How do we know early intervention works?

Context

Every year, children across the UK fail to meet developmental milestones such as gaining a healthy weight and learning to speak, play and interact with their peers at an age appropriate level. Later down the line, some young people experience severe difficulties such as engaging in youth violence, developing mental health issues, being taken into care or being excluded from school.

There is clearly a need for early intervention. We know it is possible to make a difference for children and adolescents by preventing problems before they escalate and by enhancing their ability to navigate life’s challenges. We want every child to grow up into well-functioning, happy and healthy adults.

What can we learn from psychology, economics and neuroscience?

In principle, extensive research from psychology, economics and neuroscience has shown that early intervention works. We know that:

  • The varying environments in which children grow up in shape their development.
  • Early on, there are emerging gaps in childrens’ skills and differences between children’s development becomes apparent.
  • There are certain factors that drive childrens’ development that can be influenced to enhance their life chances.
  • Research about early intervention in theory can be used to create and deliver effective interventions that can work for families and children.
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Psychology

Children’s development is shaped by the quality of their environments.

Studies consistently suggest that children raised in warm and nurturing homes are more likely to feel better about themselves as people, do well in school and make smart choices about their relationships and careers in early adulthood. For example, findings from the Minnesota Longitudinal study have observed that children who are securely attached to their parents in infancy are more likely to be self-confident, motivated and pro-social by the time they reach early adolescence.

Recent findings from the ongoing Millennium Cohort study have additionally observed parents’ education and family income were the most powerful predictors of children’s cognitive test performance at age eleven.

The quality of the parenting-family environment is predicted by risk and protective factors present within their communities and wider social networks.

Studies consistently and overwhelmingly suggest that social disadvantage makes it difficult for parents to effectively meet their children’s needs.  For example, Belsky and Fearon (2002) observed that sensitive parenting was significantly associated with the family’s overall level of deprivation, the parents’ mental and physical health, the quality of their support networks and the quality of their couple relationship.

Recent findings from the Millennium Cohort study suggest that children raised by single parents or step-parents are more likely to have behavioural problems in early adolescence.  However, this relationship is partially explained by the economic deprivation these families are likely to experience.

Well-targeted interventions can substantially reduce the risks and increase the protective factors in children’s environments and enhance their overall development.

A recent follow-up study involving the Incredible Years programme found that children with behavioural problems at age three were significantly less likely to have behavioural problems ten years later when their parents participated in the programme. Specifically, IY parents were significantly more likely to report higher levels of age appropriate supervision and expressed warmth in comparison to parents who did not participate in the programme.  Their children were also less likely to be less defiant and their reading scores were higher.

Findings involving the Family Foundations perinatal programme observed that children were more likely to be reported as prosocial by their teachers at age seven and boys in particular were less likely to have behavioural problems if their parents participated in the programme. The Family Foundations programme provides couples expecting their first child with specific support on how to manage the transition to parenthood, including strategies for establishing a warm and predictable environment through effect co-parenting practices.

PICTURE

Economics

Wide and persistent gaps in children’s wellbeing and development emerge very early in life.

Babies from a poorer background or from certain ethnic minority groups have, on average, lower birth weight (Dearden et al., 2006; Goodman and Gregg, 2010) and children in poorer families have a worse home learning environment (Dearden et al., 2011).

These factors have important consequences for future and intergenerational outcomes.

Poor speech and language at age 5 predicts with worse literacy, employment and mental health outcomes at age 34 (Law et al., 2009) and children with lowest reading ability at age 7 have 20% lower wages at age 33 (Currie and Thomas, 1999)

These factors are not set in stone immediately, and can be influenced by timely intervention.

A number of socio-emotional learning programmes have been shown to improve children’s social skills, psychological/emotional adjustment, and problem behaviours (Gutman and Schoon, 2013)

Programmes which successfully improve these factors deliver substantial individual and social benefits over time.

HighScope Perry Preschool Program delivered a long-run social rate of return of 7-10% by the time participants were age 40, mainly through improved employment and earnings, reduced crime and reduced welfare dependence.

The Carolina Abecedarian Project intervened with disadvantaged children aged 0-8 and resulted in substantial benefits by the time participants were in adulthood. These included higher maternal earnings (Barnett and Masse, 2007), higher educational attainment, reduced crime and use of welfare benefits (Moon, 2014) and improved physical health (Campbell et al., 2014).

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Neuroscience

Early adversity is associated with increased risk of long term poor outcomes and changes in neurobiological structure and function.

Reducing exposure to adverse social environments during early life may optimize brain development and reduce subsequent mental health risks in adult life. (Walsh et al., 2013)

Brain development is crucial not just in childhood but also in adolescence.

Development of executive function, social cognition and perspective taking is shown to be ongoing during adolescence. (Blakemore & Choudhury, 2006)

There are gaps in the neuroscientific literature.

To date, the evidence only indicates that early adversity shapes neuro-cognitive development in ways that are consistent with a potential for increased vulnerability for a range of future poor outcomes.

Early intervention programmes

There is a substantial body of evidence building on these theories that demonstrates that particular early interventions can be very effective at improving outcomes for young people and families. You can visit our interactive programmes library of an initial 50 early intervention programmes to find examples of what works and is being delivered across the UK.

Challenges of implementation

Whilst this research supports early intervention in theory as the right approach for helping children and young people, there are significant practical challenges in implementing early intervention and clear political leadership is required to ensure that this body of evidence is properly translated into effective practice on the ground.

Click here to find all our tools and resources. Learn more about effective commissioning and delivery in relation to:

  • Understanding the local needs of your population
  • Mapping local spending and provision
  • Setting strategic goals
  • Applying evidence to a local context
  • Delivering effective change

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