This report seeks to look at the cost effectiveness of different programmes to support the development of healthy attachment. It is hoped to be of value to commissioners trying to decide where to spend their money.

Inevitably it’s been a challenging piece of work to do and some of the conclusions are being seen as controversial.  For example, the originator and iHV ambassador of the MESCH programme in the UK, Professors Lynn Kemp and Sarah Cowley respectively, have been very disappointed at the fact that MESCH has been included in the attachment section, whereas it is a broad-based multi-faceted programme delivered as part of a universal service, rather than a targeted programme focused on attachment.

Dr Cheryll Adams, iHV director said:

“This report must be interpreted with extreme care.  It was a very difficult piece of work to embark on and some of the recommendations will be seen as very surprising or disappointing.  Indeed, there could even be an interpretation that it challenges the value of universal services, although that wasn’t at all its purpose.

We would challenge the report for promoting the commissioning of early intervention services to respond to overt problems which the EIF identifies as risk.  This suggests intervention from age 2-3 years onwards, instead of the health visitor interpretation of early intervention where the recognition of risk is in the first year of life and intervening then when interventions can be most effective.

We must encourage commissioners to invest in services upstream of problems.  Even if the evidence for the value of doing this hasn’t been invested in, there is a clear logic that prevention is better than cure.  For example, how much better to pick up glue ear affecting hearing early, rather than speech delay and its social  and emotional consequences at age 2½.”

We encourage health visitors to read the report and let us and the EIF know their thoughts on its value for strengthening commissioning to improve children’s lives.  Also to be ready to challenge inappropriate commissioning decisions based on its findings.

The Institute of Health Visiting (iHV) welcomes the cross-party manifesto that highlights the importance of acting early to enhance the outcomes for children. The relaunch of the 1001 Critical Days Manifesto, on Monday 14 December, brings the importance of early years care for children to the forefront of politics ahead of a debate in the House of Commons on Thursday.

The relaunch of this key policy commitment is to achieve better perinatal mental health and stronger attachment between babies and their parents right from the start. The ‘1001 Critical Days Manifesto’ was originally launched in the last Parliament to persuade all political parties to incorporate these measures into their election manifestos.

Dr Cheryll Adams, Director of the Institute of Health Visiting, said: “The Institute of Health Visiting is delighted to endorse the 1001 Critical Days Manifesto. As far as health visitors are concerned, the 1001 Critical Days Manifesto may yet prove to be one of the most important developments of the new millennium. It has created a long overdue focus on the essential first days of life when the blue print for an individual’s future health and wellbeing is laid down. Hence, this period also determines the future health of our society. If we are to manage many of society’s physical, social and emotional health challenges efficiently and effectively, health visitors know that we must start in the first 1001 critical days of life. The fact that government now knows that too will drive health improvements in our society.”

Relaunch of 1001 Critical Days Manifesto

Relaunch of 1001 Critical Days Manifesto

Relaunch of 1001 Critical Days

Relaunch of 1001 Critical Days


This guideline covers the identification, assessment and treatment of attachment difficulties in children and young people up to age 18 who are adopted from care, in special guardianship, looked after by local authorities in foster homes (including kinship foster care), residential units and other accommodation, or on the edge of care. It aims to address the many emotional and psychological needs of children and young people in these situations, including those resulting from maltreatment.


This guideline includes recommendations on:

  • principles of care
  • supporting children and young people with attachment difficulties
  • assessing attachment difficulties
  • interventions for attachment difficulties in children and young people on the edge of care
  • interventions for attachment difficulties in children and young people in the care system, subject to special guardianship orders and adopted from care
  • interventions for attachment difficulties in children and young people in residential care
iHV stock photography from Croydon area. Picture by:

iHV stock photography from Croydon area. Picture by: