As well as having an immediate negative impact on the child’s development, they are also more likely to face a variety of problems later in their lives, affecting their and their family’s wellbeing. 

That is why it’s vital to identify early signs of emotional and family problems in children under five and to provide effective support to the child and their family.

Currently, however, there is a lack of resource in this area and existing services are not always easy for families to access. In fact, a recent survey by the Parent-Infant Foundation (June 2021) found that nearly half of mental health services for children and adolescents did not accept children under two, and in some areas, did not accept children under five. There is also limited training for health and social care professionals in under-fives mental health. This is a problem because signs of mental and emotional distress in very young children can often be subtle and sometimes overlooked.

What is the aim of the project? 

A team of researchers from ARC South London’s children and young people theme, co-led by Dr Julia Forman, a specialist in applied statistics and epidemiology at King’s College London and Carol Hardy, an under-fives Child and Adolescent Mental Health Services (CAMHS) clinical specialist at South London and Maudsley NHS Foundation Trust, have initiated new research to better understand the emotional and mental health needs of children under five in Southwark, and how to meet those needs. Their aim is to evaluate the implementation of a new service designed to offer timely and accessible support for families. 

We want to generate new evidence to inform the development of improved mental health care pathways for babies and children under five, to improve workforce training in this area, and to help create services that are easier for families to access. The Covid-19 pandemic and its impact on families facing adversity has made this work even more urgent.

Dr Julia Forman, project co-lead

The borough of Southwark has high levels of health inequalities, including around infant mortality, obesity, and mental health, as well as socio-economic difficulties, including child poverty. An earlier project in Southwark showed a high level of social-emotional and attachment difficulties in under-fives in vulnerable families. These families faced greater adversity, including problems with parents’ mental health, domestic abuse, past childhood trauma, and other factors that can cause stress for the family, such as poor housing. 

How will the project work?

The researchers will implement and evaluate a new clinical service for children under five that provides mental health assessment, interventions, and tailored support for families. The new service is using a community model developed in two previous clinical research studies in Southwark (SUSI: Social-emotional Under fives Screening and Intervention).

The SUSI model was created to offer a tailored approach to vulnerable families with under fives that was flexible and embedded in community networks, including links to social care services. The mental health assessment for babies and children was brief but robust, and could be delivered at home or other community settings.

The researchers will be evaluating the outcomes of the new service including: 

  • Quantitative outcomes: number and sources of referrals to the service, the demographics of children and families, clinical assessment data, uptake of treatment, and treatment outcomes
  • Qualitative outcomes: service user feedback on service delivery and individual outcomes, professionals' feedback on service delivery, interface and joint working. 

The researchers will also evaluate a programme of infant mental health awareness training with groups of community professionals working in children's centres, Early Help, community perinatal mental health teams and nurseries.   


The researchers and the new service will be collaborating with a range of services for children in Southwark including: the parental mental health team, 1st Place Childrens Centre, perinatal mental health teams, the Family Nurse Partnership programme, local health visitors and nurseries, CAMHS at South London and Maudsely NHS Foundation Trust, the Children & Young Peoples Partnership, health service commissioners and the head of social care services. 

The project started in July 2021 and is expected to finish in March 2022.