Françoise Peill

The pursuit of happiness: an early year’s explorative study into the challenges of recognising and supporting child health and wellbeing.

Françoise Peill FHEA, MEd

“The health and wellbeing of today’s children depend on us having the courage and imagination to rise to the challenge of doing things differently, to put sustainability and wellbeing before economic growth and bring about a more equal and fair society” (Marmot, Allen, et al; 2020, p.6).

Abstract

The escalating concerns in relation to child mental health and the power of early intervention are wellrecognised within the early year’s sector, however, there is no mandatory practice or model of wellbeing used within early year’s environments. Practitioners have little knowledge or have received insufficient training in order to help them recognise the signs and symptoms of poor wellbeing, and do not feel confident in measuring and monitoring the children to support positive health and wellbeing. This study examined child health and wellbeing within the early years sector and drew upon the evidence from thirty-two early years practitioners and ten nursery managers working in a deprived socio-economic community in the North-West of England.

A constructivist paradigm was used to enable qualitative data to be collected from an interactive questionnaire from thirty-two different early years settings, with further data being gathered from three theme focus groups with ten experienced nursery/preschool managers. As part of the process of analysing the findings, two credible wellbeing models were used to support the discussion: the PERMA model of wellbeing (Seligman, 2015) and the SHANARRI wheel of wellbeing (Scottish Government, 2006). The findings exposed the lack of confidence of early years practitioners in identifying the precursors of health and wellbeing, and furthermore, their capacity to be able to monitor the progress to support individual children. The key issues transpiring from this analysis highlight that clear mandatory guidance should be available for early years practitioners and that there is a need for the development of a bespoke early years model to support the measuring of child health and wellbeing.

Context of study

The town of Blackpool is a seaside resort on the coast of Lancashire, which hosts an estimated transient population of 141,500 (JSNA, Blackpool, 2020). The current data reported by Public Health England (2020), rate Blackpool as one of the 20% most deprived authorities in England and highlight that 52% of children live in low-income families.

The report states that early year’s children living in the local area are severely impacted by the social determinants of the area and the impact of poverty. The community further indicates a high rate of

unemployment, child protection issues and cases of domestic abuse. Current figures further evidence that Blackpool transcends the national averages due to the high rates of drug and alcohol abuse in the town PHE, 2019).

Furthermore, a local report for the Children’s Society (2019) suggested that children living in the local area are at a significant disadvantage and are living in extreme poverty and deprivation. A government research report (Department of Education, 2016) identified Blackpool as a pathfinder for the family focused assessment tool to support child health and wellbeing, and this multiple disciplinary method continues to develop in a coherent way. Current UK statutory guidance within the Early Years Foundation Stage (EYFS) (Department for Education, 2021), advises that practitioners should work to nurture children’s individual well-being and that there are clear correlations with the emotional aspect to child development. Additionally, Seaman and Giles (2019), acknowledge that emotional well-being plays a fundamental part in the relationships that early years children make and the way that they communicate with the world around them. Furthermore, contemporary views (2020) by the NSPCC state that one in four children are living in poverty and this has a lasting impact on their wellbeing and emotional development.

Research question

“How do early years practitioners identify, record and support child health and wellbeing in the deprived area of Blackpool?”

1. Context of literature

1.1 Definition of wellbeing

UNICEF (2019) define child wellbeing as an approach that centres the happiness and satisfaction of every child, regardless of their socio-economic environment. Well-being is related to self-realisation and selfacknowledgment of the present and forthcoming competence set for children. Additionally, UNICEF’s (2019) international research simply defines wellbeing as how happy, healthy, and satisfied children are. Contemporary focus presented by the Scottish Government (2006) and the UN Convention on the Rights of the Child Bill (2020), places the value on children’s rights and their wellbeing and advises the power of collaborative decision-making. The UNCRC supports public authorities in a bid to develop the rights of wellbeing for children and young people (UNICEF, 2019. p, 3). Similar views are presented by Ben-Arieh, Casas, et al; (2014), who define child wellbeing as the interplay between children’s rights, healthy development, and their freedom to exercise those rights. In addition, stating that they are influenced by issues at the micro level and are surrounded by the social structures of the wider community. However, in comparison, the United Kingdom Government publication (2016) discusses child wellbeing as simply the quality of a child’s life which is potentially measured by an individual’s achievement and fulfilling of social and personal goals. The report evidences the socio-economic influences that impact on child health and wellbeing and supports and promotes the use of holistic intervention to support the child succeeding.

A recent publication by The Children’s Society (2020), outlines wellbeing as an ‘umbrella term’ that should be accompanied by a collection of appropriate indicators that can be used to build up a true picture of the child. Sointu (2005) disagrees and defines wellbeing as a ‘notion’ in society and a concept that impacts a person’s happiness and discusses the development of wellbeing as an evolving notion, proposing: “a lack of definition in much health policy and practice typically leaves the term ‘well-being’ as an open-ended, catch-all category” (Cameron, Mathers, et al; 2006, p. 349).

Dodge, Daly, et al; (2015) disagree, stating that there are several opposing approaches to defining wellbeing, and it is extremely problematic to identify between a hedonic belief compared with the view of achieving and flourishing.

Early childhood experiences have a profound impact on a child’s health and wellbeing; the necessity to raise the feelings of worth and satisfaction is evident in current research (Robson, Brogaard-Clausen, et al; 2019; Susman-Stillman, et al; 2020). The contributing factors that impact early development have lasting effects of a child’s self-worth and self-esteem. The impact of poverty of early development is apparent in the work of Gupta (2019) and Lyndon (2020) who express the shared belief that deficiency has lasting damage, both psychologically and physically. Chaudry and Wimer’s research (2016) disputes that poverty is a societal stimulus in a child’s wellbeing and has a lasting impact on an individual’s cognitive growth, further highlighting the connection with child development.

1.2 UK Government influences

Current practice accentuated within the Early Years Foundation Stage (Department for Education, 2021) advises that practitioners must work to ensure that every child is supported to “develop a positive sense of themselves, forming positive relationships and develop respect for others, further developing social skills and learning how to manage their feelings.” (DfE, 2021, p.29).

The value of these early experiences is further evident in the current UK government publication (Department of Education, 2019) which places the emphasis on the benefits of offering a holistic experience for early year’s children to support their overall development. The Government further advises that a clear definition for wellbeing and a robust system for measuring it needs to be a priority.

The cross-party manifesto publication 1001 Critical Days (Leadsom, Field, et al ;2015) offered a unique vision for the provision of services in the UK to support early intervention. The document acknowledges the importance of the early months of childhood up until the age of two years and how the priority should be, at this crucial stage, to ensure babies get the best start in life to support development and wellbeing. The paper highlights, that in order for a child’s wellbeing and development to prosper, the succeeding generation should be nurtured and safeguarded (Leadsom, Field, et al; 2015).

1.3 International context

On a global scale, research conducted by Grethe Baustad and Bjørnestad (2020) highlights current early years practice in Norway. More specifically, the Early Childhood Education and Care (ECEC) model focuses on the child’s personal wellbeing and play interactions. This international educational system, used with all children in early years practice is a ‘societal pedagogic’ tradition that concentrates on the individual’s personal wellbeing and play. Practitioners utilise the Caregiver Interaction Profile scales (CIP) (Helmerhorst, Riken-Walraven et al; 2014) to record their exchanges with the children. The model focuses on the interactions with professionals as they support child wellbeing and development. The interactive technique uses a video to record the engagement between the child and staff and evaluate these high-quality communications to highlight the significance of well-being (Helmerhorst, Riksen–Walraven et al., 2014; Sylva, Melhuish, et al., 2004). These encounters are of exceptional prominence for the development of the child’s wellbeing to build a secure attachment to the main carer and support relationships.

In comparison, in Croatia, the focus is placed on the co-production of a resilience-building model. Cefai, Matsopoulos, et al; (2014) review paper promotes the need for children to work to build their resilience, in

order to overcome obstacles and challenges they face in their life. By introducing a resilience perspective in education within early years that guides children to recognising the process needed to thrive and develop when dealing with adversities, disadvantages and challenges. This core competence in education allows children to work to comprehend their emotions and build empathy for others.

Australian early years practice supports the work of Baker, Green & Falecki (2017) who portray the link between purposeful pedagogy, education and positive psychology, (Figure 1). They highlight the role of early education in shaping early child development, by placing emphasis on the importance of positive intervention, therefore enhancing the synergy between pedagogy and psychology within the early years sector. The paper forges the links between intervention, creativity and engaging teaching that supports the child to build their own resilience and thus develop their emotional intelligence.

Furthermore, similarities are highlighted within Kosovo’s early years practice within a current qualitative study conducted by Zabeli & Gjelaj (2020), which highlights that all early years activities within settings should embrace inclusive education, and wellbeing should align with all elements of happiness and achievement. Moreover, Lee, Lane, et al.’s; (2020) research in Hong Kong further values the need for happiness and appraises the effects of play. The study utilises a children’s emotional manifestation Scale (1 -5 scales) to measure emotions and recognises interaction, facial expression, and vocalization.

Finally, the Department for Educations (2018) International Early Learning and Child Well-being Study (IELS) further analyses wellbeing in a global context. The study allows for clear comparisons to be made relating to children’s development in England with children in settings in other countries. The study focuses on aspects of child development and deliberates the educational outcomes that broaden a child’s wellbeing. The ongoing findings have recently been presented in the OECD current publication 2020, and relate to the specific study of five-year-old children living in England (United Kingdom), Estonia and the United States.

Figure 1. Wellbeing synergies – positive and psychology and early childhood education (Baker, Green. et al; 2017)

2. Discussion and findings

Following the thematic analysis of the findings the identified common themes have formed the discussion, in response to the research question, “How do early years practitioners identify, record, and support child health and wellbeing in the deprived area of Blackpool?” The original aims of the study explored the sub-questions

and firstly asked thirty-two early year’s practitioners, ‘What do you understand by the term child health wellbeing and what signs identify low health and wellbeing?’ Practitioners were then asked “What tools, if any, do you use to monitor and measure child health and wellbeing? and “Do they feel they are qualified and experienced enough?”. Secondly, the theme focus groups, with ten experienced managers, explored the topic of wellbeing and their understanding, also discussing how they assist and supervise staff in their setting. Further meetings deliberated what wellbeing tools they use in their setting, and did they think staff were confident using these tools. Also, they investigated if their staff had accessed training and did they feel confident supporting child health and wellbeing in their preschool settings?

Figure 2. Coding of data to form thematic analyses from early year’s practitioner’s questionnaires

Figure 3. Coding of data from themed focus groups

Theme one Definition of wellbeing 29/32 responses Theme two Understanding of wellbeing 30/32 responses Theme three Measuring 20/32 responses Theme four Effective model to measure and monitor 28/32 responses Theme five Qualifications and training 30/32 responses

Theme one Definition of wellbeing 10/10 managers Theme two Understanding of wellbeing 9/10 managers Theme three Measuring 9/10 managers Theme four Effective model to measure and monitor 8/10 managers Theme five Qualifications and training 10/10 managers

The findings from the early year’s practitioners clearly evidence that they link child health and wellbeing with the happiness of the child, and clarity is needed as to how wellbeing is defined. Both managers and practitioners echo the need for training and a reform in the content of qualifications to equip them with the skills they need and/or desire in order to support early year’s children. Finally, the challenge of measuring child health and wellbeing was paramount for all early year professionals, the results further indicated that no wellbeing tool is favoured by practitioners and confidence is lacking in using the various tools and models.

Emerging themes from the findings

2.1 Definition and understanding of child health and wellbeing

The research has highlighted a number of emerging themes via the responses of the thirty-two early years practitioners and the ten managers. What is clear within both the literature review and the research that there is no clear definition of child health and wellbeing (Morrow and Mayall, 2009; Thompson and Aked, 2009; Dodge et al, 2012). This is problematic for practitioners as they struggle to recognise, observe, and monitor issues within their setting. There is a great need for clarity and to generate a clear comprehensive definition that is both concise and comprehensible for practitioners to use (Pollard & Lee, 2003). Furthermore, the research data evidenced that half of the participants involved in the survey have a level three early years qualification, with a further quarter having a level four and a further quarter having a level five qualification as their highest form of qualification. It was clear that early year’s practitioners had varying views in relation to what health and wellbeing is, with many of the less qualified staff referring to it simply as ‘happiness’ and ‘whether the child appears happy’.

Practitioners further stated that child wellbeing is centred on whether the child feels content and happy. Similar views are evident in the international views of Lee, Lane, et al; (2020). This study attempted to appraise happiness and examine the effects of play in relation to intervention within early years settings. This echoes the work of the OECD study of five years olds (2020), which affirms that in order for a child to feel happy and thrive they must be reinforced by a strong, solid foundation surrounding them. However, Sointu (2005) disputes these views believing that wellbeing is simply a ‘notion’ in society and a concept that impacts a person’s happiness.

In comparison, more qualified staff viewed wellbeing as emotional development and the child’s ability to control their emotions. Several responses highlighted that health and wellbeing is more about a child’s emotional state, not just their cognition. This reflects the views of Seaman and Giles (2019) who accept that emotional well-being plays an essential role in the relationships that early years children form, and this supports them to interact with others. Similar principles can be seen in Croatia’s early years practice (Cefai, Matospoulos et al, 2014) which places emphasis on supporting children to work to understand their emotions and therefore build empathy for others. The approaches focus on empowering children so they can manage negative emotions, such as failure and anger.

The focus group discussions suggested that participants regarded health and wellbeing as an emotional developmental stage and believe positive wellbeing can lead to confidence and resilience within the child’s learning. Managers placed more emphasis on the external factors that can impact the child’s wellbeing highlighting that if the child’s early atmosphere is toxic, this can impact on their early brain development which can have detrimental effects for the rest of the child’s life. Similar principles are present in Bronfenbrenner’s (1979) ecological framework, which stresses the influences of social and economic factors which in turn form the layers of the community that influence a child’s wellbeing. Furthermore, the multi-layer process of Anspaugh, Hamrick and Rosato (2004) supports the holistic dimensions of wellnesses and recognition of social, emotional, physical and spiritual. All three ideologies champion and endorse the need for positive interactions within early years and value the significance of this in all areas of child development.

Anspaugh, Hamrick, and Rosato (2004) further evidence the views that the ‘holistic dimensions of wellnesses’ promote the concept that wellbeing is a multi-layer process that includes all areas of development socially, emotionally, physically and spiritually thus stating that the child’s holistic development is essential on building positive health and wellbeing. Furthermore, global recognition can be found in the Department for Education (2018) International Early Learning and Child Well-being Study (IELS), which focuses on all aspects of child development and considers the educational outcomes that increase positive wellbeing. This comparative ongoing study analyses child wellbeing within a global context and evaluates the factors that implicate child development. There are similar priorities highlighted in the current UK government focus (2020), which places emphasis on the benefits of offering a holistic experience for early year’s children to support their overall development.

Finally, there is evidence presented in the findings that illustrates that many early years practitioners recognise issues with the child’s health and wellbeing via physical, observable signs. Many highlighted the child’s behaviour or recognising a dramatic change in behaviour and sometimes a change in the child’s normal mood. Some highlighted that the child may become more introverted or lack social and communication skills and show little engagement. In comparison with the focus groups discussion, managers placed some focus on the child’s ability to build resilience, which replicates global practice in Croatia that places the emphasis on the building of resilience within early years. Cefai, Matsopoulos, et al; (2014) focus on self-regulation and the child’s ability to manage their own anger and negative emotions.

2.2 The challenge of measuring child health and wellbeing and what model is more effective

The study has provided clear findings that both the early years practitioners and managers lack self-assurance in their ability in using the various wellbeing tools accessed in early years practice. The main findings from the survey illustrated that Nursery staff do not feel confident using the adopted tools and felt they had not received sufficient training to complete the associated scales. They also lacked confidence in their own abilities, with some of the less experienced members of the team feeling that they had not had enough experience to recognise and identify what good wellbeing looks like. The views of Coles, Cheyne and Daniel (2015) highlight the challenges of early years intervention in relation to child health and wellbeing and explore the challenge of making improvements to the sector to assist early years. Similar views are suggested by Susman-Stillman, Meuwissen and Watson (2020) who recognise the pressures within the early years sector for practitioners in supporting child health and wellbeing.

Additionally, this is corroborated by the current views of Lyndon (2020), who discussed the pressure that early year’s practitioners face within their daily practice. The research discusses the increasing pressure for practitioners supporting and working in deprived areas (Susman-Stillman, Meuwissen and Watson, 2020). The analysis of the findings clearly evidences the challenges of working in a deficient area, with both practitioners and managers stating the stress this can cause them, particularly if they have experienced their own mental health issues and have grown up within the local community. It is clear that early year’s practitioners require a wide variety of skills in order to understand children’s feelings, and as key workers they should work to ensure they are nurturing children to develop positive relationships and empathy towards others (Blair and Raver, 2012; Chaudry and Wimer, 2016).

Early year’s practitioners did not favour any of the health and wellbeing tools suggested, and in fact, none have been adopted as mandatory practice. Both the Leuvan scale and SHANARRI wheel (Scottish Government, 2006) were being used to measure and monitor wellbeing. What was particularly alarming, was the fact that nearly a quarter of the early year’s practitioner respondents highlighted that their setting did not use any formal process for monitoring health and wellbeing at all. This could suggest that some practitioners do not appreciate the urgency and relevance of supporting health and wellbeing and the detrimental effect it can have on a child’s development and on their later life.

A further twenty-eight percentage of the study stated that they use some form of feelings, reward or progress chart to monitor wellbeing. This equates to nearly half of the participants involved in the research stating that they has been no official practice adopted in their setting to monitor and measure child health and wellbeing. Evidence within the findings further highlights that some less experienced staff struggle to measure and recognise “what good wellbeing looks like?”. This correlates with the interpretations specified by the global OECD Child Well-Being Data Portal (2020), (Appendix 4) which ranks England as one of the lowest ranking global countries when supporting early years positive involvements for children. Furthermore, the Department for Education (2018) International Early Learning and Child Well-being Study (IELS) presented comparisons and outlined the ongoing study which analysed the factors that implicate child development. The findings highlighted and emphasised the benefits of observing a holistic experience for early years children to support their overall development.

2.3. Qualification and training needed to support early year’s children

The study highlighted that over half of the early year’s practitioners participating did not feel sufficiently qualified to implement appropriate interventions and stated they felt that a more bespoke training is needed. Practitioners stated they lack essential knowledge and understanding and simply did not know what they are looking for when identifying the signs and symptoms of child health and wellbeing. They also highlighted the

responsibility of monitoring wellbeing and stated they often felt out of their depth. The Managers echoed the same views as they further recognised that younger, less-experienced staff struggled to recognise and monitor their abilities when supporting children’s health and wellbeing. The findings evidenced that better mandatory training should be available to all staff that is tailor-made for early years professionals.

This supports the findings of UK governments (Nutbrown, 2014) that emphasises the need for all nursery workers to be suitably skilled and well-qualified practitioners in every early years setting, dictating that high quality early education can significantly impact on child development and learning. The review focused on children living in particularly low-income areas and highlighted the impact of this on their wellbeing and the need for better outcomes for these at-risk families (Sylva, Melhuish, et al; 2004. Mathers, Eisenstadt, et al; 2014). In more contemporary research, Archer & Merrick (2020), further recognise the importance of a well-trained, high-quality workforce in recognising the issues with the child’s emotional wellbeing at the earliest point, in order to improve a child’s long-term outcomes and increase the chance of better societal progression. Similar views are presented by Coles, Cheyne and Daniel (2015) which confirms how and why early years professionals need clarity on child health and wellbeing, and the need to use a directed framework that monitors and measures wellbeing.

Early year’s managers indicated that they witness younger, less experienced staff struggling to recognise wellbeing and were not assertive in monitoring and supporting this. A further contemporary study conducted by Kay, Wood, Nuttall, & Henderson, (2021) examines the early years workforce reform in England and scrutinises early childhood education in relation to policies and qualification. The findings suggest that both the early years practitioners and managers see the value of training in relation to supporting health and wellbeing, with the majority of practitioners’ responses, in particular the more qualified early year’s staff, valued the importance of building relationships and getting to know the children, and view this as an important element of supporting child health and wellbeing. This reflects the views of Gupta (2019) who believes that relationships in the early years play a fundamental part of communication and development, supporting the practitioner to build a rapport with their key children. The importance of successful relationships is integral to the PERMA model of wellbeing (Seligman, 2012) which is the focus of one of the five priorities to happiness and positive wellbeing. A similar focus is present within Norwegian early years practice, which promotes the Early Childhood Education and Care (ECEC) model of child personal wellbeing and play interactions. This concentrates on the social interactions of professionals supporting child health and wellbeing (Helmerhorst et al., 2014; Sylva, Melhuish, et al; 2004. These recorded encounters help the child to build a secure attachment to the main carer and support the building of relationships. As key workers, practitioners need to develop their skill to comprehend children’s emotions and guarantee they are building positive relationships (Blair and Raver, 2012).

The initial research has allowed for an in-depth thematic analysis to be conducted from an early years and managers’ perspective. It has been suggested that early years practitioners view wellbeing differently, illustrating that there is a need for a clear definition of wellbeing to be established as there is confusion among the sector and there is a need for clarity for professionals (Cameron, Mathers. et al; 2006; Morrow and Mayall, 2009).

The research further illustrated that additional training is needed to support the early years workforce in combat the rising issues of supporting low child health and wellbeing (Nutbrown, 2014: Kay, Wood, Nuttall, & Henderson, 2021). This further places the attention on current early years qualification that shape and develop the early years workforce to influence the reform of course content of qualifications and reflect the current rise and issues in health and wellbeing concerns. Furthermore, it stresses the importance of the key worker relationship and the need for practitioners to build successful rapport with children (Grethe Baustad and Bjørnestad 2020; Helmerhorst, Riksen–Walraven, et al; 2014).

3. Conclusion

On reflection, it is apparent that early year’s practice has changed immensely over the last twenty-five years and the challenges that practitioners face in the sector is demanding. The words of one early year’s practitioner is particularly memorable “I do not know what I am looking for, what does good child health and wellbeing look like?”. As early years educators, it is our role to ensure we shape and train practitioners to meet the needs of current contemporary practice and furnish them with the skills to support their roles. It is clear how practice has changed radically over the years and the need for reform within qualifications to reflect the changing issues within the sector (Nutbrown, 2014: Kay, Wood, Nuttall, & Henderson, 2021). The subject of child health and wellbeing was rarely discussed historically, however, more recently via education and the constant pressure of society, the evolving issues of health and wellbeing needs to be supported efficiently.

The constructivist interpretivist approach has allowed for the gathering of rich descriptive data to emerge from the heart of early years, gathering individual opinions and views. Recognition must be given to the practitioners working amidst the many daily challenges to support the children in deprived socio-economic communities. (Lyndon, 2020; Susman-Stillman, Meuwissen and Watson, 2020). The approach however further allowed for their views to scrutinise and reveal there is not one truth which was apparent from the findings. The cohesion between the findings clearly advocates the need for a mandatory tool to be adopted by practitioners, alongside comprehensive training which will arm early years practitioners with the tools to support children living in the deprived area of Blackpool.

My own wellbeing model will reaffirm the principles highlighted from the EYFS (DfE, 2021) and will centre around the holistic development of health and wellbeing, concentrating on happiness and contentment, emotional intelligence, communication and relationships, and external socio-economic influences (Ben-Arieh, Casas, et al; 2014; Kay, Wood, Nuttall, & Henderson, 2021; Marmot, Allen, et al; 2020; Seaman and Giles, 2019). The tool will allow practitioners to make an initial assessment on the child in relation to the external socio-economic factors that can influence child health and wellbeing. The model will further support the key principles identified within the EYFS early learning goals for personal, social, and emotional development which highlight self-regulation, managing self and building relationships.

Figure 4. SERCCH model of wellbeing (2021)

Figure 4. Guidance sheet for Early Years practitioners

Socio economic factors

Emotional intelligence

Relationships

Communication

Contentment

Happiness

What contributing factors are influencing the child’s day to day life? Can the child regulate their own emotions? Can the child control their behaviour and does not evidence emotional outburst? Can the child follow instructions and simple rules? Does the child form relationships peer to peer and with other adults? Will the child be comforted by a key worker or an adult? Does the child show empathy towards others? Does the child play with other children? Does the child speak with others? Is the child content and happy? Does the child show confidence with attempt new challenges? Does the child cope with failure and adversity and show resilience to the situation? Does the child become upset easily and show emotional maturity? Does the child laugh and engage positively with others?

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