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Mental health promotion

Organisational level: Interventions to promote mental health - Pre-school children in day care settings

Read Overview

Day care for pre-school children covers a range of ill-defined interventions that include care of children in out of the home day care settings. The general term used in the literature is Early Childhood Care and Education (ECCE).

The proportion of children under 5 years who attend day care varies by country. In the UK all children aged 3–4 years now have the right to 12.5 hours a week part-time education for 38 weeks a year. This will increase to 15 hours by 2010 and in the longer term to 20 hours.

Day care programmes for at-risk children and families include additional elements such as parent involvement to improve parenting skills or parenting programmes, free transport, toy lending, meals, and being a hub for other health and social services. Some also include regular home visiting.

The benefit of providing an intervention in an organisational setting is that intensity and frequency of intervention will probably be higher than that achieved by individual or group interventions. Organisational interventions also provide the opportunity for making the desired behaviours part of the "norm", thus reinforcing the intervention.

The purpose of day care programmes has often been educational outcomes to promote speech and language acquisition, and socialisation to promote concentration and learning for later school life. These programmes are likely to impact on the mental wellbeing of adults by tackling major risk factors such as school failure, incarceration, and poor jobs. 1



In this section:

Key Messages

  • There have been three reviews, one systematic review of reviews 2 , a Cochrane review 3 and a review of follow-up studies 4 , which have investigated promotion of mental health in pre-school children in day care settings.
  • When IQ or cognitive functioning was measured, there were initial improvements in these outcomes but they diminished after a year or two following the end of day care. 3
  • One study revealed that day care prevented school failure later in life. 3
  • At 19 years, 50% of the experimental group who attended the Perry Pre-School project held jobs compared with 32% of the control group and more were still in education (38% versus 21%). 3 The long term outcome at 27 years showed that five times as many from the control group had been arrested five or more times than the experimental group (35% versus 7%, respectively). 3
  • Longitudinal research has shown impacts of pre-school educational and care interventions on social-emotional behaviour at 9 years and at high school and beyond years. Effect sizes were small but persistent averaging around 0.3 at age 9 years and at high school and beyond. The effects on parent-family functioning were also small. 4
  • Programs that included a child education component were more effective than those that just targeting parents and improving children’s cognitive functioning at pre-school and at age 9 years. 4

Population Interventions

Interventions that do work

High intensity educational day care

Zoritch’s Cochrane review 3 and Nelson’s longitudinal review 4 investigate the impacts that early educational day care programmes can have on a range of outcomes for children. These outcomes include social competence, reduced smoking and drug use, better cognitive development, better parent/child relationship, reduced antisocial behaviour and lower arrest rates and higher employment in adult life.

Characteristics of successful (high intensity) educational day care programmes for young children that have been shown to be effective in promoting the mental health of young children in day care are 2 :

  • Well qualified and well paid teachers;
  • A lower teacher to student ratio (1:7 was better than 1:10);
  • A well designed curriculum with age appropriate problem solving training (see individual level intervention: Interpersonal problem solving), acquisition of reading and language skills, and other cognitive and social skills (such as getting on with others);
  • On-going teacher support and supervision;
  • Intensive over at least two years;
  • Opportunities for parental involvement in the classroom; and
  • A comprehensive range of other programmes such as parenting programmes, free breakfast and lunch, on-going involvement of health and social services, transport, practical assistance with meeting urgent family needs.

Interventions that may work

Low intensity educational day care

Low intensity educational day care, for example, held for a few sessions a week, has variable results. 2 Programmes that start at age 4 years seem to be less successful than those starting at 3 years. 3

Two-generation programmes provide both educational day care for children and assist the older generation (their parents) in becoming more self-sufficient (for example, by providing education and literacy, job training, parenting skills). Most of these programmes had a case manager who coordinated the programmes. The programmes had modest positive effects, but were variable with very high drop-out rates in the parent component. 3

Interventions that do not work

No evaluations of day care caused harm. There has been concern that day care would affect mother–child interaction, but the evidence to date seems to suggest there is improvement.

What we don't know

Many studies provide other elements of care such as parenting programmes and home visiting, so it is difficult to ascertain the benefit of the day care alone.

The two-generation programme review looked at a range of elements for parents but did not find convincing evidence of additional benefit. 2

Most programmes have targeted at-risk children from poor families. There is insufficient research evidence to show that the gains in these children will be found similarly across the socioeconomic spectrum.

Summary of the evidence

Table 1 summarises the main mental health and wellbeing outcomes reported on in the studies. 2

Table 1. Summary of effect sizes for educational day care[2]*† (studies in these meta-analyses overlap)

Study Number of studies Effect size Outcomes
Anderson 2002 5 5 0.39 Positive effect on social competence (getting along with others)
Anderson 2002 5 5 –0.41 Reduction of risk factors such as smoking and drug use
Mrazek and Brown 1999 6 18 0.13 to 1.45 Positive effect on cognitive development
Mrazek and Brown 1999 6 2 0.66 to 0.8 (not significant) Intervention improves parenting/parent–child relationship
Yoshikawa 7 4 0.48 to 1.13 Improves antisocial behaviour and delinquency outcomes

* Excludes results from Durlak and Wells 8 which report the effects of components of day care rather than the overall impact of day care.

†Effect size 0.2 indicates a small effect; 0.5 moderate effect; 0.8 large effect.

References

  1. Commonwealth Department of Health and Aged Care. Promotion, Prevention and Early Intervention for Mental Health – A monograph. Canberra: Mental Health and Special Programs Branch, Commonwealth Department of Health and Aged Care, 2000. Cited in: Department of Health. Making it Happen: A guide to delivering mental health promotion. London: Department of Health, 2001.
  2. Thomas H, Boyle M, Micucci S, et al. Community based interventions to improve child mental health: review of reviews. Effective Public Health Practice Project City of Hamilton Social and Public Health Sciences, PHRED program. December 2002.
  3. Zoritch B, Roberts I, Oakley A. Day care for pre-school children. Cochrane Database Syst Rev 2000;3:CD000564. External Link
  4. Nelson G, Westhues A. A meta-analysis of longitudinal research on pre-school prevention programs for children. Prevention and Treatment 2003, 6.
  5. Anderson L, Shinn C, St Charles J. Community interventions to promote healthy social environments: Early childhood development and family housing. Morbidity and Mortality Weekly Report: 2002;51:1-8. External Link
  6. Mraszek PJ, Hendricks Brown C. An evidence-based literature review regarding outcomes in psychosocial prevention and early intervention in young children. Bethesda, Maryland: Prevention Technologies, LLC.
  7. Yoshikawa H. Long term effects of early childhood programs on social outcomes and delinquency. Future of Children:1995;5:51-75. External Link
  8. Durlak JA, Wells AM. Primary prevention mental health programs for children and adolescents: a meta-analytic review. Am J Community Psychol 1997;25:115–50. External Link

Contributors

Dr Hilary Guite

Mental Health

Hilary qualified as a doctor in 1981, initially working in medical oncology and later training in general practice in London’s East End. This gave her an insight into the impact of socio-demographic deprivation on people’s physical and mental well-being leading her to retrain in Public Health Medicine. She completed this training in 1994 having worked on the public health aspects of mental health since 1992, initially working on the implications of the Reed report into services for Mentally Disordered Offenders. She works part-time for Greenwich Teaching Primary Care Trust on a range of public mental health topics including the impact of the physical environment on mental health, equity audits for community mental health teams and the development of primary care mental health and the development of a new care pathway for Mentally Disordered Offenders. She is now working one day a month as an associate of the London Development Centre for Mental Health (LDCMH) advising on public health aspects of mental health promotion and mental health services.