Early Mental Health Promotion in Children Through Primary Health Care Services: A Multi‐Centre Implementation
| Date | 01 March 2000 |
| Published date | 01 March 2000 |
| DOI | https://doi.org/10.1108/17465729200000017 |
| Pages | 5-17 |
| Author | John Tsiantis,Marjorie Smith,Thalia Dragonas,Antony Cox |
| Subject Matter | Health & social care |
International Journal of Mental Health Promotion VOLUME 2 ISSUE 3 • AUGUST 2000 © Pavilion Publishing (Brighton) Limited. 5
Introduction
Disorders of child mental health are common.
The prevalence ranges from 5% to 25% according to sociocultural context
(Rae-Grant et al., 1989; Verhust & Koot, 1992; Wallace et al., 1995; Bird,
1996). There is increasing evidence of continuities and connections between
child and adult mental health (Harrington et al., 1996; Robins & Rutter,1990;
Zeitlyn, 1990;
Rutter, 1995; Fergusson et al.,1997). Promotion
of child mental health is not only humane; it builds
the foundations for healthy adulthood, not just
because children become adults but also because a developmentally
compromised child impacts negatively on adults, particularly their care-givers
(Laucht et al., 1995; Hammen, 1991; Vostanis et al., 1994; Vostanis
& Nicholls, 1995; Asarnow et al.,1988; Bebbington & Kuipers, 1993).This
scenario makes clear that specialist child mental hea lth services cannot
respond directly to the needs of all children with mental health problems, that
a reduction in the level of problems can only be achieved by promoting child
development before the emergence of difficulties, and that promotion needs to
recognise the importance of processes (Cox, 1993a), such as circular
processes in which the parent affects the child and the child affects the
parent.
Prevention has been divided into community-wide, milestone or life-
transition, and high-risk (Bloom, 1968; Heller et al. ,1984). This sub-division
emphasises developmental and ecological perspectives. A
developmental perspective draws attention to processes within children, as
well as their relationship with their environment (Finkelhor,1995). For the
infant and pre-school child, the family and immediate care givers play a
crucial promotional role.
Belsky and Vondra (1989) have put parenting and the parent-child
relationship into a broad ecological framework that demonstrates how parents
mediate a range of antecedent and concurrent influences. For the older child,
parents remain vital but other influences such as peers, school and community
also impinge directly (Cox, 1997).
Within these frameworks, linear and transactional processes and causal
chains are particularly relevant to the build-up of risk factors and the onset of
disorders. As already illustrated, circular processes
are often present where disorders are sustained.
Assets and protective processes are particularly important in considering
promotion. It is not always possible to alter the risk factors for child mental
health (such as a chronic disorder in a parent, longstanding marital discord,
poor housing or poverty) but it may be possible to provide experiences that
increase the chance of a good mental health outcome.
Protective and promotional factors that have been identified for mental
health disorders in childhood and adolescence, especially noted for conduct
disorder and depression, are:
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intelligence
Early Mental Health
Promotion in Children
Through Primary Health Care
Services:
A Multi-Centre
Implementation
John Tsiantis
Professor of Child Psychiatry,
Athens University Medical School
Marjorie Smith
Deputy Director,Thomas Coram Research Unit, Institute
of Education, and
Reader in the Psychology of the Family, Institute of
Education, London
Thalia Dragonas
Professor of Social Psychology,
Department of Pre-School Education, University of
Athens
Antony Cox
Emeritus Professor of Child and Adolescent Psychiatry,
Guy’s Kings College and
St Thomas’s School of Medicine,London
FEATURE
The paper presents results from the
implementation and evaluation of a EU/WHO
multi-centre programme on the promotion of
children’s psychosocial development through
primary health care services. The aims of the
study were to develop methods for use by
primary health care workers in their contact
with families on issues pertaining to healthy
psychosocial development in the first two years
of life, to develop a training programme for
primary health care workers to implement in
their contact with the families, to evaluate the
effectiveness of the programme and to promote
the implementation of the developed
intervention techniques through the network
of primary health care services.
ABSTRACT
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