Darshan Sachdev looks at the Mosaic method of communicating with
very young children and Michael Bryant examines how referrals to
mental health services are made.

Talking to children

A study examining the effectiveness of the Mosaic approach to
listening to children aged under five

The view that the voice of young children should inform the
development of services that affect them has been gradually gaining
ground. However, traditional methods fail to deal adequately with
the complexities of listening to very young children, and of
ascertaining their views and experiences.

This study examines the Mosaic approach to listening to children
under the age of five. A key principle of this multi-method
approach is that it is a participatory, adaptable and reflexive way
of listening that enables children and adults to construct meaning
jointly. This study involved 20 children in two groups: children
aged three to four years attending a kindergarten; and children
under two years attending a nursery, together with six staff and
five parents.

The research report describes the framework for listening
adopted by the researchers, and identifies and explains its key
components. A second part details how the Mosaic approach evolved
during the 18 months of this study.

In the first stage, children and adults gathered information
from different perspectives, providing different pieces of the
Mosaic. In the second stage, these Mosaic pieces were put together
through a process of dialogue, reflection and interpretation. The
final part of the report provides a very useful examination of the
practicalities, drawbacks and the potential of this approach.

This is a timely study as it offers an innovative framework for
listening to very young children whose perspectives have been sadly
neglected until recently. Researchers interested in gaining a
deeper understanding of the lives of very young children may well
find this approach an important tool in their methodological

Source: Alison Clark and Peter Moss, Listening to
Young Children: The Mosaic Approach
, National Children’s

Darshan Sachdev is principal officer, research and
development in Barnardo’s policy, planning and research

Prioritising mental health services

An examination of how a community mental health team prioritises
services for people with severe mental illness

Since the early 1990s government directives have led to the
prioritisation of service provision for severely mentally ill (SMI)
service users. Community mental health teams (CMHTs) have had to
ring-fence their services for SMI clients and define new criteria
for accepting referrals. This focus, in turn, has created dilemmas
for CMHTs on how to provide a service to clients with less severe
mental health problems.

The study describes how one CMHT implemented prioritisation
criteria for defining acceptable referrals of SMI clients for their

Using a qualitative methodology, the researcher identified two
separate and contradictory uses of the SMI term. The first use,
“SMI (1)” involved a strictly medical term derived from recorded
psychiatric diagnoses. This term functioned as a tight “gate
criterion”for referral access.

The second definition, “SMI (2)” varied according to a variety
of factors, including risk, disability, distress, chronicity and
socio-economic factors. Its application could change with time and
according to a team member’s changing views about these

These two definitions consequently affected team processes,
which included:

– How the team described acceptable and unacceptable cases.

– Team perceptions of case treatability.

– Team views of untreatable cases (often those involved in
illegal drug use or with serious forensic histories).

– Tensions related from skills deemed less useful for SMI
clients, (such as psychologists’ cognitive behavioural therapy

King suggests the use of regular team discussions and appraisals
of operational guidelines to help prioritise resources. This study
also has wide implications for the research and practice of
community mental health team gate-keeping processes.

Source: Charles King, ‘Severe Mental Illness: Managing
the Boundary of a CMHT’, Journal of Mental Health
10, 1, 75-86, 2001.

Michael Bryant is an approved social worker, former CMHT
and assertive outreach manager, and manager, internet and
information services at the Sainsbury Centre for Mental

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