Cheshire East Early Years Mental Health Pathway Joint Thinking Space

The NHS Cheshire and Merseyside Children and Young People’s Mental Health Plan 2024-26 highlights that 10-25% of young children experience a disorganised attachment relationship with their main carer(s) which can significantly increase the risk of poor social, emotional and cognitive outcomes. The plan also reports that the number of Children Looked After in Cheshire and Merseyside is 47% higher than the England average and that the proportion of these children with good development at 2-2.5 years old is 15.5% lower than those children not growing up in care; which would indicate there are a significant number of infants and young children with moderate to severe mental health difficulties (i.e. trauma and attachment difficulties) in the local area.

For children aged 0-5 years, developmental trauma and emerging emotional or psychological difficulties may present through disturbances in emotional regulation, attachment, behaviour, development, and relationships rather than through verbal expressions of distress.

Infants and young children who have experienced trauma, significant adversity, inconsistent caregiving, or disrupted attachment relationships may show excessive clinginess, separation difficulties, heightened distress responses, prolonged irritability, sleep and feeding problems, developmental regression, delayed social communication, sensory sensitivities, or difficulties being soothed. Some children may appear withdrawn, emotionally flat, fearful, or avoidant, while others may present with persistent aggression, hyperactivity, impulsivity, risk-taking, or behaviours that challenge that reflect underlying distress.

Mental health consultation and support may be indicated when emotional or behavioural difficulties are persistent, impact the child's development, relationships, functioning, or wellbeing, place strain on the caregiving relationship, or occur within the context of known trauma, loss, neglect, domestic abuse, parental mental health difficulties, or other adverse experiences.

Early identification and intervention can support the child's emotional development, strengthen caregiver-child relationships, and reduce the longer-term impact of developmental trauma on social, emotional, and cognitive outcomes.

The Early Years Joint Thinking Space provides consultation through a mental health, attachment and relational lens. It is designed for situations where professionals remain concerned about a child's emotional wellbeing despite universal or targeted support already being in place, or where the meaning of a child's behaviour remains unclear.

Unlike services focused primarily on neurodevelopmental differences, speech and language development, physical health needs, or behavioural management, this consultation aims to support professionals to think about the child's emotional experience, relationships, early development, and the impact of adversity or trauma.

The Joint Thinking Space recognises that children communicate distress through behaviour, relationships, play, sleep, feeding, and emotional responses. Through a collaborative and reflective discussion, we aim to support professionals to move beyond "what is the child doing?" towards "what might the child be experiencing, communicating or needing?".

The consultation also acknowledges that complex family situations can generate uncertainty, anxiety, frustration or feelings of being "stuck" within professional networks. Creating space to think together can help professionals develop shared formulations, identify strengths and needs, and consider psychologically informed support plans.

The Joint Thinking Spaces will run online via Microsoft teams, fortnightly on Wednesdays at 10am for one hour.

The space is intended as a one-to-one consultation; however, this can be expanded if a few team members would benefit from attending. Unfortunately, we cannot have observers attend due to the importance of maintaining confidentiality.

To book a slot, please complete our brief referral form or email cwp.cypearlyyearseast@nhs.net for more information.

This consultation may be a one-off appointment. Follow-up consultations will be offered where appropriate. We would invite professionals to make contact regarding a follow-up consultation.

The referral form is designed to support you to include all the relevant information and as a prompt during the consultation if needed. Some of the information which is asked includes:

• A brief description of the concerns and what support is being requested.
• Examples of the child's behaviour and when it occurs.
• Information about the child's emotional, social, and developmental presentation.
• Parent/carer views and any concerns about relationships, attachment, or bonding.
• Relevant family circumstances, significant life events, or changes.
• Strengths and protective factors within the child and family.
• Support already offered and its impact.
• Information around which professionals are currently or have been involved in supporting the family (including social work).
• Specific questions you would like the consultation to help answer.
• If there are safeguarding concerns and risk present, information around what is being implemented to manage this will be important. 

What would be helpful to prepare for the Joint Thinking Space?

As described above, completing the referral form may act as a prompt to consider why you are seeking a consultation but, it can be helpful to identify 2-3 key questions that you would like to discuss during the reflective space.

Do professionals need consent from families prior to referring into the Cheshire East Early Years Mental Health Pathway? 

Yes. Please ensure you have consent from whoever has parental responsibility, to use this space to reflect on their child and family. If it is not possible to gain consent due to unforeseen circumstances but there is a need for consultation, please do get in touch with us to discuss options.

Does a Joint Thinking Space consultation mean the child is referred to Cheshire East CYPMHS?

No, accessing the joint thinking space does not equal a referral or acceptance into the Cheshire East CYPMHS team; however, it can support referrals for specialist mental health support where this is identified as a requirement during the consultation.

What area of Cheshire East does this pathway cover?

The Cheshire East Early Years Mental Health Pathway will offer support through the Joint Thinking Space across the whole borough of Cheshire East.

Note regarding risk and safeguarding concerns:

All risk and safeguarding concerns remain the responsibility of the case holding professional during the consultation period. If there are unmet safeguarding issues, then a referral to social care should take place prior to referral to the Cheshire East Early Years Pathway.

Following a Joint Thinking Space referral, professionals may receive support with:

• Developing a shared psychological understanding of the child's presentation.
• Identifying strengths and protective factors.
• Formulating the impact of relationships, experiences and developmental factors.
• Recommendations for interventions and support strategies.
• Guidance regarding appropriate services or pathways.
• Identifying whether specialist mental health assessment may be indicated.
• Strengthening multi-agency collaboration and shared planning.