Newsletter No. 32

Child Care and Kindergartens
The concept of the kindergarten as a place where children’s social, emotional, cognitive and language development could be enhanced along with their physical health and general well-being, has been widely accepted since it was first advocated by Friedrich Froebel throughout the first half of the nineteenth century. Although Australian Governments were slow to accept their responsibilities, kindergartens have been supported from shortly after the second world war. Despite research such as the Wood Green project demonstrating that high quality early childhood services profoundly improve the whole future life trajectories of children who receive them, and produce long term benefits many times greater than the cost, Governments are still reluctant to spend money on this means of improving the human capital of the nation.
In past years advocacy for kindergartens came primarily from the public health movement. The role was seen as enhancing the total development of the child. In recent public debate, however, the emphasis has shifted towards the early education aspect, as demonstrated by improved levels of literacy and numeracy. The debate has been further confused by the overlap of kindergarten teaching and pre-school care for children whose parents are in the work-force. The labour-intensive nature of child care and its resultant high cost has taken the spotlight, compounded by political ideology about whether users should pay or whether it is an investment by society in its future.
Amidst this debate, questions have been asked about the efficiency and effectiveness of the kindergarten (and pre-school child care) programs. It is right and proper that research should be done in this area. It is important, however, not to assume that gains in literacy and numeracy are the only, or even the most important, benchmarks of children’s developmental progress.
A recent article in ‘The Age’ highlighted a research finding of ‘quality of instruction’ in Australian pre-schools to rate an average of 2 out of 7 on their rating scale, which they describe as “shocking”. The researchers observed a low level of quality interactions and too many missed opportunities for teaching. They were quoted as saying, “[Staff] don’t see the opportunity to teach. It’s a very poor story in terms of the educational content of these programs.”
Professor Thorpe, the lead researcher from Queensland University of Technology, suggested this was because past early childhood sector regulations only required services to meet a minimum standard to be accredited. “That’s what people were working to — an average. They’re actually working to minimum standards,” she said.
The federal government’s national quality standards, which came into effect on January 1, along with the national curriculum, are aimed at improving teaching standards in preschools to better prepare children for their primary school years. The new national standards include lifting the minimum standard of qualifications for staff, education benchmarks, better staff/ child ratios, and a guaranteed fifteen hours of preschool for all four-year-olds.
“The new standards are asking us to work to optimal levels,” Professor Thorpe said. “You would hope this would shift quality” “Research suggests the early environment does make a difference to a child in the long term.”
Barbara Romeril, executive director of Community Child Care Victoria, which represents community and council-run centres, said she was not surprised the study had found “we don’t come up to scratch on average”, because all three areas of the sector — childcare, family day- care and preschools — had been factored into the analysis. She said qualifications ranged from four-year university educated preschool teachers to family day-care workers who only needed to be enrolled in a certificate III course in childcare. “It is really chalk and cheese,” Ms Romeril said. “Some [workers] in the sector don’t have qualifications at all, but that will change as the new standards come in.”
MHYFVic strongly supports the implementation of the new standards, and ongoing research into the cost-effectiveness of various staffing ratios because of concerns that the new regulations might not go far enough. The quality of interaction of parents with infants is crucial in attachment and in development of cognitive and language skills and emotional security. In the absence of parents the pre-school and child care staff are alternative attachment figures who play a substitute developmental role. The quality of their interaction depends not only on their personal attributes and training but also on the time they have for responding to the children’s needs. The time is affected by the staffing ratios and the range of tasks undertaken. For example, time for administrative and cleanliness duties must be allowed for in the appropriate ratios.
Plans for shifting responsibility for kindergarten resourcing from Health to Education jurisdiction raised concerns that the holistic emphasis might be lost. The whole development of the child is important, including language and social/emotional development, not just literacy and numeracy. The Education Department gave assurances that pre-school programs would continue to be holistic, which is in keeping with the plan for improved standards. This being the case, it would be reasonable to also shift responsibility for child care to jurisdiction of the Education Department. Child care is not simply a means of enabling parents to return to the employment workforce, it is also an integral part of the developmental progress of our children and the intellectual capital of the nation.
Allan Mawdsley and Sarina Smale

The Big Tent
Liaison and consultation on pre-schoolers for Pre-School Field Officers
Pre-School Field Officers visit over 240 kindergartens, pre-schools, and child care centres in Victoria. The Field Officer is a specialist in consultation and liaison work who seeks to help struggling four-year-olds adapt to the learning environment and the relations with other children. At any one time, a Field Officer may be involved with 100 children of concern. Sometimes they act in the role of therapists with the children when parents do not engage with other services. Dr Francis Macnab, of The Cairnmillar Institute, began consulting with a group of Field Officers in the mid-1980s and has done so ever since, on a monthly basis.
Back then, they were called Kindergarten Field Officers, and the consultation acquired the name KFOG (Kindergarten Field Officers Group). The participants come along and talk about children with special psychological needs and sometimes they are helped with being therapists to the children. Anecdotally, the Field Officers report benefits for the children and the longevity of the consultation suggests that the participants have valued the opportunity, but does consultation and liaison work?
In its fifty-first year, Cairnmillar, having received funding from generous benefactors, will study the benefits of this consultation for the Field Officers and for the children. Dr Erin Pearson has been appointed to head the research, but the consultation will continue with Dr Macnab, Robyn Gordon, and other Cairnmillar staff engaged in an expanded consultation service.
Labelled, internally, the Big Tent project, the name came from one of the benefactors who suggested that small time evaluative research was limiting of the potential benefit to the children, the Field Officers, and to the wider community. The program has helped thousands of children, potentially, and Cairnmillar was encouraged to make the most of the acquired skill, knowledge, and connections to demonstrate the value of a mental health prevention program.
It is a challenge built on the preventive value of pre-school education, in general. MHYF Vic awaits more news of the venture.
Jo Grimwade

History Corner 1902 and 1987
Mental health consultation
Consultation services in child and adolescent mental health probably began at the time that Healy began his foundational studies of juvenile delinquency. This was in 1909 when Chicago and Boston youth were surveyed as to the causes of their criminal behaviour. From these studies, the structure of medico, psychologist, and social worker that was to be the foundation for all Child Guidance Clinics was developed. Social workers had the role of working with parents and conducting community liaison with respect to the clients.

Liaison psychiatry was a specialty in adult mental health prior to the First World War, but was developed in the USA by such psychoanalytic luminaries as Franz Alexander and Felix Deutsch. The aim is simple enough: to help general medical wards cope with psychological disturbance in patients who have medical conditions.
Mosher in 1902, at Albany Hospital, New York, sought to bring psychiatrists and non-psychiatrists together for the sake of training and to help the patient. In 1922, Barrett wrote of psychiatry as a liaison science between medicine and social problems. Similarly, Pratt saw the function as integrating all medical knowledge of the patient. Billings first used the term at the University of Colorado in 1937. Most trace their influence back to Adolf Meyer’s “biopsychological” approach; which, incidentally, was behind the research of Healy.
Liaison psychiatry was developed in parallel with the new science of psychosomatics, as there was a need to understand mind-body interaction and how that manifested on the hospital ward. In 1997, there was established a European Association for Consultation Liaison Psychiatry and Psychosomatics and guidelines for training were delineated.
The biggest step in the field was initiated through George Engel’s “biopsychosocial” model, which helped formalize thinking around the interaction between biological, psychological, and social processes. Dax recorded that mental health consultation was part of the mandate of the fledgling Child Psychiatry service in Victoria in his introduction to the book accompanying the Mental Health movement’s world conference in Melbourne in 1960.
Consultation can be a very vexed process and some of us are good at it and some are not. A curious mix of listening, teaching, and synthesizing a plan of action while attending to the various needs of the consulting group and the issues of the cases, is a significant and stimulating intellectual and interpersonal task. Meetings are usually monthly to a small invited group centred on one service or on one district (e.g. Ballarat services). There have been a few consultations that have lasted a very long time: Dr Allan Mawdsley visited the DHS (or as otherwise known) office in the southern suburbs (various addresses) for over twenty years. Dr Francis Macnab has kept up his consultation to Kindergarten (now Pre-School) Field Officers for over 25 years, on a monthly basis.

GET READY FOR THE CITY OF LIGHTS!!
MHYF Vic takes Advocacy Issues to the World Congress!!
Paris from July 21st to-25th will host the 20th World Congress of the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP).
MHYF Vic is playing an important role at the Congress in continuing to concentrate world attention upon how to place the client/ consumer / carer at the centre of child, adolescent and family mental health work. Symposia will focus on advocacy for the field, and on collaboration between professionals and consumers/carers in doing this. Involved are Victorians, including Sarina Smale, Suzie Dean and Lynne Ruggiero (Lynne from Austin CAMHS), joined by colleagues from Queensland (Erica Lee, Mater Hospital), the USA (Myron Belfer and Gordon Harper, Childrens Hospital Boston), and France (Elsa Willay, the National Autism Association).
One of the Symposia will demonstrate how Psychotherapy services involve a collaborative venture aimed to enable the child, adolescent or parent to find their own voice to express concerns, to discover more about the concerns of other family members, and to thus increase flexibility and control in stepping forth in life. The nature of the relationship between service provider and service user is seen as critical. The Symposium is entitled “Meetings of minds: the centrality and power of the clinician-client relationship in psychotherapy from infancy to young adulthood”; Suzie Dean (Victoria University), Jo Grimwade (Cairnmillar Institute), Campbell Paul (Royal Children’s Hospital) and Ros Webb (Victorian Child Psychotherapy Association) will present papers highlighting different aspects.
Watch this space in the next Newsletter for reports on the outcomes for advocacy of MHYF Vic’s work at the Congress!

WINSTON RICKARDS MEMORIAL ORATION for 2012
This will take place on August 8th 2012, at 7.30pm, in the Latham Theatre at the Royal Children’s Hospital.
The former Chief Justice of the Family Court of Australia, Alastair Nicholson, will reflect upon his unique experience of urgent problems and issues currently facing families in Australia, in presenting the Winston Rickards Memorial Oration (WRMO) 2012.
The WRMO is the most notable public presentation in the child, adolescent and family mental health field in Australia. It is organised on an annual basis by MHYF Vic, and is co-sponsored by the Mental Health Foundation, The Australian Infant, Child, Adolescent and Family Mental Health Association, the Faculty of Child and Adolescent Psychiatry (RANZCP), and Royal Childrens Hospital Mental Health Service.