Today our Director of Evidence, Professor Leon Feinstein, gives evidence to the Commons Science and Technology Select Committee’s inquiry into ‘evidence-based early-years intervention’. Below, Leon sets out some of the issues around the use of evidence to inform the delivery of early intervention.
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I was thrilled to work for 3 years as the director of evidence at the EIF after it was established in 2013 because it was set up in part to add to the politics, ethics, practice and human drama of early intervention by providing greater clarity on the evidence on effectiveness and cost. With a team and a lot of support from an expert, academic panel and a wide range of practitioners we assessed the evidence from economics, psychology, programme evaluation and neuroscience in particular[1] on the case for early intervention and we assessed the evidence of impact of upwards of 200 specific interventions available in England[2].
Some definition is required of early intervention. We defined it as preventive activity with children and families designed to reduce subsequent harm and cost to children with potential benefit primarily to specific individual children and young people but also to families and wider communities. This activity cannot be provided through less specialist and individuated universal services without some degree of targeting or specialisation, such as a health visitor devoting specific extra home visits to families with greater need. EI is a range of activity in between the universal services of what can be provided to all children by health visitors, schools and hospitals and the late intervention of much of children’s social care or the criminal justice system for example. It is early in that it is preventive, not necessarily in terms of being in the first years of life. Obviously early years services also include universal services like maternity, midwifery and childcare and that activity can be important to early intervention.
This range of services and activities are a critical part of the social fabric for children and families, the attempt of communities and agencies to provide support for the development of children growing up in the complex societies of our 21st Century, beyond what families can do by themselves and what the most disadvantaged families can by definition do the least. We estimated that local and national Government in England and Wales is spending £17bn per year on activity for children, young people and young adults that is required for statutory reasons or because of acute need where the state has had to step in because a situation has spiralled out of control. The £17bn barely scratches the surface of the wider social, economic and long term costs of ignoring problems but does indicate an immediate and tangible frame for structuring policy. Early intervention is not about increasing state control, it is about preventing it, providing more tailored services upstream to prevent children ending up in circumstances where a statutory response is required.
The evidence for these forms of activity is in general very strong in that in psychology and other literatures and sciences there is very rich, empirical and theoretical understanding of the requirements of contexts and services that will boost and advantage development and of the risks to development from experiences that ignore or injure children. There are many examples of interventions based on these principles that have been shown to have sufficiently scaffolded development as to transform outcomes, that is to say to have impacted on pathways through childhood into adulthood and enabled children to have avoided the worst of the risks that were otherwise present and evident in their early lives.
Accurate assessment of risk and delivery of quality responses are essential for the success of this sort of activity. Although we know that early intervention can work in general we also know that the term describes a multitude of types of activity delivered in different sorts of ways to different sorts of children at different stages of their lives by different sorts of professionals and volunteers, family members and others. Therefore, the general case that early intervention can work can never support the specific case of a specific service or activity for a specific client group. We need a lot more evidence and knowledge about the specifics. Nevertheless the general case is very clear. It is not that the whole £17bn of immediate fiscal cost could be prevented. At the EIF we called for a fund equivalent to 10% of the cost locally to be devolved to fund early intervention where that was matched by local councils and there was a serious attempt to evaluate and monitor success. Our view was that perhaps 40% of the £17bn is preventable and an equivalent amount of harm unnecessary but if we could start with a serious attempt at a 10% reduction we could test and learn our way to the larger goal. The EIF continues providing and developing the detailed evidence on what works.
The Children’s Commissioner’s office has made measuring the number of children who might benefit from early intervention a priority, to help us to assess the cost and effectiveness of current provision. Gaps in data make this a sizable challenge but we will make an initial estimate in July of the number of children who are not in the statutory or acute parts of the system but whose needs are not met by universal services. We need to find out more about the children who might benefit from early intervention. Without doing so, the capacity of local agencies to deliver relevant and carefully focussed activity and the government to ensure funding meets needs, will be limited and the outcomes for many children will be poorer.
[1] Of course any study of policy and practice necessarily takes in sociology, anthropology, implementation science, social policy, education, politics and other disciplines and sciences.
[2] For more detail on the evidence and arguments presented here see Feinstein, L., Chowdry, H and Asmussen, K. (2017) “On estimating the fiscal benefits of early intervention.” National Institute Economic Review: “Inequality, Social Mobility and the New Economy.” Issue 240
