Services for pre-school children with behaviour problems in a Midlands city

Objectives To study the services for pre-school children with behaviour problems in a Midlands city and the level of co-ordination and co-operation between providers. Setting A socially and ethnically diverse Midlands city in the UK. Methods Survey methods were employed with city health visitors in order to determine their role and identify service providers. Service providers from different agencies were interviewed and data collected related to service offered, materials used, theoretical basis of interventions, referrals to and from the service, inclusion and exclusion criteria and co-ordination and co-operation with other providers. Themes were identified related to the content and process of the services using qualitative data analysis methods. Frequencies of themes were estimated for different provider groups. Results Health visitors and nursery nurses working in the primary care services were the primary point of contact for children with pre-school behaviour problems. Nursery nurses were one of the major sources of referral for children with pre-school behaviour problems and a significant majority of these providers had not received any specific training for this role. The majority of the providers used evidence-based programmes but few adhered strictly to a particular programme and instead used a mixture of materials drawn from different programmes. Many health service providers in particular offered interventions to parents on a one-to-one basis only. Most providers used behaviour modification approaches. While many providers claimed to have knowledge of other local providers and have good links, there was little evidence of co-ordination within and between agencies. Conclusions While there appears to be high levels of activity by providers from both statutory and voluntary sectors in providing services for pre-school children with behaviour problems, there is evidence to suggest that some of the main providers of services are not being adequately prepared and supported in the role. There is a lack of co-ordination within and between services, and indication that evidence-based programmes are being modified and used in an ad hoc manner. It is concluded that surveys of this nature may be an important preliminary step in establishing co-ordinated services for the primary and secondary prevention of pre-school behaviour problems.