The findings identify the informality of the service: clinicians being visible, approachable and working alongside the children’s centre practitioners in the universal group settings is key to the successful integration of the Under-fives Service. The findings further indicate informal reflective discussions, as opposed to a more formal work discussion model, with opportunities to reflect and share observations broke down professional defences. Clinicians skills were also identified: observations, reflective thinking and specialist knowledge contained practitioners’ anxieties and developed a joint focus on emotional communications. Practitioners are more thoughtful to the meanings of a child’s behaviour, and are more likely to focus on children’s emotional wellbeing and on the parent–child relationship than on parents’ difficulties and developmental issues that keep the child at the centre. The findings also indicate practitioners have developed a deeper understanding of the importance of the quality of the early parent–child relationship in the development of a child. Practitioners are more confident in identifying infant mental health/parent–infant difficulties and feel more skilled to intervene. They feel more knowledgeable about CAMHS and better supported and are more likely to refer a child to CAMHS if needed. They feel CAMHS is a more accessible and less stigmatising service. The practitioners identified a lack of resources as the primary limitation of the Under-fives Service, and a need for training in infant mental health for all staff in the children’s centres. They suggest this model of working could be introduced to all children’s centres to support staff in delivering child-focused practice.

Item Type: Thesis (Professional Doctorate)
Additional Information: Thesis submitted in partial fulfilment of the requirements of the Tavistock and Portman NHS Foundation Trust and the University of East London for the degree of Professional Doctorate in Child and Adolescent Psychoanalytic Psychotherapy.
Uncontrolled Keywords: Professional Doctorate in Child and Adolescent Psychoanalytic Psychotherapy,University of East London
Subjects: Children, Young People and Developmental Pyschology > Child Psychotherapy
Families > Parent Child Relations/Parenthood
Research, Tests, Assessments > Psychotherapy Research
Department/People: Children, Young Adult and Family Services

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