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HM Government, 2011.
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National UK policy recommendations for pre-school initiatives to forestall later problems including those related to substance use, based partly on a review of the most promising programmes.
Summary In this first report I use the term 'Early Intervention' to refer to the general approaches, and the specific policies and programmes, which help to give children aged 0–3 the social and emotional bedrock they need to reach their full potential; and to those which help older children become the good parents of tomorrow.
The rationale is simple: many of the costly and damaging social problems in society are created because we are not giving children the right type of support in their earliest years, when they should achieve their most rapid development. If we do not provide that help early enough, then it is often too late. Here are just a few illustrations from the literature:
• A child's development score at just 22 months can serve as an accurate predictor of educational outcomes at 26 years.
• Some 54% of the incidence of depression in women and 58% of suicide attempts by women have been attributed to adverse childhood experiences, according to a study in the US.
• An authoritative study of boys assessed by nurses at age 3 as being 'at risk' found that at age 21 they had two and a half times as many criminal convictions as the group deemed not to be at risk. Moreover, in the at-risk group, 55% of the convictions were for violent offences, compared to 18% for those who were deemed not to be at risk.
Chapter 2 describes crucial areas of brain development in the first years of life, and suggests why these years may be so predictive of future outcomes. A key finding is that babies are born with 25% of their brains developed, and there is then a rapid period of development so that by the age of 3 their brains are 80% developed.
In that period, neglect, the wrong type of parenting and other adverse experiences can have a profound effect on how children are emotionally 'wired'. This will deeply influence their future responses to events and their ability to empathise with other people.
This is not to say that development stops at age 3 – far from it; but the research indicates that we need to intervene early to make sure that our children get the best possible start in life. We need to keep supporting them throughout childhood in ways which help them reach the key milestones of social and emotional development.
Chapters 3 and 4 explore the social and economic benefits of Early Intervention.
Early Intervention to promote social and emotional development can significantly improve mental and physical health, educational attainment and employment opportunities. Early Intervention can also help to prevent criminal behaviour (especially violent behaviour), drug and alcohol misuse and teenage pregnancy.
What parents do is more important than who they are. Especially in a child's earliest years, the right kind of parenting is a bigger influence on their future than wealth, class, education or any other common social factor.
The economic benefits of Early Intervention are clear, and consistently demonstrate good returns on investment. One example whose benefits have been well documented in research is the Nurse Family Partnership in the US. This programme supports at-risk teenage mothers to foster emotional attunement and confident, non-violent parenting. By the time the children concerned are 15, the programme is estimated to have provided benefits, in the form of reduced welfare and criminal justice expenditures, higher tax revenues, and improved physical and mental health, of up to five times greater than its cost.
Intervening later is more costly, and often cannot achieve the results that Early Intervention is able to deliver. However, there is currently very little expenditure on Early Intervention in comparison to later interventions. We need to redress this imbalance.
Chapter 5 explores the key themes of the first half of the Report in the context of current policy and practice. It looks at how we can build on the good things that are already going on, while keeping in mind the Government's stance on public expenditure and its policy agendas of decentralisation, localism and the creation of the Big Society.
It makes a number of recommendations that are broadly aimed at making children genuinely ready for school (the meaning of which is defined in the chapter) as part of a new 0–5 Foundation Stage. In particular, it addresses the following issues:
• increasing awareness of what Early Intervention can achieve within central government and local areas and among parents;
• increasing the effectiveness of staff such as teachers, social workers, nurses and doctors, and of existing policies and infrastructure;
• providing parents with the information and support they need to help their children;
• providing the data and measurement tools that we need to help identify those in need and to track progress; and
• creating the right financial freedoms for local areas to pool budgets and work across agencies to tackle shared problems.
Chapter 6 identifies the most effective Early Intervention programmes and presents the calculations which have been made of their cost-effectiveness. It lists 72 programmes which fulfil this criterion, with 19 in the top category.
It uses rigorous standards of evidence, highlighting programmes on a scale, according to the strength of evidence. This is intended to be a useful tool for private, public and third sector commissioners looking at how they should best spend their money.
However, the list is not final, and never should be. The report makes clear that it must be constantly reviewed and expanded. To this end, it recommends an independent Early Intervention Foundation (described more fully below) to increase the evidence available in the UK of successful Early Intervention and to provide further examples.
This list is especially important because it will underpin a second report examining alternative funding options for Early Intervention. This report will recognise that the Government is not in a position to make new large-scale spending commitments. However, it will express the conviction that the economic and social returns of Early Intervention are so great that we must develop models by which mainstream private as well as public investors can invest in the future of society.
Chapter 7 acknowledges the importance of local rather than central institutions in providing the best universal and targeted Early Intervention services.
The chief executives of 26 local authorities have already agreed in principle (if the Government so wishes) to sign up to putting Early Intervention at the heart of their strategies and to start to implement some of the recommendations from this Report. I would suggest that 15 of them should form the first group of Early Intervention Places.
Some third sector bodies might also join this approach. Some of the 26 local authority areas concerned are also Community Budget Areas, which means that they are able to pool the resources from different finance streams to make it easier to tackle multi-agency issues, such as families with multiple problems, where Early Intervention could have a profound impact.
I have already had discussions with ministers indicating that several departments would wish to pursue Early Intervention agendas in partnership with specific local areas.
If local communities are to lead this pioneering effort and operate the programmes described, they must be able to act free of central government control or interference, and also to raise money from the private sector. That is the key message of Chapter 8, which emphasises that this effort is to be organised independently of Whitehall. Central government should champion, not control, the expansion of Early Intervention. The prime recommendation of this Report is the creation of a new, independent Early Intervention Foundation. This concept is described in Chapter 8. This Foundation would be created in the first instance through private, philanthropic, ethical and local funding and it would be run by its initial funders, independently of central government. I have discussed this proposal with many witnesses and others interested in the field (including the 10 eminent experts in the field quoted in the Report) and it is clear that the will and the resources are available to establish this Foundation quickly, if central government allows.
The Foundation would undertake work with four
• to encourage the spread of Early Intervention;
• to improve, develop and disseminate the evidence base of what works, utilising rigorous methodologies;
• to provide independent and trusted monitoring of the effectiveness of programmes; and
• to act as an honest broker between financial investors, local authorities and deliverers to make the most of alternative funding mechanisms to provide the necessary investment that Early Intervention deserves.
We need to work together, effectively, to reap the benefits that Early Intervention can bring; and this will require working differently, to higher standards, and with focused activity and a vigorous institutional champion. Many contributors to the Report are excited by the potential for a real breakthrough on Early Intervention, but there is also apprehension that it could be delayed and suffocated. In Chapter 9 the Report indicates some of the actions we need to take to make these recommendations happen. Chapter 10 anticipates my second report on alternative funding mechanisms, which will be published in the spring. This is an exciting venture which, with active Treasury, City and voluntary help, will produce new ways to finance and facilitate the essential change in culture from late to Early Intervention.
Last revised 04 February 2011
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