Early childhood, birth through to around five years of age, is characterised by rapid and significant development, including in children’s social, emotional and behavioural skills (Moore, Arefadib, Deery, & West, 2017; Tully, 2020). Ensuring children’s social, emotional and behavioural (SEB) wellbeing is nurtured during the early childhood period is crucial to later outcomes. For instance, more favourable SEB wellbeing during early childhood is associated with higher levels of academic achievement and better mental health (Meagher, Arnold, Doctoroff, Dobbs, & Fisher, 2009; Sanson et al., 2009; Toumbourou, 2012; Toumbourou, Williams, Letcher, Sanson, & Smart, 2011). Young children who have higher levels of SEB wellbeing are also less likely to experience depression, hostile behaviour or aggressive interpersonal behaviour later in life (Jones, Brown, & Lawrence, 2011; Meagher et al., 2009; Toumbourou et al., 2011).

During the early childhood period, some children may experience SEB difficulties that place them at risk of developing problems later, such as those identified above (Bagner, Rodríguez, Blake, Linares, & Carter, 2012; Bor, McGee, & Fagan, 2004; Hemmi, Wolke, & Schneider, 2011; Lonigan & Phillips, 2001; Toumbourou et al., 2011; Tully, 2020). Children who exhibit SEB difficulties respond to contexts and stimuli differently from typically developing children from similar cultural or ethnic backgrounds (Poulou, 2015; Tully, 2020). Specifically, children with SEB difficulties may be inhibited in their social relationships, self-care or educational opportunities (Poulou, 2015). In Australia, the prevalence of SEB difficulties in toddlers and preschoolers (aged 1.5 to six years) is estimated to be between 13% and 23% (Oh, Mathers, Hiscock, Wake, & Bayer, 2015). National levels of SEB difficulties are consistent with international estimates of around 20% in children aged one to seven years (Vasileva, Graf, Reinelt, Petermann, & Petermann, 2020).

Early childhood is therefore recognised as a key developmental period, and prevention and early intervention may be necessary to target risk factors and stem the potential development of later problems, including diagnosable mental health conditions (McLuckie et al., 2019; Oh et al., 2015). Risk factors for SEB difficulties usually do not occur in isolation, and many children are exposed to multiple risk factors at a time, intensifying their level of risk. Risk factors for SEB difficulties during early childhood are found in a range of domains (McLuckie et al., 2019) including:

• child (e.g. prematurity; temperament)
• family (e.g. parental mental health; parental substance use; caregiver-child attachment; domestic and family violence; child maltreatment)
• structural (e.g. socio-economic status; ethnicity).

Evidence-based programs targeting SEB difficulties

Given that early childhood is a time of critical development, as well as potential exposure to risk factors, it is vital that professionals and service providers who work with children use effective programs to support them. Those programs should target known risk factors and best support favourable outcomes, minimise unintended consequences and reduce financial costs (Marsenich, n.d.; University of Canberra Library, 2020; US Department of Health and Human Services & Office of Disease Prevention and Health Promotion, 2010). However, navigating the number of options that exist may be challenging for practitioners and service providers (McLuckie et al., 2019). Additionally, information about many of these programs is only available in the scientific literature, which may be inaccessible to many practitioners. Therefore, identifying programs targeting early childhood may help guide practitioners in their decision making and service provision (Boustani et al., 2020; McLuckie et al., 2019).

A 2019 evidence review examined prevention and early intervention programs for children aged birth through to five years at risk of mental health difficulties (McLuckie et al., 2019). The review included children at risk of, or diagnosed with, SEB difficulties or mental health disorders and examined outcome measures. However, it did not investigate program outcomes and only included studies published in 2012 or earlier. Consequently, there is no current synthesis of evidence-based, effective programs targeting SEB difficulties during early childhood.

The aim of this rapid review was to identify and describe effective prevention and early intervention programs that seek to improve SEB wellbeing during early childhood for children experiencing, or at risk of, SEB difficulties. The findings of this review will help practitioners identify the types of programs that might be useful to support children at risk of SEB difficulties. In particular, the findings provide practitioners with insight into which programs are most suitable for children experiencing different types of risk factors.

Methodology

The topic for this review was identified and scoped in consultation with Emerging Minds: the National Workforce Centre for Child Mental Health as the foundation for developing practitioner resources. This rapid evidence review was guided by methodology outlined by King and colleagues (2017). Rapid reviews are a useful approach to identifying and synthesising relevant evidence on a particular issue in a timely fashion. The process included two main stages:

1. a literature search to identify effective evidence-based programs targeting early childhood SEB difficulties
2. a review of reported program features to identify types of programs and characteristics showing the greatest likelihood of effectiveness.

Inclusion and exclusion criteria are detailed in Appendix A. Included studies were drawn from systematic reviews and meta-analyses. Given the aim was to identify and describe effective prevention and early intervention programs, only reviews showing effectiveness on one or more of the targeted outcomes were included. Further, reviews where all or most studies were conducted in OECD (Organisation for Economic Co-operation and Development) countries were included to maximise the generalisability of the findings to the Australian context.

Features of programs that are assessed in this review include:

• which types of programs are effective for which outcomes
• where available in the included literature, which characteristics (e.g. delivery mode, setting, types of providers) show efficacy.

Forty-four databases were searched for peer-reviewed literature. Databases were accessed through the Australian Institute of Family Studies library and included Cochrane Database of Systematic Reviews, ERIC, Gale, Informit, MEDLINE, ScienceDirect and SocINDEX. The search targeted English language systematic reviews and meta-analyses that met the inclusion criteria and were published between May 2010 and April 2020. Searching identified 1,883 articles, which were reduced to 1,231 after duplicates were removed. Initial screening resulted in 126 full-text articles being assessed for eligibility, with 17 meeting criteria for inclusion . Full details are recorded in the PRISMA flow diagram.

Reviews were only included if they showed effectiveness against one or more variables of interest. However, some reviews reported weak, inconsistent or marginal findings of effectiveness. Those reviews are included in Appendix C. However, this paper focuses on the reviews that reported the most robust findings as these are likely to be more meaningful for practitioners.

Included reviews reported on prevention or early intervention for children at risk of or experiencing SEB difficulties. Reviews are summarised across the following target groups:

• children with early or existing SEB difficulties (n = 1)
• pre-term children/low birth weight children (n = 7)
• children of parents with mental health conditions, mainly depression (n = 3)
• children and families in other vulnerable circumstances (n = 6).