Summary

Realising the Potential of Early Intervention was published by the Early Intervention Foundation (EIF) 30th October 2018.  It is available at https://www.eif.org.uk/report/realising-the-potential-of-early-intervention

The purpose of the report is to set out “..a bold plan of action to ensure effective early intervention is available to the children, young people and families who need it most.” It brings together in a concise report the findings from the work of the EIF and makes recommendations on what needs to happen to realise the potential of early intervention. The report covers:

• Context
• What is early intervention?
• How do we know which children can benefit from early intervention?
• Where can early intervention have the greatest impact?
• How Early Intervention Works for Society and the Economy
• Building a System that Supports Early Intervention
• Realising the Potential of Early Intervention

Context

The report sets the context that too many children are facing challenges or disadvantages that affect their development and threaten their future life chances such as living in poverty, being overweight or obese, being permanently excluded from school, experiencing mental health problems and that youth violence is a pressing concern. The EIF says that not all children get the best possible start in life but that early intervention can help create “..the supportive environment that children and young people need if they are to thrive.”

What is early intervention?

The report says early intervention means “identifying and providing early support to children and young people who are at risk of poor outcomes…Effective early intervention works to prevent problems occurring, or to tackle them head-on before they get worse.” Early intervention is not just about the early years as effective interventions can improve children’s life changes at any point. Effective early intervention means using early intervention programmes and approaches that have been evaluated and tested.  The evidence is clear that families are more likely to benefit and have improved outcomes when they receive interventions shown, through rigorous testing, to have improved outcomes.

How do we know which children can benefit from early intervention?

The report says: “We have a good understanding of the risk factors that can threaten children’s development, limit their future social and economic opportunities, and increase the likelihood of mental and physical health problems, criminal involvement, substance misuse, or exploitation or abuse later in life. This helps us to identify the children and young people who are likely to benefit from early intervention.”  The report provides helpful descriptions of what the terms targeted selective interventions and targeted indicated interventions mean. Targeted selective interventions are offered to families based on demographic risks such as low income.  Targeted indicated interventions are offered to children and families identified or assessed by practitioners as having a specific or diagnosed problem.

The report provides a diagram setting out the risk factors occurring in a child’s life from child level such as physical health, gender and previous development, through family factors such as income, parents physical and mental wellbeing, quality of interpersonal relationship, to community factors such as peers and friends, housing quality and availability, schools and education and health care to wider societal factors including employment, government policies, benefits, cultural practise and beliefs.

Early intervention works to reduce the risk factors and increase protective factors in a child’s life.  The report notes that research on Adverse Childhood Experiences (ACEs) has improved understanding of the long-term impact of multiple risk factors while reminding us that ACEs are not predictive at an individual level and cannot tell us who might need early intervention or other support.  The EIF says “ACEs should not be used in isolation to determine who should receive early intervention, and an ACE score is not a substitute for careful assessment of current needs.”

Where can early intervention have the greatest impact?

The report advocates the wide-ranging benefits of early intervention.  It recognises that it is not a panacea.  Polices and initiatives are still needed to reduce the extent to which disadvantaged children fall behind.  The report recognises the vital role of universal services for all children including in identifying children who need support.  The report describes how early intervention can support the four key domains of children’s development:

• Physical
• Cognitive
• Social and Emotional
• Behavioural

For each of these it identifies the factors associated with positive development and identifies how early intervention can support this area of development, including programmes that have been shown to be effective.

The report describes how early intervention can tackle three major threats to children’s development:

• Substance misuse
• Risky sexual behaviour
• Child maltreatment

For each of these it identifies the factors associated with the threat and how early intervention can help, identifying programmes with evidence of impact in reducing the area of threat.

The report specifically addresses whether early intervention can reduce pressure on social care by reducing child maltreatment. It says, “Early intervention has the potential to reduce pressure on children’s social care, but this is in the long term, rather than the short term.” There are early intervention programmes that have been shown to have an impact on child maltreatment. It says “Long term benefits are most likely to occur when effective interventions are offered as part of an integrated package of support within a local system with clear leadership and a culture which supports this objective.”

How Early Intervention Works for Society and the Economy

This section of the report makes the broader case for early intervention. It says: “Leaving problems unresolved in childhood doesn’t only impact on the lives of individuals and families – it also impacts on society and the economy…Acting early to support children at risk of poor outcomes can build healthier, happier and more productive communities, and produce a range of benefits that significantly outweigh the costs of intervening.”

The report acknowledges that producing robust estimates of the benefits to society of intervening compared to the long-term benefits to society is difficult.  However, despite the difficulty of doing this the EIF believe there is a compelling argument that investing earlier rather than later will lead to cumulative benefits.  The biggest gains may be in the labour market through improvements in employment and earning potential.  For example, it says that small improvements in attainment have potentially large economic pay offs.

The report presents the costs of intervening late as an annual total of £17bn made up of £6.4bn for local government, £3.7bn for the NHS, £2.7bn for Welfare, £1.6bn for the Police, £1.5bn for Justice and £0.7bn for Education.  These estimates are of the resource pressures on acute statutory services required when children and young people experience difficulties which might have been prevented.

The report discusses whether early intervention can lead to reductions in public service use. It believes it can, but these will not be cashable savings in many cases.  It says “Simply reducing local demand will not lead to immediate reductions in the amount of money required to run services at the local level.“

Building a System that Supports Early Intervention

The report says that “Successful early intervention depends on making a long-term investment, coordinated across all agencies with an interest.  This task is thwarted by a siloed system biased towards short-term spending in response to immediate pressures.”  Five barriers to implementing effective early intervention at scale need to be overcome.  These are:

1. Funding
   Providing effective early intervention requires long-term investment that is sufficient to enable commissioning and implementation of high-quality interventions. The impact of cuts, which continue, is leaving Local Authorities (LAs) little space to priorities long term investment in early intervention. This problem is exacerbated by the short-term funding cycles of some grants and of short term commissioning cycles of one to 3 years. The siloed nature of government finances at local and national level limits incentives for policy makers to make long-term investments where the benefits may accrue to another part of local or national government.
2. Short-termism
   The focus on the near term and taking action to deliver short-term results to address an acute problem of public concern means too little attention goes on the evidence about what matters for child development and the complex interrelated factors that influence its development. It says “Small, short-term, single-issue funding pots can be especially unhelpful, by comparison with the advantages of long-term, strategic funding. These approaches are unlikely to deliver sustainable improvements or to make the best use of resources.”
3. Fragmented responsibility
   The report restates that the fragmentation of policy responsibility across numerous Whitehall departments is a longstanding problem. The lack of an effective way of working around this problem is identified. The report describes the current fragmentation of responsibility e.g. Department for Education leading on schools and children’s social care and sharing early years policy with Department of Health and Social Care. The Ministry of Housing, Communities and Local Government running the Troubled Families Programme while the Home Office leads on knife crime, child sexual abuse and domestic abuse. At a local level early intervention can be undermined by the benefits of investment not accruing to the investing service.
4. Not delivering what works
   The report recognises that not all early intervention is effective and that there is a gap between what the evidence tells us about what is effective and what is commissioned and delivered for children and families. The report explores the reasons for this and makes the important points that:
   • It is unlikely any single intervention will be enough on its own and it is important to consider how the impact of individual programmes can be reinforced by the wider system.
   • Poor implementation leading to poor results. High quality implementation takes time and resource.
   • A good intervention delivered to the wrong children and families through poor matching of needs to the intervention will not lead to good outcomes.
   • A workforce that is insufficiently qualified and trained to deliver the interventions effectively.
5. Gaps in our understanding of what works or is likely to work
   The evidence base in the UK is at an early stage of development. An example given of an area where there are significant gaps in knowledge is how to work with parents with substance misuse problems. In other areas such as risks relating to parental conflict the report says we have an understanding of the risk that is far ahead of our understanding of how to tackle it. There are also gaps in our understanding of effective practice and what is most effective in building the wider system in terms of culture, leadership, vision and partnership working. The report advocates national oversight of the development of the evidence base and improved local capability within local services to evaluate what is being delivered.

Realising the Potential of Early Intervention

The final section of the report makes proposals for national and local action.  It recognises there are no quick fixes and says “If we are serious about improving outcomes for vulnerable children, then we need to recognise that supporting children and families with complex problems requires a resource-intensive, long-term response.

The EIF propose the following National Actions:

1. Establish a new long-term investment fund to test the impact of a whole-system approach to early intervention in a small number of places.  The aim would be enable us to understand what effective early intervention can achieve when all the necessary conditions are in place.
2. Establish a new What Works Acceleration Fund to support a wider set of places across England to deliver effective early intervention.
3. Create an independent expert panel to advise government on a long-term early intervention research strategy to fill significant gaps in our current knowledge.  As well as supporting the trialling and evaluation of new interventions this would develop understanding about what works in relation to areas such as workforce practice and systems needed to deliver effective early intervention.
4. Set up a new cross-government taskforce on early intervention to coordinate the work of relevant Whitehall departments and to oversee the delivery of these commitments.

The EIF propose the following Local Actions:

1. Agree a clear vision that is founded on the benefits of effective early intervention to local communities and the local economy. The EIF believes local leadership can be powerful.  It also reiterates the message that the viability of early intervention at the local level should not be founded on the promise of achieving short term savings.
2. Foster a culture of evidence-based decision-making and practice.  Local leaders need to ensure evidence-based decision making is an integral part of the vision and culture they create.

The report concludes by saying:

“Early intervention needs to be put in its rightful place at the heart of our approach to supporting children and families.”