National Institute for Health and Care Research

Webinar highlights – An Introduction to SUSI: Social-Emotional Under 5s Screening and Intervention: An Evidence-Based Infant Mental Health Approach

July 4, 2024

In July 2024, our Supporting Early Mind Research Network hosted Carol Hardy as part of their infant mental health webinar series. Carol is an infant mental health specialist from South London and Maudsley NHS Foundation Trust. She introduced the framework she has developed which has become known as SUSI: Socia-Emotional Under 5s Screening and Intervention. This offers a comprehensive approach to assess and intervene in children’s social-emotional development and their relationship with caregivers.

SUSI includes a detailed assessment, a tailored intervention plan ranging from 6-15 sessions and employs therapeutic techniques aimed at addressing the core issues within the parent-child dyad. Disorganised attachment can particularly undermine children’s mental health, social behaviour and educational prospects and is therefore a high priority target for effective prevention and intervention.

Carol Hardy discussed the difference between need and demand when it comes to babies and toddlers. There is an unknown number of babies who are never identified by services but may nevertheless be in significant needs. This number may likely include the most marginalised, vulnerable and at-risk babies. The challenge therefore is how to improve outreach to these families, particularly those most at risk of later referral to children’s social care.

The aim behind SUSI was to reach out in a much more pro-active way to these at risk populations. They noticed that although they had had a more structured parenting programme offer but despite its good aims around attachment, they noticed that many of the parent participants struggled to translate these ideas into their relationships with their children. From there, they adapted the programme to better suit the needs of parents and children who had faced significant adversity.

The model was created to address challenges around identifying early concerns in babies and young children and the parent-child dyad. It aimed to engage and support parents in vulnerable populations. Its key features were to reduce the burden of the assessment on families by limiting it to two or three sessions, with a flexible location and timing. It gave clear time points for inter-agency communication and feedback and had a tailored intervention.

The SUSI Signs Framework notes numerous signs of social-emotional difficulty among babies and young children. These can be confusing and contradictory and are often adaptive to the child’s environment. They vary from failure to thrive to being overweight, to aggressive behaviour to overfamiliarity. The framework broke these signs down into emotional, behavioural, functional, physical and child-parent interaction. When meeting with the babies, study providers were careful to make sure that signs noted were observed repeatedly and were typical of the child’s behaviour.

The focus of the framework was on the child-parent relationship, to have reflective discussions with parents about their current experiences of parenting and to explore links between past and present experiences and how they relate to the child and their needs. There are however also opportunities to share understanding of the child’s needs with the wider family and or network and to develop multi-agency care plans as needed.

People taking part in the SUSI Infant Mental Health training days reported after the training that they felt more able to recognise early signs of poor infant mental health and difficulties in a baby or very young child’s emotional and social development. They also reported feeling more confident in having conversations with parents about their baby or young child’s emotional and social development. These statements offer encouraging signs in terms of practitioners being able to integrate the SUSI model into their own practice.

You can watch the webinar in full on the Supporting Early Minds website.

Or, to find out more about infant mental health and book a place on an upcoming Supporting Early Minds webinar visit: Webinars – Supporting Early Minds (mhid.org.uk)

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